Articles: analgesia.
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Vnitr̆ní lékar̆ství · Sep 1990
[Long-term pain therapy in malignancies using epidural administration of opiates].
The authors explain basic anatomical and pharmacological principles of epidural opiate analgesia. As to clinical aspects, the authors mention briefly the technique of epidural analgesia. They summarize, based on their own experience and data in the literature, the period of insertion of an epidural catheter, opiate dosage in morphine equivalents, the need of adjuvant treatment and complications. They mention briefly various techniques which can be used in epidural opiate analgesia with an outline on perspectives of this method.
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Acta Anaesthesiol Scand · Aug 1990
Meta AnalysisSide effects and complications related to interpleural analgesia: an update.
Interpleural analgesia has been successfully used for pain relief after cholecystectomy, renal surgery, breast surgery and thoracotomy. Little has been reported about side effects and complications. ⋯ Pneumothorax was the most frequently registered complication followed by signs of systemic toxicity and pleural effusion. Horner's syndrome, pleural infections and catheter rupture have also been reported.
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Randomized Controlled Trial Clinical Trial
Herpes labialis in parturients receiving epidural morphine following cesarean section.
A significant association exists between the use of epidural morphine (EM), reactivation of herpes labialis (HL) commonly known as coldsores, and pruritus in the obstetric population. A randomized prospective study was designed to eliminate previously identified confounding variables. Immediately following delivery, parturients having undergone cesarean section with epidural anesthesia with carbonated lidocaine (Xylocaine CO2, Astra, Mississauga, Ontario, Canada) with 1:200,000 epinephrine were sequentially randomized to receive either EM or im opioids for postoperative analgesia. ⋯ The incidence of oral viral shedding was low. Surgical stress, the local anesthetic solution, and epinephrine addition to the local anesthetic were eliminated as confounders. Stepwise logistic regression analysis revealed that EM and a history of herpes labialis in these patients were predictive for reactivating oral HSV.
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The ability to reduce both clinically and experimentally induced pain by hypnotic suggestion of analgesia is well known. However, the nature of hypnotic analgesia still remains uncertain. Attempts to demonstrate and identify specific psychophysiological mechanisms have, so far, been unsatisfactory. ⋯ The amplitude of the evoked brain potentials increased during hyperaesthesia and decreased during analgesia. The latency of the potential remained constant. The perception of pain during hypnosis can change very fast, indicating that slow endogenous mechanisms may play only a minor role in suggested hyperaesthesia/analgesia.
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Acta Anaesthesiol Scand · Aug 1990
Randomized Controlled Trial Clinical TrialThe effect of removal of cerebrospinal fluid on cephalad spread of spinal analgesia with 0.5% plain bupivacaine.
Increased intraabdominal pressure is well known to cause higher cephalad spread of spinal analgesia. The reason for this is believed to be a decrease in the cerebrospinal fluid (CSF) volume. If this mechanism is correct, then the cephalad spread of local anesthetic solutions should also be facilitated when the CSF volume is intentionally reduced without increasing the intraabdominal pressure. ⋯ Mean cephalad spread of analgesia 20 min after injection in the three groups was T10.2 +/- 2.0, T9.4 +/- 1.8 and T7.0 +/- 2.1, respectively. When CSF was reduced by 5 ml, the level of spread not only showed a statistically significant difference from that of the control group, but also from that of Group II (P less than 0.05). Our results show that higher cephalad spread of spinal anesthetic is possible by reducing the CSF volume without evidence of increased intraabdominal pressure.