Articles: analgesia.
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Int J Obstet Anesth · Oct 1996
Maternal expectations and experiences of labour pain and analgesia: a multicentre study of nulliparous women.
Six hospitals with large maternity units in five different European countries were involved in this multicentre study. At least 100 primiparae for each country were examined. All mothers received two standardized interviews, one during the last month of pregnancy, and one 24 h after delivery. ⋯ Maternal expectations of labor pain and the answers to the pre-delivery interview varied significantly between the centers, as did maternal knowledge, expectation and ultimate choice of analgesic technique. Generally speaking the level of maternal satisfaction with analgesia and childbirth experience was high; however, epidural analgesia was more effective than other methods of pain relief (P<0.0001). The most satisfied mothers were those who expected more pain, were satisfied with the analgesia received and had good pain relief after analgesia (P<0.001).
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The development of patient controlled analgesia (PCA) in children is the result of a search for an analgesia being both maximally efficient and secure, in the management of severe pain. The technique is based on self infusions of an analgesic, mainly morphine, by the child, through a special pump. ⋯ PCA is applicable to children older than 5 years. The main indications are post-operative and oncological pains.
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An in vitro model of epidural catheter contamination was used to determine if disconnected catheters can be safely reconnected. ⋯ There may be an area distal to the disconnected end of an epidural catheter where its interior remains sterile for at least 8 hr. Such an area exists only when the fluid in the catheter remains static. Furthermore, the exterior of the catheter can be adequately cleaned to prevent bacteria from entering the catheter when reconnected at that point.
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Int J Obstet Anesth · Oct 1996
Comparison of 15 mg and 25 mg of bupivacaine both with 50 microg fentanyl as initial dose for epidural analgesia.
Bupivacaine 15 mg is commonly used as a test dose prior to the initial dose for epidural analgesia in labour. When 15 mg or 25 mg of bupivacaine (15 ml of 0.1% or 0.167%) with 50 microg fentanyl was administered blindly to two groups of labouring women, as an initial dose, 83% and 90% of women respectively, achieved analgesia within 20 min. All the remaining women achieved analgesia with a further dose of 10 mg bupivacaine (10 m10.1%) with fentanyl 2 microg per ml given at 20 min.
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Using patient-controlled analgesia (PCA) after surgery, a patient can obtain pain-relieving injections of morphine without the direct involvement of a nurse or doctor. The present study was a response to the conventional view that patients value PCA because of the control which it affords them over their own treatment. Twenty-six patients underwent semi-structured interviews postoperatively, shortly after discontinuation of PCA. ⋯ Instead, PCA was valued as a way to avoid the difficulty of disclosing pain or securing pain relief within the usual nurse-patient relationship. In turn, PCA strained the nurse-patient relationship where it impeded either the patient's or the nurse's wish for the nurse to take responsibility for pain relief. The results showed that the professionally and theoretically constructed concept of PCA as a method of self-control over pain is inconsistent with patients' experience of it.