Articles: analgesia.
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J Assoc Acad Minor Phys · Jan 1990
Patient-controlled analgesia pain management for children with sickle cell disease.
Painful episodes account for approximately 60% of all hospitalizations of children and adults with sickle cell disease. Limited information is available on managing pain in these individuals. Increasing attention is being focused on new ways to promote pain control. ⋯ Total dose of intravenous narcotic therapy (meperidine equivalent in mg/kg) was greater in the PCA group. Five of 10 children using PCA, however, experienced relief within 6 hours compared with 1 of 10 children in the non-PCA group (P = .052). Patients, families, and hospital staff expressed satisfaction and preferred PCA to conventional management when offered a choice.
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Hist Philos Life Sci · Jan 1990
Historical ArticleThe history of algology, algotherapy, and the role of inhibition.
Cephalalgia (1st century AD), nostalgia (1678), neuralgia (18th century), causalgia (1872) were terms followed in the 1950's by Bonica's 'algology... a disease state of its own', addressed by ever-growing numbers of pain clinics, strongly foreshadowed by Leriche's douleur maladie in the 1930's. (Hence also 'algotherapy'). Philosophers first, then early academic physiologists began to exhibit interest in pain, that all too common phenomenon, only too often unyielding to theoretical as well as practical efforts. Was it, after all, an instance of built-in self-preservation, a reflex? Identification of the nervous energy and its anatomical pathways in the 19th century, endless arguments as to their 'specificity', led to new surgical attempts to control and interpret pain, by now supported by general, then local anesthesia. ⋯ Gasser and Erlanger's classification of sensory nerve fibers began to dominate research in the 1930's thanks to the cathode ray oscillograph invented in 1897. The pain inhibition concept was given another boost in the seventies when the role of the midline mesencephalic and oblongata nuclei was established as both opium receptors and producers of opioids. Finally, inhibition may also be seen as the principle underlying the age-old therapeutic effect of 'counter-irritation', mostly in the form of electrical stimulation.
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Randomized Controlled Trial Clinical Trial
Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial.
To determine whether the high rate of forceps delivery associated with the use of epidural analgesia could be reduced through giving an intravenous infusion of oxytocin during the second stage of labour. ⋯ The use of an oxytocin infusion may reduce the high rate of operative delivery associated with epidural analgesia provided that the fetal occiput is in an anterior position at the onset of the second stage of labour but within the dose range studied does not seem to correct malposition of the fetal occiput.
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Data from the charts of 40 patients in whom a continuous epidural infusion of fentanyl had been used to effect postoperative pain relief were retrospectively reviewed. Of these patients, 39 out of 40 (97.5%) reported adequate analgesia at an average fentanyl infusion rate of 1.3 micrograms/kg/h. ⋯ The overall incidence of side effects was low, and, in particular, respiratory depression was not noted. In our experience, this analgesia technique is safe, effective, and could be readily introduced into most community hospital settings.