Articles: analgesia.
-
Br J Clin Pharmacol · Nov 1992
Plasma morphine-3-glucuronide, morphine-6-glucuronide and morphine concentrations in patients receiving long-term epidural morphine.
Plasma morphine concentrations were measured in five cancer patients receiving long-term epidural morphine administration. Peak concentrations were observed within 1 h of dosage and concentrations then declined biexponentially. Plasma morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) concentrations were measured in two patients and plasma M3G concentrations were observed to be much higher than plasma M6G and morphine concentrations. Peak plasma M6G concentrations occurred within 1.0 h of dosing and plasma M6G concentrations then remained higher than plasma morphine concentrations.
-
Regional anesthesia · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia with epidural meperidine after elective cesarean section.
We report the first controlled analysis of the use of patient-controlled epidural meperidine. This randomized, prospective study compares the efficacy and safety of patient-controlled epidural meperidine to conventional intramuscular meperidine for the management of postoperative pain after elective cesarean delivery. ⋯ Patient-controlled epidural meperidine after cesarean delivery more effectively manages postoperative pain than conventional intramuscular use. The technique is preferred by both patients and nursing staff and can be used in the ward setting with appropriate organization and education. Respiratory depression, if it occurs, should present early after epidural bolus administration.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled drug administration during local anesthesia: a comparison of midazolam, propofol, and alfentanil.
To evaluate the perioperative effects of alfentanil, midazolam, and propofol when administered using a patient-controlled analgesia (PCA) device during local anesthesia. ⋯ When self-administered as adjuvants during local anesthesia using a PCA delivery system, alfentanil, midazolam, and propofol were equally acceptable to patients. However, propofol and midazolam were associated with fewer perioperative complications than was alfentanil.
-
J Pain Symptom Manage · Nov 1992
Case ReportsA survey of complications documented in a quality-control analysis of patient-controlled analgesia in the postoperative patient.
Patient-controlled analgesia (PCA) has become a cornerstone of postoperative pain management in many institutions. Despite the extensive use of this analgesic technique, there are not large population studies to determine the frequency or types of complications associated with PCA in the literature. This study looks at 1122 patients over a 1-yr period. ⋯ These complications were attributable to overdosage (escalating dosage to meet patient analgesic needs or someone other than the patient administering drug through the PCA device) or to interaction of PCA drugs with concurrent medications. There was a much higher incidence of complications associated with PCA pumps featuring continuous infusion in addition to intermittent bolus compared with those employing intermittent bolus alone. The types of complications encountered in this survey demonstrate instances of PCA use that may present a higher risk to the patient and thus require closer monitoring.
-
Anesthesia and analgesia · Nov 1992
Randomized Controlled Trial Clinical TrialAdverse effects of epidural 0.03% bupivacaine during analgesia after cesarean section.
To develop a regimen that would provide good analgesia after cesarean section with minimal side effects in the setting of prolonged (> 24 h) epidural infusion, buprenorphine or fentanyl was combined with 0.03% bupivacaine in a double-blind study of 23 parturients. Patients were randomly assigned to two groups: group I (n = 12), patient-controlled analgesia by epidural infusion of buprenorphine (3 micrograms/mL) with 0.03% bupivacaine; group II (n = 11), patient-controlled analgesia by epidural infusion of fentanyl (2 micrograms/mL) with 0.03% bupivacaine. Plasma for determination of opioid concentrations was obtained at intermittent intervals. ⋯ One patient in each group developed extensive pressure blisters on both heels. These complications led us to terminate the study. We conclude that 0.03% bupivacaine used in combination with an opioid in prolonged epidural infusions produces a high incidence of sensory loss in the lower extremities and is unsuitable for situations in which early ambulation is desired.