Articles: analgesia.
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Acta Anaesthesiol Scand · May 1994
Comparative StudyParavertebral vs epidural block in children. Effects on postoperative morphine requirement after renal surgery.
Continuous thoracic paravertebral blockade (PVB) has only recently been reported in pediatric patients. The aim of the present study was to compare retrospectively the postoperative analgesic efficacy of PVB vs conventional lumbar epidural blockade (EDA) in children. Thirty-five consecutive pediatric patients undergoing renal surgery, receiving either PVB (n = 15) or EDA (n = 20), were reviewed. ⋯ The need for supplemental morphine administration was significantly lower (P = 0.046) and the number of patients with no need for supplemental morphine administration postoperatively was significantly higher (P = 0.019) in patients treated with PVB vs EDA. The present study indicates that PVB may possess a potential for postoperative analgesia equal to or maybe even superior to conventional lumbar EDA in pediatric patients undergoing renal surgery. Further prospective studies investigating the analgesic efficacy of this novel technique are warranted.
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AJR Am J Roentgenol · May 1994
Anodyne imagery: an alternative to i.v. sedation in interventional radiology.
Pain and anxiety are to be expected in patients undergoing interventional procedures, and they are usually treated by IV conscious sedation. Insufficient treatment of pain and anxiety can cause cardiovascular strain and restlessness, which may jeopardize the success of the procedure. On the other hand, pharmacologic oversedation can provoke respiratory and cardiovascular depression, thereby increasing the procedural risks and delaying the patient's recovery. We therefore evaluated a nonpharmacologic method, which we call anodyne imagery (anodyne: able to soothe or relieve pain; soothing the feelings; relaxing), as an alternative to the use of drugs in interventional radiology. ⋯ Patients having interventional radiologic procedures frequently experience intense and frightening imagery related to the procedure. Our initial experience with anodyne imagery suggests that this alternative method of analgesia can mitigate patients' anxiety and fears and reduce the amount of drugs used during interventional radiologic procedures, and thereby has the potential to improve procedural safety and increase the speed of recovery.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialInterpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study.
The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg.ml-1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. ⋯ Adequacy of pain relief was evaluated with the Prins-Henry pain scale. Morphine requirement was registered, there was no difference between the groups in pain scores or need for additional morphine.
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Randomized Controlled Trial Clinical Trial
Bupivacaine 0.125% improves continuous postoperative epidural fentanyl analgesia after abdominal or thoracic surgery.
The addition of 0.125% and 0.25% bupivacaine to continuous postoperative epidural infusions of fentanyl, in a 10 micrograms.ml-1 concentration, were studied in 39 patients following abdominal or thoracic surgery in prospective, random, double-blind fashion. Patients received an initial bolus of 0.1 ml.kg-1 of the the study solution and an infusion of 6 ml.hr-1 which was titrated to maintain analgesia (VAS < 40). Assessments of pain (VAS), pulmonary function (pH, PaCO2), and bowel function (time to flatus or po fluids) were made until the second post-operative morning. ⋯ Fewer patients in the 0.125% bupivacaine group than in the 0.25% group developed a transient sensory loss to pinprick and ice (3 vs 10, P < 0.001). Four patients in both bupivacaine groups had leg weakness, those in the 0.125% were all a Bromage 1 score, while in the 0.25% group one had a Bromage 1, one a Bromage 2, and two Bromage 3 scores. The addition of 0.125% bupivacaine improves the analgesia of epidural infusions of fentanyl (10 microgms.ml(-1)) when used following abdominal or thoracic surgery and results in minimal sensorimotor disturbance.
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Randomized Controlled Trial Clinical Trial
Addition of oral clonidine to postoperative patient-controlled analgesia with i.v. morphine.
Using a randomized, double-blind, placebo-controlled design, we have investigated, in 40 patients undergoing major abdominal surgery, the effect of oral clonidine 300 micrograms, 1 h before and 12 h after surgery on postoperative morphine requirements (evaluated by PCA). During the 24 h of the study, pain scores measured every 6 h did not differ significantly. ⋯ Heart rate was significantly lower until 18 h after surgery and sedation was significantly more pronounced in patients receiving clonidine. We cannot recommend routine oral administration of clonidine before surgery to improve postoperative analgesia.