International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1994
Pain relief after caesarean section: comparison of different techniques of morphine administration.
We have studied postoperative pain relief after different techniques of morphine administration given in addition to bupivacaine 15 mg during spinal anaesthesia for caesarean section. In group A, morphine was given both intravenously (10 mg) and orally (30 mg slow release MST) at the end of surgery and continued orally at 8-hourly intervals for 24 h. ⋯ Pruritus was, on the other hand, observed in 48% of patients of group B compared to 7% of the patients of group A. This study suggests that adding 80 microg of morphine to the local anaesthetic used in spinal anaesthesia for caesarean section is a simple procedure that gives excellent results in term of reliability, duration of analgesia and safety.
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Int J Obstet Anesth · Oct 1994
Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia.
Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.
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Int J Obstet Anesth · Oct 1994
Abruptio placentae and disseminated intravascular coagulation: use of thrombelastography and sonoclot analysis.
We report a case in which thrombelastography (TEG) and Sonoclot analysis were used for diagnosis and treatment decisions in a patient with abruptio placentae and disseminated intravascular coagulation. In addition to providing enough information for evaluation and treatment of this patient, the TEG and Sonoclot results were obtained more quickly, with smaller blood samples and with less expense to the patient in comparison to the standard coagulation tests in our institution. Although the TEG and Sonoclot results were assessed independently of the other test and each provided similar information in this case, the TEG may be the preferred tool in evaluating coagulopathies, based on computerization and strong literature support.
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Int J Obstet Anesth · Oct 1994
Parturients' assessment of water blocks, pethidine, nitrous oxide, paracervical and epidural blocks in labour.
This prospective study evaluated the extent to which the analgesic procedures available resulted in efficient pain relief in 833 Finnish parturients. Their pain ratings were recorded according to their own assessment of pain intensity during labour before and after pain management and according to their total pain experience recalled on the third day after delivery. Only regional blocks significantly diminished pain scores during labour and a striking decrease in pain level (P < 0.0001) was maintained until the second stage by epidural analgesia (EDA) alone. ⋯ After delivery 60% of parturients in this group recalled labour pain as being very severe or intolerable. This was partly due to delays in receiving epidural blockade and partly due to the parturient's reticence in requesting analgesia. Pain relief was rated as excellent or good by 94% of the EDA group but by only 50% of the remaining patients.