Articles: analgesia.
-
Patient controlled analgesia (PCA) is a drug delivery system aimed to control acute pain using negative feedback technology in a closed loop system in which the patient plays an active role. It overcomes the inadequacies of traditional analgesic protocols due to marked differences in pharmacokinetic and dynamy of analgesis between patients. Moreover, doctors and nurses frequently underprescribe opioids in patients with severe pain for fear of dangerous side-effects. ⋯ The principles of demand analgesia are now being investigated using other agents, such as local anaesthetics, and other routes of administration, mainly epidural injection. In most patients, even in children, PCA can replace intramuscular injections, which are the standard route for opioid administration. Today PCA and spinal opioids are the two main methods of analgesia for postoperative pain management.
-
The realization that many intensive care patients develop psychoreactive problems ranging from confusion to depression to frank mutism led us to include Dehydrobenzperidol (DHB) in our analgesia and sedation scheme. The early prophylactic administration of this drug was found to be particularly effective in the prevention of delirium following an alcohol and/or drug overdose.
-
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.
-
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.