Articles: analgesia.
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Intrathecally administered clonidine has been reported to produce analgesia in cancer patients tolerant to intrathecal opiates. To assess the efficacy, safety, and appropriate dose of epidurally administered clonidine for the treatment of cancer pain, clonidine (range, 100-900 micrograms in 100-micrograms increments) was injected in nine patients with severe, intractable cancer pain. Clonidine produced analgesia, as measured by change in verbal pain scores, lasting more than 6 h. ⋯ Clonidine was absorbed in a dose-dependent manner into the systemic circulation, although absorption and elimination kinetics were highly variable. Following study seven patients received epidural clonidine/morphine infusions at home for periods of up to 5 months with sustained analgesia. These results suggest that epidurally administered clonidine may offer effective analgesia in patients with severe, intractable cancer pain.
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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.
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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.
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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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A prospective comparison of conventional analgesia and patient-controlled analgesia using morphine was conducted. Each patient underwent a major gynecologic oncology procedure and was observed on the post-operative floor. All 192 patients were studied during the first three post-operative days. The findings suggest less total medication and less sedation with equal pain control in the patient-controlled analgesia group.