Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action?
This randomized, double-blind study of 40 patients was designed to determine if the predominant analgesic effect of extradural fentanyl is mediated by a direct spinal action or an indirect systemic one. After Caesarean section, postoperative analgesia was provided for 24 h by patient-controlled extradural analgesia (PCEA group) or by patient-controlled i.v. analgesia (PCIVA group). Both groups received a bolus dose of fentanyl 20 micrograms with a 10-min lockout interval. ⋯ Mean visual analogue pain scores (0-100 mm) at 8 and 12 h were lower for PCEA (23 (sd 13) mm at rest, 31 (23) mm on coughing) than for PCIVA (50 (25) mm at rest, 67 (24) mm on coughing) (P < 0.0005). The mean dose of fentanyl self-administered between 4 and 8 h was lower in the PCEA group (38 (sd 30) micrograms h-1) compared with the PCIVA group (59 (27) micrograms h-1) (P < 0.05). Our results support the hypothesis that the predominant analgesic effect of extradural administration of fentanyl is mediated by a direct spinal action rather than an indirect action from systemic absorption.
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Anesthesia and analgesia · Feb 1995
Randomized Controlled Trial Clinical TrialA double-blind evaluation of ketorolac tromethamine versus acetaminophen in pediatric tonsillectomy: analgesia and bleeding.
The study was designed to compare intravenous ketorolac to rectal acetaminophen for analgesia and bleeding in pediatric patients undergoing tonsillectomy. We studied 50 patients, aged 2-15 yr undergoing tonsillectomy with or without adenoidectomy. In a randomized, prospective double-blind fashion, patients were assigned to receive either ketorolac (1 mg/kg) or rectal acetaminophen (35 mg/kg). ⋯ Significantly more measures to achieve hemostasis were required in the ketorolac group (P = 0.012). We conclude that ketorolac is no more effective than high-dose rectal acetaminophen for analgesia in the patient undergoing tonsillectomy. Hemostasis during tonsillectomy was significantly more difficult to achieve in patients receiving ketorolac.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo.
To determine whether transdermal fentanyl can provide a significant component of postoperative analgesia. ⋯ Efficacy of transdermal fentanyl for postoperative pain relief is shown, but intense respiratory depression is sometimes seen.
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Acta Obstet Gynecol Scand · Feb 1995
Clinical TrialParacervical block--a viable alternative for labor pain relief?
Two hundred and forty-eight consecutive deliveries with a 0.25% bupivacaine paracervical block (PCB) using a superficial injection technique were studied prospectively during the progress of labor in the three month study period. Parturients with signs of fetal distress were excluded. Pain level and the maternal, fetal and neonatal effects related to PCB were evaluated. ⋯ PCB in selected parturients with a low-dose superficial technique has been shown to be an effective analgesic modality with minimal fetal and neonatal side-effects, but post-blockade fetal bradycardia cannot be wholly eliminated.