Articles: analgesia.
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Postoperative analgesia has been neglected for a long time, whereas postoperative pain has been considered inevitable cost of operations. Postoperative pain causes not only subjective difficulties, but as a stress factor affects functions of the autonomous and endocrine system, which may cause a number of disorders after the surgery. ⋯ Advantages and disadvantages of these techniques in regard to traditional method of parenteral analgesia in the postoperative period have been pointed out. Application of regional analgesia is recommended before the surgery, because it prolongs the time when analgesia is needed for the first time and decreases both pain and postoperative analgesia.
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Ventilator-treated children often require sedation in order to facilitate the ventilation. Sedatives alone or in combination with analgesics are commonly used for this purpose. In some cases, however, the addition of a neuromuscular blocking agent (NMB) may be necessary. ⋯ The most commonly employed sedatives, opioids and NMB's are discussed. The authors stress that whichever drug is used, it should be administered to the children guided by its effects rather than by a rigid scheme. In that respect monitoring of the treatment is important.
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Randomized Controlled Trial Clinical Trial
Epidural and intravenous bolus morphine for postoperative analgesia in infants.
To compare two doses of bolus epidural morphine with bolus iv morphine for postoperative pain after abdominal or genitourinary surgery in infants. ⋯ Epidural and iv morphine provide infants effective postoperative analgesia, although side effects are common. Epidural morphine gives satisfactory analgesia with fewer doses (less total morphine); epidural morphine 0.025 mg.kg-1 is appropriate initially. Infants receiving epidural or iv morphine analgesia postoperatively need close observation in hospital with continuous pulse oximetry.
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The inadequacies of conventional intramuscular opioid analgesia have fueled an expansion in the use of patient-controlled analgesia and epidural analgesia after surgery. This is not always accompanied by increased education and specialist supervision of ward staff and patients. ⋯ Frequent review of patients and regular education of ward staff by a specialist Pain Nurse have achieved a substantial reduction in side effects of epidural analgesia and improvement in efficacy of patient-controlled analgesia. We have shown that the advantages of patient-controlled analgesia can be largely negated by failure to address deficiencies in knowledge of pain management among ward staff and patients.