Articles: analgesia.
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Alkalization of bupivacaine in the combination fentanyl-bupivacaine in epidural obstetrical analgesia].
A randomized double blind study was carried out to determine whether alkalization of a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture hastened the onset, and increased the duration and quality, of extradural analgesia during labour. The study included 120 women with uncomplicated full-term gestation. Prior to the extradural injection, 0.1 ml of either 8.4% sodium bicarbonate or normal saline was randomly added to 20 ml of 0.25% bupivacaine. ⋯ There were no statistically significant differences between the bicarbonate and control groups with regard to the speed of onset of analgesia (7.08 +/- 0.7 min vs. 6.78 +/- 0.6 min), its duration (123.6 +/- 10.7 min vs. 113 +/- 6.6 min), and the number of cases of inadequate pain relief (6 and 3 respectively). The rate of maternal adverse effects, and neonatal status, were similar in both groups. It can be concluded that alkalizing a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture for epidural analgesia in labour has no clinical value.
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Arch. Dermatol. Res. · Jan 1990
Clinical Trial Controlled Clinical TrialThe effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.
The effect of psychological pain reduction on the cutaneous inflammatory process was investigated by studying the effect of hypnotically induced analgesia on the flare reaction of cutaneous histamine prick tests. Ten highly hypnotically susceptible volunteers had their cutaneous reactivity against histamine prick tests on both arms measured before hypnosis. Their pain-related brain potentials were measured on the basis of eight argon laser stimulations. ⋯ A significant difference was measured in the histamine flare area between the pre-hypnotic and the hypnotic analgesic condition (P = 0.01-0.02) and between the hypnotic analgesic and the post-hypnotic condition when compared with the control arm. The mean ratio of flare area between the analgesic arm and the control arm was 1.04 (SD, 0.16) in the pre-hypnotic condition, 0.78 (SD, 0.22) in the hypnotic analgesic condition, and 1.37 (SD, 0.49) in the post-hypnotic condition. The results support the hypothesis that higher cortical processes can be involved in the interaction of inflammatory and pain processes.
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Postoperative pain relief with epidural morphine and buprenorphine was studied in 33 patients following hepatectomy. Morphine 2mg or buprenorphine 0.06mg in 10ml of normal saline was administered through an epidural catheter inserted at the Th10-11 or L3-4 interspace. ⋯ Buprenorphine injected at the thoracic level produced good and long-lasting (22.6 +/- 9.9 hours) pain relief, although buprenorphine injected at the lumbar level produced incomplete analgesia. The epidural administration of morphine 2mg at L3-4 or buprenorphine 0.06mg at Th10-11 may be recommended for postoperative analgesia following hepatectomy.
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Ketamine has been employed as an anesthetic for 25 years. It is the only PCP-like dissociative anesthetic in clinical use. Favourable experience with ketamine in combat situations and at accidents, together with its ability to block the effect of the excitatory neurotransmitter glutamate on NMDA-receptor mediated neurotransmission, has attracted greater attention to this drug in recent years. ⋯ Recent investigations indicate that the analgesic and anesthetic effects as well as the "dissociative" phenomena seen after analgesic doses are due to PCP receptor mediated inhibition of excitatory amino acid transmission at NMDA synapses. The excitatory effect observed at higher doses, however, may be mediated by the haloperidol sensitive sigma-receptor. The enantiomers of ketamine (R- and S-ketamine) differ in pharmacological profile and may enable improvement of ketamine as a drug.
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Operative interventions in the upper half of the abdomen have been performed in 32 surgical patients under thoracic epidural analgesia (TEA) with bupivacain at T4-L2 level, with the use of catheter technique. Before operation the patients were hydrated with 12.5 per cent of the circulating blood volume, calculated by nomogram. By noninvasive approach were monitored: pulse rate (PR), mean arterial pressure (MAP), minute cardiac volume (MCV), peripheral vascular resistance (PVR) and cardiac index (CI) for the following times; T0--basal preoperative value, T1--on the 5. min; T2--on the 10. min; T3--on the 15. min.; T4--on the 20 min.; T5--on the 50. min after application of bupivacain analgesia. ⋯ The results may be summarized, as follows: 1. Noninvasive monitoring of PR, MAP, MCV, CI and PVR in TEA is necessary for early detection and control of their pathologic changes; 2. The hemodynamic changes in TEA with bupivacain at T4-L2 level after premedication with vagolytic and hydration with Ringer-lactate (in amount 12.5 per cent of the circulating blood volume) are not significant and do not require additional treatment; 3, TEA at T4--L2 level allows performance of operative interventions in the upper half of the abdomen with adequate analgesia and relaxation, being particularly indicated for patients at risk.