Articles: analgesia.
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Anesthesia and analgesia · Dec 1988
Comparative Study Clinical Trial Controlled Clinical TrialInfluence of bupivacaine as an adjuvant to epidural morphine for analgesia after cesarean section.
The effect of the addition of bupivacaine to epidural morphine (EM) on postoperative analgesia was evaluated in 150 patients after cesarean section performed under epidural anesthesia with carbonated lidocaine. Fifty patients received 3 mg EM without bupivacaine, 50 received 3 mg EM with 0.125% bupivacaine, 25 received 5 mg EM without bupivacaine, and 25 patients received 5 mg EM with 0.125% bupivacaine. ⋯ The addition of bupivacaine did not affect the quality or duration of analgesia afforded by EM and did not influence the incidence or severity of side effects. Furthermore, there was no statistically significant difference in the analgesia obtained by patients receiving 3- and 5-mg doses of EM with or without bupivacaine.
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The occurrence of pain was investigated in 118 patients with posttraumatic brachial plexus injuries (BPI). Ninety-five patients were operated upon by the same surgeon. Three to 14 years after BPI and reconstructive surgery, 91% of the patients experienced permanent pain that was severe in 40% and mild in 51% of cases. ⋯ For 57% of patients with pain, a plurimodal medical treatment with tricyclic antidepressants, antiepileptic drugs, and behavioral therapy efficiently reduced pain. For the patients with unbearable paroxystic pain, when medical treatment failed, the destruction of deafferented dorsal horns at the level of avulsion (Nashold procedure) could produce pain relief. In all cases psychosocial management produced early rehabilitation.