Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1988
Fentanyl blood concentration-analgesic response relationship in the treatment of postoperative pain.
The inter- and intrasubject variability in blood concentration-analgesic response relationship for fentanyl were investigated using the technique of patient-controlled analgesia (PCA) in 30 consenting patients scheduled for surgical procedures involving an abdominal incision (15 upper and 15 lower abdominal incisions). All patients had a thiopental, nitrous oxide/oxygen, pancuronium anesthetic with 200 microgram fentanyl intraoperatively. Postoperative pain relief was provided with fentanyl from a Janssen On-Demand Analgesic Computer (ODAC) set to provide a basal infusion rate of 20 microgram/hr, a bolus "demand" dose of 20 microgram, and a lockout period of 5 minutes. ⋯ The mean (+/- SD) hourly fentanyl dose rate and total cumulative dose were 55.8 +/- 22 microgram/hr (range 28.8 to 136 microgram/hr) and 2739 +/- 1191 microgram (range 900 to 6260 microgram), respectively. The mean (+/- SD) MEC was 0.63 +/- 0.25 ng/ml (five-fold range from 0.23 to 1.18) and the mean intrapatient coefficient of variation in MEC was 30.2% (range 16 to 46%). The MEC values remained relatively constant in all patients over the 48-hour study period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Hyperbaric bupivacaine 0.5% (3.0 ml) was injected intrathecally in two groups of 20 patients. Both groups of patients lay in the lateral position with their hips flexed at 90 degrees. In group F, the hip flexion was maintained for 5 minutes after turning supine. ⋯ The technique of hip flexion to reduce the lumbar lordosis did not significantly limit the height of anesthetic blockade. The distribution of height of anesthetic blockade showed marked bimodality (P less than 0.05) in both groups, in group F at T4 and T9 and in group S at T3 and T9. Cardiovascular side effects were minimal and equal in both groups.
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Anesthesia and analgesia · Mar 1988
Comparative Study Clinical Trial Controlled Clinical TrialComparison of buprenorphine with morphine in the treatment of postoperative pain in children.
The safety and efficacy of buprenorphine and morphine as postoperative analgesics for children were compared in 60 boys and girls 4 to 14 years old having elective orthopedic operations on upper or lower extremities. The drugs were given in a double-blind manner initially intravenously and thereafter by sublingual buprenorphine or intramuscular morphine administered as required to relieve pain until the third postoperative morning. ⋯ The most common side effects were nausea and vomiting (28 and 16%) and urinary retention (21 and 19%) in the buprenorphine and morphine groups, respectively. Analgesia with sublingual buprenorphine was as effective and reliable as with intramuscular morphine but a longer duration of action could not be demonstrated.
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Anesthesia and analgesia · Mar 1988
Randomized Controlled Trial Clinical TrialPostoperative effects of intrathecal morphine in coronary artery bypass surgery.
To determine whether intrathecal morphine is effective in decreasing analgesic and antihypertensive drug requirements after coronary artery bypass (CAB) surgery, a prospective, randomized, double-blind study was designed. Approximately 30 minutes before induction of anesthesia with IV sufentanil and diazepam, and 2 hours before heparinization, one group of patients (n = 16) were given morphine 0.5 mg, while the control group (n = 14) were given placebo intrathecal injections through 22- or 25-gauge lumbar puncture needles. Intraoperatively, there were no differences in the numbers of patients requiring vasodilator drugs or volatile agent titration. ⋯ There were no differences in pain scores, and the only complications (itching, nausea and vomiting) were infrequent. It is concluded that an intrathecal dose of 0.5 mg of morphine is efficacious in reducing analgesic and antihypertensive drug requirements after CAB surgery. Whether these results are clinically important enough to warrant the theoretical risks of postheparinization lumbar hematoma is a topic for further investigation.