Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery.
This study systematically compared 2 opioids, morphine (MOR) and fentanyl (FEN), and 2 lockout intervals, long (L) and short (S) in patients utilizing patient-controlled analgesia (PCA). Seventy-eight women undergoing gynecological surgery were randomly assigned to 1 of 4 groups: MOR-S (7 min), MOR-L (11 min), FEN-S (5 min), FEN-L (8 min). PCA measures obtained during the first 24 h after surgery included: number of demands/h, number of completed deliveries/h, dose/h, and demand/delivery ratio. ⋯ Results indicated that pain relief was equivalent with minimal side effects for both opioids. The selection of opioid, however, influenced the pattern of PCA use, with an improved demand/delivery ratio initially for FEN. The lockout intervals chosen for this study did not influence pain or anxiety levels.
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Regional anesthesia · Jul 1995
Randomized Controlled Trial Clinical TrialEffects of epidural bupivacaine after thoracotomy.
Combinations of bupivacaine and fentanyl are popular for postoperative epidural analgesia. However, there are little data from which to select a rational dose of bupivacaine. The study examined the effects of increasing amounts of epidural bupivacaine on postoperative analgesia, epidural fentanyl consumption, and side effects after thoracotomy. ⋯ The results demonstrate improved analgesia with physiotherapy and significant opioid sparing when 10 and 5 mg/h doses of bupivacaine are used. However, the incidence of orthostasis may be increased with the use of 10 mg/h. Thus, 5 mg/h of epidural bupivacaine (.05% at 10 mL/h) improved analgesia, decreased opioid requirements, and did not have detectable hemodynamic effects.
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Int J Obstet Anesth · Jul 1995
Epidural clonidine-fentanyl combination for labour analgesia: a comparison with bupivacaine-fentanyl.
This open study of 20 women compared epidural clonidine (300 microg)/fentanyl (100 microg) with bupivacaine (25 mg)/fentanyl (100 microg) in the provision of pain relief in labour. Sensory tests in the clonidine group revealed slight alterations in the appreciation of pin prick and temperature but motor power was unchanged. ⋯ Midwives also commented favourably on the normal mobility of these labouring mothers. There was no difference between the two groups in the duration of labour or the condition of the infants.
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Randomized Controlled Trial Clinical Trial
Intrathecal fentanyl for post-thoracotomy pain.
This double-blind, placebo-controlled study investigated the efficacy of intermittent doses of intrathecal fentanyl in 30 patients undergoing thoracotomy. They were allocated randomly to three groups, two of which had microspinal catheters inserted into the lumbar subarachnoid space at the end of surgery; the third group acted as a control. Intrathecal fentanyl or 0.9% saline was administered through the catheters and all patients received morphine using a patient-controlled analgesia (PCA) system. ⋯ Intrathecal fentanyl resulted in a faster onset of analgesia (mean visual analogue scale (VAS) score at 1 h = 0.9 compared with 6.3 (95% confidence intervals for the difference -6.8, -4.0) for the other groups; P < 0.001) and significantly lower pain scores at rest, on cough and on movement. PEFR values were consistently higher in the intrathecal fentanyl group. There were no cases of early or delayed respiratory depression.
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Regional anesthesia · Jul 1995
Randomized Controlled Trial Clinical TrialCan pre-emptive interpleural block reduce perioperative anesthetic and analgesic requirements?
The hypothesis that preoperative interpleural block might reduce intraoperative anesthetic and analgesic requirements and modify the intensity of postoperative pain was examined in this double-blind, randomized, saline-controlled study. ⋯ Preoperative interpleural block, during a background isoflurane anesthetic, reduces the hemodynamic response to surgery and the intraoperative anesthetic and analgesic requirements. Preoperative interpleural block with plain bupivacaine results in significant reductions in mean arterial pressure and heart rate, probably related to unilateral sympathetic block and the concomitant use of isoflurane. The timing of interpleural block, that is, pre-emptive versus postoperative, does affect the intensity of postoperative pain or the request for supplementary analgesia.