Articles: analgesia.
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Int J Obstet Anesth · Jan 1993
Maternal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of fentanyl added to 0.5% bupivacaine improves epidural anaesthesia during caesarean section. The present prospective randomized double-blind study sought to determine the lowest effective dose of fentanyl. Eighty healthy women at term were divided into four groups of 20, with each group receiving a different 2 ml study solution: saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Pruritus was the only side-effect (P < 0.05). In conclusion, fentanyl 75 microg was the lowest effective dose for improving quality of analgesia. Onset time was not reduced by the addition of fentanyl.
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Clinical Trial Controlled Clinical Trial
Enhancement of morphine analgesia by fenfluramine in subjects receiving tailored opioid infusions.
We evaluated the ability of fenfluramine, a serotonin releaser, to increase the analgesic potency of morphine administered by tailored i.v. infusion. Ten normal volunteers participated in 4 test sessions, involving different treatments on different days: (1) oral placebo/saline infusion, (2) oral placebo/morphine infusion, (3) oral fenfluramine (60 mg)/saline infusion, and (4) oral fenfluramine/morphine infusion. Subjects experienced repetitive painful dental electrical stimuli at strong but tolerable intensities during testing. ⋯ Fenfluramine significantly increased the analgesic potency of morphine during the opioid infusion, while fenfluramine alone produced borderline analgesic effects. Fenfluramine alone decreased alertness slightly, but did not significantly increase morphine side effects. Thus, we conclude that fenfluramine enhances the analgesic potency of morphine without a parallel increase in opioid side-effect potency.
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Acta Anaesthesiol Scand · Jan 1993
Randomized Controlled Trial Clinical TrialBlood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine.
Thirty-one patients scheduled for elective cholecystectomy performed through a mini-laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg.h-1 and morphine 0.2 mg.h-1 for 38 h after surgery plus systemic ibuprofen 600 mg x 8 h-1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg x 8 h-1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest and during mobilisation was superior compared to systemic morphine and NSAID. ⋯ There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group at 24 h) or in number of episodes of dizziness, nausea or vomiting during rest or mobilisation. These results do not support the common belief that low-dose thoracic epidural bupivacaine/morphine may prevent ambulation due to sympathetic blockade or to impaired cardiovascular adaptation to the upright position.
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Int J Obstet Anesth · Jan 1993
Neonatal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.
Epidural injection of opioids has been introduced to improve analgesia during labour and caesarean section. This study was designed to quantify placental transfer of fentanyl and to evaluate neonatal effects of adding fentanyl to 0.5% bupivacaine for epidural anaesthesia in women undergoing elective caesarean section at term. The parturients were randomly allocated to one of four groups of 20, who received either saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. ⋯ Neurologic and adaptive capacity scores were evaluated at 2 and 24 h. Neonates whose mothers received fentanyl had lower scores with regard to supporting reaction at 2 h and active tone at 24 h, when compared to controls (P<0.05), but there were no differences among the groups with regard to the other test criteria in the neurobehavioural test. In conclusion, epidural injection of fentanyl 50-100 microg did not produce depression of the term neonate.
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Cahiers d'anesthésiologie · Jan 1993
Review[The use of patient-controlled analgesia by the obstetrical patient].
Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. ⋯ After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.