Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Maternal positioning affects fetal heart rate changes after epidural analgesia for labour.
Adverse fetal heart rate (FHR) changes suggestive of fetal hypoxia are seen in patients with normal term pregnancies after initiation of epidural block for labour analgesia. It was our hypothesis that, in some parturients, these changes were a consequence of concealed aortocaval compression resulting in decreased uterine blood flow. We expected that the full lateral position compared with the wedged supine position would provide more effective prophylaxis against aortocaval compression. ⋯ The quality and efficacy of the block were assessed using VAS pain scores, motor block scores and sensory levels. The results demonstrated that there was no difference in the quality of analgesia provided nor in the incidence of asymmetric blocks. There was no difference in the observed incidence of FHR changes occurring during the initiation of the epidural block.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural diamorphine with intravenous patient-controlled analgesia using the Baxter infusor following caesarean section.
In a randomised study of analgesia following Caesarean section, we compared the efficacy and side effects of on-demand epidural diamorphine 2.5 mg with intravenous patient-controlled analgesia using diamorphine from the Baxter infusor system. Pain scores fell more rapidly in the epidural group, but by the fourth hour, and thereafter, both techniques had a similar analgesic effect. ⋯ This reached statistical significance (p < 0.05) between 9-24 h. Overall satisfaction scores (0-100) were high, but the patient-controlled analgesia group scored significantly higher: mean 85.5 (SD 12.2) compared to mean 77.0 (SD 11.7) in the epidural group.
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Epidural analgesia affords new opportunities for pain management in the acute and chronic arenas for patients undergoing vascular surgery. Effective and safe management of the patient receiving epidural analgesia requires careful integration of the skills and knowledge of the health care providers. ⋯ Thus development of standardized nursing care plans to ensure safe and appropriate care of patients is imperative. Monitoring specific quality indicators ensures safe delivery of epidural analgesia and evaluates the effectiveness of the pain management program.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of patient-controlled analgesia with and without a background infusion after lower abdominal surgery in children.
Forty children aged 6-12 yr undergoing appendicectomy were allocated randomly to receive postoperative i.v. morphine by a patient-controlled analgesia (PCA) system (bolus dose 20 micrograms kg-1 with a lockout interval of 5 min) or the same PCA with a background infusion of morphine 20 micrograms kg-1 h-1. Patients breathed air and oxygen saturation was monitored by continuous pulse oximetry. Scores for pain, sedation and nausea were recorded hourly. ⋯ There were no significant differences in the pain scores of the two groups. Patients with PCA+background infusion suffered more nausea (P < 0.01), more sedation (P < 0.05) and hypoxaemia (P < 0.001) than those with PCA only. They also had a better sleep pattern than those with PCA only.