Articles: analgesia.
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A large percentage of newborns are exposed to pharmacological agents that affect the brain in connection with pain management during labor. The two most commonly used agents are meperidine, administered intravenously or intramuscularly, and bupivacaine, administered by the epidural route. Over the years, infant behavioral assessments have been used in the neonatal nursery to identify labor analgesia regimens with minimal impact on neonatal status. ⋯ Most of the assessments, including those of cognitive function, were not influenced by perinatal analgesia. However, these studies have confirmed the neonatal depressant effects of meperidine and have suggested that the course of behavioral maturation during certain periods of infancy is influenced by both meperidine and bupivacaine administration at birth. These effects could occur as a result of effects on vulnerable brain processes during a sensitive period, interference with programming of brain development by endogenous agents, or alteration in early experiences.
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Randomized Controlled Trial Clinical Trial
Epidural and intravenous bolus morphine for postoperative analgesia in infants.
To compare two doses of bolus epidural morphine with bolus iv morphine for postoperative pain after abdominal or genitourinary surgery in infants. ⋯ Epidural and iv morphine provide infants effective postoperative analgesia, although side effects are common. Epidural morphine gives satisfactory analgesia with fewer doses (less total morphine); epidural morphine 0.025 mg.kg-1 is appropriate initially. Infants receiving epidural or iv morphine analgesia postoperatively need close observation in hospital with continuous pulse oximetry.
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Respir Care Clin N Am · Dec 1996
ReviewSedation, analgesia, and neuromuscular blockade during pediatric mechanical ventilation.
The mechanically ventilated PICU patient is subjected to multiple noxious stimuli ranging from a bright, noisy, and intimidating environment to painful but necessary procedures. His or her primary disease process or processes obviously constitutes another potential source of noxious stimuli as well. As a result, these patients almost certainly need some combination of medications to allay anxiety, treat discomfort, and perhaps otherwise optimize medical management. ⋯ Although the frequent need for analgesics, sedatives, and NMBDs in the PICU is undisputed, the development of reliable methods for accurately assessing the degree of patient sedation or analgesia will greatly facilitate efforts to improve patient care Appropriate use of sedatives, analgesics, and NMBDs provides an invaluable service. It is important to remember, however, that even in the high-technology PICU environment verbal and physical reassurance remains a powerful tool for providing comfort and anxiolysis to critically ill children. There is no pharmacologic equivalent of human compassion.
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Randomized Controlled Trial Clinical Trial
[Effects of continuous epidural administration of fentanyl and morphine on postcesarean pain].
We studied the effects of continuous epidural administration of fentanyl and morphine with bupivacaine for management of postcesarean pain. Eighteen patients received either bolus epidural administration of fentanyl 100 micrograms or morphine 3 mg with 0.5% bupivacaine 4 ml, followed by continuous infusion of fentanyl 33 micrograms.ml-1 with 0.17% bupivacaine or morphine 0.21 mg.ml-1 with 0.17% bupivacaine for 48 hours, respectively. Pain score was assessed at 0 h, 12h, 24h and 48h after leaving the operating room. ⋯ In all cases pruritus was noted. Severe pruritus was observed in the morphine group significantly more than in the fentanyl group. The current results indicate that morphine may be preferable to fentanyl for postcesarean pain control using the present opioid doses.