Articles: analgesia.
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Rev Esp Anestesiol Reanim · Aug 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative study of continuous epidural analgesia versus intermittent, patient-controlled, epidural analgesia during labor].
To assess the analgesic efficacy and the incidence of side effects of three procedures of epidural analgesia during labor. ⋯ We believe that the protocol of choice is the one used with group B (initial dose of 10 ml bupivacaine 0.125% + epinephrine 1/400,000 + 50 micrograms fentanyl followed by 12 ml/h bupivacaine 0.0625% + epinephrine 1/800,000 + 12 mu cg/h fentanyl in continuous infusion). The use of PCA systems with our unscreened patients yielded no advantages over the procedure used with group B.
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Anaesth Intensive Care · Aug 1995
Randomized Controlled Trial Clinical TrialClinical experience with patient-controlled and staff-administered intermittent bolus epidural analgesia in labour.
A prospective, randomized study was performed to detail clinical experience with both patient-controlled epidural analgesia (PCEA) and midwife-administered intermittent bolus (IB) epidural analgesia during labour, under the conditions pertaining in a busy obstetric delivery unit. Both methods used 0.125% bupivacaine plus fentanyl, and similar rescue supplementation, although management decisions related to epidural analgesia were made principally by attending midwives. One hundred and ninety-eight women were recruited and data analysed from 167 (PCEA n = 82, IB n = 85). ⋯ The PCEA group had a significantly higher rate of supplementation and bupivacaine use (P < 0.01), and a longer duration of the second stage of labour (P < 0.03). The relative risk of instrumental delivery with PCEA versus the IB method was 1.57 (CI 1.07-2.38). Experience within our unit with PCEA is contrasted with that of IB epidural analgesia, the method most commonly used; and with that of controlled trials comparing these two methods.
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A 31-year-old primigravida woman presenting with term pregnancy was admitted for labor and delivery. After approximately 10 hours of labor, which included an oxytocin infusion, she requested anesthesia intervention. A combined spinal/epidural (CSE) block was administered featuring a 3 1/2-in, 18-gauge Hustead epidural needle into the epidural space, through which was placed a 4 11/16-in, 27-gauge Whitacre spinal needle into the subarachnoid space. ⋯ The CSE technique provides a safe, flexible choice of anesthesia for labor and delivery. Monitoring of the patient by the anesthetist is necessary for only the initial 30 minutes after block administration. This, coupled with the advantage of having an epidural catheter as a backup, makes it an especially attractive alternative for the solo anesthetist.
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Continuous epidural analgesic infusion is widely recognized to be helpful for pain relief in the patient with cancer pain, but it can be as beneficial for the patient with non-cancer pain. Cancer pain patients have been offered long-term epidural infusion for relief of chronic pain, but non-cancer pain patients have less frequently been provided the same opportunities for pain relief. Both patient outcome and cost-effectiveness must dictate treatments offered as alternatives to long-term use of oral or injectables, nonsteroidal anti-inflammatories and muscle relaxants. ⋯ Epidural infusion is a safe and effective route of pain relief if the medical criteria as been met for choosing the patients receiving the treatment, and if the caregivers understand the treatment and expected outcomes. This article discusses anatomic considerations in drug selection, physiology, patient selection, neuropharmacology and patient care for epidural infusion. This article is designed to assist the nurse in accomplishing the patient and physician goals in this treatment modality for chronic non-cancer pain.