Articles: analgesia.
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Int J Obstet Anesth · Jul 1995
Sequential spinal epidural analgesia for pain relief in labour: an audit of 620 parturients.
This investigation was designed to evaluate sequential spinal epidural analgesia with a needle through needle technique for pain relief in labour. The spinal injection was made using a Becton Dickinson 29 gauge Quincke point needle. Bupivacaine 1 mg, sufentanil 5 microg and adrenaline 25 microg (2 ml) were injected intrathecally. ⋯ Of the 620 parturients in the investigation, 500 had a mean dose of 4.3 mg bupivacaine per hour. Hypotension and paresis were of no concern. Patient satisfaction was excellent, 85% of the parturients being very satisfied and 10% satisfied.
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Postoperative pain therapy often appears to be inadequate in children. The present study was a retrospective investigation of the administration of analgesics given to 133 children and adults following surgery for funnel chest between 1983 and 1994. ⋯ Children received smaller quantities of narcotics than adults when postoperative analgesia was performed with PRN administration. PCA led to delivery of larger quantities of narcotic drugs than PRN medication in children.
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Minerva anestesiologica · Jul 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Patient-controlled postoperative analgesia in orthopedic surgery: epidural PCA versus intravenous PCA].
To evaluate both effectiveness and incidence of side effects of two techniques of postoperative pain treatment: intravenous and epidural PCA. ⋯ Our data show a better control of postoperative pain arising from total hip replacement during PCEA when compared to PCA. It should be emphasized that incident pain is far more decreased by PCEA, so that this technique is particularly indicated when an early postoperative mobilization is required.
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Pharmacokinetically designed infusions have been demonstrated to achieve rapidly and maintain desired concentrations of drug in plasma after intravenous administration. In this study we tested whether a similar approach, targeting concentrations in cerebrospinal fluid (CSF), could be used with epidural administration of the alpha 2-adrenergic analgesic clonidine. ⋯ This study suggests that pharmacokinetically designed infusions of drugs in the epidural space in humans can maintain steady concentrations of drug in CSF. In addition to providing a useful tool for investigation of mechanisms of action and drug interactions, this technique may improve analgesia and diminish side effects from epidurally administered analgesics.
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Anesthesia and analgesia · Jul 1995
Comparative StudyThe effects of differing concentrations of bupivacaine on the epidural somatosensory evoked potential after posterior tibial nerve stimulation.
The somatosensory evoked potential (SEP) recorded from the cervical epidural space in response to stimulation of the posterior tibial nerve is often used to monitor spinal cord integrity during scoliosis surgery. Epidural analgesia may be used as part of the anesthetic technique for scoliosis surgery, but the effects of the local analgesic on the evoked potential must be determined to ensure that it does not interfere with the monitoring of spinal cord function. Therefore, we compared the effects of the administration of 10 mL of 0.25% (n = 8), 0.5% (n = 8), or 0.75% (n = 8) bupivacaine injected into the L3-4 epidural space on the somatosensory evoked potential to posterior tibial nerve stimulation in patients anesthetized with a propofol infusion, nitrous oxide and oxygen, immediately before scoliosis surgery. ⋯ There were no significant differences between 0.25% bupivacaine and the control group, but both 0.5% and 0.75% bupivacaine were associated with clinically and statistically significant decreases in overall amplitude (P < 0.002, 0.5% bupivacaine; P < 0.001, 0.75% bupivacaine). Latency increased similarly in all groups. We conclude that bupivacaine in concentrations greater than 0.25% is not suitable for scoliosis surgery, if spinal somatosensory evoked potentials (SSEP) are to be measured.