Articles: analgesia.
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Clinical Trial Controlled Clinical Trial
[Effect of celiac plexus block and thoracic epidural block on arterial ketone body ratio].
We evaluated the effect of intraoperative celiac plexus block (CPB) and thoracic epidural block (TEB) on arterial ketone body ratio (AKBR) in the patients undergoing total or partial gastrectomy. Mean arterial pressure (MAP), heart rate, AKBR, and arterial blood gas were measured at the end of esophago-jejunostomy, gastro-duodenostomy, or gastro-jejunostomy (pre-block) and at the end of operation (post-block), respectively. After pre-block measurement, CPB with 99.5% ethanol 15-20 ml was carried out in 8 patients with advanced gastric cancer (CPB group); TEB with 2% lidocaine was performed on 8 patients (TEB group); and neither CPB nor TEB was done on 8 patients (control group). ⋯ However, there were no difference in AKBR, pH, and BE between pre-block values and post-block values in TEB group as in the control group. These findings suggest that ethanol used in CPB reduces the redox state of hepatic mitochondria and increases lactate. Therefore we should pay attention to the changes in AKBR, pH, and BE after celiac plexus block with ethanol.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural opioid analgesia after caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine.
The quality of analgesia, patient satisfaction and incidence of side effects following a single bolus of epidural morphine were compared with patient-controlled epidural analgesia (PCEA) with meperidine during the first 24 hr after elective Caesarean section. Seventy-five women were randomly assigned to three equal groups. Group I received 30 mg epidural meperidine after delivery and PCEA with meperidine; Group 2 received 3 mg epidural morphine after delivery and PCEA with saline in a double-blind fashion. ⋯ Forty-six percent of patients in Group 1 were very satisfied with pain management, compared with 77% in Group 2 and 79% in Group 3. Nurse workload was higher in the PCEA study groups than in Group 3 (P < 0.05). A single bolus of epidural morphine provides superior analgesia and satisfaction at low cost, but with a higher incidence of nausea and pruritus than PCEA with meperidine.
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Anesthesia and analgesia · Nov 1994
Randomized Controlled Trial Clinical TrialThe effect of low-dose bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography.
We performed a prospective, randomized, double-blind study to determine the effect of bupivacaine on postoperative epidural fentanyl analgesia and thrombelastography in 120 patients who underwent extensive gastrointestinal or genitourinary surgery. The patients were randomized into four groups, 30 patients per group: Group I = epidural fentanyl (EF), 10 micrograms/mL in saline; Group II = EF with 0.1% bupivacaine; Group III = EF with 0.15% bupivacaine; and Group IV = EF with 0.2% bupivacaine. Pain relief was evaluated by a visual analog scale (VAS), both at rest and during coughing, and by a visual rating scale (VRS). ⋯ The VAS, VRS, sedation scores, changes in postoperative FVCs, and the incidence of side effects were not statistically different among the four groups. The 24-h total volumes of infusion in the four groups (146 +/- 40 mL, 140 +/- 38 mL, 142 +/- 40 mL, 124 +/- 21 mL, respectively) were not statistically different from each other. There were no significant differences in the TEG values [reaction time (R), coagulation time (K), angle (alpha), and maximum amplitude (mA)] among the four groups at anytime nor was there any difference between the baseline, PARR, and 24-h TEG values within any group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Managing pain during mediastinal chest tube removal.
To compare four analgesic regimens used in preparing patients for chest tube removal. ⋯ Blind ratings of subjects' descriptions of sensations suggest subfascial lidocaine may be useful in reducing discomfort during chest tube removal.
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Ann Acad Med Singap · Nov 1994
Randomized Controlled Trial Clinical TrialCombination of intramuscular Ketorolac and low dose epidural morphine for the relief of post-caesarean pain.
Epidural morphine produces profound analgesia but also causes many adverse effects in a dose-dependent manner. This double-blind, randomized, prospective study evaluated the analgesic efficacy and safety of low dose (2 mg) epidural morphine in combination with 30 mg intramuscular (IM) Ketorolac, a non-steroidal anti-inflammatory drug with potent analgesic activity, in patients suffering pain after caesarean surgery. Ninety parturients who received epidural anaesthesia in the postoperative period were divided into 3 equal groups: group A received epidural morphine 2 mg plus IM placebo; group B received epidural morphine 2 mg plus IM Ketorolac 30 mg; and group C received epidural saline placebo plus IM Ketorolac 30 mg. ⋯ Results showed that group B had statistically significant superior pain relief to that of the other 2 groups. The incidence of adverse effects was similar between those of group A and B. We concluded that the addition of Ketorolac by IM administration enhanced the analgesic effect of low dose (2 mg) epidural morphine in the relief of post-caesarean pain without potentiating its adverse effects.