Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain.
A double-blind randomised clinical trial was undertaken in 40 patients undergoing major abdominal surgery. Postoperative pain relief was provided using epidural infusions of 0.06% bupivacaine with fentanyl 4 micrograms.ml-1 (n = 20) (group F) or with pethidine 1.5 mg.ml-1 (n = 20) (group P). Postoperative pain scores using a visual analogue scale (0-100 mm) were not significantly different between the two groups. ⋯ Nine patients were withdrawn from the study (four from group F, five from group P) due to failure of the epidural technique or other complications. Fourteen patients, equally distributed, required a total of 24 epidural 'top-ups' by an anaesthetist because of inadequate analgesia. We demonstrated no advantage with epidural pethidine over fentanyl when used by infusion in combination with bupivacaine in the management of postoperative pain.
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Randomized Controlled Trial Clinical Trial
Patient controlled oral analgesia with morphine.
When using strong oral opioids for postoperative pain management, demand titration is desirable. A device for patient controlled oral analgesia (PCORA) and first results of its use for oral titration of morphine are presented. ⋯ Patient controlled oral analgesia is an effective and non-invasive mode of postoperative pain management. The PCORA-device is reliable and easy to use.
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Int J Obstet Anesth · Jul 1996
Anaesthetic management of labour in two patients with Klippel-Feil syndrome.
Two patients with Type I Klippel-Feil syndrome presented at the antenatal clinic. The first patient, who suffered from sleep apnoea, was delivered of a healthy infant by vacuum extraction. ⋯ In both cases epidural analgesia was employed to allow pain relief during labour. Anaesthetic management of Klippel-Feil syndrome is discussed and the benefits of early anaesthetic assessment and continued involvement of senior anaesthetic and obstetric staff emphasized.
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The report of the Expert Maternity Group 'Changing Childbirth' (The Cumberlege Report) advocates a greater role for midwives in the care of the low risk pregnant woman, and has promoted much discussion about the future development of maternity services in the UK. At Leicester Royal Infirmary NHS Trust the 'Home from Home' delivery scheme provides midwifery-led antenatal and intrapartum care of women with uncomplicated pregnancies. We have performed a retrospective review of the requirements for anaesthetic services in this unit. ⋯ One hundred and eighty one women subsequently received anaesthetic intervention. Of this group, 137 (77.0%) required an epidural, 17 (9.6%) a spinal, 18 (10.1%) a general anaesthetic, 5 (2.8%) an epidural and a general anaesthetic and 1 (0.6%) an epidural and a spinal. Our results demonstrate that low risk pregnant women in labour being cared for in a midwifery led unit have a considerable need for anaesthesia and analgesia.
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Anesteziol Reanimatol · Jul 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Preventive analgesia: true of preventing the postoperative pain syndrome].
A total of 152 patients subjected to operations mainly of an orthopaedic profile were divided into 8 groups for the development of the optimal method of preventive analgesia. The best results were attained by combined use of opiate premedication, regional blocking as a component of anesthesiologic care, and parenteral diclophenak-Na before and after the operation. 31.5% of patients in this group did not need any postoperative analgesia. ⋯ Preventive analgesia reduced the incidence of phantom pain syndrome after limb amputation in patients with the preamputation pain from 63.3 to 25.1%. The postoperative pain syndrome may be prevented if the factors determining it (preoperative pain, intraoperative nociceptive stimulation, and perioperative tissue inflammation) are eliminated simultaneously.