Articles: analgesia.
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Preservative-free morphine sulphate (0.5 mg in 0.5 ml normal saline) was injected intrathecally as the sole analgesic in 10 primiparous patients in the first stage of labour. Elective forceps were applied under pudendal block anaesthesia to assist the second stage of labour to prevent cephalad spread during bearing down, and so reduce the side-effects of morphine sulphate. ⋯ No side-effects of morphine sulphate were observed in any of the infants delivered. It is concluded that intrathecal morphine sulphate combined with elective forceps delivery provides a satisfactory alternative to epidural anaesthesia in those patients whose cardiovascular status demands preservation of a normal or elevated systemic vascular resistance.
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Randomized Controlled Trial Clinical Trial
Epidural clonidine analgesia after cesarean section.
Epidurally administered clonidine has been reported to produce postoperative analgesia. To assess the efficacy, safety, and appropriate dose of epidural clonidine for post-cesarean section analgesia, we designed a double-blind, placebo-controlled study. Sixty women were randomly assigned to receive epidural administration of saline bolus followed by 24-h saline infusion, 400-micrograms clonidine bolus followed by 10 micrograms/h clonidine infusion, or 800-micrograms clonidine bolus followed by 20 micrograms/h clonidine infusion. ⋯ Clonidine decreased heart rate (one patient required atropine for asymptomatic bradycardia) and produced transient sedation. The 800-micrograms clonidine dose prolonged resolution of local anesthetic-induced motor blockade compared to saline. The results suggest that epidurally administered clonidine provides analgesia, as measured by decreased need for supplemental morphine, after cesarean section, but continuous infusion is required for analgesia of more than 6 h duration.