Articles: analgesia.
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Anesthesia and analgesia · Aug 1991
Comparative StudyComparison of continuous epidural bupivacaine infusion plus either continuous epidural infusion or patient-controlled epidural injection of fentanyl for postoperative analgesia.
We compared the postoperative epidural analgesia provided by the continuous epidural infusion of bupivacaine supplemented with patient-controlled injection (PCA) of epidural fentanyl with that provided by a continuous infusion of bupivacaine supplemented with a continuous epidural infusion of fentanyl. Our patient population comprised 16 ASA physical status I or II patients undergoing laparotomy with a midline incision under general anesthesia combined with bupivacaine epidural analgesia. Post-operatively, a continuous epidural infusion of bupivacaine (0.1 mg.kg-1.h-1) was combined with epidural fentanyl given by either (a) PCA (15-micrograms bolus with a lockout interval of 12 min, n = 8) or (b) continuous infusion (1 microgram.kg-1.h-1, n = 8). ⋯ The dose of fentanyl given during each 4-h interval ranged between 40 and 160 micrograms in the PCA group and 251 and 292 micrograms in the continuous infusion group. Clinically detectable respiratory depression was not observed in either group. In conclusion, epidural administration of 0.1 mg.kg-1.h-1 bupivacaine combined with fentanyl provides effective postoperative analgesia with a total dose of fentanyl required that is lower when fentanyl is administered by epidural PCA rather than by continuous epidural infusion.
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Case Reports
Continuous intravenous infusion fentanyl for sedation and analgesia of the multiple trauma patient.
Fentanyl is an attractive agent for analgesia in the emergency department. Its use in this setting has been limited to IV bolus administration. We report successful sedation, muscle relaxation, and analgesia of a multiple trauma patient with fentanyl IV bolus and continuous infusion in the ED.
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Patient Controlled analgesia is being given more and more consideration as a method of post-operative pain relief. John Wells describes how it was introduced in Gloucester and considers the need for a multi-disciplinary team to oversee and evaluate its effective use.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intermittent injection vs patient-controlled analgesia for sickle cell crisis pain. Comparison in patients in the emergency department.
--The purpose of this study is a prospective assessment of morphine sulfate administration by intermittent intravenous (IV) injections (Int-IV) vs patient-controlled analgesia (PCA) in patients in the emergency department (ED) with sickle cell crisis pain. ⋯ --At both the low- and high-dose regimens, PCA is equally safe and effective and may be used in place of Int-IV administration of morphine in the ED treatment of sickle cell crisis pain.