Articles: analgesia.
-
Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialEffects of epidural morphine and intramuscular diclofenac combination in postcesarean analgesia: a dose-range study.
To assess the efficacy of combinations of epidural morphine and intramuscular diclofenac in postcesarean analgesia, a double-blind, randomized study was conducted. Epidural anesthesia was administered to 120 parturients who were randomly allocated into six treatment groups; these groups, A, B, C, D, and E, received 0.5, 1, 2, 3, and 4 mg of epidural morphine in 10 mL of normal saline solution, respectively, and 75 mg (3 mL) of diclofenac intramuscularly (IM). Group F received 4 mg of epidural morphine in 10 mL of normal saline solution and 3 mL of normal saline solution IM. ⋯ The incidence of nausea or vomiting or both, pruritus, and bleeding was similar. There was no evident relationship between severity of pruritus and morphine doses. No bradyspnea was observed during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialIntraarticular analgesia following knee arthroscopy.
A randomized, double-blind, controlled study was conducted in patients undergoing elective knee arthroscopy to assess the analgesic effect of intraarticular morphine and bupivacaine, alone and in combination. Patients in group 1 (n = 10) received 5 mg of morphine in 25 mL of saline; patients in group 2 (n = 10) received 25 mL of 0.25% bupivacaine (62.5 mg); patients in group 3 (n = 10) received a combination of 5 mg of morphine and 62.5 mg of bupivacaine in 25 mL dilution; and patients in group 4 (n = 10) received 25 mL of saline. All the drugs were injected intraarticularly. ⋯ These low pain scores were associated with lower requirements of supplementary analgesics. The patients in group 4 showed the highest pain scores and analgesic requirements. We conclude that intraarticular morphine significantly reduces postoperative pain following knee arthroscopy and that there is no advantage of combining bupivacaine with morphine.
-
Randomized Controlled Trial Clinical Trial
Can pre-emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?
In a double-blind study, 36 patients who received a standard general anaesthetic for abdominal hysterectomy or myomectomy, received either 15 ml of bupivacaine 0.5% with adrenaline by lumbar epidural injection 15 min before surgery (group A) or the same dose at the end of surgery but before waking (group B). Pain was assessed for 24 h by cumulative morphine dose (self-administered by patient-controlled analgesia), visual analogue scale and verbal rating score. Patients were included for analysis if they were pain free on waking and for at least 2 h after. ⋯ Consequently, we compared the morphine dose, visual analogue scale and verbal rating score at 23 h in group A with those at 24 h in group B. Again there were no significant differences between the two groups. We were unable to demonstrate that epidural blockade had a significantly better effect on postoperative pain when administered before, rather than after, surgery.
-
Acta Anaesthesiol Scand · Feb 1993
Randomized Controlled Trial Comparative Study Clinical TrialInterpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study.
The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8-hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double-blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. ⋯ Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8-h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.
-
Thirty-five cancer patients, treated with chronic epidural morphine, were assayed for plasma and cerebrospinal fluid (CSF) minimum steady-state concentrations (Css min) of morphine (M), morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) by high performance liquid chromatography (HPLC). A linear dose-concentration relationship was found for the 3 substances in plasma and for morphine and M3G in CSF. The mean +/- S. ⋯ CSF M6G concentrations were low and did not contribute to any detectable analgesia. We conclude that after epidural administration of morphine, the M3G and M6G metabolites in CSF are low compared to unchanged morphine and seem to have little influence on analgesia. However, the fact that a significant passage of the glucuronide metabolites occurs to the CSF may indicate a role in morphine analgesia after other routes of administration.