Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2002
Meta Analysis Comparative StudyIntrathecal opioids versus epidural local anesthetics for labor analgesia: a meta-analysis.
Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. ⋯ Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery.
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Comparative Study Clinical TrialEpidural infusions for labor analgesia: a comparison of 0.2% ropivacaine, 0.1% ropivacaine, and 0.1% ropivacaine with fentanyl.
Epidural infusion of 0.2% ropivacaine is recommended by the manufacturer for labor analgesia, but lower concentrations may be effective. The objective of this study was to compare 0.1% ropivacaine with 0.2% ropivacaine and to examine the effect of addition of fentanyl. ⋯ We conclude that epidural infusion of 0.1% ropivacaine alone at 10 mL/h provided adequate analgesia in the first stage of labor, and that the addition of 2 microg/mL fentanyl to that concentration improved analgesia to a quality similar to 0.2% ropivacaine alone.
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Clinical TrialMultimodal analgesia and intravenous nutrition preserves total body protein following major upper gastrointestinal surgery.
This study examined whether perioperative multimodal analgesia (MMA) improves the effectiveness of intravenous nutrition (IVN) as a means of preventing protein wasting following major upper abdominal surgery (UAS). The MMA regimen utilized combined epidural opioid/local anesthetic and the systemic nonsteroidal anti-inflammatory drug (NSAID) ketorolac for 48 hours. ⋯ In conclusion, we have shown that the combination of MMA and IVN prevents protein loss and improves pain control after major UAS. Our results suggest that after UAS, MMA significantly reduced pain and, in combination with IVN, preserves total body protein and fat. This is the first direct evidence of such effects associated with a commonly used multimodal regimen.
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Reg Anesth Pain Med · Jan 2002
Randomized Controlled Trial Clinical TrialHypnosis increases heat detection and heat pain thresholds in healthy volunteers.
Hypnosis has been reported to induce analgesia and to facilitate anesthesia. To date, hypnotic-induced analgesia has had little explanation and it has even been questioned. The current study was thus designed to investigate the effect of hypnotic suggestion on thermal-detection thresholds, heat pain, and heat-pain tolerance thresholds. ⋯ These results indicate that hypnosis may partly impair the detection of A delta and C fibers stimulation, potentially explaining its analgesic effect.
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Reg Anesth Pain Med · Jan 2002
Case ReportsIntrathecal baclofen: a useful agent in the treatment of well-established complex regional pain syndrome.
We present 2 case reports that illustrate that chronic intrathecal (IT) baclofen administration may be efficacious in treating patients with long-standing complex regional pain syndrome, type I (CRPS I) who have failed treatment with multiple drugs and procedures. ⋯ IT baclofen appears to be an option for patients with intractable CRPS who have failed other modalities, including IT morphine.