Articles: analgesia.
-
Randomized Controlled Trial Clinical Trial
Patient-controlled epidural analgesia with sufentanil following caesarean section: the effect of adrenaline and clonidine admixture.
Sixty patients, scheduled for Caesarean section were randomly allocated to receive by the epidural route in a double-blind fashion one of the following patient-controlled analgesia mixtures for the relief of postoperative pain: sufentanil 2 micrograms.ml-1 in 0.9% sodium chloride, sufentanil 2 micrograms.ml-1 + adrenaline 2.5 micrograms.ml-1, or sufentanil 2 micrograms.ml-1 + clonidine 3 micrograms.ml-1. Patient-controlled analgesia settings were a basal infusion rate of 2.5 ml.h-1, an incremental dose of 2.5 ml, a lockout interval of 10 min and a 1-h limit of 10 ml. ⋯ The quality of sleep appeared to be significantly better in the sufentanil/adrenaline group despite a significantly lower degree of sedation and higher incidence of pruritus. Treatment of pruritus with naloxone did not seem to influence the quality of analgesia.
-
Randomized Controlled Trial Clinical Trial
Antiemetic efficacy of metoclopramide when included in a patient-controlled analgesia infusion.
A double-blind, randomised, controlled trial was performed to assess the antiemetic efficacy of metoclopramide when included in a morphine patient-controlled analgesia regimen. Fifty ASA grade 1 or 2 patients scheduled for elective intermediate or major gynaecological surgery were allocated into one of two groups. All patients received a standardised anaesthetic and metoclopramide 5 mg was given intravenously 10 min before the end of the procedure. ⋯ Pain scores, sedation scores, and morphine requirement were not significantly different between the groups. There was no difference in nausea scores between the groups, but more patients suffered moderate or severe nausea in group 1 (10 patients) than group 2 (three patients, p < 0.026). We conclude that metoclopramide, when included in a patient-controlled analgesia regimen, reduces the incidence of moderate to severe nausea, but not the overall incidence of nausea.
-
Regional anesthesia · Sep 1994
Case ReportsColonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient.
A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids, and early oral feeding and mobilization. ⋯ The technique of combined neural and humoral mediator block should be evaluated in other high-risk patients undergoing major surgical procedures, where minimal invasive techniques are not possible.
-
Journal of anesthesia · Sep 1994
Tolerance to the mydriatic effect of buprenorphine, butorphanol, nalbuphine, and cyclorphan, and cross-tolerance to morphine in mice.
An increase in the use of opioid derivatives in the treatment of pain syndrome in clinical practice, and especially in the treatment of cancer, has added impetus to the search for an agent which does not induce tolerance and cross-tolerance to other opiodis. The mydriatic effect of opioids in mice, the correlation between analgesia and mydriasis, and tolerance to the analgesic effect of morphine in mice were evaluated previously. ⋯ Tolerance and cross-tolerance to morphine were developed following a chronic use of buprenorphine, nalbuphine, and cyclorphan. After chronic injection of butorphanol, no tolerance or cross-tolerance to morphine was observed.
-
Randomized Controlled Trial Clinical Trial
Epidural diamorphine infusions with and without 0.167% bupivacaine for post-operative analgesia.
Forty patients who underwent upper or mid-abdominal surgery were randomly allocated to receive a post-operative epidural infusion of 0.083 mg ml-1 of diamorphine in either 0.167% bupivacaine or 0.9% NaCl solution. The nursing staff, who were unaware of which solution was being infused, managed the patients' pain according to a standardized scheme. They adjusted the epidural infusion rates to 3, 5 or 7 ml h-1 according to the patient's hourly reports of pain on a four point verbal rating scale (none, mild, moderate or severe), aiming to use the lowest allowed infusion rate to prevent or reduce any pain that was more than mild. ⋯ Diclofenac was needed by six patients receiving diamorphine in saline and one receiving diamorphine in bupivacaine (P < 0.05). The range of average hourly epidural infusion rates was constrained by design to between 3 and 7 ml h-1 but the median of these values was 5 ml h-1 in the diamorphine-saline group and 3.35 ml h-1 in the diamorphine-bupivacaine group (P < 0.02). In patients receiving diamorphine in saline, a median of 6 (range 0-16) of the 24 h reports were of more than mild pain, whereas in the diamorphine-bupivacaine group, the corresponding figures were 2 (range 0-13) (P < 0.02)).(ABSTRACT TRUNCATED AT 250 WORDS)