Articles: analgesia.
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Combined spinal epidural (CSE) analgesia for labour is usually performed with sufentanil (or fentanyl) which provides powerful and fast onset pain relief (< or = 5 min). Dose reduction of sufentanil from 10 to 5 micrograms may be recommended and has little influence on the 1.5-2 hours of analgesia usually obtained. This mean duration of action may be prolonged by half an hour with the addition of a low dose of bupivacaine (< or = 2.5 mg). ⋯ Major improvement will be to prolong the excellent pain relief provided by intrathecal analgesia throughout the whole labour. This will require prolonging substantially the intrathecal analgesia duration and/ or influencing positively the epidural analgesia used afterwards. However, women prefer CSE technique to standard epidurals because of faster onset, less motor block, and feelings of greater self-control.
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Cahiers d'anesthésiologie · Jan 1996
[Study of a protocol of intra-articular analgesia after arthroscopy of the knee].
The purpose of this study was to assess the analgesic effects of intra-articular injection of a morphine-bupivacaine combination following knee arthroscopy. 47 patients were evaluated. Knee arthroscopies were all performed under general anaesthesia, using propofol, alfentanil, isoflurane and nitrous oxide. Analgesic effects were evaluated by a visual analogic pain scale. ⋯ Analgesia was good in the immediate postoperative period, with minimal side effects. The serum bupivacaine levels were low. However the analgesic efficacy of intra-articular injection of morphine-bupivacaine should be corroborated through a double blind study.
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Acta Anaesthesiol Scand · Jan 1996
Randomized Controlled Trial Clinical TrialDoes epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?
To assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n = 20, ES group) or 10 ml normal saline (n = 20, control group) via a thoracic epidural catheter. The study solution was given (double-blind and at random) after the patients had been anaesthetized with i.v. midazolam, sufentanil and vecuronium. Anaesthesia was maintained with 60% nitrous oxide in oxygen and halothane at a 1% inspiratory concentration. ⋯ The mean dose administered i.v. did not differ significantly between the two groups: 105 +/- 109.5 mu g vs 138.5 +/- 126.9 mu g (mean +/- SD) in 5 and 13 patients, respectively. No cardiovascular changes were observed after the epidural bolus dose. Postoperative analgesia, consisting of a continuous epidural infusion of 50 mu g sufentanil in 50 ml bupivacaine 0.125% at a rate of 6-10 ml/h after a bolus dose of 10 ml of this solution, was adequate in the majority of patients, as determined by VAS-scores assessed during the epidural treatment (4.3 +/- 1.5 days).
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Acta Anaesthesiol Scand · Jan 1996
Randomized Controlled Trial Clinical TrialDoes morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty?
Evidence of pre-emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain. Forty-one patients undergoing total knee arthroplasty were randomly allocated to four groups. ⋯ Nausea, vomiting, itching and urinary retention were the most frequent side effects without significant differences between the groups. In conclusion, morphine premedication had a temporary rest effect on the postoperative pain. Epidural morphine provides a better analgesia than intravenous PCA-fentanyl.