Articles: pain.
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Ann R Coll Surg Engl · Jul 1983
Letter Comparative StudyAn open comparison between routine and self-administered postoperative pain relief.
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The present study examined the influence of spinally administered fentanyl on the spontaneous and noxiously evoked activity of wide dynamic range (WDR) neurons in the dorsal horn of decerebrate, spinal cord-transected cats. This work was performed in order to evaluate the dose-response relationship, time course, and naloxone reversibility of fentanyl suppression of neurons that are involved with the transmission of information about pain. Extracellular single neuron recordings were obtained from 18 WDR neurons in the lumbar enlargement. ⋯ Such results support the concept that fentanyl is acting through a specific drug-receptor interaction. The onset of neuronal suppression occurred more rapidly, and the duration of the suppression was longer following fentanyl than that seen following spinal morphine. The onset and duration of this suppression correlates well with human clinical data, providing further evidence that alterations of WDR neuronal activity may be important in the production of spinal opioid analgesia.
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Autonomic measures (skin conductance and heart rate) were obtained from subjects before (warning period), during (immersion period), and after (resting state) the performance of the Cold Pressor task under tolerance instructions. The Autonomic Perception Questionnaire was administered shortly before the Cold Pressor task. Skin conductance and heart rate during the warning period proved to be significant predictors of pain tolerance behaviorally measured. The Autonomic Perception Questionnaire did not reveal any relationship between awareness of autonomic arousal and pain tolerance nor between actual level of arousal and subjective awareness of this arousal.
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Randomized Controlled Trial Clinical Trial
The role of epidural morphine in the postcesarean patient: efficacy and effects on bonding.
This study was designed to determine in postcesarean patients whether in addition to superior analgesic effects, epidural morphine administration results in secondary benefits in maternal well-being and maternal-infant interaction. Following elective cesarean section with bupivacaine epidural anesthesia, 40 healthy mothers received 5 mg preservative-free morphine sulfate in 10 ml of saline, either by the epidural (Group 1, n = 20) or the intravenous (Group 2, n = 20) route, in a randomized, double-blind fashion. Each received a simultaneous injection of saline by the alternate route. ⋯ Itching occurred in 58% of Group 1 patients and only 16% of Group 2 patients (P less than 0.01); the incidences of nausea, vomiting, and urinary retention were not statistically different between the groups. No respiratory depression was observed. Benefits of epidural morphine in this patient population appear limited to the provision of improved analgesia and earlier mobility.
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Continuous intercostal nerve blockade was used to provide analgesia after cholecystectomy. The blockade was maintained by the insertion of a single extradural catheter into an appropriate intercostal space and by "topping-up" with local anaesthetic on demand. ⋯ A mean improvement of 37% on pre- "top-up" peak flows, was found. It is suggested that continuous intercostal analgesia is a a safe, reliable and powerful form of analgesia which may improve respiratory function after cholecystectomy.