Articles: analgesia.
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Case Reports
Complications of continuous epidural infusions for postoperative analgesia in children.
To determine the incidences of side effects and complications associated with the use of epidural analgesia for infants and children at the Alberta Children's Hospital, we reviewed our experience over a two-year period. A database was established for recording management, side effects and complications of each epidural, and this is a retrospective review of that database. Problems were identified as complications if there was a need for medical intervention related to the patient complaint, and if the intervention was documented in the patient record. ⋯ Early discontinuation of the epidural occurred in 41 cases, technical problems with the epidural catheter being the commonest reason (21 cases). Although three potentially serious complications were identified (one catheter site infection, one seizure, one respiratory depression) none was associated with lasting consequences. The majority of complications associated with the use of epidurals were minor and easily remedied.(ABSTRACT TRUNCATED AT 250 WORDS)
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The purpose of this report is to describe a new complication of epidural blood patch for inadvertent dural puncture. A dural tap in an obstetric patient was managed initially with a prophylactic blood patch via the epidural catheter. Despite this, 48 hr later, she developed post-dural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch. ⋯ There were no further sequelae. Although severe complications of epidural blood patch are rare, they are alarming. Exacerbation of the original symptoms of post-dural puncture headache caused by, or following, epidural blood patching has not previously been reported.
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Randomized Controlled Trial Clinical Trial
[Preemptive analgesia produced with epidural analgesia administered prior to surgery].
The effect of epidural analgesia administered before or during surgery on postoperative pain relief using continuous epidural infusion of the mixture of local anesthetics and narcotics was studied. Ninety patients undergoing abdominal hysterectomy were randomly allocated to three groups; thirty patients of group 1 who received general anesthesia alone, thirty patients of group 2 with epidural analgesia 20 min before the end of surgery under general anesthesia and thirty patients of group 3 with epidural analgesia plus general anesthesia before surgery. Epidural analgesia was induced with 2% mepivacaine solution 15 ml without epinephrine in group 2 and 3, and in group 3 followed with 5 ml of the same solution at one-hour intervals. ⋯ Immediately after surgery, 5 ml of the mixture of 0.225% bupivacaine and 0.0005% fentanyl was injected epidurally and followed with continuous infusion of the same mixture at the rate of 2.1 ml.h-1 over 24 h. Visual analogue score and Prince-Henry score were significantly less in group 3 than in group 1 and group 2 at 4 hours and 24 hours after surgery (P < 0.01, P < 0.05 respectively). These results suggest that postoperative continuous epidural analgesia is more effective if the entrance of noxious stimuli into the central neural system is prevented by preincisional epidural block.
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The use of epidural analgesia has become so widespread in recent years that many women are now requesting repeat epidural analgesia for their second or subsequent labour. This study examines the incidence of problems at insertion and of inadequate block in 71 multiparae having second epidurals compared with 150 primiparae having their first epidural. ⋯ Epidurals were inserted at a greater dilatation (P < 0.05) and there was a shorter time to delivery (P < 0.01) in the multiparous group. We conclude that unilateral block is thus more common in women receiving repeat epidurals.
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Anesthesia and analgesia · Jul 1994
Randomized Controlled Trial Clinical TrialSystemic opioids enhance the spread of sensory analgesia produced by intrathecal lidocaine.
The effect of different doses of fentanyl and nalbuphine on the spread of spinal analgesia produced by lidocaine was studied in 68 patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia. Patients were randomly assigned to six groups: fentanyl A, B, or C (FA, FB, FC) or nalbuphine A, B, or C (NA, NB, NC), which received intravenous (i.v.) 50, 100, or 150 micrograms of fentanyl or 10, 15, or 20 mg of nalbuphine, respectively, 20 min after spinal anesthesia with lidocaine. We tested the level of spinal analgesia with pinprick sensation 20 min after spinal anesthesia and 10 min after the opioid administration, when 0.4 mg of naloxone was administered i.v. ⋯ Ten minutes after fentanyl or nalbuphine, the level of analgesia increased (1.8 +/- 1.7, 3.1 +/- 1.2, and 4.1 +/- 1.5 cm, in the FA, FB, and FC groups and 1.9 +/- 0.9, 2.6 +/- 1.4, and 3.7 +/- 2.2 cm in the NA, NB, and NC groups, respectively). The increases in the level of analgesia differed significantly between the fentanyl groups (F = 8.0939; df = 2.35; P < 0.001), the increase produced by 150 micrograms being significantly higher than produced by 50 micrograms of fentanyl (limits of confidence -4.236809 and -0.4431909; P < 0.01). Naloxone reversed the effect of fentanyl and 10 min after its administration the fentanyl groups did not differ with regard to the level of spinal analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)