Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2006
Randomized Controlled TrialPostoperative analgesia and recovery course after major colorectal surgery in elderly patients: a randomized comparison between intrathecal morphine and intravenous PCA morphine.
Intrathecal morphine is a widely used method for postoperative pain relief after major abdominal surgery. The aim of this randomized, double-blinded study was to compare intrathecal morphine and intravenous PCA morphine for postoperative analgesia and recovery course after major colorectal surgery in elderly patients. ⋯ Intrathecal morphine, as compared with intravenous PCA morphine alone, improves immediate postoperative pain and reduces parenteral morphine consumption but does not improve postoperative recovery in elderly patients after major colorectal surgery.
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Reg Anesth Pain Med · Nov 2006
Randomized Controlled TrialIntra-articular morphine 5 mg after knee arthroscopy does not produce significant pain relief when administered to patients with moderate to severe pain via an intra-articular catheter.
Intra-articular (IA) morphine for postoperative analgesia after knee arthroscopy is controversial. The IA catheter technique for test drug administration allows baseline pain assessment before inclusion. Results from one such randomized controlled trial (RCT) in patients with moderate to severe pain have shown equal effects of IA saline with or without morphine 2 mg. However, the IA catheter technique may have an unintended placebo effect. The aims of this placebo-controlled RCT were (1) to compare the analgesic effect of IA saline 1 mL (placebo) with morphine 5 mg given through an IA catheter and (2) to analyze the impact on pain of immediate or delayed removal of the IA catheter. ⋯ IA morphine 5 mg does not produce clinically significant pain relief in patients with moderate or severe pain after knee arthroscopy.
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Reg Anesth Pain Med · Nov 2006
Randomized Controlled Trial Multicenter StudyFentanyl iontophoretic transdermal system for acute-pain management after orthopedic surgery: a comparative study with morphine intravenous patient-controlled analgesia.
The fentanyl HCl iontophoretic transdermal system (ITS) has been demonstrated in clinical trials to be safe and effective for acute-pain management after several types of major surgery. The current study compared the efficacy, safety, and convenience of fentanyl ITS with morphine intravenous patient-controlled analgesia (IV PCA) for acute-pain management after unilateral total-hip replacement (THR). ⋯ Results of this study demonstrate fentanyl ITS and a standard regimen of morphine IV PCA were comparable methods of pain control for management of acute postoperative pain after THR, on the basis of the PGA success ratings and pain intensity in the first 24 hours of treatment.
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Reg Anesth Pain Med · Nov 2006
Randomized Controlled TrialA comparison of injection at the ulnar and the radial nerve in axillary block using triple stimulation.
A triple-stimulation technique for axillary block consists of the localization and injection of 2 nerves, median and musculocutaneous, which lie superior to the axillary artery, and of 1 nerve, the radial, which lies inferior. However, in some patients, the ulnar nerve is located first during the search for the radial nerve. The aim of this study was to verify if an ulnar motor response could be considered a satisfactory endpoint as a radial motor response. ⋯ Local anesthetic injection at the ulnar nerve significantly reduces the efficacy and prolongs the onset time of the radial-nerve block when triple-stimulation axillary block is performed.
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Reg Anesth Pain Med · Nov 2006
Randomized Controlled TrialEffects of intrathecal midazolam on postoperative analgesia when added to a bupivacaine-clonidine mixture.
Previous clinical and experimental studies have shown that a midazolam-clonidine mixture has a synergistic antinociceptive effect. This study evaluated the postoperative analgesic effect of adding midazolam to an intrathecal bupivacaine-clonidine mixture. ⋯ Addition of midazolam to an intrathecal B-C mixture does not potentiate postoperative analgesia but prolongs the motor blockade.