Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural tramadol and epidural morphine for postoperative analgesia.
The present study compared epidural tramadol with epidural morphine for postoperative analgesia in 20 patients undergoing major abdominal surgery. Intraoperatively, the patients were anaesthetized by a balanced technique of general anaesthesia combined with lumbar epidural lidocaine. In ten of the patients 100 mg tramadol diluted in 10 ml normal saline was also injected epidurally, while 4 mg epidural morphine was used in the other ten patients. ⋯ This was not associated with any increase in PaCO2 or a decrease of respiratory rate, suggesting that hypoxaemia rather than hypercarbia or decreased respiratory rate may be an earlier indicator of respiratory rate, suggesting that hypoxaemia rather than hypercarbia or decreased respiratory rate may be an earlier indicator of respiratory depression in patients breathing room air without oxygen supplementation. The absence of clinically relevant respiratory depression following epidural tramadol compared with epidural morphine may be attributed to the different mechanisms of their analgesic action. The results suggest that epidural tramadol can be used to provide prolonged postoperative analgesia without serious side effects.
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We describe a case of accidental subdural block, after attempted extradural puncture for Caesarean section. Fractionation of the local anaesthetic dose led to avoidance of more serious complications. Subdural fentanyl and a continuous low-dose subdural infusion were used satisfactorily for intraoperative management and postoperative analgesia. As little as 0.5 ml of bupivacaine, hourly, provided satisfactory analgesia over a 15-h period.
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The severity of postoperative pain after thoracotomy means that total analgesia cannot be achieved with a single method or agent without significant side-effects. Recent advances in our understanding of the mechanism of pain generation and maintenance mean that measures prior to surgery greatly affect the requirement for postoperative analgesia. We review the methods available for post-thoracotomy analgesia in the light of our knowledge of peripheral and central mechanisms of neuronal hypersensitivity. The combination of opiate premedication, preoperative non-steroidal anti-inflammatory drugs (NSAIDs), preincisional regional block and postoperative continuous paravertebral block together with NSAIDs may be the ideal combination for near total analgesia following thoracotomy.
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A case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre-operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
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An epidural catheter can be chosen for domiciliary oncological pain relief when relief is not achieved with oral drugs. The patient/relatives put in the central nervous systems the analgesic solution, through this peridural catheter. This article discusses how pain relief occurs, the infusion systems of opioids in the peridural space, the complications and side effects of this therapy.