Articles: analgesia.
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Regional anesthesia · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialEpidural analgesia during and after cesarean delivery. Comparison of five opioids.
A randomized, double-blind study was designed to determine the effects on maternal intraoperative analgesia of adding one of the following opioids to the local anesthetic at the onset of epidural block, before surgery and neonatal delivery: morphine (3 mg), fentanyl (75 micrograms), sufentanil (50 micrograms), buprenorphine (0.3 mg) and oxymorphone (1 mg). The duration of postoperative analgesia, the presence of side effects and the neonatal outcome were also studied. Ninety healthy multiparas, at term, undergoing elective cesarean delivery using lumbar epidural anesthesia with 2% lidocaine were randomized in six equal groups to receive one of the opioids or saline. ⋯ Morphine provided the longest pain-free interval, followed by oxymorphone, buprenorphine, sufentanil and fentanyl. Postoperatively, the number of patients having pruritus and vomiting was significantly higher in the morphine and buprenorphine groups, respectively (p less than 0.01 versus others). No adverse neonatal effects were noted in any group.
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Regional anesthesia · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialNalbuphine pretreatment in cesarean section patients receiving epidural morphine.
A double-blind, placebo-controlled study of 60 patients post cesarean delivery was conducted to determine whether nalbuphine reverses the side effects of pruritus and respiratory depression associated with epidurally administered morphine. Patients randomly received either three doses of intravenous nalbuphine or the equivalent volume of saline. Vital signs, sedation, pain, pruritus and oxygen saturation were assessed hourly for 18 hours. ⋯ Five patients had respiratory depression (respiratory rate lower than 10 BPM or oxygen saturation less than 90%); three occurred in the nalbuphine group and two in the saline group. Although theoretically advantageous, nalbuphine, as administered in this study of obstetric patients, offered no prophylactic benefit against the pruritus associated with epidural morphine. Its benefit with regard to respiratory depression remains unclear.
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This report describes the case of an 80-year-old woman with a long history of chronic, stable angina pectoris who underwent resection of an abdominal aortic aneurysm and placement of an aortobifemoral bypass graft under a combination of epidural and general anesthesia. Epidural morphine was administered postoperatively for pain management. The patient suffered a massive myocardial infarction (MI) in the immediate postoperative period but experienced no chest pain or discomfort similar to her usual anginal symptoms. The use of epidural and spinal opioids in the treatment of anginal pain is reviewed and discussed in terms of the possibility that such epidural opioid therapy may have masked this patient's anginal symptoms.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusion of diamorphine with bupivacaine in labour. A comparison with fentanyl and bupivacaine.
We have compared the analgesic effects of three epidural infusions in a randomised, double-blind study of 61 mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by either bupivacaine 0.125%, bupivacaine 0.125% with diamorphine 0.0025% or bupivacaine 0.125% with fentanyl 0.0002%. ⋯ Diamorphine was shown to be the more effective supplement to bupivacaine. The 5% incidence of pruritus in the opioid groups was less than that reported by earlier authors.
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Epidural or intrathecal opiate analgesia, combined with bupivacain by means of an implanted pump, represents a possibility for providing good pain management for cancer patients as well as other chronic pain patients. Several indications, for implantation of a percutanously refillable pump are demonstrated in 27 patients. Twenty-four patients were treated with epidural and 3 with intrathecal catheters. ⋯ In the course of 2 years there has been no significant increase in the daily dose of buprenorphin given epidurally to patients with chronic pain. There were no addiction problems with opiates given epidurally or intrathecally by means of implanted pumps. Because of a 13% complication rate, pumps and epidural or intrathecal catheters should only be implanted by an experienced team.