Articles: pain.
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Randomized Controlled Trial Clinical Trial
Effect of the addition of adrenaline to extradural diamorphine analgesia after caesarean section.
In a randomized double-blind study the effect of the addition of adrenaline to extradural diamorphine was assessed in 54 patients after Caesarean section. Patients received extradural diamorphine 5 mg in saline 10 ml with or without adrenaline 1 in 200,000 for postoperative pain relief. Analgesia was profound and of rapid onset in both groups. ⋯ Analgesia was also more consistent in the adrenaline group, with 77% of patients having more than 8 h of good analgesia compared with 48% in the saline group (P less than 0.05). Plasma morphine concentrations, measured in 12 patients, were lower, although not significantly so, in the adrenaline group and mean time to peak concentration markedly delayed. No serious side effects were observed, but there was a higher incidence of vomiting in the adrenaline group.
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Acta Anaesthesiol Scand · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialEpidural sufentanil for intra- and postoperative analgesia in thoracic surgery: a comparative study with intravenous sufentanil.
A comparative study was undertaken to evaluate the effectiveness of epidural sufentanil in providing intra- and postoperative analgesia during thoracic surgery. Sufentanil was chosen on the basis of its high lipid solubility and its potent opiate receptor binding. Epidural sufentanil was compared with intravenous sufentanil as the major intraoperative analgetic agent in an anesthesia regimen with midazolam and nitrous oxide. ⋯ Sufentanil provided good analgesia with a very fast onset and a mean duration of almost 7 h. Severe respiratory depression was observed in one patient within 1 h of extubation, probably due to the combined effects of the narcotic administration and residual midazolam. It is concluded that 50 micrograms of sufentanil administered in the thoracic epidural space provides valuable intraoperative analgesia which can easily be extended into the postoperative period, although all necessary precautions for epidural opiate administration should be taken.
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Acta Anaesthesiol Scand · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical TrialOpioid treatment for radiating cancer pain: oral administration vs. epidural techniques.
In order to determine the optimal pain treatment for patients with cancer involvement of the brachial or lumbar nerve plexuses, a prospective comparative study was carried out using peroral opioid therapy (SO), epidural opioid by a conventional tunnelled epidural catheter (CE) or an epidural catheter connected to an implanted injection port (Port). Pain relief, measured by a visual analog scale (VAS), was similar and adequate in every group already after the first 24 h. CNS side-effects were less frequent and the Karnofsky performance grades slightly superior in the epidural groups. ⋯ Both epidural techniques seem suitable for long-term pain therapy. Technical improvements are needed in the epidural catheter and the port. The long-term epidural catheter does not seem to cause any major changes in the histology of the dura mater or the connective tissue of the epidural space.
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Randomized Controlled Trial Comparative Study Clinical Trial
Transcutaneous electrical nerve stimulation after thoracotomy. Pain relief and peak expiratory flow rate--a trial of transcutaneous electrical nerve stimulation.
Forty patients scheduled to undergo thoracotomy were randomly allocated to receive either transcutaneous electrical nerve stimulation with intramuscular papaveretum (20 patients) or intramuscular papaveretum alone (20 patients) for postoperative pain relief. Total intramuscular analgesic requirements in the first 24 hours, time to satisfactory transfer to oral analgesia, antiemetic requirements and length of stay in hospital postoperatively were noted. ⋯ Use of nerve stimulation did not significantly alter the requirements for analgesia although there was a reduction in postoperative nausea and vomiting in the nerve stimulation group. There was no difference between the two groups with respect to changes in peak expiratory flow rate.
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Randomized Controlled Trial Clinical Trial
Lack of analgesic effect of opioids on neuropathic and idiopathic forms of pain.
The aim of the present study has been to assess the responsiveness of various types of chronic pain to opioids given i.v. and tested against placebo in a double-blind, randomized fashion. Pain classified as primary nociceptive was effectively alleviated (P greater than 0.001) while neuropathic deafferentation pain was not significantly influenced by morphine or equivalent doses of other opioids. Also 'idiopathic' pain, defined as chronic pain with no or little demonstrable pathology, failed to respond. ⋯ It may also support the indication and choice of invasive stimulation procedures (spinal cord or brain). The results of the study illustrate the misconception of chronic pain as an entity and highlight the importance of recognizing different neurobiological mechanisms and differences in responsiveness to analgesic drugs as well as to non-pharmacological modes of treatment. The opioid test has thus become a valuable tool in pain analysis and helpful as a guide for further treatment.