Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2007
Randomized Controlled TrialTransdermal scopolamine for prevention of intrathecal morphine-induced nausea and vomiting after cesarean delivery.
Intrathecal morphine for cesarean delivery provides excellent postoperative analgesia but is associated with significant nausea and vomiting. ⋯ Scopolamine is an effective medication for prophylactic use in parturients receiving intrathecal morphine while undergoing cesarean delivery. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.
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Anesthesia and analgesia · Sep 2007
ReviewThe effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review.
The effect of postoperative analgesia on patient-reported outcomes, such as quality of life, quality of recovery, and patient satisfaction, has not been systematically examined. These outcomes are assessed from the patient's perspective and are recognized as valid and important end-points in clinical medicine and research. We performed a systematic review to examine the effect of postoperative analgesia on patient-reported outcomes. ⋯ Although there are data suggesting that improved postoperative analgesia leads to better patient outcomes, there is insufficient evidence to support subsequent improvements inpatient-centered outcomes such as quality of life and quality of recovery. Modest reductions in pain scores do not necessarily equate to clinically meaningful improved pain relief for the patient. Further studies are needed to develop validated patient-reported instruments and to assess the effect of analgesic techniques on patient-reported outcomes in the perioperative period.
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Anesthesia and analgesia · Sep 2007
Randomized Controlled Trial Comparative StudyLocal anesthetics and mode of delivery: bupivacaine versus ropivacaine versus levobupivacaine.
The influence of the labor epidural local anesthetic (LA) on mode of delivery has not been adequately studied. In this study, we sought to determine if there is a difference in mode of delivery among parturients who receive epidural bupivacaine, ropivacaine, or levobupivacaine. ⋯ Bupivacaine, ropivacaine, and levobupivacaine all confer adequate labor epidural analgesia, with no significant influence on mode of delivery, duration of labor, or neonatal outcome.
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Anesthesia and analgesia · Sep 2007
The evolution of primary hyperalgesia in orthopedic surgery: quantitative sensory testing and clinical evaluation before and after total knee arthroplasty.
Quantitative sensory testing (QST) allows precise characterization of sensory deficits and painful symptoms and may offer additional information on the pathophysiology of postoperative pain. ⋯ Heat hyperalgesia was the predominant QST symptom associated with perioperative pain after total knee arthroplasty, and was predictive of postoperative morphine consumption.
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Anesthesia and analgesia · Sep 2007
Comparative StudyAntithrombin levels, morbidity, and mortality in a surgical intensive care unit.
Antithrombin (AT) levels have been suggested as being predictive of outcome in intensive care unit (ICU) patients with septic shock. We investigated the time course of AT levels in a surgical ICU and tested the hypothesis that AT levels may be associated with morbidity and increased mortality rates in a cohort of surgical ICU patients. ⋯ AT levels are low on admission to the ICU, regardless of the presence of sepsis. Although associated with the degree of organ dysfunction and the severity of sepsis, AT levels were not independently associated with worse outcome in this group of surgical ICU patients.