Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural sufentanil and bupivacaine for labor analgesia and Doppler velocimetry of the umbilical and uterine arteries.
The pain of parturition is associated with major physiologic alterations mediated by neurohumoral factors and increased activation of the sympathetic nervous system. Epidural local anesthetics abolish or alleviate many of the pain-mediated responses by reducing maternal catecholamine levels, inducing sympathectomy and consequent vasodilatation. The hormone response to surgical stress is not attenuated after epidural opioids as efficiently as after local anesthetics. Opioid receptors may modulate sympathetic outflow at a spinal level. This study was performed to compare the effects of epidural sufentanil and bupivacaine on the uterine and placental circulation. ⋯ Epidural sufentanil and bupivacaine provide effective analgesia with acceptable side effects during the first stage of labor in healthy parturients. Neither drug had any detrimental effects on blood flow indexes reflecting peripheral vascular resistance in the umbilical and uterine arteries in healthy parturients.
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The opioid analgesic agents exhibit relatively large pharmacokinetic differences between drugs, and there is substantial pharmacokinetic and pharmacodynamic variability across subjects or patients with each agent. The advent of patient-controlled analgesic administration techniques and their widespread use in contemporary pain management, especially in postsurgical and cancer patients, has decreased the unfortunate impact of interpatient variability on achieving the optimal balance between pain relief and opioid adverse effect intensity. ⋯ Finally, physicochemical and pharmacokinetic characteristics of these agents are important determinants of the speed of onset of effects, duration of action and spinal selectivity of epidurally and intrathecally administered analgesics. Thus, effective patient-controlled analgesia depends on an understanding of the differential pharmacokinetics of opioids self-administered by a variety of possible modes.
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Anaesth Intensive Care · Feb 1993
Randomized Controlled Trial Clinical TrialThe influence of adrenaline on postoperative analgesia after subarachnoid morphine.
A randomised, double-blind study was conducted to investigate the postoperative effects of subarachnoid morphine, with or without adrenaline, after major gynaecological surgery. Seventy-five women having spinal anaesthesia combined with either sedation or general anaesthesia were randomised to receive subarachnoid morphine 0.25 mg with (group MA) or without (group M) adrenaline 200 micrograms; or normal saline (group C). ⋯ There was no significant difference in any outcome between groups MA and M. It was concluded that, under the study conditions in a post-gynaecological surgery population, the addition of adrenaline to subarachnoid morphine was of no benefit.
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Spinal administration of morphine and other opiates has been used in clinical practice since many years, particularly in the outpatient management of cancer pain patients. The rationale and the safety of chronic spinal opiate administration is well established and not questioned anymore. However, the indications to use these therapies remain unclear, essentially because no controlled studies have ever shown the advantages of these treatments. ⋯ This raises technological and financial issues, as well as management problems related to the home care system. The choices that have to be made should include the home physician, the home care nursing team as well as the hospital based pain management team. This short overview will deal with some of these aspects.