Articles: analgesia.
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Regional anesthesia · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialAn evaluation of epidural bupivacaine with and without meperidine in labor.
One aim of epidural analgesia during childbirth is to provide satisfactory pain relief with minimal side effects. We hypothesized that a combination of opioid and local anesthetic would better achieve this aim than either drug alone. This study compared the efficacy and side effects of epidural meperidine and bupivacaine combined to those of meperidine and bupivacaine alone. ⋯ The low-dose combination of meperidine and bupivacaine used in this trial proved a satisfactory preparation for epidural administration during the early stages of labor.
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Acta Anaesthesiol Belg · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative analgesia for major abdominal surgery with continuous thoracic epidural infusion of bupivacaine with sufentanil, versus bupivacaine with morphine. A randomized double blind study.
Forty-six patients undergoing major abdominal surgery were given postoperative epidural analgesia for four days with bupivacaine-sufentanil or bupivacaine-morphine. Both groups received a bolus of 8 ml bupivacaine 0.5% followed after 30 minutes by an infusion of 20 ml/h bupivacaine 0.1%. The sufentanil group (group A: 21 patients) received a loading dose of 50 micrograms sufentanil and a continuous infusion of 5 micrograms/h sufentanil. ⋯ There was also a high incidence of hypotension after the loading dose of bupivacaine 0.5%. Although we noticed a large incidence of pruritus, no patient needed naloxone reversal. In view of these side effects we recommend a lower loading dose of both bupivacaine and sufentanil.
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Case Reports
Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.
Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.
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A 69-year-old white female presented for corneal transplant, but her numerous medical problems placed her at unacceptably high risk for prolonged general anesthesia. Routine monitored anesthesia care measures would not have provided her or the surgeon the comfort and repose necessary for a successful outcome. We describe anesthetic management for ophthalmic surgery, using epidural anesthesia in conjunction with retrobulbar block, in an elderly patient at high risk for general anesthesia whose intractable back and leg pain would have otherwise precluded her cooperation in maintaining a motionless operative field.
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Scand J Thorac Cardiovasc Surg · Jan 1992
Randomized Controlled Trial Clinical TrialContinuous extrapleural intercostal nerve block and post-thoracotomy pulmonary complications.
To evaluate the effects of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary complications, a randomized, double-blind, placebo-controlled study was conducted on 80 patients undergoing elective thoracotomy for pulmonary (n = 47) or oesophageal (n = 33) procedures. In patients who received continuous bupivacaine infusion, the requirement for intramuscular opiate and rectal diclofenac was less, the score on a visual linear analogue pain scale lower and recovery of pulmonary function more rapid than in saline-infused controls. ⋯ Among the patients without COAD there was no significant intergroup difference in such complications. We conclude that continuous extrapleural intercostal nerve block is effective for post-thoracotomy analgesia and reduces pulmonary complications of thoracotomy in patients with COAD.