Articles: analgesia.
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J Cardiothorac Anesth · Oct 1989
Bilateral intrapleural regional analgesia for postoperative pain control: a dose-finding study.
Postoperative pain management for major abdominal or thoracoabdominal procedures requires bilateral multisegmental intercostal nerve blocks or epidural analgesia. This study was undertaken to examine the possible role of bilateral intrapleural regional analgesia (BIRA) and to select the proper dose for this new technique. Bilateral intrapleural catheters were inserted after surgery, using a Mancao dual-cannula system. ⋯ Patients in groups I and II received narcotic medication whenever they felt pain or discomfort. The duration of BIRA was considered to be from the injection of the drug until the time a narcotic was administered to the patient. Demographic variables, changes in BP and heart rate after surgery, frequency of narcotic administration during the first four postoperative days, and postoperative hospital stay were compared in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)
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Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response group--pain relief with placebo solutions; fentanyl response group--pain relief with epidural fentanyl; lidocaine response group (LRG)--pain relief with lidocaine but not fentanyl; and no response group--no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. ⋯ On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.
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Randomized Controlled Trial Clinical Trial
Prevention of epidural morphine-induced respiratory depression with intravenous nalbuphine infusion in post-thoracotomy patients.
The efficacy of nalbuphine, an agonist/antagonist opioid, in preventing respiratory depression from epidural morphine analgesia after thoracotomy, was assessed in a randomized double-blind placebo controlled trial. After a standardized general anaesthetic and 0.15 mg.kg-1 of epidural morphine, patients received a bolus and then a 24 h infusion of nalbuphine (200 micrograms.kg-1 + 50 micrograms.kg-1.hr-1, 100 micrograms.kg-1 + 25 micrograms.kg-1.hr-1, or 50 micrograms.kg-1 + 12.5 micrograms.kg-1.hr-1) or placebo. ⋯ A 200 micrograms.kg-1 bolus of nalbuphine followed by a 50 micrograms.kg-1.hr-1 infusion achieved a mean steady state blood level of 38.2 ng.ml-1 and prevented CO2 retention greater than 50 mmHg in all but two patients, neither of whom required naloxone. There was no difference in the incidence of side effects among groups, and analgesia appeared to be unaffected by nalbuphine.