Articles: postoperative-pain.
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Epidural morphine was evaluated for the control of postoperative pain after cesarean section (CS). Sixty-five patients undergoing elective CS with epidural bupivacaine were studied. Of these, 40 were given a single dose of 4 mg of morphine through an epidural catheter on termination of surgery. ⋯ The epidural morphine was associated with a prolonged period of postoperative analgesia and a greatly reduced total papaveretum requirement for the 48 h (30.9 mg for the study group in contrast to 67.6 mg for the controls). The difference between the two groups was significant (P less than 0.001). We concluded that epidural morphine is an efficient method for the control of postoperative pain following CS, a single dose of 4 mg providing relief from pain for 8 to 12 h and sometimes longer.
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Acta Anaesthesiol Scand · Apr 1981
Randomized Controlled Trial Comparative Study Clinical TrialEpidural morphine for postoperative pain relief.
Thirty-three patients were randomly assigned to two groups to study the analgesic potency, duration of action and side effects of epidural and intramuscular morphine after hip surgery. Two milligrams of preservative-free morphine chloride in 10 ml of normal saline in the epidural space was compared to 10 mg of intramuscularly administered morphine. There was a more rapid onset of action after intramuscular morphine. ⋯ Nausea and/or vomiting was less common after epidural morphine (20% versus 55%). Pruritus or respiratory depression which have been reported previously were not encountered. However, it is recommended that preservative-free solution are used to avoid itching and that the patients are monitored, as respiratory depression may occur long after administration of epidural opiate.
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Int J Clin Pharmacol Ther Toxicol · Apr 1981
Randomized Controlled Trial Clinical TrialPropiram and codeine in episiotomy pain.
To evaluate relative efficacy, safety, and time course of analgesia, propiram fumarate (50 and 100 mg), a new narcotic agonist-antagonist, was compared with codeine sulfate (60 mg) and placebo in a clinical trial with a single peroral dose, parallel, stratified, randomized, and double-blind design involving 80 hospitalized postpartum women with medium or severe episiotomy pain. Using verbal subjective reports as index of response, patients rated pain intensity and side effects at periodic interviews for 6 h. Relative efficacy findings based on peak effects and summed pain-intensity differences suggested dose-dependent analgesia with propiram and also that 60 mg codeine lay between 50 mg propiram and placebo. ⋯ All three active drugs continued to act until the 5th or 6th h. Drowsiness was the only statistically significant side effect reported after propiram. These results suggest that single 50 or 100 mg doses of propiram were effective in episiotomy pain, induced stronger analgesia than 60 mg codeine, and took effect more rapidly.
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Surgery on the upper abdomen is associated with marked postoperative pulmonary dysfunction that results largely from restriction of lung expansion secondary to incisional pain. This study, utilizing three groups of patients (a control group, a sham group, and a group receiving transcutaneous electric nerve stimulation [TENS] for pain control), was designed to determine whether this modality is effective in alleviating postoperative pain. Spirometry, arterial blood gases, clinical as well as radiologic evidence of postoperative pulmonary complications, and the frequency of analgesic requests were determined. ⋯ There were a total of six postoperative pulmonary complications, all occurring in the groups not receiving TENS. Postoperative arterial Po2, vital capacity, and functional residual capacity were least depressed in the TENS group. The data suggest that TENS minimizes the tendency toward postoperative alteration in respiratory mechanics and decreases the incidence of pulmonary complications by alleviating incisional pain.
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A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. ⋯ The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.