Articles: analgesia.
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Gynecol. Obstet. Invest. · Jan 1997
ReviewLumbar epidural analgesia for labor and vaginal delivery.
Lumbar epidural analgesia has become the preferred method of pain relief for labor and delivery. Proper administration of epidural analgesia offers many advantages for both mother and fetus. With the availability of various local anesthetics, opioids, and infusion techniques, the analgesia can be tailored to the specific needs of the mother, fetus, and labor. Its effect on the progress of labor remains a controversial topic subject to ongoing investigation.
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J Pain Symptom Manage · Jan 1997
Spinal epidural metastasis: implications for spinal analgesia to treat "refractory" cancer pain.
Two hundred one consecutive patients with cancer pain who received intrathecal pain treatment between 1985 and 1993 were included in this retrospective study undertaken to test the hypothesis that epidural metastasis is a common cause of "refractory" cancer pain and that its presence may affect the efficacy and the complication rates of intraspinal pain treatment. Fifty-seven (approximately 28%) patients were investigated by metrizamide myelography, computerized tomography (CT), magnetic resonance imaging (MRI), laminectomy, or neurohistopathology. Epidural metastases were found in 40 (70%) and spinal stenosis in 33 (approximately 58%); 7 patients with total and 26 with partial occlusion of the spinal canal. ⋯ During the period of the intrathecal treatment, the patients with confirmed epidural metastasis and total spinal canal stenosis needed significantly (P < 0.05) higher daily doses of opioid (means = 77 +/- 103 versus 22 +/- 29 mg) and intrathecal bupivacaine (means = 65 +/- 44 versus 33 +/- 20 mg) and had significantly (P < 0.05) higher rates (14% versus 0%) of radicular pain at injection and poor distribution of analgesia than those without epidural metastasis and spinal canal stenosis. In contrast, the rate of occurrence of post-dural puncture headache was significantly (P < 0.05) lower in patients with partial (4%) and total (14%) spinal stenosis than in those without (29%). Unexpected paraplegia occurred in four patients and was due to accidental injury during attempted dural puncture (N = 1) and collapse (due to cerebrospinal fluid leakage leading to "medullary coning" of an unknown epidural metastasis (N = 3).
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Patients who were treated for fractures of the limbs were assigned to 1 of 2 groups for the management of postoperative pain. In Group 1 (postoperative patient-controlled analgesia group), 46 patients were given postoperative continuous epidural anaesthesia in combination with narcotic analgesics and this was regulated by the patient using a device. ⋯ The time spent by nurses for pain management in Group 1 was less than that in Group 2. It appears that this patient-controlled method, combined with postoperative continuous epidural anaesthesia, is a safe, effective and efficient method for the management of postoperative pain.