Articles: analgesia.
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Ugeskrift for laeger · Mar 1994
Review[Complications of epidural bupivacaine analgesia in vaginal labor].
Epidural analgesia is accepted as a good and effective method of analgesia in labor. The method is, however subject to a variety of complications, the worst being life long sequelae and death. The article presents a survey of the complications of bupivacaine epidural analgesia in labour and state prophylactic measures and treatments. The existing literature on the field is commented and criticized.
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Auditory continuous reaction time was studied in three treatment groups. Twenty opioid naive patients received intramuscular morphine 0.15 mg kg-1 bodyweight for premedication. Thirty-one cancer patients were treated with oral opioids, 180 mg morphine per 24 h (median). ⋯ The reaction time was measured using 152 auditory signals and summarized as 10%, 50% and 90% percentiles. Analysing reaction time distributions, the opioid naive patients showed the greatest difference to the control group in the shortest reaction times while chronic opioid users showed the greatest difference for the longest reaction times. There seems to be a qualitative difference in reaction time distribution, between opioid naive individuals treated with single dose morphine and cancer patients in long-term treatment.
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Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. ⋯ Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.