Articles: analgesia.
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Int J Obstet Anesth · Jan 1997
Clinical Trial Controlled Clinical TrialPerioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination.
In a double-blind placebo-controlled trial we compared perioperative pain relief using different intrathecal opioid regimens given with bupivacaine during spinal anaesthesia for elective caesarean section. One hundred and sixteen patients undergoing elective caesarean section were divided into four groups (A, B, C, D) of 29 patients each. In addition to hyperbaric bupivacaine (12-14 mg), group A received 1 ml of normal saline, group B 25 microg of fentanyl, group C 100 microg of morphine, and group D received both fentanyl 25 microg and morphine 100 microg intrathecally. ⋯ The use of the opioids in association, however, was found to increase the incidence of side-effects. The quality of postoperative analgesia with fentanyl, when used alone, was found to be inferior to that with morphine. The combination of opioids offered no advantage over morphine alone.
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Int J Obstet Anesth · Jan 1997
Determination of the minimum local analgesic concentration of epidural chloroprocaine hydrochloride in labor.
The aim was to determine the effective concentration in 50% of patients (EC(50)) of chloroprocaine in the first stage of labor. A constant dose modification of a model where EC(50) was previously defined as the minimum local analgesic concentration (MLAC) was used. Parturients (n = 36) requesting epidural analgesia in labor, at cervical dilatation not exceeding 7 cm, were enrolled into this prospective, double-blinded study. ⋯ MLAC (95%CI) was 0.42%w/v (0.34 to 0.5) using the formula of Dixon & Massey and as a sensitivity test was 0.4%w/v (0.35 to 0.46) using probit regression analysis. In conclusion, MLAC of chloroprocaine was 0.42%w/v in these parturients, equivalent to 14 millimolar solution. This study confirmed that concentration rather than dose could be used as a measure of efficacy in this constant dose model.
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Int J Obstet Anesth · Jan 1997
Low dose epidural bupivacaine/fentanyl infusion does not mask uterine rupture.
A patient is described in whom the symptoms and signs of uterine rupture were not masked by combined spinal epidural analgesia with an epidural infusion of 0.1% bupivacaine and 1.5 microg ml(-l) fentanyl. Early recognition of the dehiscence of a previous caesarean section scar resulted in an excellent neonatal and maternal outcome.