Articles: analgesia.
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Regional anesthesia · Jul 1996
Editorial Comment Comparative StudyIs an ounce of preoperative local anesthetic better than a pound of postoperative analgesic?
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We studied if ethnicity influences patient-controlled analgesia (PCA) for the treatment of post-operative pain. Using a retrospective record review, we examined data from all patients treated with PCA for post-operative pain from January to June 1993. We excluded patients who did not have surgery prior to the prescription of PCA or were not prescribed PCA in the immediate post-operative period. ⋯ While there were no differences in the amount of narcotic self-administered, there were significant differences in the amount of narcotic prescribed among Asians, Blacks, Hispanics, and Whites (F--7,352, P < 0.01). The ethnic differences in prescribed analgesic persisted after controlling for age, gender, pre-operative use of narcotics, pain site, and insurance status. Patient's ethnicity has a greater impact on the amount of narcotic prescribed by the physician than on the amount of narcotic self-administered by the patient.
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Acta Anaesthesiol Scand · Jul 1996
Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993.
This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia. ⋯ Headache and backache are both common following dural puncture with a 16 G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.
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Anesthesia and analgesia · Jul 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine.
The purpose of this study was to compare meperidine to meperidine with bupivacaine when used for patient-controlled epidural analgesia (PCEA) after thoracotomy. For 3 days after thoracotomy patients received thoracic PCEA with meperidine 0.1% plain or with added bupivacaine 0.1% or 0.01%. No background infusion was used. ⋯ The addition of bupivacaine 0.1% reduced the incidence of pruritus (P = 0.036), but 5 of 23 patients in this group were with-drawn from the study because of significant hypotension, oliguria, and/or motor or sensory block (P = 0.006). We conclude that the addition of bupivacaine 0.1% or 0.01% to thoracic PCEA meperidine 0.1% does not affect meperidine requirements or analgesia after thoracotomy. The addition of bupivacaine 0.1% may reduce pruritus, but is associated with signs of excessive sensory, motor, or autonomic blockade in a significant number of patients.