Articles: analgesia.
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Regional anesthesia · Nov 1996
Randomized Controlled Trial Clinical TrialKetamine potentiates analgesic effect of morphine in postoperative epidural pain control.
Ketamine is currently the only N-methyl-D-aspartate receptor channel blocker in clinical use. This study evaluated the analgesic efficacy of epidurally coadministered ketamine and morphine in postoperative pain control. ⋯ Ketamine, although not itself an epidural analgesic agent, potentiates the analgesic effect of morphine, especially when administered as a pretreatment. The resulting lowered dosage of epidural morphine needed for postoperative pain relief reduces, in turn, the incidence of side effects. Pretreatment of patients with ketamine epidurally, followed by injections of combined morphine and ketamine could be a promising new analgesic regimen.
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The Journal of pediatrics · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia for mucositis pain in children: a three-period crossover study comparing morphine and hydromorphone.
(1) To test the safety and efficacy of a clinical protocol for administering opioid by using patient-controlled analgesia (PCA) for the management of mucositis pain in children after bone marrow transplantation, (2) to compare the efficacy, side-effect profile, and potency ratio of morphine with those of hydromorphone by using PCA as the method of opioid administration, and (3) to obtain pharmacokinetic data on hydromorphone and morphine in this population of children. ⋯ The safety and efficacy of a clinical protocol for the administration of opioids by means of PCA for mucositis pain after bone marrow transplantation was demonstrated. In this small study, hydromorphone was not superior to morphine in terms of analgesia or the side-effect profile: a larger study would be needed to show a difference. The clearances of hydromorphone and morphine in the children studied were generally greater than those previously recorded, but this finding may be related to disease or treatment variables. Apart from clearance, the morphine pharmacokinetics in the study population were similar to those previously recorded. Hydromorphone may be less potent in this population of children than indicated by adult equipotency tables.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of intrathecal morphine-6-glucuronide and intrathecal morphine sulfate as analgesics for total hip replacement.
Postoperative analgesia was assessed after intrathecal administration of morphine-6-glucuronide (M6G) 100 micrograms and 125 micrograms in 75 patients undergoing total hip replacement. Analgesia was excellent and was similar to that obtained after intrathecal administration of morphine sulfate 500 micrograms. Visual analog pain scores recorded postoperatively were low (median = 0) and were similar in all three groups. ⋯ The lack of statistical significance in the difference in incidence of respiratory depression between the groups may represent a type II error. However, the risk of late respiratory depression developing after administration of any intrathecal opioid necessitates careful postoperative observation of patients. As M6G is a potent intrathecal analgesic further investigation of this drug using small doses may be useful.
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Regional anesthesia · Nov 1996
ReviewEpidural opioid delivery methods: bolus, continuous infusion, and patient-controlled epidural analgesia.
Multiple methods of delivery of epidural opioids are acceptable, including bolus injection, continuous infusion, and patient-controlled infusion. The incidence of side effects appears to be reduced with the use of continuous infusion techniques, especially with the liquid-soluble opioids, although these appear to be most effective when infused near the center of the dermatomal pain site. with more distant catheters, the water-soluble opioids are more effective, but there use is associated with more frequent side effects. The lowest dose requirement appears to be associated with PCEA, but further study is needed to confirm the theoretical safety and efficacy of this modality, especially if a constant background infusion is used along with the PCEA. At present, significant advantages appear to be obtainable by adding local anesthetic to the opioid infusion, but the ideal drug and dosage are yet to be determined.