Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Metabolic response to lower abdominal surgery: analgesia by epidural blockade compared with intravenous opiate infusion.
To determine whether the type of peri-operative analgesic regimen affects the metabolic response during and after surgery, we studied 19 women undergoing abdominal hysterectomy under propofol anaesthesia. Patients were randomized to receive either continuous intravenous opioid or a bupivacaine-opioid mixture through a lumbar epidural catheter. Total body oxygen consumption and carbon dioxide excretion, blood glucose and haemodynamic variables were determined up to 24 h after surgery. ⋯ In the post-operative period, the increase in oxygen consumption up to pre-operative values, the urinary nitrogen excretion and the changes in acute phase proteins were similar in both treatment groups. In contrast, the respiratory quotient was significantly higher in the lumbar epidural group than in the intravenous opioid group, 0.87 (SD 0.04) vs 0.77 (SD 0.06) (P < 0.05) and the hyperglycaemic response was more delayed in the epidural group. These data suggest that prolonged sympathetic blockade associated with epidural analgesia might contribute to better preservation of glucose homeostasis in the perioperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of patient-controlled analgesia in children by i.v. and s.c. routes of administration.
Sixty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group IV received standard i.v. PCA with a bolus dose of morphine 20 micrograms kg-1 and a background infusion of 4 micrograms kg-1 h-1 while group SC received PCA by the s.c. route with a bolus dose of morphine 20 micrograms kg-1 and a background infusion of 5 micrograms kg-1 h-1. ⋯ PCA. By giving patients feedback on the occurrence of valid demands for analgesia, s.c. PCA may produce more appropriate and effective use of PCA.
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Acta Anaesthesiol Scand · May 1994
Randomized Controlled Trial Clinical TrialIntraarticular morphine for pain relief after knee arthroscopy performed under regional anaesthesia.
Eighty patients scheduled to undergo knee arthroscopy were studied in random and double blind fashion. Spinal anaesthesia with hyperbaric 0.5% bupivacaine was selected for 40 overnight-in-patients. At the end of arthroscopy, 1 mg morphine or saline was injected intraarticularly. ⋯ Duration of analgesia was slightly longer after morphine than in the control group (ns). There was no difference between the morphine patients and the control patients in the two studies regarding the incidence of side effects. We conclude that postoperative analgesia in patients undergoing knee arthroscopy under local anaesthesia, but not under bupivacaine spinal anaesthesia, can be improved with a single intraarticular injection of 1 mg morphine.
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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.
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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.