Articles: analgesia.
-
Randomized Controlled Trial Clinical Trial
Epidural nalbuphine for analgesia following caesarean delivery: dose-response and effect of local anaesthetic choice.
The analgesic profile of epidural nalbuphine for postoperative pain relief and the impact of local anaesthetic choice upon this profile was investigated in 58 patients undergoing elective Caesarean delivery under epidural anaesthesia. Patients were randomized to receive either lidocaine 2% with 1:200,000 epinephrine or 2-chloroprocaine 3% for perioperative anaesthesia, followed by either 10, 20, or 30 mg of epidural nalbuphine administered at the first complaint of postoperative discomfort. Postoperative analgesia was quantitated on a visual analogue (VAS) scale, and by the time from the epidural opioid injection until the first request for supplemental pain medication. ⋯ No evidence of respiratory depression was noted in any patient. It is concluded that 20 or 30 mg of epidural nalbuphine provides analgesia for only two to four hours following Caesarean delivery with lidocaine anaesthesia, but anaesthesia with 2-chloroprocaine resulted in minimal or no analgesia from this opioid. Nalbuphine appears to be a disappointing agent for epidural use after Caesarean delivery.
-
A 30-year-old parturient requested epidural analgesia during labor. Immediately after the epidural space was presumably identified using the loss-of-resistance-to-air technique, she reported severe back pain, followed by neck pain, which progressed to severe unrelenting headache. An emergency computerized tomographic (CT) scan performed during labor showed air in the intracranial subarachnoid space.
-
Controlling patients' pain is no longer a luxury in health care. Studies have shown that pain can cause physical harm. A better understanding of the pain pathway has enabled health care professionals to control pain more effectively. ⋯ Fewer side effects and decreased narcotic use are among the advantages demonstrated with PCA and intraspinal infusions. Side effects can be minimized and complications reduced when nursing can intervene during narcotic infusions. The role of the intravenous nurse is expanding into the area of pain management as educator and clinical practitioner.