Articles: analgesia.
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Anesthesia and analgesia · Oct 1991
Randomized Controlled Trial Clinical TrialOnset of epidural blockade after plain or alkalinized 0.5% bupivacaine.
This double-blind study investigated the effect of adding 1.4% bicarbonate to 0.5% bupivacaine on onset time of sensory and motor blockade after epidural administration. Forty patients were randomly divided into one of two groups. Group 1 received 20 mL of 0.5% bupivacaine (pH, 5.58 +/- 0.12) and group 2 received 20 mL of 0.5% bupivacaine + 0.6 mL of 1.4% bicarbonate (pH, 6.53 +/- 0.06). ⋯ Maximum motor blockade was reached after 30 min in group 1 and after 36 min in group 2. No difference in motor blockade or upward spread of anesthesia was noted between the two groups. The authors conclude that alkalinization of 0.5% bupivacaine offers no improvement in the onset of epidural blockade.
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Seminars in perinatology · Oct 1991
ReviewOptions for labor analgesia: techniques of epidural and spinal analgesia.
The results of the clinical research evaluating techniques of labor analgesia suggest that drug combinations hold much promise for providing excellent analgesia for labor, while minimizing the adverse effects associated with each technique. With the various combinations of drugs and techniques available, the anesthesiologist is better able to customize the control of pain for each parturient.
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The anatomy and physiology of the epidural space and the mechanism of action, sites of action, and pharmacokinetics of analgesics administered by continuous epidural infusion are reviewed, and the efficacy, adverse effects, and postoperative indications for use of analgesics administered by this route are discussed. Narcotics selectively block pain conduction by occupying specific opiate receptors in the spinal cord. Local anesthetics provide analgesia by axonal membrane blockade; they also can produce nonselective sympathetic and somatic (sensory and motor) blockade in addition to analgesia. ⋯ Adverse effects of epidurally administered local anesthetics include urinary retention, hypotension, numbness, motor weakness, tachyphylaxis, and, rarely, systemic toxicity. The cost of epidurally administered drugs is substantially higher than that for i.m. or i.v. narcotic analgesia, but this cost may be offset by other benefits such as a shorter hospital stay. Current studies suggest superior analgesia for the majority of surgical procedures with continuous epidural analgesia infusions compared with more traditional methods of providing analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nausea and vomiting after termination of pregnancy as day surgery cases: comparison of 3 different doses of droperidol and metoclopramide as anti-emetic prophylaxis.
Frequency of nausea and vomiting following day case termination of pregnancy was found to be rather high (42%) without anti-emetic prophylaxis. Droperidol in doses of 2.5 mg, 1.25 mg and 0.25 mg were found to be equally effective as prophylactic anti-emetic, but not metoclopramide 10 mg. This study confirms that low dose droperidol 0.25 mg is effective as a prophylactic anti-emetic, without any delay in immediate recovery and hence suitable for day surgery cases.
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Pain that cannot be controlled by traditional oral and parenteral methods in those patients with advanced cancer can be alleviated by spinal administration of narcotics. Epidural and intrathecal infusion with morphine causes analgesia by blocking spinal receptors without significant long-term central nervous, gastrointestinal, and genitourinary system effects. Of the total of 33 patients, epidural catheters inserted in 20 patients then connected by a subcutaneous tunnel to a continuous infusion system. ⋯ Patient assessment by a linear analogue scale to measure pain levels determined that 23 of the 33 total patients (70%) had excellent or good relief of pain. The delivery of spinal administration of narcotics to treat intractable cancer pain in patients is safe. Most importantly, this method of delivery can be used in community hospitals, in outpatient settings, and in home health care programs.