Articles: analgesia.
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The Journal of urology · Jan 1995
Clinical TrialIntraoperative irrigation with bupivacaine for analgesia after orchiopexy and herniorrhaphy in children.
Effective postoperative analgesia is important, especially in pediatric surgery. The efficacy of intraoperative surgical wound irrigation with bupivacaine for postoperative analgesia was investigated in 90 children undergoing elective inguinoscrotal surgery. ⋯ Bupivacaine irrigation was simple and complication-free. We believe that the irrigation of surgical wounds with bupivacaine should be a routine procedure in elective inguinoscrotal surgery in children.
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We prospectively studied the relationship between upper facial sensory-evoked muscle potential amplitude, uterine contraction amplitude and heart rate in 20 healthy parturients during the first stage of labour. Monitoring began when minimal pain was reported and continued until severe pain occurred and extradural analgesia was established. Pain intensity was assessed by each patient using a 10 cm visual analogue score. ⋯ No constant relationship was seen between heart rate and uterine contraction. Following extradural analgesia (mean pain scores of 2.1 cm, SD 1.3 cm) a variable relationship between sensory evoked muscle potential and uterine contraction amplitude, and heart rate and uterine contraction, was recorded. A continuous display of the relationship between filtered sensory evoked muscle potentials of the frontalis muscle and uterine contraction may, in the future, permit an objective assessment of the adequacy of analgesia following extradural analgesia for the pain of labour.
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Combined spinal and epidural analgesia is a new concept in the field of regional anesthesia. It combines the positive qualities of spinal and epidural analgesia, and is performed by the "needle-in-needle" technique, described in the paper. This type of analgesia is practically implemented in the Clinical Center of Urology over the past few months, and shows encouraging results. ⋯ The block induced is with 4-hour duration, and lends itself to prolongation through an epidural catheter. This renders the method variable and suited for postoperative analgesia too. The Espokan set technical devices used make puncture of the spinal-epidural space readily practicable.
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Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. ⋯ Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.