Articles: analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of patient-controlled analgesia (PCA) with tramadol or morphine.
To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system. ⋯ Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.
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In the obstetric setting, spinal and epidural analgesia/anesthesia are the 2 most frequently used forms of analgesia and anesthesia. One of the potential complications of these procedures is the postdural puncture headache (PDPH), and there is a high probability that the anesthetist will have occasion to evaluate the headache complaints of the parturient. The author reviews the differential process and discusses some of the causes and treatments of headaches in the parturient.
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Ann Acad Med Singap · Nov 1999
Comparative Study Clinical Trial Controlled Clinical TrialUse of EMLA cream or alfentanil for analgesia during ophthalmic nerve blocks.
This prospective double-blind study compared the effectiveness of EMLA with alfentanil and placebo in reducing the overall pain during ophthalmic nerve blocks. Seventy-five patients scheduled for cataract surgery were divided into three groups. ⋯ Patients then received facial nerve blocks and retrobulbar block by the same surgeon. Pain scores by patients and independent observers were significantly lower in the EMLA and alfentanil groups compared to placebo (P < 0.005) with no significant difference between the EMLA and alfentanil groups.
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Fetal. Diagn. Ther. · Nov 1999
Randomized Controlled Trial Comparative Study Clinical TrialInitiating extradural analgesia during labour: comparison of three different bupivacaine concentrations used as the loading dose.
Potential effects of extradural analgesia on the progress of labour and obstetric outcome are still a matter of concern and the focus of ongoing debates. Despite this, little attention is paid to the initiation of extradural labour analgesia. The objective of this prospective, randomized, double-blind trial was to identify the optimal of three concentrations of bupivacaine used as a loading bolus for initiating extradural analgesia during labour. ⋯ Of the three concentrations used in this clinical setting, 0.125% was the most suitable concentration of plain bupivacaine to initiate extradural analgesia in labour. Using 0.25% bupivacaine increased the incidence of motor block, whereas for 0.0625% plain bupivacaine the probability to achieve adequate analgesia was unacceptably low.
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Combined spinal epidural anesthesia offers the advantages of each method while minimizing their respective disadvantages. First described in 1937, this technique has risen in popularity over the last 15 years and is being used successfully in orthopedic, urologic, and gynecologic surgeries and for anesthesia/analgesia for labor and delivery as well as cesarean section. The history and development of combined spinal epidural anesthesia/analgesia, the different techniques, and controversies and problems associated with its use are discussed. The use of the technique of obstetric anesthesia/analgesia is also examined.