Articles: analgesia.
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Case Reports
Computerized axial tomo-epidurographic and radiographic documentation of unilateral epidural analgesia.
A 23-year-old primigravid patient who received epidural analgesia for pain of labour presented with persistent, apparently irremediable, unilateral analgesia. Computerized axial tomo-epidurography demonstrated absence of circumferential spread due to lateral placement of the catheter. Transforaminal escape of contrast medium into the paravertebral area had occurred and anterior and posterior midline partitioning of the epidural space was obvious. All the usual measures to promote contralateral analgesia, except re-insertion of the catheter, had been tried without success.
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Regional anesthesia · Nov 1989
Randomized Controlled Trial Clinical TrialEffect of diluting fentanyl on epidural bupivacaine during labor analgesia.
In a randomized prospective study carried out on 60 laboring primiparous parturients, fentanyl 80 micrograms, either in 2 ml or in 8 ml, was added to 12 ml of 0.25% bupivacaine administered epidurally for pain relief. The aims of this protocol were to evaluate the effect of varying the volume of fentanyl added to epidural bupivacaine on the quality and duration of labor analgesia. ⋯ The incidence of pruritus was higher in the fentanyl-diluted group (43% versus 23%). No clinical advantage was found in this study, therefore, when fentanyl 80 micrograms was added to 0.25% bupivacaine.
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Clinical Trial Controlled Clinical Trial
Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine.
The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. ⋯ Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.
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Anaesth Intensive Care · Nov 1989
Comparative StudyA controlled oximetric evaluation of inhalational, opioid and epidural analgesia in labour.
The effects on patient oxygenation of nitrous oxide, narcotic and epidural analgesia in labour were evaluated using pulse oximetry. Five groups of ten patients received either no analgesia (Control, Group 1), an epidural block alone (Group 2), nitrous oxide in oxygen alone (Group 3), intramuscular pethidine (Group 4), or nitrous oxide in oxygen combined with intramuscular pethidine (Group 5). Derived parameters included the maximum (MAX), minimum (MIN), average maximum (AV MAX), and average minimum (AV MIN) arterial haemoglobin oxygen saturation (SaO2), and differences between maxima and minima (MAX-MIN). ⋯ All other groups showed no significant difference in any parameter when compared with the control group. The results are discussed with reference to normal and disordered maternal physiological changes in pregnancy. It is suggested that nitrous oxide should not be used for analgesia in labour where there is concern about maternal, placental or foetal reserve.
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Over a period of 4 months, the authors have observed 414 deliveries, including 30 which presented a hyperthermia exceeding or equal to 37.8 degrees C (7.2%). 27 hyperthermias occurred under peridural analgesia. The thermogenic effect of this loco-regional anesthesia seems debatable since it occurs at an early stage, is transient and has a peripheral effect. ⋯ Peridural analgesia is advocated in most primiparous patients as well as in imperative labor inducements. Sometimes, this permits accepting a longer-lasting labor, exposing the patient to the risk of amniotic infection.