Articles: analgesia.
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Pediatr Hematol Oncol · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia in children with sickle cell crisis: comparison of intermittent opioids vs. continuous intravenous infusion of morphine and placebo-controlled study of oxygen inhalation.
The objectives of the study were to compare the efficacy and safety of a continuous infusion (CIV) of morphine and intermittent parenteral opioids (IPO) in children with sickle cell vaso-occlusive crises (VOCs); to determine whether 50% oxygen administration through a face mask can reduce the duration of severe pain in patients receiving CIV morphine; and to measure morphine concentration at steady state for pharmacokinetic and pharmacodynamic analysis in patients receiving CIV morphine. The study was designed as a prospective, controlled, "before-and-after" evaluation of two different analgesic regimens. For patients receiving CIV morphine, there was a randomized, double-blind, placebo-controlled study of O2 vs. air. ⋯ Total body clearance (TBC) of morphine was greater in children before puberty than after (40.4 +/- 10 vs. 28 +/- 11 mL/kg/min; p < 0.05). In conclusion, in children with severe VOCs, continuous infusion of morphine provides better analgesia than intermittent opioid therapy. Fifty percent oxygen inhalation had no effect on the duration of pain.
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Case Reports
Accidental subdural catheterization: radiological evidence of a possible mechanism for spinal cord damage.
We describe the inadvertent subdural insertion of a lumbar extradural catheter in a primiparous woman in labour. A small quantity of local anaesthetic resulted in extensive motor and sensory block. ⋯ We postulate that this could result in arterial compression or direct damage to the spinal nerve roots. Such a mechanism might explain some of the cases of permanent neurological damage associated with extradural analgesia.
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Journal of anesthesia · Oct 1992
Effects of tilting in the sagittal plane on the cephalad spread of anesthesia.
The effect of tilting in the sagittal plane on the spread of anesthesia was studied in 30 healthy male patients. Two ml of 0.3% hyperbaric dibucaine was used for intrathecal injection in the lateral position. After 3 min of resting on their side, 15 patients were placed in the horizontal supine position. ⋯ There was no significant difference in the mean cephalad spread of the analgesic level in the dependent side between the two groups. Unilateral motor anesthesia of the dependent side seemed to be canceled by the sagittal tilting maneuver. A 7 to 8 degree tilt in the sagittal plane is recommended to facilitate the cephalad spread of analgesia and to avoid unilateral anesthesia.
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We have studied prospectively 10 ASA I or II postpartum patients after inadvertent dural puncture during labour. An extradural blood patch (autologous blood 15 ml) was performed within 18 h of delivery, with continuous EEG, upper facial EMG (Datex: Anesthesia and Brain Activity Monitor), pulse oximetry and heart rate measurement before, during and for 30 min after extradural injection. ⋯ Bradycardia was observed for a mean duration of 12.4 (1.1) s. Upper facial EMG, EEG, SpO2 and arterial pressure did not change.
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Comparative Study
Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain.
Intrathecal morphine analgesia for the treatment of cancer pain was administered using implanted ports and drug delivery systems (DDS) in 79 patients. Effective control of the pain was achieved in nearly all patients; in only two patients was the use of the DDS discarded because of relative ineffectiveness. Fifty-three manual drug release systems (41 lumbar, 12 ventricular) and 26 lumbar ports were used. ⋯ Three patients with less than 2 months' survival time had a rather continuous increase. All long-time survivors (i.e., with more than 2 months' survival time) reached a plateau and remained there until a preterminal if any increase occurred. These findings suggest the morphine dosage to be indicative of the progress of the disease rather than of a drug tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)