Anesthesia and analgesia
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Anesthesia and analgesia · Jan 1989
Dose-response relationships for edrophonium and neostigmine as antagonists of moderate and profound atracurium blockade.
To measure the ability of neostigmine and edrophonium to reverse moderate and profound atracurium blockade, dose-response relationships were established for these reversal agents given at 1% and 10% twitch height recovery. Eighty-five ASA I and II adult patients received atracurium, 0.4 mg/kg, during a thiopental-nitrous oxide-enflurane anesthetic. Train-of-four stimulation was applied every 12 seconds, and the force of contraction of the adductor pollicis muscle was recorded. ⋯ The ED80 for edrophonium was 0.22 +/- 0.04 mg/kg and 1.14 +/- 0.33 mg/kg, respectively. These values corresponded to neostigmine:edrophonium potency ratios of 16.6 +/- 3.5 and 35.3 +/- 8.9 at 90% and 99% blockade respectively (P less than 0.006). We conclude that the relative potency of neostigmine is greater than that of edrophonium for antagonism of profound atracurium blockade.
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Anesthesia and analgesia · Dec 1988
Comparative Study Clinical Trial Controlled Clinical TrialInfluence of bupivacaine as an adjuvant to epidural morphine for analgesia after cesarean section.
The effect of the addition of bupivacaine to epidural morphine (EM) on postoperative analgesia was evaluated in 150 patients after cesarean section performed under epidural anesthesia with carbonated lidocaine. Fifty patients received 3 mg EM without bupivacaine, 50 received 3 mg EM with 0.125% bupivacaine, 25 received 5 mg EM without bupivacaine, and 25 patients received 5 mg EM with 0.125% bupivacaine. ⋯ The addition of bupivacaine did not affect the quality or duration of analgesia afforded by EM and did not influence the incidence or severity of side effects. Furthermore, there was no statistically significant difference in the analgesia obtained by patients receiving 3- and 5-mg doses of EM with or without bupivacaine.
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Anesthesia and analgesia · Dec 1988
Epidural morphine delivered by a percutaneous epidural catheter for outpatient treatment of cancer pain.
Twenty-three outpatients with cancer pain refractory to other methods of pain control were treated with epidural morphine (EM) delivered through a chronically placed percutaneous lumbar epidural catheter. Patients and their families were taught to administer EM at home. ⋯ There were no catheter-related infections or cases of respiratory depression. After 2500 patient treatment days, we have found this method to be a safe and effective method of cancer pain management in outpatients.
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Anesthesia and analgesia · Nov 1988
Clinical Trial Controlled Clinical TrialA dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects.
We performed a double-blind study of the dose-response relationship of intrathecal morphine (0, 0.3, 1, and 2.5 mg) for postoperative pain relief in 33 subjects who underwent total knee or hip replacement surgery. Assessments commenced 1 hour after the opioid injection, which was given at the end of surgery, and continued for 24 hours. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. ⋯ Pruritus was unique to intrathecal morphine administration, but nausea, vomiting, and urinary retention were common in all the groups. We conclude that no ideal dose of intrathecal morphine exists because, even with small quantities, minor adverse effects are evident. Doses between 0.3 and 1 mg, however, should provide good analgesia free from the major complication, respiratory depression.