Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the addition of three different doses of sufentanil to 0.125% bupivacaine given epidurally during labour.
In a double-blind, randomised, prospective study 150 women in labour received intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) with 5, 7.5 or 10 micrograms of sufentanil added. The onset, duration, and quality of analgesia were compared. Motor block, type of delivery and neonatal Apgar scores were noted. ⋯ Motor blockade and type of delivery did not differ between the groups and there were no differences in neonatal Apgar scores. No patient required more than three injections. We conclude that 7.5 micrograms sufentanil is the optimal dose to add to intermittent epidural injections of 10 ml 0.125% bupivacaine with adrenaline (1:800,000) for pain relief in labour.
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Anesthesia and analgesia · Aug 1994
Randomized Controlled Trial Clinical TrialPreoperative analgesia with epidural morphine.
In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intraabdominal surgery were randomly assigned to two groups: a control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. ⋯ The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 +/- 2.4 vs 3 +/- 2), at 36 h (0.3 +/- 0.6 vs 3 +/- 2.7), and at 60 h (0.1 +/- 0.3 vs 1.8 +/- 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.
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A survey of the analgesia regimens used in burns units throughout the UK was performed. Continuous intravenous opiate infusions remain the mainstay for providing pain relief in patients in severe pain as a result of burn injuries. Other methods include: patient-controlled analgesia in appropriate patients, bolus doses of opiates combined with Entonox for control of peaks of pain and a wide variety of oral analgesics for less painful burn injuries.
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Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients.
We prospectively studied surgical cancer patients who received epidural bupivacaine-morphine to determine perioperative morphine use, side effects, and complications. ⋯ Continuous epidural analgesia with 0.05-0.1% bupivacaine and 0.01% morphine is an effective method of postoperative analgesia with a low incidence of side effects, that can be safely administered on the surgical wards with no special monitoring equipment.
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Anesthesia and analgesia · Aug 1994
Previous wet tap does not reduce success rate of labor epidural analgesia.
Whether unintentional dural puncture (wet tap) during a previous labor epidural increases the failure rate of epidural analgesia for later deliveries is controversial. In this study, charts of 47 women with a previous wet tap who received epidural analgesia for labor were compared to those of 500 consecutive women receiving epidural analgesia in 1991 and, separately, to 44 women matched for month of delivery, previous epidural without a wet tap, and the same anesthesiologist. In comparison to the 500 consecutive control patients, women with a previous wet tap had a lower incidence of epidural catheter manipulation for inadequate block (9% vs 20%), but a similar incidence of catheter removal for failed block (4% vs 6.7%). ⋯ Epidural analgesia was considered successful in 93% of cases and 89% of matched control subjects by chart review. Two women (4%) with previous wet tap experienced a second wet tap during attempted epidural catheterization, compared to 0% in 500 consecutive patients (P < 0.001). These data suggest that there is no decrease in the success rate of epidural analgesia in women with a previous wet tap, although the chance for a repeated wet tap may be increased.