Articles: analgesia.
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Comparative Study Clinical Trial Controlled Clinical Trial
Superiority of multi-orifice over single-orifice epidural catheters for labor analgesia and cesarean delivery.
To investigate whether a change from a single-orifice to multi-orifice catheter could reduce the incidence of inadequate epidural blocks requiring replacement of the epidural catheter in obstetric patients. ⋯ The multi-orifice design offers significant advantages over the single-orifice type for obstetricepidural analgesia.
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Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. ⋯ Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.
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Regional anesthesia · Mar 1997
Case ReportsAnesthetic management of a parturient with an incompletely resected cerebral arteriovenous malformation.
The anesthetic, neurosurgical, and obstetric literature regarding management of parturients with intracranial arteriovenous malformations is relatively sparse. A case report is given of a parturient, with a recent subtotal resection of a cerebral arteriovenous malformation, who presented for delivery of a viable male fetus. ⋯ The available obstetric and neurosurgical literature does not offer firm recommendations for the optimal route of fetal delivery or the timing of neurosurgical resection of an arteriovenous malformation in the parturient. Anesthetic management is predicated on the principles of minimizing the cardiovascular changes of labor and preventing involuntary Valsalva maneuvers during the second stage of labor. Both of these goals are readily accomplished with epidural anesthesia.
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Int J Gynaecol Obstet · Mar 1997
Effect of epidural analgesia on duration and outcome of induced labor.
To evaluate the effect of epidural block on the duration of labor and maternal and fetal outcome in induced-labor patients. ⋯ Epidural anesthesia, significantly prolongs labor time in induced patients. While instrumental delivery was more prevalent in these parturients, c-section rate was not increased and intra-partum complications were significantly reduced in these patients.
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Veterinary surgery : VS · Mar 1997
Comparative StudyPreliminary investigations of pain and analgesia assessment in horses administered phenylbutazone or placebo after arthroscopic surgery.
Twenty-five horses undergoing arthroscopic surgery were studied to develop a scheme for assessing pain in horses while investigating the effects of phenylbutazone (PBZ) analgesia. Fifteen of the 25 horses received PBZ 4 mg/kg intravenously (IV) before surgery and 2 mg/kg (IV) every 12 hours thereafter until 60 hours; the remaining 10 (placebo group) were given a corresponding volume of saline. In both groups, venous blood samples were collected for catecholamine, beta-endorphin, and cortisol assays before premedication and up to 72 hours after surgery. ⋯ A total postoperative pain severity index (TPPSI) was calculated using all variables. There were no differences between PBZ and placebo groups in plasma beta-endorphin or catecholamine concentrations, but the TPPSI was higher in the placebo group than in the PBZ group, suggesting that perioperative treatment with PBZ has some analgesic benefit. This study shows the difficulties associated with pain assessment in horses.