Articles: analgesia.
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The effectiveness of postoperative pain relief and the frequency of side effects with three different doses of epidural diamorphine (2.0, 3.5 and 5 mg) was investigated. The study was carried out double-blind in 30 women undergoing awake elective caesarean section. Postoperative pain intensity was measured on a linear analogue scale. ⋯ Three patients in the 2 mg group failed to achieve scores of zero but were comfortable. No nausea or vomiting was seen but the incidence of itching was 0, 30% and 80% in the 2.0, 3.5 and 5 mg groups respectively. We conclude that epidural diamorphine 2 mg is adequate for relief of post-caesarean pain and higher doses may increase the incidence of unwanted side-effects.
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Intensive care medicine · Jan 1992
Review Case ReportsRare procedures during delivery room resuscitation--cardioversion of ventricular tachycardia in an asphyctic neonate.
Successful cardioversion of ventricular tachycardia in a full-term male infant, born severely depressed by emergency Cesarean section 9 min after the mother was given bilateral paracervical bupivacaine blocks for pain relief during normal labor, is described. The apparently stillborn baby was resuscitated by conventional means until electronic heart monitoring revealed transition from asystole to rapid ventricular tachycardia 14 min after birth. ⋯ The child recovered rapidly and neurological status at 12 months was normal. Obviously, active search and aggressive management of rapid ventricular arrhythmias are indicated during neonatal resuscitation, if potentially arrhythmogenic drugs are used in perinatal care.
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Regional anesthesia · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialAn evaluation of epidural bupivacaine with and without meperidine in labor.
One aim of epidural analgesia during childbirth is to provide satisfactory pain relief with minimal side effects. We hypothesized that a combination of opioid and local anesthetic would better achieve this aim than either drug alone. This study compared the efficacy and side effects of epidural meperidine and bupivacaine combined to those of meperidine and bupivacaine alone. ⋯ The low-dose combination of meperidine and bupivacaine used in this trial proved a satisfactory preparation for epidural administration during the early stages of labor.
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Case Reports
Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.
Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.
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Acta Anaesthesiol Belg · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for major abdominal surgery with continuous thoracic epidural infusion of bupivacaine with sufentanil, versus bupivacaine with morphine. A randomized double blind study.
Forty-six patients undergoing major abdominal surgery were given postoperative epidural analgesia for four days with bupivacaine-sufentanil or bupivacaine-morphine. Both groups received a bolus of 8 ml bupivacaine 0.5% followed after 30 minutes by an infusion of 20 ml/h bupivacaine 0.1%. The sufentanil group (group A: 21 patients) received a loading dose of 50 micrograms sufentanil and a continuous infusion of 5 micrograms/h sufentanil. ⋯ There was also a high incidence of hypotension after the loading dose of bupivacaine 0.5%. Although we noticed a large incidence of pruritus, no patient needed naloxone reversal. In view of these side effects we recommend a lower loading dose of both bupivacaine and sufentanil.