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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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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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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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.
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Patient controlled analgesia (PCA) has a number of advantages compared with traditional methods of pain management. Some of these advantages include superior pain relief, less sedation due to superior drug titration, increased psychological satisfaction due to patient control of pain management, individualized analgesic dosing, decreased staff time for patient care, and increased patient activity and mobility. ⋯ Appropriate candidates for PCA include terminally ill-cancer patients, postoperative patients, mentally clear and alert trauma patients, and patients who require massive doses of oral narcotics to control pain but are experiencing intolerable side effects. This article focuses on the principles involved in selecting the optimal analgesic and the therapeutic variables involved in using PCA.