Articles: analgesia.
-
Int J Obstet Anesth · Jan 1995
A comparison of informed consent for obstetric anaesthesia in the USA and the UK.
The practice of 75 UK and 75 US obstetric anaesthetists in obtaining informed consent for obstetric anaesthesia (for caesarean section) and obstetric analgesia (for labour) was compared using a postal questionnaire. The response rate was approximately 60% for each group. Of the US anaesthetists 47% obtained separate written consent for obstetric anaesthesia compared to 22% of the UK group (P=0.012). ⋯ Significantly more of the listed risks and benefits relating to general anaesthesia were discussed by the US anaesthetists compared to the UK group, median (interquartile range), 6 (4-7) and 3 (1-4), P < 0.001. There was no significant difference in discussion before regional anaesthesia but the US group discussed more information before epidural analgesia for labouring mothers obtunded by pain or drugs. These results suggest that discussion and documentation of informed consent for obstetric anaesthesia and analgesia could be improved in both countries, especially the UK.
-
Review Comparative Study
[Treatment of postoperative pain by balanced spinal analgesia].
Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. ⋯ Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable.
-
Epidural analgesia with local anesthetics and opioids is one of the most effective methods for postoperative pain control. In critical patients it seems to improve outcome as well as pain control. This technique works better when started in the intraoperative time. ⋯ Nursing staff cooperates with the Acute Pain Service doctors and nurses who are on call on a 24 hour basis. Many perspective and retrospective studies showed a very low incidence of major side effects with epidurals. So we can consider it safe and effective even if we consider its invasiveness.
-
Subcutaneous injection of dilute formalin in the hind paw of the rat produces a biphasic nociceptive response. Initial C-fiber activity is accompanied by flinching of the paw for about 5 min (phase 1), followed by cessation of activity and resumption of flinching beginning 15 min after injection and lasting about 40 min or more (phase 2). The second phase depends on changes in dorsal horn cell function that occur shortly after the initial C-fiber discharge. It was previously shown that isoflurane, administered during phase 1, reduced phase 2 activity, but a combination of isoflurane and nitrous oxide given throughout phase 1 did not suppress spinal sensitization. The same model was used to determine the effects of several inhalation and intravenous anesthetic agents on phase 2 of the formalin test. ⋯ Volatile anesthetics or nitrous oxide significantly suppress spinal sensitization, whereas the combination of nitrous oxide plus halothane causes no suppression. Thiopental does not affect spinal sensitization, whereas propofol causes significant suppression. These results may have important implications regarding the development of postoperative pain.
-
The neurophysiologic concept of neuroplasticity represents one of the current basis of the pathophysiology of painful post-injury phenomenons (postoperative, post-traumatic...). Deriving directly from these experimental data, the idea of preemptive analgesia has gradually developed in the last five years, the central question being to know if an analgesic intervention preceding surgical intervention is more efficient, as efficient, or less efficient than the same intervention following surgery. The authors bring current data of the literature in favor of the role of neuroplasticity in the genesis and the persistence of painful states in the course of postoperative outcome. A review of the various clinical studies and controversies published is proposed, in the attempt to make the point on current therapeutic implications of the concept of preemptive analgesia.