Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Diamorphine-bupivacaine mixture compared with plain bupivacaine for analgesia.
We have studied the efficacy of two extradural infusions (10 ml h-1) in 50 patients in active labour. Patients in the diamorphine group (n = 25) received 0.0625% plain bupivacaine 6.25 mg h-1 mixed with 0.005% diamorphine 0.5 mg h-1 and those in the control group (n = 25) received 0.125% plain bupivacaine 12.5 mg h-1. ⋯ There were no differences in the incidence of hypotension, instrumental vaginal delivery, number of "top-ups", duration of the second stage or extent of motor block. However, patients in the diamorphine group had a high incidence of pruritus (44%, compared with 0% in the control group (P < 0.01)).
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Stereotact Funct Neurosurg · Jan 1994
Multicenter StudyItalian multicentric study on pain treatment with epidural spinal cord stimulation.
A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centers devoted to pain therapy. Neurosurgical and anesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 days) and 74% underwent the definitive implant. ⋯ These results were favorable (i.e. excellent or good; more than 50% reduction of pain) in 87% of the patients at the 3-month follow-up, 75% at the 6-month follow-up, 69% at the 1-year follow-up, and 58% at the 2-year follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.
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Paracervical block during labor following normal, uncomplicated pregnancy is occasionally accompanied by fetal bradycardia. To evaluate whether a paracervical block with bupivacaine causes changes in the vascular resistance of uteroplacental and umbilicoplacental blood flow, a total of 12 singleton, uncomplicated pregnancies in active labor at the end of pregnancy were included to this study. By using pulsed color Doppler ultrasound techniques the pulsatility indices were measured from both uterine and umbilical arteries before, one minute and 20 minutes after a paracervical block with bupivacaine. ⋯ When the fetal bradycardia ceased the pulsatility indices returned to the levels at the beginning of the study. Paracervical block with bupivacaine in normal pregnancies without signs of chronic or acute fetal distress does not change the vascular resistance in the uterine or umbilical arteries. If fetal bradycardia develops, it seems to be due to the direct effect of bupivacaine on the fetus, mainly on the umbilical vessels.
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Loperamide effects on hepatobiliary function, analgesia and gut transit were studied in mice. Varying doses of the antidiarrheal drug, loperamide, were administered to mice by intracerebroventricular, intravenous, subcutaneous and intragastric routes. Gut motility was determined by intestinal transit of India ink, analgesia by warm water tail flick latency, and hepatobiliary function by retention of the anionic dye, sulfobromophthalein in plasma and liver. ⋯ Intragastric loperamide at one fortieth its LD50 caused marked elevation of sulfobromophthalein levels and gut slowing, but no analgesia. Sulfobromophthalein elevation and gut slowing by intragastric loperamide were not affected by spinal cord transection but were reversed by naltrexone, an opiate antagonist. Non-toxic doses of loperamide slow gut transit and modify hepatobiliary function in mice by opiate actions at peripheral sites.
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Ann Fr Anesth Reanim · Jan 1994
[Training evaluation of the nursing staff in patient-controlled analgesia].
Intravenous patient-controlled analgesia (PCA) is an effective technique to relieve most forms of acute postoperative pain. However it is not easy to apply. An adequate training of the nursing staff has been for a safe and successful use in the recovery room and the wards as well. ⋯ There is no longer any resistance against the introduction of PCA in the wards. Training of nursing staff for the use of PCA devices is essential in order to avoid "human errors". PCA has become routine for the management of postoperative pain.