Articles: analgesia.
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Rev Esp Anestesiol Reanim · Mar 1991
Comparative Study Clinical Trial Controlled Clinical Trial[Addition of fentanyl to mepivacaine in axillary brachial plexus block. Effects on the anesthetic and postoperative analgesic quality].
The possible potentiating effect of phentanyl on mepivacaine in brachial plexus blockade was evaluated, both for operative anesthesia and postoperative analgesia. Sixty ASA I patients, scheduled for upper limb surgery, were selected and distributed in 3 groups: 1) Mepivacaine 1% 40 ml (control group); 2) Mepivacaine 1% 40 ml + phentanyl 100 micrograms; 3) Mepivacaine 1% 40 ml + subcutaneous phentanyl 100 micrograms. The latency time and the quality of anesthesia were evaluated. ⋯ There were no significant differences between the 3 groups in the latency times of the development of blockade nor in the quality of surgical anesthesia. Also, there were no significant differences in the duration of postoperative analgesia (307, 316 and 326 minutes, respectively, in each group). It was concluded that the addition of phentanyl 100 micrograms to the local anesthetic in the axillary blockade of the brachial plexus does not change the anesthetic characteristics nor the time of postoperative analgesia.
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The Journal of pediatrics · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia in children and adolescents: a randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia.
A randomized, prospective trial of patient-controlled analgesia (PCA), that is, a method of analgesia administration involving a computer-driven pump activated by patients to receive small doses within defined limits was performed in 82 children and adolescents after major orthopedic surgery to compare (1) intramuscularly administered morphine, (2) PCA morphine and (3) PCA morphine with a low-dose continuous morphine infusion (PCA-plus). Patients receiving PCA and PCA-plus had lower pain scores and greater satisfaction than patients receiving intramuscularly administered morphine. ⋯ In particular, PCA and PCA-plus did not increase the incidence of opioid-related complications, and patients receiving PCA-plus were less sedated than patients receiving intramuscular therapy. We conclude that PCA and PCA-plus are safe and effective methods of pain relief in children and adolescents after orthopedic surgery, are better accepted than intramuscular injections, and do not increase perioperative morbidity.
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Rev Esp Anestesiol Reanim · Mar 1991
[Epidural perfusion with fentanyl in the treatment of postoperative pain].
In 40 patients with high abdominal surgery the analgesia achieved with continuous epidural phentanyl infusion was evaluated. Treatment was started when the patients had pain, with the injection of 150 micrograms of phentanyl in 18 ml of saline and going on with the infusion. The patients were divided in 4 groups. ⋯ In the statistical analysis the only significant difference was an increase in pCO2 after 24 h in the patients who received the highest doses. The incidence of nausea and vomiting was 10%, with 13.04% of urinary retention Clinical respiratory depression was not observed. We think that administration of 150 micrograms of epidural phentanyl followed by a continuous epidural infusion of the drug (0.5 microgram/kg/hour in 5 ml of saline) is an adequate technique of postoperative analgesia.
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Obstetrics and gynecology · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled epidural analgesia during labor.
This study compared the safety, efficacy, local anesthetic usage, patient satisfaction, and anesthesia manpower demands of patient-controlled epidural analgesia and continuous epidural infusion during labor. After establishment of epidural analgesia, 88 parturients with vertex presentation were assigned randomly to receive either patient-controlled epidural analgesia or continuous epidural infusion, using 0.125% bupivacaine containing 1 microgram/mL of fentanyl. Inadequate analgesia was treated in both groups with a 10-mL "top-up" of 0.25% bupivacaine. ⋯ Use of local anesthetic solution was examined with respect to cervical dilatation and did not increase late in labor. Patients generally viewed infusion technology favorably. These findings suggest that patient-controlled epidural analgesia is safe and effective, reduces anesthesia manpower needs, and is well accepted.
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Anesthesia and analgesia · Mar 1991
Randomized Controlled Trial Clinical TrialPatient-controlled sedation during epidural anesthesia.
The purpose of this study was to evaluate the feasibility and advantages or disadvantages, if any, of patient-controlled sedation compared with sedation administered by the anesthesiologist during surgical epidural anesthesia. Forty patients were divided at random into two groups with 20 patients in each group. Patients in group 1 received 0.5-1.0 mg intravenous midazolam and 25-50 micrograms intravenous fentanyl in increments administered by the anesthesiologist to achieve intraoperative sedation; patients in group 2 self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 micrograms) in increments using an Abbott Lifecare PCA infuser to achieve sedation. ⋯ This could have been due to a positive psychological effect produced by allowing patient to feel that they have some control over their situation. The findings of this study indicate that patient-controlled sedation using a combination of midazolam and fentanyl is a safe and effective technique that provides intraoperative sedation ranked better by patients than that provided by anesthesiologists using the same drugs. More studies are, however, needed to determine the best choice of drug(s), the doses, the lock-out intervals, and the possible use of continuous infusion with patient-controlled sedation.