Articles: analgesia.
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Randomized Controlled Trial Clinical Trial
Partial reversal of the effects of extradural clonidine by oral yohimbine in postoperative patients.
Extradural clonidine produces analgesia, with sedation, hypotension and bradycardia, in postoperative patients. This study assessed if oral yohimbine would reverse these side effects. We studied 30 ASA I-II patients undergoing orthopaedic surgery. ⋯ Pain score was measured on a visual analogue scale (VAS); sedation was assessed on a simple scale graded from 0 (awake and alert) to 3 (deeply sedated, awakening after tactile stimulations) and heart rate and arterial pressure were monitored for 5 h. Yohimbine reversed the sedation induced by extradural clonidine, but also shortened the duration of analgesia (31 (SD 15) min, 186 (72) min and 126 (52) min in the placebo, extradural clonidine and extradural clonidine+yohimbine groups, respectively) (P < 0.05), and did not reduce the hypotension and bradycardia related to clonidine administration. These results suggest that alpha 2 adrenoceptors are mediators of the sedation induced by clonidine and that the haemodynamic effects are not related to stimulation of supraspinal alpha 2 receptors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids.
Different types of analgesia have been proposed for the prevention of postoperative respiratory complications. The aim of this prospective, double-blind randomized study was to compare the impact of epidural bupivacaine and opioids versus parenteral opioids on respiratory complications in patients who had undergone major abdominal surgery. ⋯ Epidural analgesia with a combination of local anesthetic and opioid improves patient comfort. However, this type of analgesia does not decrease the incidence of postoperative pulmonary complications, does not reduce the length of the hospital stay, and carries the risk of complications from episodic systemic hypotension.
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A case of phrenic nerve paralysis following interpleural analgesia for cholecystectomy is reported. The pre-operative chest X ray was normal but chest X ray after cholecystectomy and interpleural analgesia revealed a raised right hemidiaphragm. This resolved after discontinuation of the interpleural analgesia and was probably a result of phrenic nerve paralysis produced by the interpleural local anaesthetic.
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An epidural catheter can be chosen for domiciliary oncological pain relief when relief is not achieved with oral drugs. The patient/relatives put in the central nervous systems the analgesic solution, through this peridural catheter. This article discusses how pain relief occurs, the infusion systems of opioids in the peridural space, the complications and side effects of this therapy.