Articles: analgesia.
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Case Reports
[Postoperative continuous epidural infusion of morphine in a patient with myotonic dystrophy].
Patients with myotonic dystrophy present potential problems during and after anesthesia, especially respiratory dysfunction. A 42-year-old female with myotonic dystrophy associated with slight impairment of respiratory functions and muscular power, underwent abdominal total hysterectomy under epidural anesthesia uneventfully. ⋯ She obtained adequate analgesia after the surgery without respiratory depression or other major complications. We demonstrated that the continuous epidural infusion of morphine in a patient with myotonic dystrophy is safe and adequate for postoperative pain relief.
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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 Clinical TrialThe effect of epidural fentanyl on the minimum local analgesic concentration of epidural chloroprocaine in labor.
The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration (EC50) in a 20-mL volume in the first stage of labor. The aim of this study was to determine the local anesthetic sparing efficacy of epidural fentanyl by its effect on the MLAC of chloroprocaine. Fifty-six parturients, not exceeding 7 cm cervical dilation, who requested epidural analgesia were allocated to one of two groups in this double-blind, randomized, prospective study. ⋯ Analgesic efficacy was assessed using 100-mm visual analog pain scores with 10 mm or less within 30 min defined as effective. The MLAC of chloroprocaine was reduced from 0.43% wt/vol to 0.26% wt/vol by fentanyl (P = 0.023). Thus, the addition of epidural fentanyl 3 micrograms/mL (60 micrograms resulted in a significant 40% reduction in the MLAC of chloroprocaine in the first stage of labor.
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Anesthesia and analgesia · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialA minimum dose of clonidine added to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.
This study assessed the minimum dose of clonidine required to prolong the duration of both anesthesia and analgesia after axillary brachial plexus blockade. Eighty patients scheduled for elective hand surgery were divided into eight groups in a randomized, double-blind fashion. An axillary brachial plexus block was performed with 40 mL 1% mepivacaine plus 1:200,000 epinephrine. ⋯ The minimum dose of clonidine required to significantly prolong the duration of analgesia and anesthesia was, respectively, 0.1 and 0.5 microgram/kg. No side effects (sedation, drowsiness, bradycardia, arterial hypotension) were reported. We conclude that the dose of clonidine required to prolong significantly the duration of both anesthesia and analgesia after axillary brachial plexus blockade is 0.5 microgram/kg and that, at this dose, clonidine may be used without important reported side effects even in outpatients.