Articles: analgesia.
-
Anesthesia and analgesia · Dec 1996
Randomized Controlled Trial Clinical TrialMaternal posture influences the extent of sensory block produced by intrathecal dextrose-free bupivacaine with fentanyl for labor analgesia.
The cephalad extent of sensory block produced by intrathecal (IT) dextrose-free local anesthetics and opioids has been reported to be quite variable. Most reports describing the effects of IT analgesics do not control for patients posture. Because these medications are hypobaric relative to cerebrospinal fluid (CSF), parturients in a sitting position may develop greater cephalad extents of sensory block than those in a lateral position during IT injection. ⋯ Mean cephalad extent of block was greater in the sitting group at 20 and 30 min. When sensory block asymmetry was observed, the extent of block was greater on the nondependent side. Posture during IT injection of this dextrose-free analgesic combination affects extent of sensory block in laboring parturients.
-
Owing to recent emphasis upon the benefits of effective pain management, parents and health care providers expect infants and children to receive safe, effective sedation and analgesia for diagnostic and therapeutic procedures. The Committee on Drugs of the American Academy of Pediatrics has addressed the issue of safety in its recently revised guidelines for monitoring and management of patients undergoing sedation for procedures. Patients undergoing emergency procedures present additional problems because of the limited opportunity to optimally prepare patients and families. ⋯ New formulations of local and topical anesthetics have enhanced their efficacy and reduced pain associated with administration. Innovations in the administration of sedatives and analgesics, as well as antagonists, have enhanced both efficacy and safety. This article reviews recommended guidelines for monitoring and management of patients undergoing sedation for minor procedures and discusses various sedative, analgesic, and anesthetic alternatives available to clinicians.
-
Randomized Controlled Trial Clinical Trial
Intraoperative continuous epidural lidocaine for early postoperative analgesia.
We determined the early postoperative analgesia using intraoperative continuous epidural infusion of lidocaine during general anesthesia in patients undergoing upper abdominal surgery in a prospective double-blind manner. After insertion of an epidural catheter at the T10-T11 interspace, general anesthesia was induced. Thirty patients were randomly allocated to receive continuous epidural infusion of either 0.5% (n = 15) or 1% (n = 15) plain lidocaine at 10 ml/hr. ⋯ Visual analog pain scale (0-10) within 30 minutes after the end of surgery was significantly lower in the 1% lidocaine group (5.6 +/- 0.9, mean +/-SE) than in the 0.5% lidocaine group (8.2 +/- 0.8), however, it was unsatisfactory in both groups. Plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide, gradually increased through epidural infusion, but remained below the toxic range in both groups. We conclude that continuous epidural lidocaine during general anesthesia offered limited analgesia in the early postoperative period.
-
Comparative Study Clinical Trial
Clinical analgesic equivalence for morphine and hydromorphone with prolonged PCA.
A morphine to hydromorphone equivalence ratio of 7:1 has become the accepted standard, but evidence supporting it comes from single dose studies performed before the advent of patient controlled analgesia (PCA). We compared morphine and hydromorphone use with PCA in bone marrow transplantation patients who required opioids for the control of severe oral mucositis over several days or weeks. An exploratory analysis of clinical records from 102 patients (981 patient days) who used PCA opioids for varying periods of up to 50 days suggested a morphine to hydromorphone use ratio of 3:1. ⋯ Thirty-six patients who used morphine and 21 who used hydromorphone contributed data on pain, satisfaction with pain control, and drug consumption. We observed an average morphine/hydromorphone ratio of 3:1. This differs markedly from historical single dose studies used in published dose equivalency recommendations implying that other equivalency ratios in clinical use may be inappropriate.