Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Obstetric epidural analgesia with mixtures of bupivacaine, adrenaline and fentanyl.
We performed a double-blind comparison of six solutions for epidural analgesia in 90 healthy Chinese women with uncomplicated pregnancies. Patients were randomly allocated to receive 10 ml bupivacaine 0.125% or 0.25% plain, bupivacaine 0.125% with adrenaline 1.25 micrograms/ml, bupivacaine 0.25% with adrenaline 2.5 micrograms/ml or the latter two solutions with added fentanyl 50 micrograms. ⋯ There were no differences in method of delivery or neonatal Apgar scores among groups. The least concentrated mixture that gave the best analgesia was the combination of bupivacaine 0.125% with adrenaline 1.25 micrograms/ml and fentanyl 50 micrograms.
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Patient-controlled Analgesia (PCA) permits patients to treat their postoperative pain by activating a pump to deliver doses of intravenous narcotic. This technique was developed in response to the undertreatment of postoperative pain with conventional intramuscular therapy. ⋯ Careful patient screening and preoperative teaching are essential. While data regarding cost-effectiveness are limited, increasing use and patient satisfaction could make PCA the standard of care in the future.
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Forty-four patients were treated with a continuous infusion of lumbar epidural hydromorphone (0.05%) after thoracic operations. Postoperatively, visual analog pain scores were obtained. ⋯ The incidence of side effects (hypoventilation, pruritus, and nausea) was less than reported with other epidurally administered opioids. Continuous infusion of lumbar epidural hydromorphone produced safe, predictable analgesia after thoracotomy.
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Comparative Study
Pressure generated during insertion of lumbar epidurals. A comparison with the Portex epidural injection simulator.
The aim of this study was to measure pressures exerted during insertion of lumbar epidurals in obstetric patients. The pressures were compared with those obtained when the Portex epidural injection simulator was used, and were significantly greater when a saline technique was used compared to those when air was used (p less than 0.05). There were no differences between the pressures obtained with the simulator and those measured in vivo.
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We report our experience in introducing patient-controlled analgesia at the Royal Hospital for Sick Children, Glasgow. Twenty-five children used the technique after orthopaedic or general surgery using the Graseby system. The pump was loaded with 1 mg/kg morphine sulphate in 50 ml. ⋯ Adverse effects were few and minor. Education of patients, parents and nurses is essential for its success and safety. The technique is an effective and safe means of providing good quality analgesia in school age children.