Articles: analgesia.
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Clin. Pharmacol. Ther. · Apr 1991
Comparative Study Clinical Trial Controlled Clinical TrialCentral analgesic effect of acetaminophen but not of aspirin.
The central nervous system effect of acetaminophen (paracetamol) and acetylsalicylic acid was investigated in healthy volunteers according to a crossover, double-blind, and placebo-controlled design. Ten subjects received, by intravenous route, a placebo, 1 gm acetaminophen, and 1 gm acetylsalicylic acid. Analgesia was assessed by measurement of the subjective pain threshold and the objective nociceptive flexion reflex threshold in response to selective transcutaneous electrical stimulations. ⋯ In contrast, acetylsalicylic acid had no noticeable effect on either threshold. These findings show that acetaminophen-induced analgesia is centrally mediated, in contrast to aspirin. The time delay between plasma concentration kinetics and acetaminophen analgesic effect is another argument in favor of its direct action on the central nervous system.
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J Pain Symptom Manage · Apr 1991
Clinical TrialInitial clinical experience with the SKY epidural catheter.
The new SKY epidural catheter was evaluated, based upon information collected about implant and use of 53 catheters by 51 patients. Catheters were used to treat chronic pain of a malignant (n = 25) and nonmalignant (n = 28) origin. Of 3450 treatment days, 89% occurred at home. ⋯ No subarachnoid or epidural infections occurred. The SKY catheter proved to be safe and reliable. Therapy was cost-effective, since patients achieved substantial pain relief while treated at home.
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of epidural diamorphine and intramuscular morphine after elective caesarean section, with computerised analysis of continuous pulse oximetry.
A randomised, double-blind comparison of the efficacy, duration of action and side effects of two analgesic regimens following elective epidural Caesarean section is described. Patients received epidural diamorphine 3 mg or intramuscular morphine 10 mg in the immediate postoperative period. Time to next analgesia was longer after epidural diamorphine (11.0 hours) compared to intramuscular morphine (6.5 hours) (p less than 0.05). ⋯ However, more patients in the diamorphine group required catheterisation and suffered emetic sequelae, whereas more patients in the morphine group were sedated at 8 hours. Ten patients in each group had continuous pulse oximetry performed overnight after administration of the trial medications. Neither group demonstrated evidence of hypoxia.
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Anesthesia and analgesia · Apr 1991
Comparative Study Clinical Trial Controlled Clinical TrialSensory and motor blockade during epidural analgesia with 1%, 0.75%, and 0.5% ropivacaine--a double-blind study.
Levels of sensory (pinprick) and somatic motor blockade were measured in a double-blind study of 30 volunteers given single epidural injections of 1%, 0.75%, and 0.5% ropivacaine. Onset of analgesia was rapid with all concentrations (7-10 min). Maximal levels of analgesia were established 60 min after injection, with no significant differences in the maximal median cephalad spread. ⋯ Motor blockade described by the Bromage scale showed only the first part of the regression phase. Full recovery of muscle strength (Bromage scale = 0) was attained 1.5-2.5 h earlier than assessed by the quantitative method. No adverse effects were registered.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients.
To compare the efficacy and side effects of 0.2 mg intrathecal (IT) morphine with 0.125% epidural bupivacaine, 62 women in labor were studied. They were randomly divided into three groups: group 1 (n = 20) received IT morphine; group 2 (n = 22) received epidural bupivacaine; and group 3 (n = 20) received a combination of both using a combined spinal-epidural (CSE) technique. According to a visual analogue scale for assessing analgesia, neither IT 0.2 mg morphine nor 10 ml 0.125% epidural bupivacaine was effective in producing adequate pain relief in labor, whereas the combination produced excellent analgesia. ⋯ No serious respiratory depression occurred in any of the patients. When the course of labor was studied, the prior use of IT morphine significantly prolonged the duration of the first stage of labor and the total duration of labor. We conclude that the administration of 0.2 mg IT morphine in combination with epidural administration of 0.125% bupivacaine provides better analgesia than the administration of either drug alone.