Anesthesia and analgesia
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Anesthesia and analgesia · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia with intramuscular morphine at fixed rate versus epidural morphine or sufentanil and bupivacaine in patients undergoing major abdominal surgery.
We assessed the efficacy and side effects of postoperative analgesia with three different pain regimens in 90 patients undergoing major abdominal surgery. The patients were randomly assigned to one of three groups: epidural morphine (EM) or sufentanil (ES), both combined with bupivacaine, or IM morphine (IM) at fixed intervals. Before incision, patients in the epidural groups received sufentanil or morphine in bupivacaine via a thoracic catheter, followed by a continuous infusion 1 h later. General anesthesia consisted of N2O/O2 and isoflurane for all groups. Patients in all groups received IV sufentanil as part of their anesthetic management. Patients in the IM group received IV sufentanil 1 microg/kg before incision, and patients in all groups received sufentanil 10 microg for inadequate analgesia. Postoperatively, the epidural or IM treatment was continued for > or =5 days. Postoperative analgesia at rest and during coughing and movement was significantly better in the epidural groups than in the IM group during the 5 consecutive days. There were no significant differences between the epidural groups. The incidence of most side effects was similar in all groups. We conclude that epidural analgesia provided better pain relief than IM analgesia, even if the latter was optimized by fixed-dose administration at fixed intervals and included adjustments on demand. Epidural sufentanil and morphine, both combined with bupivacaine, seemed to be equally effective with similar side effects. ⋯ Postoperative analgesia with epidural sufentanil or morphine and bupivacaine after major abdominal surgery seemed to be better than the conventional method of IM morphine treatment, despite optimal administration, i.e., fixed doses at fixed intervals with regular adjustments. Analgesic efficacy and side effects of epidural sufentanil and morphine were similar.
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Anesthesia and analgesia · Dec 1998
Randomized Controlled Trial Clinical TrialIntrathecal bupivacaine reduces pruritus and prolongs duration of fentanyl analgesia during labor: a prospective, randomized controlled trial.
Pruritus is a frequent complication (40%-100%) of intrathecal (IT) fentanyl 25 microg (F) for labor analgesia. The addition of IT bupivacaine 2.5 mg (B) to F has been reported in a nonrandomized series to have a 17.3% incidence of pruritus. This study prospectively evaluated the incidence and distribution of pruritus in laboring parturients receiving IT F + B. Sixty-five laboring parturients were randomly assigned to receive IT F, B, or F + B as part of a combined spinal-epidural technique. Visual analog scores, sensory level, motor strength, and pruritus were recorded before injection and at intervals thereafter. When present, the distribution of pruritus was evaluated. The duration of analgesia was determined as the time from IT drug administration until the patient requested supplemental analgesia. The median duration of analgesia in the F, B, and F + B groups was 62.5, 55.0, and 94.5 min, respectively. Compared with F alone, the combination of F + B led to a decreased frequency of pruritus (36.4% vs 95%). The incidence of facial pruritus (25%) was same in the F + B and F groups; however, the occurrence of pruritus distributed over the rest of the body was significantly more frequent in the F compared with the F + B group. The combination of F + B prolongs the duration of labor analgesia compared with IT F or B alone. F + B also leads to a decreased incidence of pruritus, except in the facial region. ⋯ When administered intrathecally with fentanyl 25 microg in laboring parturients, bupivacaine 2.5 mg attenuates the frequency of pruritus on all parts of the body except the face. This combination also results in a rapid onset and prolonged duration of labor analgesia compared with either drug alone.