Articles: analgesia.
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An updated review of patient-controlled analgesia (PCA) for acute pain relief in the postoperative period is presented. The technique, becoming more and more popular with patients, surgeons, and nurses, is undergoing numerous clinical trials under a variety of clinical protocols that are currently being reviewed. Benefits found with PCA include the fact that it is individualized therapy, allowing optimum drug titration; it decreases a patient's anxiety in the postoperative period; and it is a safer and more efficient technique of acute pain relief than conventional therapy. ⋯ Contraindications to the technique and most current equipment in use are listed herein. Clinical experience with PCA at Georgetown University Medical Center has provided, as has been the case elsewhere, data showing the superiority of the technique and its wide acceptance as part of the Acute Pain Service. The anesthesiologist plays a vital role in coordinating the various people and aspects involved in PCA for postoperative pain relief.
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Sixty-six patients undergoing total knee arthroplasty were offered epidural morphine as a method of postoperative analgesia. Of the 66 patients, 50 completed the minimum protocol of 3 days in a special epidural monitoring unit and were thus available for study. In this study group, 86% stated that they obtained 75-100% relief of pain with each epidural injection. ⋯ Epidural morphine provided excellent but inconsistent postoperative pain relief. When relief was present, aggressive in-house rehabilitation could be instituted, and a shorter overall hospital stay was achieved when compared with conventional analgesia. Nonetheless, the related adverse effects and inconsistent pain relief on many patients may preclude the use of epidural morphine as a single postoperative analgesic agent.
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Verh. K. Acad. Geneeskd. Belg. · Jan 1989
Historical Article[Historical aspects of pain relief during normal parturition].
Traditional methods used for the relief of pain during normal delivery are few and the medical literature remained silent on this topic up to the middle of the 19th century. Indeed, the first effective method was etherization, and it was introduced by Simpson (Edinburgh) in 1847. Obstetric inhalation analgesia was followed by many other methods the development of which was based on new discoveries in chemistry, pharmacology, physiology, and psychosomatic medicine. This paper reviews the milestones in the historical development of obstetric analgesia.
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Comparative Study
Sufentanil and alfentanil pattern of consumption during patient-controlled analgesia: a comparison with morphine.
Pattern of drug consumption and side effects of sufentanil and alfentanil were compared to morphine, using "on-demand" patient-controlled analgesia (PCA). After a non-narcotic general anesthetic, a bolus dose of the narcotic was given intravenously towards the end of surgery. PCA was started in the recovery room. ⋯ There was a similar incidence of nausea in all the groups. Further study is needed to determine precisely the best dose regimens for sufentanil and alfentanil, especially in reference to optimum loading doses. Sufentanil appears to be a promising drug for PCA use.