Articles: analgesia.
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Anesthesia and analgesia · Feb 1993
Comparative StudyA comparison of postoperative epidural analgesia between patients with chronic cancer taking high doses of oral opioids versus opioid-naive patients.
Our study evaluated 116 surgical patients with cancer who received postoperative epidural analgesia with bupivacaine (BUP) (0.1%) and morphine (MS) (0.01%) during 5 days after epidural-light general anesthesia. Patients in group I (n = 17) were taking opioids in doses larger than 50 mg of morphine daily for 3 mo or more, whereas patients in group II (n = 99) were opioid-naive. Postoperative epidural infusions were started at 10 mL.h-1 for group I and 5 mL.h-1 for group II. ⋯ Daily epidural and IV MS usage were always more for group I by two- to threefold. No patient experienced respiratory depression or opioid withdrawal during the hospitalization. Thus, epidural BUP-MS appears to provide adequate postoperative analgesia while preventing withdrawal in opioid-dependent patients, if three times the normal dosage and duration of therapy are employed.
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Comparative Study Clinical TrialA randomized double-blind comparison of epidural fentanyl infusion versus patient-controlled analgesia with morphine for postthoracotomy pain.
The authors conducted a prospective, randomized, double-blind comparison of an epidural fentanyl infusion versus patient-controlled analgesia (PCA) with morphine in the management of postthoracotomy pain. Thirty-six patients were randomized into one of two groups. The epidural group received an epidural fentanyl infusion, 10 micrograms/mL, and saline through their PCA machine. ⋯ There were no differences in postoperative forced vital capacity between the two groups. More patients in the PCA group had greater degrees of sedation on postoperative day 1 (P = 0.005), whereas pruritus was more frequent (P < 0.02) in the epidural group. We conclude that an epidural fentanyl infusion is superior to that of PCA with morphine in the management of pain after thoracotomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia.
Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. ⋯ Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.
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Randomized Controlled Trial Clinical Trial
Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy.
Intrapleural bupivacaine has been reported to be effective for analgesia following cholecystectomy and thoracic surgery. Twenty patients who had a posterolateral thoracotomy were studied in a randomized, double-blind, placebo-controlled fashion. Patients were assigned to receive intrapleural administration of either 0.5 percent bupivacaine or saline solution every 4 h for 12 doses postoperatively, as well as narcotic analgesics as needed for additional pain control. ⋯ Two patients who received bupivacaine and three patients who received placebo had development of pneumonia or atelectasis postoperatively. There was no statistically significant difference in any parameter between those who received bupivacaine and those who received placebo. Thus, there was no subjective or objective clinical benefit of this method of postoperative analgesia compared with placebo following posterolateral thoracotomy.
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Comparative Study
A comparison of patient-controlled and intramuscular morphine in patients after abdominal surgery.
This prospective, randomized study compared the effects of two methods of morphine administration after abdominal surgery in 62 adults. All patients were offered intravenous morphine in the Postanesthesia Care Unit. On the ward, one group (PCA-CI) received a continuous infusion of morphine that could be supplemented by a patient-controlled bolus every 10 minutes. ⋯ Comparison of both groups demonstrated no significant differences in analgesia, incidence of adverse opioid effects, 24 and 36 hour morphine dose, time to first oral analgesic medication, operating cost, and length of hospital stay. Patients in the PCA-CI group received a slightly greater dose of morphine in relation to body weight (24 hr, P = 0.03; 36 hr, P = 0.05) and reported a greater degree of satisfaction at each assessment (P = 0.005, P = 0.02, P = 0.01). These data support the greater patient satisfaction associated with patient-controlled analgesia but suggest that the wide range of reported pain scores and morphine requirements makes it difficult to demonstrate, in a small population, superior pain relief from patient-controlled analgesia when nurses are encouraged to administer intramuscular pain medication more effectively.