Articles: analgesia.
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The safety and efficacy of a disposable, nonelectronic, patient-controlled-analgesia (PCA) device for alleviating postoperative pain were evaluated. Patients who were to undergo abdominal surgical procedures under general anesthesia were instructed in the use of the Travenol Infusor with Patient Control Module. Patients used the PCA device upon emerging from anesthesia in the recovery room. ⋯ Results of a poststudy self-assessment questionnaire showed that 90% of the patients reported experiencing mild to moderate pain overall, and 78% reported only mild discomfort throughout the postoperative period. Ninety-two percent of the patients strongly preferred PCA therapy over intramuscular injections. The Travenol Infusor with Patient Control Module represents a safe and effective device for PCA therapy of postoperative pain.
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Intrathecally administered clonidine produces analgesia, but also produces hypotension. To assess the effects of epidural administration, the authors inserted lumbar epidural catheters in seven nonpregnant ewes, and injected, on separate days, clonidine (50-750 mcg), morphine (5-10 mg), and a clonidine-morphine combination (clonidine 150 mcg + morphine 5 mg). Clonidine produced dose-dependent antinociception and sedation, with the lowest maximally effective antinociceptive dose being 300 mcg. ⋯ Epidurally administered clonidine did not decrease blood pressure or heart rate or affect arterial blood gas tensions or spinal cord histology. These data suggest that epidurally administered clonidine produces analgesia by a local, alpha 2-adrenergic mechanism. In sheep, epidurally administered clonidine does not produce hypotension.
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Journal of anesthesia · Mar 1987
Spread of epidural analgesia following a constant pressure injection--an investigation of relationships between locus of injection, epidural pressure and spread of analgesia.
(1) The spread of epidural analgesia following injection of 15 ml of 2% mepivacaine was 17.3 +/- 0.6, 14.3 +/- 0.4, and 13.3 +/- 0.7 spinal segments in cervical, thoracic, and lumbar epidural analgesia, respectively. The patient's age showed significant correlation with the spread of epidural analgesia in cervical (r = 0.5776, p < 0.001), thoracic (r = 0.3758, p < 0.01), and lumbar area (r = 0.8195, p < 0.001). ⋯ The lower epidural pressure associated with higher age, the wider spread of analgesia. There was no significant correlation between the residual pressure at 60 seconds and the age or the spread of analgesia.
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Clin. Orthop. Relat. Res. · Feb 1987
Patient-controlled analgesia in the total joint arthroplasty patient.
In a prospective study of 30 total hip or knee joint arthroplasty patients, the use of the patient-controlled analgesia (PCA) pump was evaluated for patient acceptance and relief of pain. In 30 patients, (average age, 72.5 years) excellent analgesia was obtained with the PCA machine without the side effects of conventional intramuscular dosing. PCA was enthusiastically received by nurses, physicians, and patients, and it has become the method of choice in the author's hospital.
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Extracellular and intracellular recordings were made from within the dorsal horn of 10 anaesthetised and gallamine triethiodide-paralysed cats. Inhibition of background and residual noxious-evoked discharge by cooling and warming was demonstrated in 7 out of 33 nociceptor-driven dorsal horn neurones. Five units were inhibited by warming of the noxious mechanical excitatory receptive field. ⋯ Cooling (32-20 degrees C) excited two units; warming (32-43 degrees C) also excited two units. Heating above 43 degrees C excited 8 units; cold below 20 degrees C excited 3 units. The units inhibited by thermal stimulation may provide some neuronal basis for thermal analgesia.