Articles: analgesia.
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Minerva anestesiologica · Jan 1994
[Peridural administration of low-dose morphine on demand following major abdominal surgery].
The present report deals with 20 patients undergoing major abdominal surgery, in whom a postoperative antalgic regimen has been administered on demand by means of morphine via lumbar peridural catheter. We injected 3 mg as the first dose after surgery and subsequent 2 mg doses when required. In each patient we controlled regularly for 72 hours the following: respiratory function, antalgic effects and side effects. We concluded that this technique is fit to obtain good analgesia with rare and mild side-effects.
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Ann Fr Anesth Reanim · Jan 1994
Case Reports[Accidental subdural extra-arachnoid catheterization during epidural analgesia in obstetrics].
The authors describe a case of accidental catheterization of the subdural extra-arachnoid space during epidural analgesia for labour. The epidural catheter had been inserted at the L3-L4 interspace without any problem. A severe hypotension occurred 90 min after the onset of analgesia. ⋯ After delivery, a water-soluble contrast medium (10 mL of Omnipaque 180) was injected through the catheter and subsequent radiograph of spine showed subdural spread of the contrast medium. This complication might occur more frequently than usually thought and may be life-threatening. Anaesthetic management is discussed in the case of Caesarean section during labour.
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Palliative medicine · Jan 1994
Case ReportsEpidural infection associated with epidural catheterization in a cancer patient with back pain: case report.
Single epidural injections of local anaesthetic/steroid mixtures and epidural catheterization are useful in controlling pain when other measures fail. However, epidural infection is a recognized risk of these procedures, but can be difficult to diagnose. This case report illustrates the complexity of diagnosis and management of epidural infection.
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Int J Obstet Anesth · Jan 1994
The use of a paraspinal field block before epidural analgesia for labour.
The purpose of this study was to determine whether paraspinal field block (PSFB) reduced the pain of epidural needle insertion and the incidence of prolonged post partum back pain in patients receiving epidural analgesia for labour. Patients were randomly assigned to receive local infiltration only with 1-1.5 ml of 1.5% lidocaine (group C, N = 27) or PSFB consisting of an additional 1 ml of 1.5% (group S, N = 30) through the midline skin wheal, on either side of the midline (total 2 ml), near the lamina, before needle insertion. Back pain was measured at the time of needle insertion, before discharge from hospital and 6 weeks post partum, by a blinded observer. ⋯ The cause of post partum back pain is multifactorial and is not dependent on technique of epidural insertion. We conclude that PSFB is ineffective in reducing the pain of epidural needle insertion in labouring patients. Although this study was too small to detect a difference in incidence of late post partum back pain, it appears to be less common than previously reported.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy.
Although preemptive analgesia has been shown to decrease postinjury pain in animals, studies in humans have provided controversial results. The authors studied whether surgical epidural anesthesia with local anesthetics could affect postoperative pain and analgesic demands, when compared with general anesthesia. ⋯ In patients undergoing lower abdominal surgery, the neuraxial blockade and surgical anesthesia achieved by epidural local anesthetics was associated with decreased postoperative analgesic demands. Lower postoperative analgesic requirements in the EA group, when compared with both the EG and GA groups, indicate that: (1) EA patients had less postoperative pain, and (2) an efficient intraoperative blockade of noxious afferent signals to the central nervous system is fundamental in reducing postoperative pain.