Articles: analgesia.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative extradural analgesia in children: comparison of morphine with fentanyl.
We have compared the efficacy and side effects of extradural morphine with extradural fentanyl for postoperative pain relief. Thirty children (ages 1-16 yr) were allocated randomly to receive, after extradural administration of 0.5% bupivacaine 0.75 ml kg-1 and before surgical incision, extradural morphine 0.75 microgram kg-1 (group M), with an additional dose administered 24 h later or extradural fentanyl 2 micrograms kg-1 (group F) followed by a continuous extradural infusion (during 48 h). There was no major complication (respiratory depression). ⋯ Pruritus, nausea and vomiting were less common with extradural fentanyl (20% vs 53%, P < 0.05 and 0% vs 33%, P < 0.05) than with morphine. Urinary retention occurred with equal frequency (25%) in the two groups. After a bolus of 2 micrograms kg-1, continuous extradural infusion of fentanyl 5 micrograms kg-1 day-1 provided analgesia comparable to that from a daily bolus of extradural morphine 0.75 mg kg-1 and produced fewer side effects.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different bolus doses of morphine for patient-controlled analgesia in children.
Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. ⋯ There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.
-
J. Oral Maxillofac. Surg. · Feb 1994
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia: a comparison of dosing regimens for acute postsurgical pain.
This study compares several dosing regimens for patient-controlled analgesia (PCA) in the management of acute maxillofacial surgical pain. The dosing methods differed by presence or absence of an active drug (morphine [MS] vs saline), presence of a baseline infusion, and dose of drug delivered. Sixty-eight patients were enrolled in this prospective, randomized, double-blind, placebo-controlled trial that lasted 24 hours. ⋯ This study calls into question the usefulness of PCA with MS in maxillofacial surgery patients. Pain control was questionable at best, and the rate of emesis was unacceptably high in patients with potentially compromised airways. Further research is required to determine if other analgesics provide better pain control with less nausea in the PCA system or if antiemetics can effectively be used to lower the incidence of nausea and vomiting.
-
Pain is a major problem and primary concern of patients in the ICU. While nonintubated patients can verbalize their discomfort to healthcare providers, intubated patients cannot effectively communicate and are more at risk for inadequate analgesia. Mechanically ventilated, paralyzed patients are at even greater risk for inadequate control of pain. ⋯ A number of techniques are available, ranging from nonsteroidal anti-inflammatory drugs to other techniques and medications. However, analgesia usually requires the use of exogenous opioids. The most critically ill, mechanically ventilated patient receiving controlled alveolar minute ventilation is a candidate for continuous infusion of intravenous narcotics.(ABSTRACT TRUNCATED AT 250 WORDS)