Articles: analgesia.
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The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. ⋯ Piritramid/promethazine, pethidine/flunitrazepam, pethidine/promethazine and tramadol/methohexital required more time for awakening. On the basis of these results, we prefer to use the combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam to judge all patients' neurologic scores.
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Anesthesiology review · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled and nurse-administered analgesia using intravenous fentanyl during labor.
Preliminary observations have shown that fentanyl citrate, a potent narcotic, is helpful during labor without undue side effects. This randomized prospective investigation compared the patient-controlled administration of fentanyl with that of administration by nurses on request. Eighty healthy women beginning active labor (cervical dilation 4 cm) at term were assigned to receive fentanyl intravenously by either patient-controlled administration (n=37) or nurse administration on demand (n=43). ⋯ Maternal oversedation and vomiting did not occur. Neonatal naloxone therapy was used infrequently, umbilical serum levels of fentanyl were the same in both groups, and postnatal neuroadaptive testing revealed comparable results in both groups. Despite the usefulness of fentanyl during labor, administration by the patient had no advantages over administration by the nurses in significantly reducing drug use, improving pain relief, or avoiding drowsiness.
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Acta Anaesthesiol Scand · Jan 1991
Randomized Controlled Trial Comparative Study Clinical TrialTransnasal butorphanol: a new method for pain relief in post-cesarean section pain.
This study was undertaken to evaluate the efficacy and the safety of transnasal butorphanol (TNB) compared to intravenous butorphanol (IVB) in 186 patients experiencing moderate to severe post-cesarean section pain. Patients were randomly assigned to five groups in a double-blind fashion: Group I (n = 37) received 2 mg IVB, Group II (n = 38) 2 mg TNB, Group III (n = 36) 1 mg TNB followed by a repeat dose of 1 mg TNB at 60 min, Group IV (n = 38) 0.5 mg TNB followed by a repeat dose of 0.5 mg at 60 min, and Group V (n = 37) received placebo. All administrations were double dummy. ⋯ There were no incidences of nasal mucosa irritation, or cardiovascular or respiratory depression. It is concluded that transnasal butorphanol represents a safe and effective alternative to injectable butorphanol for post-cesarean section pain and offers a better and longer duration of analgesia compared to IV butorphanol. The optimum dose seems to be 2 mg TN butorphanol and it is tolerated better when divided into 1 mg increments, given 1 h apart.
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Ann Fr Anesth Reanim · Jan 1991
Randomized Controlled Trial Comparative Study Clinical Trial[Evaluation of obstetrical pain by a questionnaire of adjectives. Comparison of 2 epidural analgesia protocols].
A French version of the McGill pain questionnaire, the "Questionnaire Douleur Saint Antoine" (QDSA), was assessed prospectively by comparing two epidural analgesia protocols using bupivacaine. One hundred women in labour who asked for epidural analgesia were randomly allocated to two groups and received either 0.25% or 0.5% bupivacaine (mean initial doses 32.5 and 50 mg respectively) with adrenaline 1 in 200,000. All the patients were then instructed to trigger a patient controlled analgesia (PCA) device for top-up doses of 0.25% bupivacaine with adrenaline 1 in 400,000 once they became aware of pain returning. ⋯ On the other hand, the affective part of the score was only correlated with the level of anxiety and behaviour. The sensory part of this score was the only one to show a difference between the different initial doses given to the patients. The results obtained with this series of patients underline the value of a multidimensional assessment of labour pain.
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Seven different schemes for analgesic anaesthesia were investigated for their clinical applicability, potential side effects, and impacts on circulation parameters of the systemic and pulmonary (peripheral) circulation as well as on the intracranial pressure. In all, so patients per group were treated. The results revealed different reactions of patients, such as a higher incidence of disturbances of the autonomic nervous system and excitation after medication withdrawal. ⋯ In several instances, a clear increase in the right atrial and the pulmonary arterial mean pressure as well as the intracranial pressure was observed during ketamine/flunitrazepam therapy. The combinations pethidine/promethazine or pethidine/flunitrazepam also showed clear side effects on the circulation and evoked an increase in the intracranial pressure. Fentanyl/midazolam or alfentanil/midazolam treatments were the most favourable combinations for most of the patients who were artificially respirated.