Articles: analgesia.
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Critical care medicine · Feb 1990
Comparative StudyEpidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function.
Changes in pulmonary function tests were compared in 14 thoracic trauma patients, of whom seven received thoracic epidural bupivacaine for analgesia and seven received lumbar epidural morphine. In both groups epidural analgesia decreased subjective pain levels when compared to parenteral narcotics which the patients received before epidural catheter placement. ⋯ Patients in the morphine group had no significant change in pulmonary function. The use of thoracic epidural bupivacaine for analgesia in post-traumatic chest injuries produced superior improvement in pulmonary function when compared to lumbar epidural morphine.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural and intramuscular morphine in patients following cesarean section.
This randomized, double-blind study compared epidural (EP) and intramuscular (IM) morphine in 24 healthy parturients for 24 h after cesarean section. The 11 EP subjects received 5 mg of EP morphine and normal saline intramuscularly, and the 13 IM patients received 5 mg of IM morphine and normal saline epidurally. Both injections were given simultaneously just after delivery and then upon request with at least 30 min between each pair of injections. ⋯ There were no major respiratory abnormalities. During control monitoring of nine EP and 11 IM subjects while asleep postoperatively, the RR, Spo2, and incidence and frequency of SRR and AP were similar to the study period in both groups. In conclusion, EP morphine was a more effective analgesic than IM morphine, but the side effects of both were similar.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prophylactic oral naltrexone with epidural morphine: effect on adverse reactions and ventilatory responses to carbon dioxide.
The influence of two different doses of oral naltrexone on the adverse effects and the analgesia of epidural morphine were compared in a double-blind, placebo-controlled study. Forty-five patients undergoing cesarean section were provided postoperative analgesia with 4 mg epidural morphine. Five minutes later they received 6 mg naltrexone, 9 mg naltrexone, or placebo as an oral solution. ⋯ The CO2 response slopes were depressed compared to control values from 6-16 h in the placebo group, from 6-12 h in the 6 mg naltrexone group. No significant depression was noted in the 9 mg naltrexone group. The authors conclude that oral naltrexone 6 mg significantly reduces the incidence of pruritus associated with epidural morphine without affecting analgesia and that 9 mg naltrexone is associated with shorter duration of analgesia than 6 mg naltrexone.
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Randomized Controlled Trial Clinical Trial
Administration of nitrous oxide to pediatric patients provides analgesia for venous cannulation.
To determine whether administration of nitrous oxide, 50% and 70%, could provide analgesia and anxiolysis during venous cannulation in pediatric patients, 165 ASA Physical Status 1 patients scheduled for elective surgery were studied. Children, 3 weeks to 18 yr of age, were randomly assigned either to receive nitrous oxide, 50% or 70% in oxygen, or 100% oxygen via mask or to a group breathing room air, for 3 min prior to and during venous cannulation. A blinded observer using a behavioral scale for rating pain in children performed assessments of behavior and pain before and following venous cannulation. ⋯ Of those given 100% oxygen or no mask, only 30% and 21%, respectively, were considered relaxed, and 16% and 15% had little evidence of pain during venous cannulation. Side effects were seen in 28% of the group given 70% nitrous oxide and included excitement, dysphoria, nausea, restlessness, and opisthotonic movements. Both 50% and 70% nitrous oxide in oxygen administered to pediatric patients are effective at decreasing the pain and anxiety associated with venous cannulation, but use of the latter is associated with side effects.
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Thorac Cardiovasc Surg · Feb 1990
Randomized Controlled Trial Comparative Study Clinical TrialIntrapleural bupivacaine for early post-thoracotomy analgesia--comparison with bupivacaine intercostal block and cryofreezing.
54 patients who had posterolateral thoracotomy were prospectively studied to compare the efficacy of intrapleural bupivacaine with that of bupivacaine intercostal block and cryofreezing. Patients were randomized into three groups. The intrapleural catheter group included 16 patients who had intermittent intrapleural instillation of 20 ml of 0.25% bupivacaine for forty-eight hours postoperatively. ⋯ No complications related to the use of the intrapleural catheter or to bupivacaine toxicity were encountered. In conclusion, the technique of intermittent intrapleural bupivacaine is safe and comparable in efficacy to bupivacaine intercostal block and cryofreezing. Narcotic requirements may be reduced when this technique is used.