Articles: analgesia.
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Comparative Study Clinical TrialPost-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. The effects of per- and post-operative analgesia on morbidity.
One hundred and twenty-nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v. nicomorphine during surgery and epidural nicomorphine post-operatively (epidural group, n = 58) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation and with post-operative intramuscular nicomorphine (intramuscular group, n = 71). Post-operative nicomorphine was only given at the request of the patients, and as frequently as needed to obtain satisfactory pain relief. ⋯ The requirements of nicomorphine over a period of 3 days were significantly lower in the epidural group 42 mg (s.d. = 18) versus 92 mg (s.d. = 33) in the intramuscular group. Significantly fewer pulmonary complications were observed in the epidural group: 7 atelectases compared to 27 in the intramuscular group. The epidural group showed no signs of ventilatory depression in spite of a catheter inserted at the T3-T4 level.
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Clinical TrialThe effect of thoracic epidural analgesia on respiratory function after cholecystectomy.
To assess the effect of thoracic epidural analgesia (TEA) on postoperative respiratory function and pulmonary complications, a prospective randomized trial was conducted in patients undergoing cholecystectomy. One hundred patients were allocated to TEA (n = 30), TEA + general anesthesia (TEA + GA) (n = 30), or general anaesthesia (GA) (n = 40) groups. Respiratory function was analysed by measuring forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), total lung capacity (TLC), peak expiratory flow (PEF) in the supine and sitting postures, and arterial blood gases. ⋯ The preoperative difference of 27% in FRC between the sitting and supine postures was maintained after operation. PaO2 decreased by 0.8 kPa after TEA, by 1.5 kPa after TEA + GA with the lowest value on the 2nd postoperative day and by 1.5 kPa after GA, with the lowest value immediately after operation. Simultaneous hypercarbia indicated hypoventilation, which may have contributed to impaired respiratory function on the following days.(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of anesthesia · Sep 1987
Epidural pressure and its relation to spread of epidural analgesia.
The relationships between the epidural pressures following the injection of local anesthetic solution and the spread of epidural analgesia were investigated. In 46 patients, 15 ml of 2% mepivacaine was injected into the lumbar epidural space at a constant rate (1 ml/sec) using an electropowered syringe pump. Injection pressures and residual pressures were recorded and the spread of analgesia to pinprick was assessed. ⋯ The spread of analgesia closely correlated with the epidural pressures during and following the injection of local anesthetic solution. The most close correlation was found between the epidural pressure immediately after the completion of injection and the spread of analgesia (r = -0.5659, P < 0.001). In conclusion, the lower the terminal injection pressure and the residual pressures associated with higher age, the wider the spread of epidural analgesia.