Articles: analgesia.
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A questionnaire survey of current practice at a small cross-section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre-eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre-eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). ⋯ Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 x 10(9)/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre-eclamptic patients only. For these patients first line testing could be limited to a platelet count.
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J Pain Symptom Manage · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of patient-controlled analgesia (PCA) versus PCA plus continuous infusion in postoperative cancer patients.
The benefits of two dosing methods, patient-controlled analgesia (PCA) with morphine sulfate (MS) alone and PCA plus continuous infusion of morphine sulfate (PCA + CI) were clinically evaluated in a randomized, single-blinded study of 30 adult abdominal surgery patients. Doses were adjusted based on pain and sedation ratings. Respirations, pulse, blood pressure, pain and sedation ratings were assessed. ⋯ There seems to be a trend for the PCA + CI group to have less fluctuation in sedation between days and better pain control (as demonstrated by verbal and visual analog pain scores) on the third postoperative day. Statistical significance was not found, however. PCA plus continuous infusion of MS may be a beneficial approach to the management of postoperative pain in selected patients; studies to identify these patients need to be done.
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Ann Fr Anesth Reanim · Jan 1991
Review Randomized Controlled Trial Comparative Study Clinical Trial[Prevention by naloxone of adverse effects of epidural morphine analgesia for cancer pain].
Forty cancer patients were randomly assigned to two groups (n = 20). All had incapacitating pain unresponsive to the usual non opioid analgesic drugs. An epidural catheter was set up at the level of the most painful metamere, and made to pass subcutaneously so as to exit either in the supraclacicular fossa, or on the patient's flank. ⋯ There was no statistically significant difference between the groups in quality and duration of analgesia. Pain reached its lowest level 4 h after the injection of morphine, returning to half its original value at the 24th h. This was also true for the incidence of nausea (11 in group N, 5 in group P), vomiting (3 in both groups), and urinary retention (6 in group P, 5 in group N).(ABSTRACT TRUNCATED AT 250 WORDS)
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Despite its severity, the disposition of women towards pain during childbirth is influenced by many complex personal and cultural factors. Such influences may inspire a degree of stoicism towards labour pain which would be extraordinary in other painful circumstances. Nevertheless, the majority of women who deliver in a modern obstetric unit request some form of pharmacological pain relief. ⋯ Recent advances have demonstrated that many of the adverse effects traditionally associated with epidural analgesia can be substantially reduced by administering local anaesthetics in smaller doses. It is becoming apparent that additional patient benefits are possible when epidural opioids are also used in combination with local anaesthetics. Techniques which allow the mother to exercise personal control over her epidural analgesia requirements are received more favourably and may help reduce the need for obstetric intervention.
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In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. ⋯ During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.