Articles: analgesia.
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The practice of critical care medicine has progressed dramatically over the past several decades. With the advent of new pharmacological therapies and technological interventions, our ability to manage a multitude of pathophysiologic conditions has grown. ⋯ Associated with new therapeutic and diagnostic interventions are secondary side effects and complications. It is often the undesired sequela of all interventions that forces clinicians to periodically reevaluate to whom, why, how, and when we employ new drugs or procedures.
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Case Reports
Continuous spinal analgesia--initial experiences with differential sensory block and labour pain relief.
This report describes the use of microcatheters to provide continuous spinal analgesia for the relief of labour pain. Bupivacaine 0.025% was administered through a 28G spinal microcatheter resulting in a differential block which provided effective labour pain relief. Conduction by the smaller pain fibres from the uterus were blocked, while relatively sparing the larger A fibres. ⋯ No patient had hypotension (blood pressure fall greater than 20%). However one patient suffered a severe post-dural puncture headache which required an epidural blood patch. Continuous intra-thecal spinal analgesia is a potential alternative to continuous epidural analgesia in the relief of labour pain.
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Clin. Orthop. Relat. Res. · Feb 1994
Comparative StudyContinuous epidural analgesia using fentanyl and bupivacaine after total knee arthroplasty.
Eighty consecutive patients undergoing unilateral total knee arthroplasty received postoperative analgesia consisting of a continuous epidural infusion of fentanyl and bupivacaine. Nineteen patients (24%) were unable to complete the three-day course of epidural infusion: two thirds for technical reasons and one third because of adverse effects. The remaining 61 patients (76%) successfully completed the 72-hour protocol. ⋯ Nausea was problematic in both groups. The incidence of respiratory depression was 5% for either opiate. The degree of hypoventilation and treatment required for it were less severe with fentanyl, however.
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The use of ketamine anaesthesia is described for the transport from home to hospital of patients in severe pain secondary to malignant disease. The technique is simple and highly effective and introduces a new role for anaesthetists and pain relief specialists.
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To determine whether continuous epidural analgesia could effectively decrease pain and thereby improve the management of severe vaso-occlusive crisis in children with sickle cell disease who were unresponsive to conventional analgesic therapy. ⋯ Epidural analgesia with local anesthetics administered alone or in combination with fentanyl effectively and safely treats the pain of sickle cell vaso-occlusive crisis unresponsive to conventional pain management and does so without causing sedation, respiratory depression, or significant limitation on ambulation. Furthermore, early treatment of painful crisis with this technique may improve oxygenation, a critical factor in the evolution of further sickling.