Articles: analgesia.
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Regional analgesia and anesthesia for obstetrical patients are undergoing revolutionary changes which will, ultimately, benefit parturients and neonates. These changes have taken place in the arena of techniques, equipment, as well as in medications. This review will cover the management techniques both for vaginal delivery and cesarean section.
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Randomized Controlled Trial Clinical Trial
Addition of droperidol to patient-controlled analgesia: effect on nausea and vomiting.
A double-blind trial of the effect of droperidol on the incidence of nausea and vomiting in patients using patient-controlled analgesia was carried out in 60 healthy women undergoing abdominal hysterectomy. After a standard anaesthetic including droperidol 2.5 mg as a prophylactic antiemetic, patients were randomly allocated to receive postoperative patient-controlled analgesia with either morphine alone (2 mg.ml-1) or morphine (2 mg.ml-1) with droperidol (0.2 mg.ml-1) added to the syringe. Verbal scores and visual analogue scores for nausea, vomiting, pain and sedation were made at 4, 12 and 24 h postoperatively, and any requirement for intramuscular prochlorperazine noted. ⋯ At 12 h, patients receiving droperidol experienced significantly less nausea, and over the first 24 h, 31% required prochlorperazine compared with 59.3% of patients not receiving droperidol. The number of patients with sedation at 24 h was significantly greater in the droperidol group. We conclude that the addition of droperidol to morphine both reduces nausea and the need for further antiemetic treatment.
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Minerva anestesiologica · Oct 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Postoperative intravenous analgesia].
The authors report the results of two clinical studies on postoperative pain relief with PCA. In the first clinical study 44 patients, undergoing gynecologic surgery, were assigned at random to two groups. The first was treated by PCA (infusor Baxter) with morphine i.v. (basal bolus 0.05 mg/kg, loading doses 1 mg every 6-15'), the second with 10 mg morphine i.m. at the end of surgery and then on demand with a lock-out of 6h at least. ⋯ Patients and nurses agree PCA. Nursing staff expressed a positive opinion and patients said they benefitted from PCA. As reported, PCA appears from our results, valid and safe in postoperative pain relief.
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We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. ⋯ There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.
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Case Reports
Severe respiratory depression after epidural morphine in a patient with myotonic dystrophy.
We describe a patient with myotonic dystrophy who underwent cholecystectomy, and developed severe respiratory depression following epidural administration of morphine to provide postoperative analgesia. At preoperative assessment, he demonstrated near normal vital capacity and maximal voluntary ventilation, but the presence of chronic ventilatory failure with a resting value of PaCO2 51 mmHg. ⋯ Intravenous naloxone resulted in transient improvement in minute volume, suggesting that epidural morphine was responsible for the depression. Epidural morphine can cause unexpected respiratory depression, even at a small dose, because of the sensitivity of the respiratory centre to morphine in patients with myotonic dystrophy.