Articles: analgesia.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of a bupivacaine-clonidine mixture with plain bupivacaine for caudal analgesia in children.
In a randomized, double-blind study in children undergoing elective orthopaedic surgery, we have assessed the clinical value of combining clonidine with bupivacaine for caudal analgesia. Forty-six children, aged 1-10 yr, were allocated randomly to two equal groups to receive 0.25% bupivacaine 1 ml kg-1 combined with either normal saline 1 ml (group A) or clonidine 2 micrograms kg-1 in normal saline 1 ml (group B). Mean (SD) duration of caudal analgesia for groups A and B were 5.2 (1.2) h and 9.8 (2.1) h, respectively (P < 0.0001). ⋯ There was no significant difference in the incidence of side effects between the two groups. The longer duration of sedation in group B (9.1 (2.5) h) resulted partly from the sedative effect of clonidine and partly from the longer duration of analgesia provided by clonidine. We conclude that, when added to bupivacaine, clonidine improves the efficacy of caudal analgesia in children.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia.
This double-blind randomised study compared the analgesic efficacy, respiratory effects, side effects, and pharmacokinetic disposition of 24 hr lumbar epidural and intravenous infusions of the same dosage regimen of fentanyl (1.5 micrograms.kg-1 bolus then 1 microgram.kg-1.hr-1 infusion) in 50 patients after thoracotomy. Patients received either epidural fentanyl and intravenous normal saline, or epidural normal saline and intravenous fentanyl, for postoperative analgesia, after a standard low-dose alfentanil and isoflurane general anaesthetic. Visual analogue pain scores were lower in the epidural group (P < 0.05) only at two hours postoperatively, and there was no difference in the amount of supplementary morphine self-administered by patient-controlled analgesic pump. ⋯ Thereafter there was no difference in the plasma concentration profiles between the two groups. Seven patients in the epidural group and ten patients in the intravenous group received naloxone for PaCO2 > 50 mmHg, and one patient in the intravenous group had the infusions stopped because of PaCO2 elevation and somnolence. In patients who did not receive naloxone, the epidural route produced better analgesia throughout the study period (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
-
Anesthesia and analgesia · Mar 1994
Randomized Controlled Trial Comparative Study Clinical TrialHigh thoracic epidural sufentanil with bupivacaine: continuous infusion of high volume versus low volume.
The purpose of the study was to investigate whether continuous infusion of a high volume of a sufentanil/bupivacaine mixture at a high thoracic level improves the analgesic effect of the mixture, compared with a dose-equivalent continuous low-volume infusion. In a prospective, observer-blind study, 60 patients scheduled for thoracic surgery received a thoracic epidural catheter for 3 days. The patients were randomly assigned by lot to one of two groups: a low-volume (LV) group (bupivacaine 0.75% with sufentanil 4 micrograms/mL, 1.0-1.3 mL/h), or a high-volume (HV) group (bupivacaine 0.125% with sufentanil 0.7 microgram/mL, 6-8 mL/h). ⋯ A difference was found between both groups in the mean preoperative PaCO2 value (P < 0.05) and also for the PaCO2 values on Day 1 versus the preoperative values within the group (P < 0.05). On the first postoperative day the analgesic effects of a sufentanil/bupivacaine mixture at a high thoracic epidural level can be improved when injected at a continuous high-volume rate compared with a dose-equivalent continuous low-volume rate. This is true for pain at rest; for pain at exercise, there were no differences.
-
One-hundred sixteen patients were given nalbuphine by 10 specifically trained ambulance paramedics over a 9-month period. Forty-seven had suspected myocardial infarction and 69 had sustained trauma or burns. ⋯ There were no serious side effects. We conclude that nalbuphine can be safely administered by trained paramedics to provide effective analgesia to those in pain in a prehospital setting.
-
Jornal de pediatria · Mar 1994
[Pain in intubated and ventilated preterm neonate: multidimensional assessment and response to fentanyl analgesia].
The purpose of this study was to verify if multidimensional pain assessment, performed through physiologic and behavioral measures, together with this assessment modifications in response to opioid analgesia, could determine the presence of pain in preterm neonates (PT) under mechanical ventilation through endotracheal tube (ETT). The population consisted of 22 PT with gest. age < or = 32 weeks, between 12-48 h of life. All of them had an ETT and an umbilical arterial line in place and were on mechanical ventilation. ⋯ None of these occurred in neonates that received placebo. Critically ill intubated and ventilated PT do feel pain, as assessed by this multidimensional evaluation. Analgesia should be considered in order to treat these patients' pain.