Articles: analgesia.
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Anesthesia and analgesia · Mar 1989
Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy.
This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. ⋯ The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.
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Patient-Controlled Analgesia is a new method of narcotic delivery. It allows titration of analgesic drugs to the individual patient's requirements. ⋯ It may shorten postoperative recovery time and decrease hospital length of stay. At a time when physicians and hospitals are feeling compelled to hasten patients' recovery and still provide good quality of care, Patient-Controlled Analgesia may be an excellent way to accomplish both goals.
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Cahiers d'anesthésiologie · Mar 1989
Comparative Study[Addition of a morphinomimetic to the continuous perfusion of 0.125% bupivacaine for peridural obstetrical anesthesia. A comparative study of fentanyl and alfentanyl].
Morphinic drugs added to epidural local anesthetic during labour enhance analgesia and obstetrical conditions. Fentanyl, 1 microgram/kg-1, is safe for the newborn. Alfentanil is of faster and shorter duration and its pharmacokinetics suggests less accumulation than fentanyl. ⋯ No cesarean section is observed. Neonatal status, established according to Apgar scores and then Amiel Tison neurological scales (0 to 30) respectively at 30 to 120 minutes are in the same favorable ranges: Apgar score is in all cases more than 9. The neurological score is 24 (group A) and 22.9 (group F) at 30 minutes and increases significantly at 120 minutes in the 2 groups (27 in the two groups).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Feb 1989
Randomized Controlled Trial Clinical TrialProphylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.
To evaluate the efficacy of prophylactic transdermal scopolamine in reducing nausea associated with postoperative epidural analgesia, we studied 32 healthy adult women undergoing major gynecologic surgery. The patients were randomized in a double blind fashion to receive either a cutaneous scopolamine patch or a visually identical cutaneous placebo patch. Postoperative analgesia was provided solely with epidural morphine. ⋯ The number of patients reporting "zero nausea" was significantly greater with scopolamine patches than with placebo patches (13 vs 1, P less than 0.01). The mean number of times antiemetic drugs were administered per patient was lower with scopolamine than with placebo patches (0.2 +/- 0.4 vs 2.8 +/- 2.6, P less than 0.05). It is concluded that prophylactic transdermal scopolamine patches reduce nausea in postoperative patients receiving epidural morphine.
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Acta Anaesthesiol Scand · Feb 1989
Epidural morphine delays gastric emptying and small intestinal transit in volunteers.
The influence of a painful stimulus and lumbar epidural morphine on gastric emptying, the orocecal transit time and small intestinal transit were studied in nine healthy volunteers. Acetaminophen absorption was used as a measure of the rate of gastric emptying. Orocecal transit time was determined by measuring the end-expiratory hydrogen concentration. ⋯ Gastric emptying, orocecal transit time and small intestinal transit were delayed during epidural morphine analgesia compared with the findings under the control and plain cold pain conditions. Cold pain stress alone did not influence gastric emptying, orocecal transit time or intestinal transit. To conclude, epidural morphine in itself delayed gastric emptying, orocecal transit and transit through the small intestine in healthy volunteers.