Articles: analgesia.
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The 3 in 1 block provides effective analgesia for the greater part of the lower limb. The technique is simple, it requires no special positioning and because of the favorable anatomical situation of the femoral nerve it has a particularly low complication rate. The prompt administration in the acute situation considerably reduces the symptoms and consequences of traumatic shock. ⋯ The 3 in 1 block enables almost painfree positioning of the side for the performance of spinal and epidural anaesthesia. Finally the 3 in 1 block can be a most potent method of analgesia in postoperative pain. With its minimal effects on vasomotor tone and bladder function the 3 in 1 block is in many cases preferable to continuous blockade via an epidural catheter.
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Comparative Study
Postoperative analgesia for day-case herniorrhaphy patients. A comparison of cryoanalgesia, paravertebral blockade and oral analgesia.
Patients were admitted as day-cases for inguinal herniorrhaphy under epidural anaesthesia and chlormethiazole sedation. The patients were given oral analgesia, and in addition, some were given either a paravertebral block with a dextran/bupivacaine mixture or cryoanalgesia of the ilio-inguinal nerve for postoperative pain relief. These anaesthetic and analgesic techniques are discussed in relation to day-case herniorrhaphy.
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The effects of intrathecally administered opiates (morphine sulfate and meperidine), alpha-adrenergic agonists (clonidine and ST-91) and baclofen were examined on the shock titration threshold of macaque monkeys chronically prepared with intrathecal (I) or epidural (E) catheters. Spinal opiates produced a long-lasting analgesia which was antagonized by naloxone. The order of potency was I morphine greater than I meperidine greater than E meperidine greater than E morphine. ⋯ Baclofen, in contrast, produced a dose-dependent decrease in muscle strength. That the intrathecal drugs did not produce anesthesia was demonstrated by their failure to block the avoidance response to ensuing ear shock cued by a light tactile stimulus applied to the hind paw. These results clearly indicate that a powerful analgesia can be produced by selectively activating adrenergic, opiate, and baclofenergic receptor systems in the spinal cord.
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One hundred patients undergoing thoracotomy had their intercostal nerves blocked by cryoanalgesia before closure and the effect of this on their postoperative pain was evaluated. Of the 100 patients, 79 were free of pain, 12 had some discomfort, and nine reported severe pain necessitating narcotic analgesia (mean 1.5 injections per patient). ⋯ Overall, lack of pain and greater alertness much enhanced the value of physiotherapy, which resulted in a low incidence of complications and a smooth recovery. The technique of cryoanalgesia is simple, extremely effective, and apparently offers benefits not conferred by other methods of preventing pain after thoracotomy.