Articles: analgesia.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of extradural clonidine with those of morphine on postoperative pain, stress responses, cardiopulmonary function and motor and sensory block.
We have examined the effects of extradural clonidine 150 micrograms or morphine 4 mg on postoperative pain, stress responses, cardiopulmonary function and motor and sensory block in a double-blind, randomized study in 20 patients undergoing hysterectomy with general anaesthesia. Observations were made for 6 h after each patient's first request for analgesia. Clonidine provided greater pain relief than morphine only for the first 2 h of observation (P less than 0.001). ⋯ After clonidine, mean arterial pressure decreased from 100 (SEM 3) mm Hg to 70 (3) mm Hg (P less than 0.05), but there was no change after morphine. There were no significant changes in heart rate, pulmonary function (FEV1), motor function or sensory analgesia to touch, temperature and pinprick in both groups. Additional systemic opioids were required by five and six patients in the clonidine and morphine groups, respectively.
-
Fifteen patients with cancer pain refractory to other methods of pain control were treated with epidural sufentanil. They all suffered from very severe or unbearable pain but had expressed the wish to spend the last period of their lives at home. On the first day of hospitalization, an epidural catheter and a portal catheter were implanted under local anesthesia. ⋯ Nine patients had epidural sufentanil as their sole analgesic till they died; six patients needed adjunctive nonepidural medications. There were no epidural- or portal-catheter related infections or cases of respiratory depression. After 1651 patient treatment days, we have found continuous epidural sufentanil infusion to be a safe and effective method for cancer pain control in outpatients.
-
Randomized Controlled Trial Clinical Trial
Continuous versus intermittent epidural analgesia. A randomised trial to observe obstetric outcome.
A randomised study of 381 women was carried out to compare the obstetric outcome after epidural analgesia maintained by an intermittent top-up regimen or with a continuous infusion. The two groups were well matched with respect to age, parity, mode of onset of labour and indication for epidural. ⋯ A reduction in the incidence of hypotension, cardiotocographic evidence of intrapartum fetal hypoxia and Caesarean section was associated with this. It is concluded that the maintenance of epidural analgesia by continuous infusion is a safe and reliable method and may be more advantageous and less labour intensive than the traditional intermittent regimen.
-
Epidurally administered clonidine has been reported to produce postoperative analgesia. To assess the efficacy, safety, and appropriate dose of epidural clonidine for postoperative analgesia, clonidine (range, 100-900 micrograms in 100-micrograms increments) was injected in 22 patients following abdominal surgery or total knee arthroplasty (TKA). Clonidine produced analgesia, as measured by change in verbal pain scores and supplemental iv morphine usage. ⋯ Oxyhemoglobin saturation, serum glucose, and arterial blood gas tensions were not altered by clonidine, whereas there was a small (28%) dose-independent decrease in serum cortisol following clonidine injection. Clonidine was absorbed in a dose-dependent manner into the systemic circulation, with plasma concentrations 0.1-3.3 ng/ml 1 h following injection. These results suggest that hemodynamic depression and short-lasting analgesia may limit the usefulness of bolus epidural clonidine analgesia in the postoperative setting.
-
Review
Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.
The administration of epidural and intrathecal narcotics is a technique of providing postoperative analgesia that is gaining popularity in many operating rooms, labor suites, and intensive care units. The epidural and intrathecal methods, first introduced a century ago, have been implemented as additional techniques for the administration of narcotic analgesics. Patients who have received epidural or intrathecal narcotics are frequently admitted to the intensive care unit for postoperative care. Because of their continuous proximity to the patient and their monitoring skills, critical care nurses are able to evaluate the analgesic effect and intervene in the event of a complication.