Articles: analgesia.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone.
Epidural opioid analgesia can offer advantages over intravenous administration, however, opioid-related side effects are common after epidural administration. We studied the effect of adding nalbuphine (NB), an opioid agonist-antagonist, to hydromorphone (HM) for patient-controlled epidural analgesia (PCEA) in 78 healthy women after elective cesarean delivery. Patients were randomly assigned to one of four treatment groups. ⋯ Although the overall incidences of nausea (19%-35%) and pruritus (32%-62%) were similar in all four groups, the addition of NB decreased the need for bladder catheterization. The highest NB concentration resulted in increased PCA demands during the 32-h study period. In conclusion, the combination of HM 0.075 mg/mL and NB 0.04 mg/mL resulted in lower nausea scores and a decreased incidence of urinary retention compared with HM alone, without increasing the opioid analgesic requirement.
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To determine the rate of increase in serum bupivacaine concentration during continuous extrapleural infusion. ⋯ Continuous extrapleural infusion of bupivacaine over five days after thoracotomy is associated with a steady increase in total serum bupivacaine concentration and no elevation in free serum bupivacaine concentration.
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Int J Obstet Anesth · Apr 1997
Randomized Controlled Trial Clinical TrialAnalgesia after caesarean section: patient-controlled intravenous morphine vs epidural morphine.
In a randomized, double-blind study, conducted in 60 patients after caesarean section, we compared epidural morphine (5 mg) with intravenous morphine patient-controlled analgesia (PCA). Efficacy of pain relief (visual analogue scale), comfort, satisfaction and side-effects were studied. In the PCA group, pain scores were higher (P < 0.005) from the third hour onward. ⋯ Consumption of morphine was higher in the PCA group. We conclude that epidural morphine analgesia, though of good quality, was associated with more pruritus. Morphine PCA, although producing a lesser degree of analgesia compared to epidural morphine, gave good satisfaction.
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J. Cardiothorac. Vasc. Anesth. · Apr 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison of lumbar and thoracic epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair.
To determine whether there is an advantage of thoracic over lumbar epidural narcotics for postoperative analgesia in patients undergoing abdominal aortic aneurysm repair. ⋯ There is no advantage of thoracic over lumbar epidural analgesia using morphine in patients undergoing abdominal aortic aneurysm repair.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialContinuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery.
The purpose of this study was to determine whether a lumbar epidural infusion of ropivacaine 0.2% would provide effective analgesia with an acceptably low incidence of motor blockade and side effects after lower abdominal surgery. After combined general and epidural anesthesia and surgery, 125 patients were randomly assigned to receive either saline or ropivacaine 0.2% at a rate of 6, 8, 10, 12, or 14 mL/h (Groups R6, R8, R10, R12, and R14, respectively) for 21 h. Supplemental analgesia, if required, was provided with intravenous patient-controlled analgesia with morphine. ⋯ Sensory blockade at 8 and 21 h was greater in the ropivacaine groups compared with the saline group. Approximately 30% of R8, R10, and R12 patients, and 63% of R14 patients had demonstrable motor block of the lower limbs at 21 hours. We conclude that lumbar epidural ropivacaine 0.2% reduces parenteral morphine requirements but has little effect on pain scores and may be associated with motor blockade.