Articles: analgesia.
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Am J Pediatr Hematol Oncol · Aug 1992
Continuous epidural anesthesia for postoperative analgesia in the pediatric oncology patient.
When compared with conventional techniques, epidural anesthesia not only provides improved analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy of this technique in children has been demonstrated, extensive experience in the pediatric oncology patient has not been previously reported. We retrospectively reviewed our 2-year experience with epidural analgesia and discuss the techniques involved in implementing this service for the pediatric oncology patient. ⋯ Postoperative analgesia was provided by a continuous infusion of a bupivacaine/fentanyl mixture, supplemented with intermittent epidural fentanyl by bolus dose as needed. No complications related to epidural catheters were noted. Our review supports the efficacy of this technique for providing postoperative analgesia after various major surgical procedures in the pediatric oncology patient.
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The American surgeon · Aug 1992
Comparative StudyThe use of epidural anesthesia and analgesia in aortic surgery.
During a 3-year period, sixty-four consecutive patients, who had elective aortic reconstruction were investigated to determine whether epidural anesthesia and analgesia, combined with light general anesthesia, would lower the rate of perioperative complications in this high-risk group of patients. The epidural group comprised 32 consecutive patients who had surgery during the 20-month period from July 1986 to December 1987. These patients were compared with the previous 32 patients who had aortic reconstruction at Huntington Memorial Hospital (Pasadena, CA) using conventional general anesthetic techniques. ⋯ There was no statistically significant difference in cardiovascular morbidity, length of hospital stay, or intensive care unit stay between the two groups. There was however, a striking decrease in respiratory complications and length of intubation in the epidural anesthesia group (P less than 0.005). The authors conclude that epidural anesthesia and analgesia, combined with a light general anesthetic may confer benefits over conventional general anesthesia in patients undergoing aortic surgery.
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Randomized Controlled Trial Clinical Trial
Comparison of the maternal and fetal effects associated with intermittent or continuous infusion of extradural analgesia.
Eighty normal primigravidae received an extradural dose of 0.25% bupivacaine and were then allocated randomly to receive "top-ups" of 0.25% bupivacaine (group A) or an infusion of 0.125% bupivacaine (group B). Group B received supplementary top-ups if required. Group A required more top-ups (147 vs 80) (P < 0.01). ⋯ More episodes in group A were related to top-ups (42/71 vs 18/69; P < 0.01) but the incidence of episodes after a top-up was similar (group A, 42/147 (28.6%); group B, 18/80 (22.5%)). In group A, 31/42 events (73.8%) were transient compared with 11/18 persistent episodes (61.1%) (> 10 min duration) in group B. However, the difference in the deceleratory patterns did not influence the condition of the fetuses at delivery.
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Anesthesia and analgesia · Aug 1992
Randomized Controlled Trial Comparative Study Clinical TrialEpidural patient-controlled analgesia: an alternative to intravenous patient-controlled analgesia for pain relief after cesarean delivery.
Epidural administration of an opioid analgesic by means of a patient-controlled analgesia (PCA) system was compared with conventional intravenous PCA for pain relief after cesarean delivery. One hundred seventeen healthy women were randomly assigned to receive hydromorphone either intravenously (IV-PCA) or epidurally (EPI-PCA) after cesarean delivery with epidural bupivacaine for operative anesthesia. The hydromorphone requirements were 3.4 and 4.2 times more in the IV-PCA group on the first (P less than 0.01) and second (P less than 0.01) postoperative days, respectively. ⋯ Pruritus was reported more frequently in the EPI-PCA (67%) than in the IV-PCA (33%) group. Nausea was experienced by only 10% of patients in the IV-PCA and 6% in the EPI-PCA group. There was no evidence of postoperative respiratory depression, with minimal oxygen saturation values of 93% (+/- 3%) and 94% (+/- 1%) in the IV-PCA and EPI-PCA groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)