Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine.
This prospective, randomised, double-blind study compared PCA fentanyl with PCA morphine for post-Caesarean section analgesia. Following a standardised general anaesthetic, 37 women were allocated to receive either fentanyl (n = 18) or morphine (n = 19). The PCA was commenced after the women had been made comfortable in the postanaesthetic recovery room with the appropriate opioid solution (mean dose required = fentanyl 375 micrograms or morphine 16 mg). ⋯ Both analgesic solutions provided effective analgesia for a mean of 37 hr with high levels of patient satisfaction, and there were no differences in VAS scores for pain and patient satisfaction, or for side effects (nausea, itch, and sleepiness) between fentanyl or morphine. However, more patients in the fentanyl group required supplementary boluses or alterations to the PCA settings (13/18 vs 4/19: P = 0.005), and one patient was removed from the study due to inadequate analgesia. We conclude that fentanyl is not recommended for routine PCA use following Caesarean section.
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Review Comparative Study
[The pre-emptive analgesia in the treatment of postoperative pain].
The term "pre-emptive analgesia" implies the hypothesis that an analgesic treatment, given before nociceptive stimuli reach the Central Nervous System, could prevent or reduce the subsequent pain. The rational basis of this phenomenon, giving rise to much interest in the last years, comes from the finding that noxious stimuli cause wind-up and receptive fields expansion phenomena in the dorsal horn neurons of the spinal cord leading to hyperalgesia. ⋯ Conflicting results emerged from trials employing local anesthetics, opioids or associations of the three classes of drugs. Thus, the "pre-emptive analgesia" represents a very important phenomenon for the basic research, but further trials must investigate its clinical impact.
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Anesthesia and analgesia · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of different methods of administering droperidol in patient-controlled analgesia in the prevention of postoperative nausea and vomiting.
We performed a double-blind, placebo-controlled study to evaluate the different methods of administering droperidol in patients using patient-controlled analgesia (PCA) with morphine. Eighty patients undergoing major orthopedic procedures received temazepam 0.2 mg/kg orally followed by induction of general anesthesia with propofol 2.5 mg/kg, fentanyl 2 micrograms/kg, and vecuronium 0.1 mg/kg. Anesthesia was maintained with nitrous oxide, oxygen, and enflurane. ⋯ Droperidol significantly reduced the incidence of postoperative nausea and vomiting (PONV) (P < 0.01) and request for rescue antiemetic (P < 0.01) compared to placebo. However, there was no difference in the incidence of PONV between droperidol given either as a single dose at the end of surgery (Group 2) or mixed in morphine PCA (Group 3). The addition of droperidol in PCA after an initial dose (Group 1) should be avoided, as it resulted in more sedation and no further reduction in the incidence of PONV compared to Groups 2 and 3.
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Anesthesia and analgesia · Jan 1995
Randomized Controlled Trial Clinical TrialEpidural sufentanil for postoperative patient-controlled analgesia (PCA) with or without background infusion: a double-blind comparison.
To evaluate the usefulness of a concurrent infusion in patient-controlled epidural analgesia (PCEA), 40 patients scheduled for elective cesarean section under a combined spinal-epidural technique were assigned randomly in a double-blind fashion to receive sufentanil by PCEA with a concomitant infusion of either sufentanil or saline. The sufentanil 24-h consumption was significantly (P < 0.001) higher in those patients receiving the opioid-containing infusion (212.7 +/- 9.5 vs 128.4 +/- 10.8 micrograms, SEM). The number of additional demands and the quality of sleep did not differ between the two groups. ⋯ The visual analog scale (VAS) pain scores at rest were identical in both groups except at 6 h (2.5 +/- 0.4 vs 3.7 +/- 0.3, in favor of the patients treated with the sufentanil background infusion). We conclude that, except for a lower pain score during the initial hours, a background infusion in PCEA with sufentanil does not offer major advantages in terms of sleep quality or sufentanil consumption. Side effects may be more pronounced owing to increased drug administration.