Articles: analgesia.
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In many institutions postoperative patients may receive morphine for analgesia administered into the epidural space, epidural opioid analgesia (EOA), or through intravenous self-administered patient-controlled analgesia pumps (PCA). Although a number of studies have compared the two approaches with regard to efficacy and side effects, there is less known with regard to patient satisfaction and its sources. In this study, 711 patients using PCA morphine and 205 patients receiving epidural morphine following a variety of gynaecological, urological, orthopaedic, and general surgical procedures rated their satisfaction with the method they used on a 0-10 verbal analogue satisfaction scale (0 = very dissatisfied; 10 = very satisfied). ⋯ Overall satisfaction (mean +/- SD) in the two large groups was 8.6 +/- 1.8 for PCA and 9.0 +/- 1.5 for EOA (P < 0.01). In the subset of 100 patients, there were differences between the EOA and PCA groups with regard to the advantages and disadvantages selected. Patients in the PCA group identified "personal control" and "method worked quickly" as advantages whereas patients receiving EOA selected "clear mind," "effective relief resting," and "effective relief while moving or coughing." The single disadvantage identified more frequently by PCA patients was "pain immediately after surgery before method became effective." Disadvantages identified more frequently by EOA patients were "side effects" and "poor pain relief." We conclude that overall patient satisfaction was high whether patients received PCA or EOA.(ABSTRACT TRUNCATED AT 250 WORDS)
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This study evaluated, the influence of mode of delivery, obstetric analgesia and anaesthesia on the maternal plasma renin angiotension system (RAS) in the normotensive primigravidae (n-10) and those with Pregnancy Induced Hypertension (PIH) (n-18). A total of 56 plasma samples from these subjects were assayed for Plasma Renin Concentration (PRC) and Plasma Renin Activity (PRA), using the radio-immunoassay technique. The normotensive subjects had normal delivery, while their hypertensive counterparts were delivered vaginally under lumbar epidural analgesia (n = 10) and with Caesarean Section (n = 8). ⋯ The mean pre-labour PRC and PRA levels for the normotensive subjects were 5.73 +/- 0.25, and 3.56 +/- 0.13 ngml.1hr-1; and the post-delivery PRC and PRA values were 4.43 +/- 0.18 and 2.1 +/- 0.05ngml-1hr-1 respectively. The mean pre-labour PRC and PRA levels for the hypertensive subjects, who were delivered under epidural analgesia were 6.38 +/- 0.52 and 3.64 +/- 0.09 ngml-1hr-1 and the post-delivery values for this group were 5.04 +/- 0.21 and 2.34 +/- 0.07 ngml-1hr-1 respectively. The mean pre-labour PRC and PRA levels for the hypertensive subjects who were delivered by Caesarean Section were 5.87 +/- 0.36 and 3.83 +/- 0.36 ngml-1hr-1 and their post-delivery PRC and PRA values were 4.55 +/- 0.30 and 2.30 +/- 0.09 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Twelve patients with refractory angina pectoris previously treated with angioplasty or coronary bypass and under optimal medical therapy were treated with spinal cord electrical stimulation (SCES) at the C7 to D2 level since 1988. Six patients had a significant improvement of symptoms confirmed by a reduced incidence of chest pain and decreased used of nitroglycerin. ⋯ Three patients died. The SCES may improve the quality of life by reducing the incidence of chest pain in patients previously uncontrolled with maximal medical and surgical therapy.
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Patient controlled analgesia improves titration of analgesic drugs, minimizing individual pharmacodynamic differences between patients, during the postoperative period. We describe the efficacy and the safety of intravenous PCA, based on the follow-up of 300 patients, recovering from upper and lower abdominal surgery. Successful use of PCA requires the choice of two important parameters: the PCA bolus and the lock-out period. ⋯ Patient's acceptance proved to be excellent and only 4 patients were not satisfied with PCA therapy. The incidence of respiratory depression was low (0.02%) and only one patient required naloxone. The side effects were dysphoria, nausea, pruritus and urinary retention; their incidence was low.
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Cahiers d'anesthésiologie · Jan 1994
Comparative Study[Peridural morphine or intravenous patient-controlled (PCA) morphine: which is the best choice?].
Postoperative analgesia must be adapted to each case. When postoperative course is moderately painful, as in day case surgery, non opioid analgesics are sufficient. ⋯ Morphine by intravenous PCA is the technique of choice for it provides an optimal comfort in most cases. Nevertheless, when an intensive analgesia is needed, as for active physiotherapy in a risk patient after an important surgery, an epidural combination of opioids and local anaesthetics is much more suitable.