Articles: analgesia.
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Anesthesia and analgesia · Mar 1996
Randomized Controlled Trial Comparative Study Clinical TrialAdding fentanyl 0.0002% to epidural bupivacaine 0.125% does not delay gastric emptying in laboring parturients.
Previous studies have shown that bolus doses of fentanyl (50 and 100 micrograms) with epidural bupivacaine delay gastric emptying by up to 45 min. We studied the effect of the addition of small-dose fentanyl to epidural bupivacaine infusions on gastric emptying during labor. The acetaminophen absorption technique was used to infer gastric emptying. ⋯ There were no significant demographic differences between the groups. There were no differences detected between groups in the peak plasma concentrations of acetaminophen, the time to achieve the peak plasma concentrations, or the area under the curve at 45 and 90 min. Our results indicate that epidural infusions for labor analgesia using 0.125% bupivacaine and 0.0002% fentanyl do not delay gastric emptying compared to infusions of bupivacaine 0.125% alone.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural infusion of low-dose bupivacaine and opioid in labour. Does reducing motor block increase the spontaneous delivery rate?
Labouring women were randomly allocated to receive epidural infusions during labour of either 0.125% plain bupivacaine (n = 200) or a combination of 0.0625% bupivacaine with either 2.5 micrograms.ml-1 fentanyl or 0.25 micrograms.ml-1 sufentanil (n = 199) each starting at 12 ml.h-1 and adjusted as necessary to maintain analgesia. The dose of bupivacaine, both hourly (p < 0.001) and total (p < 0.001), was significantly lower in the group receiving the combination. Motor block was significantly less common and less severe in the combination group (p < 0.001). ⋯ Maternal satisfaction with first (p < 0.001) and second stage analgesia (p < 0.001) was significantly increased in the combination group. The addition of opioid to the epidural infusion did not reduce the incidence of perineal pain. There were no significant differences between the groups in neonatal outcome or the incidence of early postnatal symptoms.
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Anesthesia and analgesia · Mar 1996
Randomized Controlled Trial Clinical TrialThe effects of intrathecal neostigmine on somatic and visceral pain: improvement by association with a peripheral anticholinergic.
This study was designed to qualitatively evaluate the analgesic actions of intrathecal neostigmine alone and with intravenous (IV) N-butyl-scopolamine on somatic and visceral pain. Twenty-seven patients scheduled for both tubal ligation and vaginoplasty were divided into three groups. Patients received a standard anesthetic with thiopental, atracurium, and N2O/O2/enflurane. ⋯ Patients from the NSG were pain free during all assessment times (P < 0.0001). Neostigmine was more effective for somatic pain than visceral pain. N-butyl-scopolamine administration acted peripherally as an effective complement for treatment of visceral pain, reflecting an association between central cholinergic effects and peripheral anticholinergic effects in the treatment of visceral postoperative pain.
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Randomized Controlled Trial Clinical Trial
The opposite effects of the opiate antagonist naloxone and the cholecystokinin antagonist proglumide on placebo analgesia.
Discovery of the involvement of endogenous opiates in placebo analgesia represents an important step in understanding the mechanisms underlying placebo response. In the present study, we investigated the effects of the opiate antagonist naloxone and the cholecystokinin antagonist proglumide on placebo analgesia in a human model of experimentally induced ischemic pain. First, we found that part of the placebo response was reversed by naloxone, confirming previous studies on the role of opioids in the placebo phenomenon. ⋯ The placebo effect can thus be modulated in two opposite directions: it can be partially abolished by naloxone and potentiated by proglumide. The fact that placebo potentiation by proglumide occurred only in placebo responders, but not in non-responders, suggests that activation of an endogenous opiate system is a necessary condition for the action of proglumide. These results suggest an inhibitory role for cholecystokinin in placebo response, although the low affinity of proglumide for cholecystokinin receptors does not rule out the possibility of other mechanisms.
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Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial
[Patient acceptance of patient-controlled intranasal analgesia (PCINA)].
Patient-controlled intravenous analgesia (i.v.-PCA) represents the gold standard in the management of acute postoperative pain. However, in many countries i.v.-PCA is rarely used. Recent clinical studies demonstrated that intranasal fentanyl titration provides a rapid and safe form and pain management. In the present study we investigated patients' acceptance and assessment of patient-controlled intranasal analgesia (PCINA) and compared it to intravenous PCA and the customarily prescribed pain therapy. ⋯ The results demonstrate that the patients' satisfaction with PCINA is comparable to that with i.v.-PCA. Both PCINA and i.v.-PCA were assessed as superior to the customarily prescribed pain management (P = 0.0001). Patients' acceptance of a given form of pain management is mainly related to its efficiency. However, side effects such as pain on injection with i.v.-PCA, or frequent opioid administration with PCINA, must be considered when assessing a method of pain control. Patients' global assessment includes both efficiency and side effects. PCINA represents an interesting alternative non-invasive method for postoperative pain management.