Articles: analgesia.
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The aim of this study was to assess the efficacy of epidural morphine plus bupivacaine for post-operative pain control following Harrington rod insertion. In 22 scoliotic patients, studied prospectively, the epidural catheter was positioned under direct vision, intra-operatively before wound closure. Post-operatively, the patients received 2 mg morphine in 4 ml of 0.25% bupivacaine through the epidural catheter whenever they complained of pain. ⋯ The mean (+/- SD) pre-injection pain score decreased from 2.5 +/- 0.15 on the first post-operative day to 0.7 +/- 0.2 by the fourth day. The side-effects, including nausea, vomiting and pruritus, were minimal. It is concluded that morphine, in 0.25% bupivacaine administered through an intra-operatively placed epidural catheter, provides a safe and effective post-operative analgesia in patients undergoing Harrington rod insertion for idiopathic scoliosis.
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Clinical Trial Controlled Clinical Trial
[Rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery].
This investigation was conducted to determine the analgesic efficacy of rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery. Forty patients in control group received epidural buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infusion was started with the solution of epidural buprenorphine 15 micrograms in 1 ml of 0.23% bupivacaine at a rate of 1 ml.h-1 for 48 h. ⋯ Adding rectal diclofenac to continuous epidural infusion of buprenorphine and bupivacaine produced enhanced analgesia and reduced pain scores measured by VAS after upper abdominal surgery. However, after lower abdominal surgery, such effects of rectal diclofenac obtained after upper abdominal surgery were not demonstrable.
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Good analgesia does not normalize post-operative pulmonary function but is important in allowing measures such as post-operative physiotherapy to be applied following major abdominal or thoracic surgery. Clinical studies have generally failed to duplicate animal work on the effectiveness of pre-emptive analgesia possibly because the nociceptor stimuli persist as long as there is wound pain. Anaesthetic techniques which include sensory blockade are associated with a lower incidence of several post-operative complications and this improvement is more marked in high-risk patients. ⋯ There is no evidence that multimodal 'balanced' analgesia offers any advantages in terms of improved outcome or reduction in adverse events. Whilst sophisticated methods for providing post-operative pain relief, such as PCA and PCEA, are highly effective, they are appropriate for only a minority of surgical operations. An Acute Pain Service can delivery a traditional intermittent opioid regime effectively at relatively low cost.