Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative assessment of the anaesthetic and analgesic effects of intramuscular and epidural clonidine in humans.
The aim of the study was to assess and compare in analogous controlled experimental conditions, the anaesthetic sparing and analgesic effects of the same dose of clonidine administered by the intramuscular (im) and epidural (ep) routes. ⋯ Epidural and intramuscular clonidine decreased isoflurane requirements similarly, but only the epidural route provided postoperative analgesia, suggesting a spinal site for the analgesic action.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block.
To determine the postoperative analgesic efficacy of, and the effects on, intraoperative inhalational anesthetic requirements of preincisional caudal epidural block versus postincisional infiltration of local anesthetic following umbilical herniorrhaphy in children. ⋯ Preincisional caudal epidural block is more effective in controlling pain following umbilical herniorrhaphy than is postincisional local infiltration.
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Owing to recent emphasis upon the benefits of effective pain management, parents and health care providers expect infants and children to receive safe, effective sedation and analgesia for diagnostic and therapeutic procedures. The Committee on Drugs of the American Academy of Pediatrics has addressed the issue of safety in its recently revised guidelines for monitoring and management of patients undergoing sedation for procedures. Patients undergoing emergency procedures present additional problems because of the limited opportunity to optimally prepare patients and families. ⋯ New formulations of local and topical anesthetics have enhanced their efficacy and reduced pain associated with administration. Innovations in the administration of sedatives and analgesics, as well as antagonists, have enhanced both efficacy and safety. This article reviews recommended guidelines for monitoring and management of patients undergoing sedation for minor procedures and discusses various sedative, analgesic, and anesthetic alternatives available to clinicians.
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Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Clinical TrialMaternal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia.
The cephalad extent of sensory block produced by intrathecal (IT) dextrose-free local anesthetics and opioids has been reported to be quite variable. Most reports describing the effects of IT analgesics do not control for patients posture. Because these medications are hypobaric relative to cerebrospinal fluid (CSF), parturients in a sitting position may develop greater cephalad extents of sensory block than those in a lateral position during IT injection. ⋯ Mean cephalad extent of block was greater in the sitting group at 20 and 30 min. When sensory block asymmetry was observed, the extent of block was greater on the nondependent side. Posture during IT injection of this dextrose-free analgesic combination affects extent of sensory block in laboring parturients.
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Randomized Controlled Trial Clinical Trial
Intraoperative continuous epidural lidocaine for early postoperative analgesia.
We determined the early postoperative analgesia using intraoperative continuous epidural infusion of lidocaine during general anesthesia in patients undergoing upper abdominal surgery in a prospective double-blind manner. After insertion of an epidural catheter at the T10-T11 interspace, general anesthesia was induced. Thirty patients were randomly allocated to receive continuous epidural infusion of either 0.5% (n = 15) or 1% (n = 15) plain lidocaine at 10 ml/hr. ⋯ Visual analog pain scale (0-10) within 30 minutes after the end of surgery was significantly lower in the 1% lidocaine group (5.6 +/- 0.9, mean +/-SE) than in the 0.5% lidocaine group (8.2 +/- 0.8), however, it was unsatisfactory in both groups. Plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide, gradually increased through epidural infusion, but remained below the toxic range in both groups. We conclude that continuous epidural lidocaine during general anesthesia offered limited analgesia in the early postoperative period.