Articles: postoperative-pain.
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Randomized Controlled Trial Clinical Trial
Effect of epinephrine on intrathecal fentanyl analgesia in patients undergoing postpartum tubal ligation.
Eighty women receiving spinal anesthesia for postpartum tubal ligation were entered into a double-blind, randomized protocol studying the effects of epinephrine on intrathecal fentanyl-induced postoperative analgesia. All patients received 70 mg hyperbaric lidocaine with either 0.2 mg epinephrine (LE), 10 micrograms fentanyl (LF), epinephrine and fentanyl (LFE), or 0.4 ml saline (L). ⋯ The simultaneous administration of epinephrine and fentanyl prolonged the duration of complete analgesia (137 +/- 47 min (LFE); 76 +/- 32 min (LE); 85 +/- 44 min (LF); 65 +/- 36 min (L)) and the duration of effective analgesia (562 +/- 504 min (LFE); 227 +/- 201 min (LE); 203 +/- 178 min (LF); 198 +/- 342 min (L)). Administration of epinephrine decreased the incidence of pruritus associated with intrathecal fentanyl (1/18 (LFE); 1/21 (LE); 8/19 (LF); 2/19 (L)).
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Forty patients (ASA status I-III) recovering from major orthopedic or gynecological operations were investigated to evaluate analgesic efficacy and threshold concentrations of tramadol and its main metabolite O-demethyltramadol (M1) in serum during the early postoperative period, using patient-controlled analgesia (PCA) by means of the Abbott Lifecare Infuser. Following an individualized intravenous loading dose of 97.5 +/- 42.3 mg (mean, SD), tramadol demand doses were 20 mg with a limit of 500 mg within 4 h; the lockout time was set to 5 min. The duration of PCA was 20.5 +/- 4.8 h. ⋯ Minimum effective tramadol serum concentration (MEC) varied greatly and could be best described by a log-normal distribution (range 20.2-986.3 ng/ml, median 287.7 ng/ml). Intraindividual MEC variability was lower than intersubject variability (38.2 vs 59.1%). Median M1 concentrations were 36.2 ng/ml.
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Int J Gynaecol Obstet · Sep 1990
Comparative StudyPost-cesarean analgesia using a subcutaneous pethidine infusion.
A pethidine infusion administered subcutaneously using a syringe pump was evaluated in 118 women following cesarean section. One hundred three women (87%) were satisfied with their postoperative analgesia. The mean length of infusion was 18.8 h, and the mean total dose of pethidine was 402 mg. ⋯ There were no cases of respiratory depression. This mode of analgesia has advantages over conventional intramuscular bolus injections. It was judged acceptable to both patients and ward staff.
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This retrospective study was undertaken to assess the efficacy and safety of epidural morphine in providing analgesia following Caesarean section under epidural anaesthesia. The morphine was administered as a single bolus, following delivery, in doses ranging from 2 to 5 mg. The charts of 4880 Caesarean sections, performed on 4500 patients, were reviewed. ⋯ Herpes simplex labialis was recorded in 3.5 per cent of patients. Epidural morphine is thus confirmed as an effective analgesic technique post-Caesarean section with 3 mg being the optimal dose. Even in this young healthy patient population, clinically detectable respiratory depression occurs so clinical respiratory monitoring is indicated.