Articles: analgesia.
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Anesthesia and analgesia · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialProphylactic antiemetic therapy with patient-controlled analgesia: a double-blind, placebo-controlled comparison of droperidol, metoclopramide, and tropisetron.
This placebo-controlled, randomized, double-blind trial was designed to evaluate the efficacy of three prophylactic antiemetic regimens on postoperative nausea and vomiting (PONV) during patient-controlled analgesia (PCA) with morphine. We studied 286 elective surgical patients for 36 h postoperatively. Group 1 was saline control. ⋯ Metoclopramide had a marginally significant effect under these conditions. Only droperidol decreased the need for rescue medication (P < 0.01), although rescue with tropisetron was highly effective. Side effects and patient satisfaction were comparable among the groups, but patients receiving droperidol were sleepier (P < 0.05) than control patients and recalled somewhat more anxiety (P = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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Obstet Gynecol Surv · May 1994
ReviewEpidural analgesia in labor and cesarean delivery for dystocia.
Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. ⋯ Epidural is safe and may be a superior labor analgesic when compared with narcotics. However, patients should be informed that epidural analgesia may increase the risk of cesarean birth in first labors.
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Regional anesthesia · May 1994
Randomized Controlled Trial Clinical TrialPlasma concentration profile of epidural alfentanil. Bolus followed by continuous infusion technique in the parturient: effect of epidural alfentanil and fentanyl on fetal heart rate.
A combined bolus and continuous epidural infusion technique of opioid and bupivacaine mixture has been described, although no pharmacokinetic data for this technique exists. The study documents the plasma concentration profile of epidural alfentanil in parturients using this technique, and evaluates the fetal heart rate tracing for associated changes following opioid administration. ⋯ With the dosage regimen used in this study, an initial epidural bolus with continuous infusion technique generates a steady state plasma concentration of alfentanil that is below levels associated with direct respiratory depression.
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Letter Case Reports
Staphylococcus aureus meningitis after short-term epidural analgesia.
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This self-directed learning module highlights advances in therapeutic options in pain management. It is part of the chapter on pain rehabilitation for the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This section discusses pharmacologic agents, modalities, behavioral strategies, and invasive techniques in pain management, with case studies illustrating pain management approaches in clinical practice. Advances that are covered include use of opioid receptors, receptor-specific categories of drugs used in painful conditions, components of behavioral programming for chronic pain, and the limitations of invasive techniques in chronic pain patients.