Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of intramuscular pethidine and nalbuphine in labour.
A double-blind, between-patient comparison of intramuscular pethidine 100 mg and nalbuphine 20 mg for the relief of pain during labour in 80 patients is described. Severity of pain was assessed before and after treatment by subjective pain scores and visual analogue scales. Neither of these methods showed a significant difference between the treatments. ⋯ The mean umbilical vein/maternal vein ratio was significantly higher for nalbuphine (0.78, SEM 0.03) than for pethidine (0.61, SEM 0.02), which suggests easier placental transfer of the former. This finding was reflected in significantly lower 2-4 hour neurobehavioural scores for the infants of mothers given nalbuphine, but there was no significant difference between these scores at 24 hours. On the basis of this study, nalbuphine does not offer a substantial improvement over pethidine for pain relief in labour.
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Anesthesia and analgesia · Oct 1986
Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery.
Twenty patients scheduled for elective major abdominal surgery were matched into two groups with regard to age, sex, height, body weight, and surgical procedure. Both groups received general anesthesia plus lumbar epidural analgesia with similar loading doses of bupivacaine 0.5% (23.1 +/- 1.0 and 23.3 +/- 0.8 ml) (mean +/- SEM) followed by continuous infusion of plain bupivacaine 0.5% (8 ml/hr) plus, in one group, epidural morphine (0.5 mg/hr). Pain score on a 5-point scale and sensory analgesia (pin prick) were assessed hourly for 16 hours after skin incision. ⋯ Thus, within 10 hr after skin incision, seven patients in this group were discharged from the study, and 16 hr after incision only one patient maintained initial level of sensory analgesia. In contrast, each patient receiving bupivacaine plus morphine had stable sensory analgesia and was completely free of pain as indicated by a mean pain score of zero during the 16-hr observation period. Thus epidural morphine may improve pain relief and maintain analgesia during continuous epidural bupivacaine administration after abdominal surgery.
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Data from this laboratory on ketamine-induced analgesia and catalepsy in rats revealed that factors other than dose modified the difference in the latency of the tail flick response (TFLD), a measure of analgesia, and the duration of the loss of the righting reflex (DLRR), a measure of catalepsy. Untreated female rats showed a longer latency than males in their response to a noxious stimulus at midnight, but not at noon. Females also showed a longer loss of righting reflex response to ketamine than did males, whether at noon or midnight; the loss of righting reflex at night was augmented in both. ⋯ There was a 3-fold increase in the latency of the tail flick response and loss of righting reflex during the winter, as compared with summer, for females treated with ketamine; males showed a similar variation in the loss of righting reflex. Since analgesia is produced by both melatonin and ketamine, and since ketamine appears to share opiate receptors with an endogenous ligand, beta-endorphin, a role was sought for the pineal and melatonin in the variation of responsiveness to ketamine. Pinealectomized rats failed to show augmentation of the loss of righting reflex induced by ketamine at night and mice showed a seasonal variation in the analgesia induced by melatonin.(ABSTRACT TRUNCATED AT 250 WORDS)