Articles: analgesia.
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Anesthesia and analgesia · Feb 1993
Randomized Controlled Trial Clinical TrialEffects of epidural morphine and intramuscular diclofenac combination in postcesarean analgesia: a dose-range study.
To assess the efficacy of combinations of epidural morphine and intramuscular diclofenac in postcesarean analgesia, a double-blind, randomized study was conducted. Epidural anesthesia was administered to 120 parturients who were randomly allocated into six treatment groups; these groups, A, B, C, D, and E, received 0.5, 1, 2, 3, and 4 mg of epidural morphine in 10 mL of normal saline solution, respectively, and 75 mg (3 mL) of diclofenac intramuscularly (IM). Group F received 4 mg of epidural morphine in 10 mL of normal saline solution and 3 mL of normal saline solution IM. ⋯ The incidence of nausea or vomiting or both, pruritus, and bleeding was similar. There was no evident relationship between severity of pruritus and morphine doses. No bradyspnea was observed during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Clinical Trial
Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy.
Intrapleural bupivacaine has been reported to be effective for analgesia following cholecystectomy and thoracic surgery. Twenty patients who had a posterolateral thoracotomy were studied in a randomized, double-blind, placebo-controlled fashion. Patients were assigned to receive intrapleural administration of either 0.5 percent bupivacaine or saline solution every 4 h for 12 doses postoperatively, as well as narcotic analgesics as needed for additional pain control. ⋯ Two patients who received bupivacaine and three patients who received placebo had development of pneumonia or atelectasis postoperatively. There was no statistically significant difference in any parameter between those who received bupivacaine and those who received placebo. Thus, there was no subjective or objective clinical benefit of this method of postoperative analgesia compared with placebo following posterolateral thoracotomy.
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Acta Anaesthesiol Scand · Feb 1993
Randomized Controlled Trial Comparative Study Clinical TrialInterpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study.
The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8-hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double-blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. ⋯ Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8-h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.
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Randomized Controlled Trial Clinical Trial
Can pre-emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery?
In a double-blind study, 36 patients who received a standard general anaesthetic for abdominal hysterectomy or myomectomy, received either 15 ml of bupivacaine 0.5% with adrenaline by lumbar epidural injection 15 min before surgery (group A) or the same dose at the end of surgery but before waking (group B). Pain was assessed for 24 h by cumulative morphine dose (self-administered by patient-controlled analgesia), visual analogue scale and verbal rating score. Patients were included for analysis if they were pain free on waking and for at least 2 h after. ⋯ Consequently, we compared the morphine dose, visual analogue scale and verbal rating score at 23 h in group A with those at 24 h in group B. Again there were no significant differences between the two groups. We were unable to demonstrate that epidural blockade had a significantly better effect on postoperative pain when administered before, rather than after, surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous intercostal nerve block versus epidural morphine for postthoracotomy analgesia.
Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. ⋯ Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.