Articles: analgesia.
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Regional anesthesia · May 1994
Randomized Controlled Trial Clinical TrialPlasma concentration profile of epidural alfentanil. Bolus followed by continuous infusion technique in the parturient: effect of epidural alfentanil and fentanyl on fetal heart rate.
A combined bolus and continuous epidural infusion technique of opioid and bupivacaine mixture has been described, although no pharmacokinetic data for this technique exists. The study documents the plasma concentration profile of epidural alfentanil in parturients using this technique, and evaluates the fetal heart rate tracing for associated changes following opioid administration. ⋯ With the dosage regimen used in this study, an initial epidural bolus with continuous infusion technique generates a steady state plasma concentration of alfentanil that is below levels associated with direct respiratory depression.
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Acta Anaesthesiol Scand · May 1994
Comparative StudyParavertebral vs epidural block in children. Effects on postoperative morphine requirement after renal surgery.
Continuous thoracic paravertebral blockade (PVB) has only recently been reported in pediatric patients. The aim of the present study was to compare retrospectively the postoperative analgesic efficacy of PVB vs conventional lumbar epidural blockade (EDA) in children. Thirty-five consecutive pediatric patients undergoing renal surgery, receiving either PVB (n = 15) or EDA (n = 20), were reviewed. ⋯ The need for supplemental morphine administration was significantly lower (P = 0.046) and the number of patients with no need for supplemental morphine administration postoperatively was significantly higher (P = 0.019) in patients treated with PVB vs EDA. The present study indicates that PVB may possess a potential for postoperative analgesia equal to or maybe even superior to conventional lumbar EDA in pediatric patients undergoing renal surgery. Further prospective studies investigating the analgesic efficacy of this novel technique are warranted.
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Letter Case Reports
Staphylococcus aureus meningitis after short-term epidural analgesia.
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This self-directed learning module highlights advances in therapeutic options in pain management. It is part of the chapter on pain rehabilitation for the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This section discusses pharmacologic agents, modalities, behavioral strategies, and invasive techniques in pain management, with case studies illustrating pain management approaches in clinical practice. Advances that are covered include use of opioid receptors, receptor-specific categories of drugs used in painful conditions, components of behavioral programming for chronic pain, and the limitations of invasive techniques in chronic pain patients.