Articles: analgesia.
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Editorial Comment
Respiratory depression with patient-controlled analgesia.
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Randomized Controlled Trial Clinical Trial
Analgesia after laparoscopic sterilisation. Effect of 2% lignocaine gel applied to Filshie clips.
We performed a randomised controlled study in patients undergoing day case laparoscopic sterilisation to assess whether coating Filshie clips with 2% lignocaine gel prior to application to the Fallopian tubes would reduce postoperative pain. Sixty-two patients were studied, in 33 of whom the Filshie clips were coated in sterile 2% lignocaine gel. Pain scores in the lignocaine gel group were significantly lower than in the control group at 1 h after return to the ward, but no differences were found immediately on return to the ward, or at discharge or at 24 h. There were no significant differences between the two groups in postoperative analgesic requirements or in side effects.
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In parturients, extension of epidural analgesia to include the sacral roots is necessary for adequate analgesia during the second stage of labour and for vacuum extraction and forceps delivery. There is clinical evidence that if the sitting position is adopted after local anaesthetic administration, it impairs the sacral spread of analgesia. An in vitro model representing the lumbar spinal canal has been used to demonstrate how, in the vertical position, a CSF plug can prevent downward spread of local anaesthetic. ⋯ Sacral sensory blockade was greater in the head up group. The difference was significant on the left side (P < 0.05) at 15, 20, and 30 minutes after the main dose. There were more patients with blocks extending to S5 (on either the left or right sides) in the head up group at 15, 20 and 30 minutes (P < 0.05 at 20 and 30 minutes on left side).