Cahiers d'anesthésiologie
-
Cahiers d'anesthésiologie · Jan 1993
Review[The use of patient-controlled analgesia by the obstetrical patient].
Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. ⋯ After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.
-
Cahiers d'anesthésiologie · Jan 1993
Review[Is there an advantage to using opioid combinations by the peridural route?].
Epidural opioids provide a potent analgesia not devoided of side effects. In addition, epidural administration of lipid soluble opioids has no clear advantage over the IV route. Combination of epidural opioids with other analgesics may strengthen analgesia and may decrease the incidence of side effects because of a reduction in the amount of opioid administered. ⋯ Clonidine, which is a selective alpha-2-adrenergic agonist has been demonstrated to improve and to prolong analgesia produced by opioids in postoperative patients. Clonidine administration induces side effects, like sedation, bradycardia and hypotension, but allows to highly reduce the opioid dose. None of the combined techniques of analgesia implies that monitoring of the side effects of opioids has to be reduced.
-
Recovery period after anaesthesia, even if short in ambulatory surgery, must not be neglected. Most of serious accidents occur in recovery period but recovery assessments are not clearly defined. ⋯ Tests of upper functions also exist but are not commonly and easily used. They don't disclaim physician responsibility and increase his task appreciably.
-
Cahiers d'anesthésiologie · Jan 1993
Review[Routes of administration of opioids excluding patient-controlled analgesia].
Opioid analgesics can be administered postoperatively by different routes. Pharmacokinetic peculiarities are evoked for the perimedullar, sublingual, oral, rectal, transcutaneous and intranasal ways.
-
Cahiers d'anesthésiologie · Jan 1993
Review[The use of locoregional anesthesia in the prevention of postoperative pain].
Preemptive analgesia is a new concept suggesting that postoperative pain may be attenuated if the transmission of pain is blocked before the occurrence of noxious stimuli. The widespread use of regional anesthesia whether or not associated to general anesthesia has contributed to the improvement of postoperative pain both in ambulatory surgery and inpatients. Numerous studies have demonstrated that postoperative analgesia was better after regional anesthesia when compared to general anesthesia. ⋯ In conclusion, the participation of regional anesthesia in preventing postoperative pain remains controversial. Numerous studies are needed in the future. These studies should take into account the above criterias and should include a large number of patients in order to find first the type of surgery that could benefit and second, the preemptive analgesia treatment that should be used in such indications.