Articles: analgesics.
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Randomized Controlled Trial Comparative Study Clinical Trial
Opioid and opioid-like drug effects on whole-gut transit measured by scintigraphy.
We studied the effects of several drugs on gastrointestinal transit (tramadol HCl, acetaminophen with codeine and placebo) in a randomized, double-blind, crossover study. ⋯ Tramadol and APAP/C had no effect on gastric emptying or small bowel transit. At equianalgesic doses, tramadol caused less delay in colonic transit than APAP/C for 48 hr and delay in the GC agreed with the subjective complaints of constipation on both drugs.
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Regional anesthesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of morphine with and without fentanyl for epidural analgesia after major abdominal surgery.
The study compared bolus injection of fentanyl versus morphine to supplement epidural infusion of morphine for pain relief after major abdominal surgery. ⋯ When fentanyl is added continuously to epidural morphine, the resulting higher total serum levels of opioids during prolonged treatment may increase the risk of respiratory depression. Combining the two opioids for the loading dose, however, may be valuable to shorten the onset time of analgesia.
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Randomized Controlled Trial Clinical Trial
Prophylactic use of epidural mepivacaine/morphine, systemic diclofenac, and metamizole reduces postoperative morphine consumption after major abdominal surgery.
Surgical trauma induces nociceptive sensitization leading to amplification and prolongation of postoperative pain. While preemptive analgesic treatment with numerous agents has been successful in experimental animals, results of human studies remain conflicting. The authors used a multimodal approach for preemptive analgesia before abdominal surgery: diclofenac and metamizole inhibit prostaglandin synthesis, thus influencing peripheral sensitization; epidural local anesthetics induce conduction block, epidural opioids inhibit nociceptive synaptic transmission, and metamizole induces descending inhibition. The interaction of these drugs might suppress spinal nociceptive sensitization and postoperative analgesic demand. ⋯ A significant reduction of patient controlled analgesia requirements could be achieved by our preincisional balanced analgesia regimen compared to application before wound closure. The more distinct difference between patients receiving balanced analgesia and those in the control group is based on the analgesic action of the study substances, which lasted about 14 h.
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Regional anesthesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialSpinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia.
The purpose of this investigation was to evaluate the effectiveness and side effects of combined spinal-epidural (CSE) injection of a bupiv-acaine-sufentanil-epinephrine mixture during labor as compared with epidural analgesia alone. ⋯ The CSE mixture induced long-lasting analgesia, with fast onset and without motor block or hypotension. Pruritus and headache were the major drawbacks of this technique.
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Anesthesia and analgesia · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialA multidimensional comparison of morphine and hydromorphone patient-controlled analgesia.
Although patient-controlled analgesia (PCA) pumps have been in use for more than a decade, the optimal PCA analgesic has yet to be identified. Many drugs are used; however, morphine remains the "gold standard" of opioid analgesics worldwide. The present study evaluated morphine and hydromorphone (Dilaudid) PCA with respect to analgesic efficacy, side effects, mood, and cognitive function. ⋯ A similar incidence of side effects and dose medication can be anticipated with morphine and hydromorphone. When considering cognitive effects, morphine had less adverse consequences, while hydromorphone appeared to result in improved mood. We conclude that hydromorphone may provide a suitable alternative to morphine.