Articles: analgesia.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 1995
ReviewInfluence of epidural analgesia on fetal and neonatal well-being.
Epidural analgesia is a frequently used method to reduce the pain of child-bearing. Concerns regarding the safety and potential hazards still persist in the medical community. This review intends to examine how epidural analgesia determines the various factors of fetal and neonatal well-being. ⋯ Neonatal depression can occur however with epidural use of morphine, fentanyl and alfentanil. Sufentanil, again in doses up to 30 micrograms in association with bupivacaine seems to be devoid of depressive effects on the neonate. In summary, the anaesthetist has good arguments to reassure his obstetrical colleagues that providing epidural analgesia for pregnant women in labour is a justifiable intervention to support the natural process of child-bearing.
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Providing sedation and analgesia is an integral part of emergency care for children. To become facile at pediatric pain control and sedation, clinicians must develop expertise regarding proper monitoring, drugs and doses, potential side effects, and strategies to select the best agent for a given procedure and clinical setting. Currently available agents, methods, and monitoring guidelines are reviewed with an emphasis on conscious sedation.
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The purposes of this article are to introduce the reader to patient-controlled analgesia (PCA) and to summarize its use in several selected pain-related conditions. patient-controlled analgesia is a relatively new technique for managing pain in which patients are able to self-administer small doses of opioid analgesic medications when needed. The authors briefly review some of the problems associated with current and previous opioid delivery strategies and highlight the advantages of PCA over these other methods. They then discuss the components of the PCA system and briefly describe how the system is operated and controlled. ⋯ The authors close with a brief summary of several reports describing the use of PCA in the management of postoperative pain, cancer pain, and pain associated with labor and delivery. Indications and contraindications for use in these conditions are presented. Because physical therapists often play a major role in pain management, it is important for them to be well informed with regard to recent developments in this rapidly developing area of clinical practice.
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Dimens Crit Care Nurs · May 1995
ReviewIntravenous patient-controlled analgesia in critically ill postoperative/trauma patients: research-based practice recommendations.
PCA use is increasingly common in the Intensive Care Unit. The authors review current PCA research and make recommendations for the optimal use of PCA in the critically ill patient.
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Randomized Controlled Trial Clinical Trial
[Analgesia with intra-articular morphine following knee joint arthroscopy? A double-blind, randomized study with patient-controlled analgesia].
Previous studies investigating the peripheral action of locally instilled morphine after arthroscopic knee surgery found evidence for an analgesic effect. Follow-up studies have lead to conflicting results. We used patient-controlled analgesia (PCA) to test the analgesic potency of intraarticular morphine. METHODS. Patients undergoing arthroscopic knee surgery under general anaesthesia received, after written informed consent and in double-blind and randomised manner, 1 mg morphine diluted in 10 ml saline either intraarticularly or intravenously at the end of the surgical procedure. A control injection of 10 ml saline was given at the other site. The pain intensity on a visual analogue scale (VAS) and the cumulative morphine consumption were recorded at 1, 2, 3, 4, 6, 8 and 24 h after the end of general anaesthesia. ⋯ Wilcoxon rank sum test with P < 0.05. RESULTS. A total of 59 patients were included in the study; 29 received morphine intraarticularly (verum group), 30 intravenously (control group). There was no difference in gender, age, duration of arthroscopy or anaesthesia. There were more than 60% diagnostic arthroscopies in both groups; other types of surgery were comparable, with the exception of cruciate band repair procedures only in the control group. We found no difference in morphine consumption or pain intensity between the two groups throughout the study period. Median overall consumption of morphine after 24 h was 14 mg in the verum group and 15 mg in the control group, with wide interindividual variation. Pain intensities were remarkably low. The peak pain intensity of both groups was found at 1 h postoperatively, with median 16/100 on the VAS in both groups. Blinding was robust. CONCLUSION. We found no reduction in postoperative morphine supplementation after 1 mg morphine intraarticularly compared to 1 mg intravenously given at the end of knee arthroscopies. There were also no differences in pain intensities on a VAS. We conclude that titration of postoperative pain with a morphine-filled PCA pump was unable to show a difference in analgesic potency between intraarticular and intravenous morphine.