Articles: analgesia.
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Acta Anaesthesiol Belg · Jan 1996
ReviewPain relief and clinical outcome: from opioids to balanced analgesia.
If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts should aim at including physical rehabilitation programs in the pain treatment regimen.
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Anesthesia and analgesia · Jan 1996
Clinical TrialThe analgesic response to intravenous lidocaine in the treatment of neuropathic pain.
This study was performed in order to determine concentration-effect, and graded and quantal dose-response relationships for the clinical administration of intravenous (IV) lidocaine to patients with neuropathic pain. Thirteen patients were administered 500 mg of IV lidocaine at a rate of 8.35 mg/min over 60 min. Visual analog pain scores and venous blood samples were obtained concomitantly at 10 min intervals for 60 min. ⋯ Interestingly, the free concentration of lidocaine had no better correlation with the onset of analgesia or the attainment of complete analgesia than the serum concentration of lidocaine. This suggests that the mechanism of analgesia to IV lidocaine may not be based upon a conventional concentration-effect relationship. In conclusion, the results of this study suggest that the analgesic response to IV lidocaine is best characterized by a precipitous "break in pain" over a narrow dosage and concentration range.
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Veterinary surgery : VS · Jan 1996
Comparative StudyA comparison of epidural saline, morphine, and bupivacaine for pain relief after abdominal surgery in goats.
The purpose of this study was to determine the analgesic efficacy of bupivacaine, morphine, or saline (control) when injected epidurally into the lumbosacral epidural space in goats after abdominal surgery. Goats received either bupivacaine (0.5%; 1.5 mg/kg in 0.9% sodium chloride solution), 0.9% sodium chloride solution (0.2 mL/kg), or preservative-free morphine (0.1 mg/kg). Total volume injected into the epidural space was 0.2 mL/kg for all groups. ⋯ At 50 minutes, the pain score for the saline group was higher than the morphine group. Pain score over all time in the saline group (1.5 +/- 0.10) was higher than the morphine (1.2 +/- 0.07) and bupivacaine (1.2 +/- 0.04) groups. One goat in the saline group required two intravenous injections of flunixin meglumine for pain.
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Regional anesthesia · Jan 1996
Case ReportsEpidurograms in the management of patients with long-term epidural catheters.
Standardized test doses have been established in the practice of anesthesiology to determine the location of the epidural catheter tip. The resulting data obtained after test dosing is open to interpretation, and comparison is difficult. A more objective method of catheter verification and epidural space measurement is indicated in long-term epidural catheterization. The goal of this review is to define a standard procedure for epidurography, explore the use of an epidurogram algorithm in differential diagnosis, and review the temporal relationship of a series of epidurograms. ⋯ The review of repeated epidurograms and presented case reports support the use of epidurograms as a diagnostic tool for clinical practice. Abnormal epidurograms helped determine epidural space infection, tumor obstruction, space compression from vertebral compression fractures, and epidural fibrosis. The addition of a contrast computed tomographic scan after epidurography allows for more accurate diagnostic interpretation of epidural space pathology. The use of a standard epidurogram technique allows this procedure to be used in the differential diagnosis of suspected problems in the epidural space.