Articles: opioid-analgesics.
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The Journal of pediatrics · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia for mucositis pain in children: a three-period crossover study comparing morphine and hydromorphone.
(1) To test the safety and efficacy of a clinical protocol for administering opioid by using patient-controlled analgesia (PCA) for the management of mucositis pain in children after bone marrow transplantation, (2) to compare the efficacy, side-effect profile, and potency ratio of morphine with those of hydromorphone by using PCA as the method of opioid administration, and (3) to obtain pharmacokinetic data on hydromorphone and morphine in this population of children. ⋯ The safety and efficacy of a clinical protocol for the administration of opioids by means of PCA for mucositis pain after bone marrow transplantation was demonstrated. In this small study, hydromorphone was not superior to morphine in terms of analgesia or the side-effect profile: a larger study would be needed to show a difference. The clearances of hydromorphone and morphine in the children studied were generally greater than those previously recorded, but this finding may be related to disease or treatment variables. Apart from clearance, the morphine pharmacokinetics in the study population were similar to those previously recorded. Hydromorphone may be less potent in this population of children than indicated by adult equipotency tables.
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Randomized Controlled Trial Clinical Trial
High dose alfentanil pre-empts pain after abdominal hysterectomy.
This study tested the hypothesis that high dose systemic alfentanil administered before and during abdominal hysterectomy would pre-empt post-operative pain to a greater extent than administration of either low dose alfentanil or no alfentanil perioperatively. Patients (ASA 1 or 2) were randomly assigned to group 1 (n = 15), no opioid; group 2 (n = 15), low dose alfentanil; or group 3 (n = 15), high dose alfentanil. Anaesthesia was induced in group 1 with midazolam and thiopentone and was maintained with isoflurane and 70% N2O in O2. ⋯ A 6-month follow-up did not reveal any significant differences among the three groups. It is concluded that intra-operative high dose alfentanil anaesthetic pre-empts post-operative pain after abdominal hysterectomy, but the effects are small and of short duration. Surgical procedures carried out under general anaesthesia using standard (and even high) doses of opioids intraoperatively provide suboptimal protection from the injury barrage brought about by incision and subsequent noxious surgical events.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of opioid solutions for patient-controlled epidural analgesia.
Sixty patients took part in a randomised, double-blind study to compare the analgesic and side effects of three opioid-containing solutions for patient-controlled epidural analgesia following abdominal surgery. Patients in group 1 received a solution containing bupivacaine 0.125% with fentanyl 10 micrograms.ml-1, group 2 bupivacaine 0.125% with diamorphine 125 micrograms.ml-1, group 3 pethidine 2.5 mg.ml-1. ⋯ Motor block was significantly higher in group 2 (p < 0.004) and pruritus occurred significantly less in group 3 (p < 0.05). We conclude that these three solutions produce equivalent analgesia but that pethidine 2.5 mg.ml-1 may be associated with fewer side effects.
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Randomized Controlled Trial Clinical Trial
Potentiation of sufentanil by clonidine in PCEA with or without basal infusion.
Sufentanil or a sufentanil-clonidine combination was evaluated to determine whether the basal rate in patient-controlled epidural analgesia (PCEA) might affect the daily consumption, quality of analgesia or incidence of side effects. Following Caesarean section delivery, 60 patients were randomly assigned to receive one of the four following PCA regimens (15 patients per group) for the relief of post-operative pain by the epidural route: sufentanil 2 micrograms mL-1 in 0.9% NaCl, demand dose 5 micrograms i.e. 2.5 mL, (group S+ with, group S without an infusion at 2.5 mL hr-1) or sufentanil 2 micrograms mL-1 + clonidine 3 micrograms mL-1, demand dose 5 micrograms sufentanil + 7.5 micrograms clonidine i.e. 2.5 mL (group SC+ with and SC without an infusion of 2.5 ml hr-1). The other PCA settings (Bard I PCA pump) were a lock out of interval of 10 min and a 1 h limit of 20 micrograms sufentanil and 30 micrograms clonidine i.e. 10 mL. ⋯ Patients treated with the mixture tended to reach lower pain scores than those receiving sufentanil only without basal rate. Patients receiving the mixture with basal rate requested significantly fewer additional demands compared with the three other groups, but this did not influence the quality of sleep. Since side effects were more frequently registered in the patients in this group, it was concluded that the optimum regimen was the sufentanil-clonidine combination but with deletion of the basal rate.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of caudal bupivacaine and diamorphine with caudal bupivacaine alone for repair of hypospadias.
Forty-five boys undergoing repair of hypospadias were allocated randomly to one of two groups. After induction of anaesthesia, 22 patients received 0.25% caudal bupivacaine 0.5 ml kg-1 and diamorphine 30 micrograms kg-1 and the remaining 23 patients received 0.25% caudal bupivacaine 0.5 ml kg-1 alone. ⋯ There was a statistically significant reduction in early pain scores. There was also a statistically significant increase in the time to first passage of urine in those boys in the diamorphine group who were not catheterized during operation.