Articles: analgesia.
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This report describes the case of an 80-year-old woman with a long history of chronic, stable angina pectoris who underwent resection of an abdominal aortic aneurysm and placement of an aortobifemoral bypass graft under a combination of epidural and general anesthesia. Epidural morphine was administered postoperatively for pain management. The patient suffered a massive myocardial infarction (MI) in the immediate postoperative period but experienced no chest pain or discomfort similar to her usual anginal symptoms. The use of epidural and spinal opioids in the treatment of anginal pain is reviewed and discussed in terms of the possibility that such epidural opioid therapy may have masked this patient's anginal symptoms.
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Rev Esp Anestesiol Reanim · Mar 1991
[Epidural perfusion with fentanyl in the treatment of postoperative pain].
In 40 patients with high abdominal surgery the analgesia achieved with continuous epidural phentanyl infusion was evaluated. Treatment was started when the patients had pain, with the injection of 150 micrograms of phentanyl in 18 ml of saline and going on with the infusion. The patients were divided in 4 groups. ⋯ In the statistical analysis the only significant difference was an increase in pCO2 after 24 h in the patients who received the highest doses. The incidence of nausea and vomiting was 10%, with 13.04% of urinary retention Clinical respiratory depression was not observed. We think that administration of 150 micrograms of epidural phentanyl followed by a continuous epidural infusion of the drug (0.5 microgram/kg/hour in 5 ml of saline) is an adequate technique of postoperative analgesia.
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Anesthesia and analgesia · Mar 1991
Randomized Controlled Trial Clinical TrialPatient-controlled sedation during epidural anesthesia.
The purpose of this study was to evaluate the feasibility and advantages or disadvantages, if any, of patient-controlled sedation compared with sedation administered by the anesthesiologist during surgical epidural anesthesia. Forty patients were divided at random into two groups with 20 patients in each group. Patients in group 1 received 0.5-1.0 mg intravenous midazolam and 25-50 micrograms intravenous fentanyl in increments administered by the anesthesiologist to achieve intraoperative sedation; patients in group 2 self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 micrograms) in increments using an Abbott Lifecare PCA infuser to achieve sedation. ⋯ This could have been due to a positive psychological effect produced by allowing patient to feel that they have some control over their situation. The findings of this study indicate that patient-controlled sedation using a combination of midazolam and fentanyl is a safe and effective technique that provides intraoperative sedation ranked better by patients than that provided by anesthesiologists using the same drugs. More studies are, however, needed to determine the best choice of drug(s), the doses, the lock-out intervals, and the possible use of continuous infusion with patient-controlled sedation.
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Anesthesia progress · Mar 1991
Case ReportsEpidural buprenorphine or morphine for the relief of head and neck cancer pain.
We present three cases in which epidural buprenorphine or morphine was used for intractable cancer pain of the head and neck. Excellent pain relief and minimal side effects offered by epidural opioids were of significant benefit. The use of epidural opioids prior to the administration of high doses of oral morphine may be the treatment of choice for pain from malignancy of the head and neck, especially when there is tumor extension or distant metastasis.