Articles: postoperative-pain.
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The authors evaluated the return of sensory, motor, and sympathetic nervous system function following caudal block in children. Twenty children, ASA PS I, aged 5 +/- 4 yr (mean +/- SD), weighing 22 +/- 9 kg, scheduled for lower abdominal and urologic surgical procedures were studied. Anaesthesia was induced and maintained by halothane, N2O and oxygen. ⋯ Upper level of cutaneous analgesia was T10 +/- 2 after the block. Two hours after the caudal injection an incomplete motor blockade was found in 14 of 20 children, and at 4 hours no block was found in any child. Heart rate was significantly increased in the upright position (122 +/- 12 to 131 +/- 26 bpm at 2 hours, and 110 +/- 21 to 118 +/- 28 bpm at 4 hours), whereas arterial blood pressure was unchanged in the upright position.
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Forty patients (ASA status I-III) recovering from major orthopedic or gynecological operations were investigated to evaluate analgesic efficacy and threshold concentrations of tramadol and its main metabolite O-demethyltramadol (M1) in serum during the early postoperative period, using patient-controlled analgesia (PCA) by means of the Abbott Lifecare Infuser. Following an individualized intravenous loading dose of 97.5 +/- 42.3 mg (mean, SD), tramadol demand doses were 20 mg with a limit of 500 mg within 4 h; the lockout time was set to 5 min. The duration of PCA was 20.5 +/- 4.8 h. ⋯ Minimum effective tramadol serum concentration (MEC) varied greatly and could be best described by a log-normal distribution (range 20.2-986.3 ng/ml, median 287.7 ng/ml). Intraindividual MEC variability was lower than intersubject variability (38.2 vs 59.1%). Median M1 concentrations were 36.2 ng/ml.
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An alternative to parenteral narcotic management is the administration of analgesics into the epidural space. The recognition and prevention of complications or side effects of epidural analgesia are prime concerns in planning nursing care for these patients.