Articles: analgesia.
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Fifty patients undergoing cholecystectomy either electively or urgently were treated in the postoperative period with the intrapleural injection of 30 mL of 0.75% bupivacaine hydrochloride with epinephrine (1:200,000). The frequency of narcotic administration and the postoperative stay were compared with those of 50 historical controls. ⋯ There were no complications related to catheter insertion or bupivacaine toxic effects. This technique is safe and effective in controlling perioperative pain.
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Acta Anaesthesiol Scand · Apr 1989
Randomized Controlled Trial Clinical TrialSpinal buprenorphine for postoperative analgesia after caesarean section.
Two doses of intrathecal buprenorphine for postoperative analgesia have been compared. Forty-five women undergoing elective caesarean section under spinal anaesthesia were randomly divided into three groups. ⋯ Patients receiving buprenorphine had a longer pain-free interval than the controls (P less than 0.01). Within the buprenorphine groups, patients receiving the higher dose had a longer effect (420 min s.d. 24) than those receiving the lower dose (173 min s.d. 31) (P less than 0.01) without any increase in side-effects.
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J Cardiothorac Anesth · Apr 1989
Randomized Controlled Trial Clinical TrialIntrapleural bupivacaine v saline after thoracotomy--effects on pain and lung function--a double-blind study.
The effects of intrapleural (IP) bupivacaine on pain, morphine requirement, and pulmonary function were evaluated in 15 patients for 24 hours after thoracotomy. An IP catheter was placed during surgery. Patients were randomized in a double-blind fashion to receive 1.5 mg/kg of 0.5% bupivacaine IP or saline on two occasions, eight hours apart. ⋯ The analgesic effect was shortlived (two to five hours), possibly because of loss of bupivacaine in the chest drains. No differences were seen between the two groups after the effect of IP bupivacaine had worn off. Plasma bupivacaine levels had a Cmax of 0.44 to 1.50 micrograms/mL, with a Tmax at 5 to 30 minutes with levels well below 2 to 4 micrograms/mL where increasing toxicity is seen.
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J Cardiothorac Anesth · Apr 1989
Clinical Trial Controlled Clinical TrialIntrapleural bupivacaine--technical considerations and intraoperative use.
The authors evaluated the incidence and type of technical problems associated with blind insertion of intrapleural catheters placed in 21 anesthetized patients and then injected in a double-blind fashion with 0.5% bupivacaine (1.5 mg/kg) or isotonic saline. The patients' chests were then opened, catheter positions located, and the lungs inspected. Eleven of the catheters were located with the tips intrapleurally, three extrapleurally, and seven actually in lung tissue. ⋯ It is concluded that blind insertion of intrapleural catheters can be hazardous, especially if followed by positive-pressure ventilation. In addition, catheter placement in lung tissue, which was not uncommon, delays the time for peak plasma concentrations and may increase risk of toxicity. Intrapleural bupivacaine was not found to be a useful adjunct to general anesthesia during thoracotomies.
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According to our results, permanent epidural anaesthesia was significantly superior to systemic opioid treatment in patients with serial rib fractures. The main advantages were not only continuous pain relief despite the fact that the nonepidural control group required more than twice the dosage of morphine derivatives; also, the respiratory and pain-related recovery time was reduced. Another advantage was the selective effect (due to the local application) on respiratory pain and therefore on respiration as a whole. ⋯ When morphine was temporary contraindicated (frequently the final diagnosis in the case of an "acute abdomen" delayed the administration of morphine) the use of bupivacaine alone provided a satisfactory result for a certain time (we never observed tachyphylaxis). Additional systemic pain relievers were only necessary when the patient was suffering from pain caused by other injuries beyond the area of effectiveness of the epidural catheter (the only obvious disadvantage of the local application technique). On the other hand, epidural anaesthesia enabled us to treat a patient's lower-leg fracture by interlocking nailing, while adding only 0.01 mg fentanyl (= 2 ml Fentanyl Janssen) and 1.2 mg flunitrazepam (Rohypnol).