Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Nerve stimulator-guided occipital nerve blockade for postdural puncture headache.
Postdural puncture headache (PDPH) is one of the most common complications of spinal anesthesia, where adequate hydration with bed rest in the horizontal position is the initial recommendation. Epidural blood patch is to date the most effective treatment, but it is an invasive procedure that may result in serious complications. The aim of the current study was to conduct a prospective, randomized, single-blinded comparison between bilateral occipital blockade and conventional expectant therapy in adults suffering from PDPH. ⋯ Visual analog scales were significantly lower in the block group (P < 0.01), and the block group consumed significantly less analgesics in the follow-up period (P < 0.05) compared with control group. Block patients had significantly shorter hospital stays and sick leave periods (P < 0.001). The studied method is superior to expectant conservative therapy in the treatment of patients suffering from PDPH.
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Randomized Controlled Trial
Intermittent wound perfusion for postoperative pain relief following upper abdominal surgery: a surgeon's perspective.
Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. ⋯ Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.
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Randomized Controlled Trial Comparative Study
The efficacy of levobupivacaine, ropivacaine, and bupivacaine for combined psoas compartment-sciatic nerve block in patients undergoing total hip arthroplasty.
The aim of our study was to compare postoperative analgesic efficacy, and the extent of sensory and motor blockade of levobupivacaine, ropivacaine, and bupivacaine administered in a combined psoas compartment-sciatic nerve block (PCSNB) for total hip arthroplasty. ⋯ Levobupivacaine, bupivacaine and ropivacaine are equally effective for PCSNB in patients undergoing total hip arthroplasty. Residual pain may be due to the lack of sensory block in dermatome L1, suggesting that modification of this technique should be considered for this type of surgery.
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Randomized Controlled Trial Comparative Study
A randomized double-blind comparison of a morphine-fentanyl combination vs. morphine alone for patient-controlled analgesia following bowel surgery.
An ideal patient-controlled analgesia (PCA) opioid would have both a rapid onset and a long duration of action, attributes, which are not available in currently existing opioids including morphine, the most widely used agent. A mixture of rapid onset and long-acting opioids may potentially achieve both these qualities. In a randomized, double-blind study, we compared a fentanyl-morphine combination with morphine alone for PCA, in 54 patients undergoing bowel surgery. ⋯ Groups were well matched for age, weight, and sex. There were no significant differences between groups in time to effect, PCA usage, pain scores or side effects other than the occurrence of nausea, which was lower for the combination group in 1 visit. Further studies are needed to explore the potential of different potency ratios and opioid combinations to achieve rapid and long-lasting pain control.
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Randomized Controlled Trial
Improved cancer pain treatment using combined fentanyl-TTS and tramadol.
The aim of the study was to facilitate dose escalation of strong opioids. In this randomized open-label study the influence of tramadol on dose adjustment of transdermal fentanyl in advanced cancer pain control was prospectively evaluated. Seventy patients affected by intractable cancer disease with visual analog scale (VAS) score >3 were enrolled. ⋯ The combination of a strong opioid with a weak opioid to treat severe cancer pain allowed a more gradual increase of analgesic delivery than was possible using fentanyl-TTS alone, minimizing periods of under- and overdosing. In addition, it considerably slowed the pace of fentanyl dose escalation. In conclusion, this TTS fentanyl-tramadol analgesic protocol provides a useful alternative to the usual treatment of cancer pain with fentanyl-TTS alone, especially in case of quick progression of disease and pain.