Articles: analgesia.
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Minerva anestesiologica · Jun 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Post-thoracotomy analgesia in pediatric heart surgery: comparison of 2 different techniques].
The aim of this study was to compare two different post-operative pain control techniques in pediatric patients undergoing thoracotomy with reference to a control group receiving conventional treatment in the form of endovenous morphine. The post-operative antalgic treatment protocol included the random distribution of patients to three groups: control group: endovenous analgesia with morphine boluses; group 1: intrapleural analgesia with bupivacaine boluses; group 2: caudal epidural analgesia in a single bolus with a mix of bupivacaine and morphine. In the comparison it was seen that the method that offered the most effective pain control and fewest collateral effects was caudal peridural analgesia. The authors conclude by suggesting the use of this method and underlining the need to pay greater attention to the problem of postoperative pain in pediatrics.
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Middle East J Anaesthesiol · Jun 1995
Randomized Controlled Trial Clinical TrialHemodynamic and oxygenation variables during radical cystectomy. Does the anesthetic technique really matter?
The effect of anesthetics on hemodynamic variables (HV) has been clarified, but ambiguity existed concerning their effect on oxygenation variables (OV). Radical cystectomy provided a clinical setting for studying the effect of anesthetics on perioperative HV and OV. Patients subjected to radical cystectomy (n = 33) were assigned through balanced randomization to receive one of four anesthetic modalities, namely; group I: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine (n = 11); group II: inhalation anesthesia using N2O:O2, halothane, d-tubocurarine, and supplemented with epidural analgesia (EA) (n = 11); group III: total intravenous anesthesia (TIVA) using ketamine 10-30 ug.kg-1.min-1, propofol 2 mg.kg-1.h-1, d-tubocurarine, and supplemented with continuous EA (n = 6): and group IV:TIVA using ketamine 20-50 ug.kg-1.min-1, midazolam in increments of 1.5 to 5 mg, and supplemented with intermittent EA (n = 5). ⋯ Mixed venous oxygen tension and saturation were higher in group I over group IV. Other OV did not show remarkable differences. In conclusion, HV and OV in 4 anesthetic modalities did not elicit striking differences.
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Randomized Controlled Trial Clinical Trial
[Bupivacaine-fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia].
We compared bolus injection of morphine 51 +/- 9 micrograms.kg-1 (M-S group) with 48 h-continuous infusion of bupivacaine and fentanyl mixture (BF-C group) for postoperative epidural analgesia in 100 patients who had undergone upper abdominal laparotomy. The epidural analgesia was started about 60 min before completion of surgery. The mixed solution, consisting of bupivacaine 48 ml (240 mg), fentanyl 24 ml (1.2 mg) and 0.9% saline (24 ml), was administered at a rate of 2 ml.h-1 by using a 100 ml balloon infuser. ⋯ There was no significant difference in side effects between the two groups. The plasma fentanyl concentration in the BF-C group (n = 5) was maintained almost constant for the period from 24 to 49 hours after the start of infusion and was approximately 1.6 ng.ml-1. We conclude that continuous infusion of bupivacaine (2.5 mg.ml-1) and fentanyl (12.5 micrograms.ml-1) at a rate of 2 ml.h-1 is superior to bolus injection of morphine for postoperative analgesia.