Articles: analgesia.
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J Pain Symptom Manage · Jan 1993
Intrathecal infusional therapies for intractable pain: patient management guidelines.
This article focuses on appropriate patient selection for and management of patients selected for continuous spinal infusional opioid therapy. Patients with cancer-related pain who have undergone sequential strong opioid drug trials, who have intractable, unmanageable side effects, and who have undergone a successful spinal opioid efficacy trial are candidates for implantable spinal infusional therapy. ⋯ Patients with cancer-related pain who have life expectancies less than 3 mo have implanted permanent epidural catheters connected to external pump systems. Management guidelines for complications of therapy broadly categorized as surgical, mechanical, and pharmacologic are presented.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of EMLA cream for skin anaesthesia prior to epidural insertion in labour.
The efficacy of the use of EMLA cream to provide skin anaesthesia prior to the insertion of 16 G Tuohy needles was assessed. Sixty women in labour were randomly allocated to receive either EMLA cream over the proposed epidural site for a minimum period of 5 min (mean 9.1 min), a skin bleb and subcutaneous injection of lignocaine 2% (1 ml), or a skin bleb with additional lignocaine 2% (2 ml) infiltrated into the supra- and interspinous ligaments using a 23 G needle. ⋯ Patients' perception of pain was not significantly different in any of the three groups, although the mean pain score was least in the group receiving full infiltration. The anaesthetists consistently underestimated the patients' perception of pain.
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Analgesia after thoracotomy by extrapleural administration of continuous bupivacaine].
This study was aimed to assess the efficiency and the side effects of a continuous administration of bupivacaine into the paravertebral space. Twenty patients, ranked ASA 2 or 3, with a mean age of 57.9 years, and having had a posterolateral thoracotomy for resection of lung tissue, were randomly assigned to one of two groups, B or C. At the end of the surgical procedure, a 22 gauge catheter was inserted into the paravertebral extrapleural space, at T4 levels As soon as pain occurred during recovery (T0), the patients were given two-hourly intravenous boluses of buprenorphine. ⋯ In group B, plasma bupivacaine concentrations were measured throughout the infusion, and for an 8-hour period after its end. The statistical analysis included 15 patients only, as the catheter had moved into the chest cavity in the other 5. Analgesia was qualified to be adequate by all patients, but there was no statistically significant difference in the amounts of self-administered buprenorphine between groups B and C.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cahiers d'anesthésiologie · Jan 1993
Review[Is there an advantage to using opioid combinations by the peridural route?].
Epidural opioids provide a potent analgesia not devoided of side effects. In addition, epidural administration of lipid soluble opioids has no clear advantage over the IV route. Combination of epidural opioids with other analgesics may strengthen analgesia and may decrease the incidence of side effects because of a reduction in the amount of opioid administered. ⋯ Clonidine, which is a selective alpha-2-adrenergic agonist has been demonstrated to improve and to prolong analgesia produced by opioids in postoperative patients. Clonidine administration induces side effects, like sedation, bradycardia and hypotension, but allows to highly reduce the opioid dose. None of the combined techniques of analgesia implies that monitoring of the side effects of opioids has to be reduced.