Articles: analgesia.
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J. Gastrointest. Surg. · Jan 1998
Thoracoscopic splanchnicectomy for "small duct" chronic pancreatitis: case selection by differential epidural analgesia.
Management of patients with intractable pain from "small duct" chronic pancreatitis has been difficult, often resulting in narcotic addiction and/or malnutrition from major pancreatic resection. Recently, denervation of sympathetic pain afferents from the pancreas by surgical splanchnicectomy has shown promise in relieving pain while preserving residual pancreatic function. However, results from surgical splanchnicectomy have been mixed in large part because of patient selection. ⋯ None of the three patients with DEA-predicted somatic pain were benefited by splanchnicectomy. During an average follow-up of 23.3 months, initial good results from surgical splanchnicectomy were maintained in 8 of 10 patients. The following conclusions were reached: (1) surgical splanchnicectomy is a safe, often effective technique for amelioration of intractable pain from "small duct" chronic pancreatitis and (2) DEA is a promising approach for identifying patients most likely to respond to surgical splanchnicectomy.
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Ann Fr Anesth Reanim · Jan 1998
Comparative Study-Anesthesia and analgesia practice patterns in French obstetrical patients-.
To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). ⋯ In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.
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Case Reports
Intrathecal catheter insertion during labour reduces the risk of post-dural puncture headache.
To describe the anaesthetic management and report the incidence of PDPH in three parturients who had experienced accidental dural puncture during labour and the subsequent deliberate intrathecal insertion of an epidural catheter. ⋯ Immediate intrathecal insertion of the epidural catheter after accidental dural puncture during labour proved to be an effective prophylactic technique to prevent PDPH in these three parturients.