Articles: analgesia.
-
The first report of epidural analgesia for labour in a 26-yr-old woman with von Recklinghausen's neurofibromatosis is described. Epidural anaesthesia is often considered as contraindicated because neurofibromas may involve spinal cord and nerve roots. However, general anaesthesia was considered at high risk for this parturient on the basis of her previous medical and surgical history and of physical findings. The present observation suggests that epidural analgesia may be used in such circumstances provided that spinal cord neurofibromas have been ruled out by clinical and CT scan (or magnetic resonance imaging) examination.
-
Clinical Trial Controlled Clinical Trial
[Rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery].
This investigation was conducted to determine the analgesic efficacy of rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery. Forty patients in control group received epidural buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infusion was started with the solution of epidural buprenorphine 15 micrograms in 1 ml of 0.23% bupivacaine at a rate of 1 ml.h-1 for 48 h. ⋯ Adding rectal diclofenac to continuous epidural infusion of buprenorphine and bupivacaine produced enhanced analgesia and reduced pain scores measured by VAS after upper abdominal surgery. However, after lower abdominal surgery, such effects of rectal diclofenac obtained after upper abdominal surgery were not demonstrable.
-
Eur J Anaesthesiol Suppl · May 1995
ReviewPre-emptive analgesia: evidence, current status and future directions.
Although some studies of pre-emptive analgesia have reported small reductions in post-operative pain or analgesic consumption in favour of pre-incisional vs. post-incisional or post-operative treatment, most have not demonstrated any benefit at all. This paper reviews recent evidence supporting the effectiveness of pre-emptive analgesia and discusses factors that may be responsible for the lack of consistent results. ⋯ Given the constraints of clinical research and current standards of practice, it is unlikely that studies of pre-emptive analgesia using conventional analgesics or local anaesthetics will yield large reductions in post-operative pain or analgesic consumption. Extending the pre-emptive treatment well into the post-operative period using balanced, multimodal analgesia, may prolong the initial advantage conferred by the pre-operative blockade and possibly interfere with the development of long-lasting pain.
-
Randomized Controlled Trial Clinical Trial
Improving patient-controlled analgesia: adding droperidol to morphine sulfate to reduce nausea and vomiting and potentiate analgesia.
Opioid-related side effects, including nausea and vomiting, are common in patients using morphine in patient-controlled analgesia for postoperative pain relief. The purpose of this study was to determine if the addition of droperidol to a morphine sulfate delivery system could decrease the incidences of nausea and vomiting without increasing droperidol-related side effects. Forty ASA 1 and 2 patients scheduled to undergo peripheral orthopedic surgery were randomized to receive either morphine sulfate (2 mg/mL), or morphine sulfate (1.9 mg/mL) plus droperidol (0.125 mg/mL) for postoperative self-controlled analgesia. ⋯ The patients who used morphine sulfate plus droperidol had significantly less nausea and vomiting and used significantly less morphine. No patient experienced droperidol-related side effects. We conclude that the routine addition of droperidol to morphine sulfate in self-controlled analgesia improves the comfort of patients following peripheral orthopedic surgery.