Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intraarticular bupivacaine with the addition of morphine or fentanyl for analgesia after arthroscopic surgery.
A randomized study on 30 patients undergoing knee arthroscopy was performed. Group I (n = 15) received 50 mg of 0.25% bupivacaine and 1 mg of morphine, and group II (n = 15) received 50 mg of 0.25% bupivacaine and 100 micrograms of fentanyl. The visual analogue scale was recorded at intervals of 1, 2, 3, 4, 6, 12, 24, and 48 hours after the operation. ⋯ In group I, pain scores were lower than group II (P < .05) during the 1st, 2nd, 3rd, 12th, 24th, and 48th hours. The duration of analgesia on group I was significantly longer than group II. The combination of intraarticular morphine and bupivacaine has a longer analgesic duration and effect than a combination of fentanyl and bupivacaine.
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Meta Analysis
Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials.
The purpose of the study was to assess the efficacy of epidural steroid injections for low-back pain. Data was obtained using computer-aided search of published randomized clinical trials and assessment of the methods of the studies. Twelve randomized clinical trials evaluating epidural steroid injections were identified. ⋯ The efficacy of epidural steroid injections has not been established. The benefits of epidural steroid injections, if any, seem to be of short duration only. Future research efforts are warranted, but more attention should be paid to the methods of the trials.
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Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards, and that its effects will outlast the pharmacological duration of action of the analgesic used. The idea of pre-emptive analgesia is based upon experimental neurophysiological work demonstrating that afferent nociceptive impulses result in alterations of central nervous system function. These changes, most easily elicited by C-fibre afferents, particularly affect the spinal dorsal horn. ⋯ Clinical studies have so far only used short-term analgesia. To permit extrapolation from the experimental to the clinical situation, pre-emption in the surgical context must correspond adequately to the duration and extent of the nociception involved. Studies of pre-emptive analgesia in a clinically relevant form, i.e. where nociception and analgesia are correctly matched, are called for.