Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Epidural clonidine analgesia for intractable cancer pain. The Epidural Clonidine Study Group.
Although the vast majority of patients with cancer pain receive effective analgesia from standard therapy, a few patients, particularly those with neuropathic pain, continue to experience severe pain despite large doses of systemic or intraspinal opioids. Animal studies suggest intraspinal alpha 2-adrenergic agonists may be effective in such cases. Eighty-five patients with severe cancer pain despite large doses of opioids or with therapy-limiting side effects from opioids were randomized to receive, in a double-blind manner, 30 micrograms/h epidural clonidine or placebo for 14 days, together with rescue epidural morphine. ⋯ Clonidine, but not placebo, decreased blood pressure and heart rate. Hypotension was considered a serious complication in 2 patients receiving clonidine and in 1 patient receiving placebo. This study confirms the findings from previous animal studies which showed the effective, potent analgesic properties of intraspinal alpha 2-adrenergic agonists and suggests that epidural clonidine may provide effective relief for intractable cancer pain, particular of the neuropathic type.
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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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Acta Anaesthesiol. Sin. · Jun 1995
Randomized Controlled Trial Clinical TrialIntravenous tenoxicam reduces dose and side effects of PCA morphine in patients after thoracic endoscopic sympathectomy.
Among surgical modalities for treatment of palmar hyperhidrosis, endoscopic sympathectomy is the most popular choice in recent years. After surgery, the major complaint was anterior chest pain. This study was conducted to evaluate the analgesic efficacy and side effects of tenoxicam (a thienothiazine derivative) in combination with patient-controlled analgesia (PCA) using morphine in patients who received thoracic endoscopic sympathectomy. ⋯ Tenoxicam may be an effective adjuvant to PCA morphine for postoperative pain control. This combination reduces the total consumption of PCA morphine with less side effects.
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Anesthesia and analgesia · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparative analgesic efficacy of patient-controlled analgesia with ketorolac versus morphine after elective intraabdominal operations.
We conducted a randomized, double-blind trial to compare analgesia and side effects produced by ketorolac and morphine during postoperative patient-controlled analgesia (PCA). Fifty-one patients (ASA classes I and II) undergoing elective intraabdominal procedures were assigned to one of two groups. When postoperative pain first increased to 4/10 (by visual analog scale [VAS]), patients were randomly assigned to one of two groups. ⋯ Mean pain scores were less in Group 1 than in Group 2 at each time, but only significantly so at 15 min (P < 0.0021), 30 min (P < 0.0336), and 24 h (P < 0.0358) after starting PCA. Time to acceptance of oral liquids was equivalent in Groups 1 and 2 (22 h and 21 h, respectively). IV ketorolac PCA, although well tolerated, has limited effectiveness as the sole postoperative analgesic after intraabdominal operations.