Articles: analgesia.
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Reg Anesth Pain Med · May 2000
Randomized Controlled Trial Clinical TrialPatient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.
Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period. ⋯ Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.
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Anesthesia and analgesia · May 2000
Randomized Controlled Trial Comparative Study Clinical TrialDoes the addition of fentanyl to bupivacaine in caudal epidural block have an effect on the plasma level of catecholamines in children?
We evaluated the effect of adding fentanyl to bupivacaine, compared with bupivacaine alone, on the stress response. The effect was evaluated by determining blood levels of epinephrine (E) and norepinephrine (NE) in pediatric patients receiving caudal epidural blocks. Sixty children, 1-8 yr of age, scheduled for elective herniorrhaphy, were randomly allocated to two groups of 30 patients each. ⋯ There were no significant differences in the E and NE plasma levels between the two groups at H(0), H(1), and H(2) (P = 0.5, P = 0.12, P = 0.5, respectively). Pain scores (modified Children's Hospital of Eastern Ontario Pain Score) were also similar in both groups (P = 0. 19). This study suggests that adding fentanyl 1 microg/kg to bupivacaine in the caudal epidural block in children does not influence plasma levels of E and NE, nor does it improve the analgesic intensity of the caudal block.
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Physiology & behavior · May 2000
Randomized Controlled Trial Clinical TrialEffects of hypnosis on diffuse noxious inhibitory controls.
The neurophysiological mechanisms of hypnotic analgesia are still under debate. It is known that pain occurring in one part of the body (counterstimulation) decreases pain in the rest of the body by activating the diffuse noxious inhibitory controls (DNICs). The aim of this study was to explore the effects of hypnosis on both pain perception and heterotopic nociceptive stimulation. ⋯ Both hypnosis and DNICs were able to modify the perception of pain. It seems likely that DNICs and hypnosis use the same descending inhibitory pathways for the control of pain. The susceptibility of the subject is a critical factor in hypnotically induced analgesia.
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Rev Esp Anestesiol Reanim · May 2000
Review[Combined subarachnoid-epidural technique for obstetric analgesia].
Combined spinal-epidural blockade for labor pain has enjoyed increasing popularity in obstetric anesthesia. The usual procedure is to use a single space and a single needle for dural puncture, inserting a spinal needle through an epidural needle followed by insertion of a catheter. A small dose of one or several substances (usually a lipophilic opioid and a local anesthetic) is first injected in the intrathecal space to provide rapid, effective analgesia with minimal muscle blockade. ⋯ The most widely-recognized advantage of the technique is high maternal satisfaction with rapid and effective analgesia. Mobility of the lower extremities is preserved and the mother is often able to walk. Because opioids are injected into the intrathecal space and because the technique is more invasive than standard epidural analgesia, the potential risk to mother and fetus increases.
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A large, retrospective chart review was conducted to analyze the length of stage II labor and instrumental and cesarean-section delivery rates in nulliparous women who received either 0.0625% bupivacaine with 2 mu/mL fentanyl or 0.125% bupivacaine with 2 mu/mL fentanyl. Data collected included length of stage II labor, incidence of operative or instrumental delivery rates, concentration of bupivacaine used, and demographic data. Demographics obtained included maternal age, weight, and height, as well as neonatal gestational age, weight, and Apgar scores. ⋯ Cesarean delivery rate was 17% in the 0.125% bupivacaine group versus a 21% ratio in the 0.0625% bupivacaine group. Duration of stage II labor was noted to be prolonged in the 0.125% bupivacaine group but was not statistically significant. Based on this data, it can be concluded that the use of 0.125% bupivacaine with 2 mu/mL fentanyl does not cause a statistically significant increase in instrumental or cesarean delivery rates, nor does it have a detrimental effect on length of stage II labor.