Articles: analgesia.
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Comparative Study
Postoperative analgesia in children who have genito-urinary surgery. A comparison between caudal buprenorphine and bupivacaine.
A study conducted on 40 children, aged 1-11 years, who had genito-urinary surgery compared the quality and duration of analgesia after caudal blocks in two groups of patients. Group 1 (n = 20) received caudal bupivacaine 0.25% and group 2 (n = 20) caudal buprenorphine 4 micrograms/kg; each received 0.5 ml/kg body weight. Patients were operated on under general anaesthesia. ⋯ The results indicate that caudal buprenorphine provides excellent postoperative analgesia in children comparable to caudal bupivacaine in the early postoperative period. Buprenorphine proved better in the late postoperative period. Analgesia lasted from 20 hours to more than 24 hours after caudal buprenorphine with fewer side effects.
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The possible options for the management of acute pain are quite numerous and continue to expand as our understanding of the mechanisms of pain becomes increasing sophisticated. Many of the options discussed have been available for years, and their present underutilization may be a reflection of the lack of emphasis on the importance of management of acute pain. An illustration of this would be our present ritual of prescribing narcotics postoperatively, a longstanding, but unfortunately inadequate practice. ⋯ Certain techniques, such as continuous local anesthetic infusions, may warrant an escalated level of monitoring and ancillary care. Other techniques, such as the infiltration of a wound with local anesthetic or the addition of a nonsteroidal anti-inflammatory agent to a regimen of mild oral narcotics are so simple that excluding them from patient care is almost callous and inconsiderate. Attention to the mechanisms of pain that may be present in a given situation, whether it be muscle spasm, ischemia, inflammation, edema, or nerve injury, may guide the clinician toward a more rational approach in managing that pain.
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A close correlation between the threshold of the nociceptive flexion reflex and pain threshold makes this reflex useful for the examination of pain and analgesia level. Earlier investigations showed that in sciatica the threshold of the nociceptive reflex was decreased in the extremity with pain, and that the degree of this decrease was proportional++ to pain intensity and intensity of radicular sings. ⋯ Improvement was obtained in 80% of patients, with complete disappearance of pain in 55%. In all improved patients the previously decreased threshold of the nociceptive flexion reflex increased again to normal values.