Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Gastric emptying during lumbar extradural analgesia in labour: effect of fentanyl supplementation.
We measured gastric emptying (by paracetamol absorption) and duration of analgesia in 30 women in labour after extradural injection of 0.375% bupivacaine 10 ml either alone or combined with fentanyl 100 micrograms. Treatment was administered double blind by random allocation after the first request for analgesia. ⋯ Mean duration of analgesia, from the first extradural bolus until return of pain in those given bupivacaine alone was 113 (87-139) min and 154 (131-176) min when fentanyl was added to the local anaesthetic (P = 0.016). These results confirm the prolongation of analgesia after fentanyl supplementation of lumbar extradural analgesia, but indicate that it results in delayed gastric emptying.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain.
Thirty-four patients undergoing thoracotomy were entered into a randomized, double-blind, placebo-controlled study to compare the effects of patient-controlled, lumbar epidural (PCA-E) fentanyl with patient-controlled intravenous (PCA-i.v.) fentanyl with respect to drug requirements, analgesic efficacy and respiratory function. Prior to chest closure patients received fentanyl 2 micrograms.kg-1 by the epidural or i.v. route. In the recovery room further doses of epidural or i.v. fentanyl, 50 micrograms, were administered by the patients who controlled two PCA pumps. ⋯ There were no differences between groups in respiratory rates, PaCO2, VAS pain scores or changes in pulmonary function as measured by FVC and FEV1. It is concluded that satisfactory patient-controlled analgesia can be achieved with both epidural and i.v. fentanyl after thoracotomy but that fentanyl requirements are less when given via the epidural route. This supports a direct spinal cord site of action for lumbar epidural fentanyl.
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Randomized Controlled Trial Clinical Trial
Effects of a nighttime opioid infusion with PCA therapy on patient comfort and analgesic requirements after abdominal hysterectomy.
Since pain during the early postoperative period can disrupt a patient's normal sleep pattern, we investigated the influence of a nighttime "basal" infusion of morphine on patient comfort, ability to sleep at night, restfulness, and analgesic requirements following elective abdominal hysterectomy. One hundred fifty-six adult women were randomly assigned to receive either patient-controlled analgesia (PCA) alone or PCA supplemented with a nighttime infusion of morphine 1.0 mg.h-1. The infusion was started in the postanesthesia care unit and continued until the morning after surgery. ⋯ In addition, the number of patient demands and supplemental bolus doses, opioid usage, and recovery parameters were similar in the two treatment groups. The use of a basal infusion resulted in six programming errors, and three patients required discontinuation of the infusion because of hemoglobin oxygen desaturation (i.e., SpO2 less than 85% for greater than 5 min). We concluded that the routine use of a continuous nighttime opioid infusion in combination with a standard PCA regimen failed to improve the management of postoperative pain, sleep patterns, or recovery profiles compared to PCA alone after abdominal hysterectomy.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Postoperative myocardial ischemia. Therapeutic trials using intensive analgesia following surgery. The Study of Perioperative Ischemia (SPI) Research Group.
Recent data suggest that postbypass and postoperative myocardial ischemia are related to adverse cardiac outcome following myocardial revascularization. Therapeutic trials to suppress postoperative ischemia are warranted. Because anesthetics can suppress a variety of physiologic responses to stress as well as myocardial ischemia intraoperatively, we examined whether use of intensive analgesia in the stressful postoperative period could decrease postoperative ischemia. ⋯ During the ICU-on-therapy period, the incidence of ischemic episodes was less in group S patients, and the severity was less: area-under-the-ST-time curve, S versus M: -21 mm.min versus -161 mm.min (P = 0.05). After discontinuation of the drug regimen in the ICU, the incidence and severity of ischemic episodes was similar. The incidence of hypotension, hypertension, and tachycardia was similar in both groups in both the intraoperative and ICU periods.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
Epidural lidocaine with sufentanil and epinephrine for abdominal hysterectomy under general anaesthesia: respiratory depression and postoperative analgesia.
The purpose of this investigation was to compare the analgesic actions and side-effects of a 50 micrograms epidural bolus of sufentanil and 50 micrograms epinephrine, with a control group receiving saline and epinephrine. The method employed was a prospective, randomised, double-blind trial involving 40 ASA I or II patients for total abdominal hysterectomy. All received 1.5% lidocaine with 1/200,000 epinephrine epidurally before operation, until a block to T4 was established. ⋯ Glycopyrollate was given to 11/20 patients in the sufentanil group vs 1/20 in the control group (P less than 0.01) following bradycardia and hypotension. Clinical respiratory depression occurred in the sufentanil group; 5/20 patients required controlled ventilation following apnoea greater than 20 sec. It is concluded that epidural sufentanil causes considerable cardiorespiratory depression in the setting of general anaesthesia, and should be used with caution in the spontaneously breathing, anaesthetised patient.