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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 387 pat., we observed the interdependence of abnormal vertebral column and failures in epidural anaesthesia by medial tap with the "los of resistance" method. We could show that in contradistinction to other opinions scoliosis induces no higher rate of failure of epidural anaesthesia than the normal vertebral column. In patients with kyphoscoliosis and ossified ligaments the epidural space was identified less frequently than in the normal group, perforations of the dura were encountered more frequently. These results are statistically significant. In patients who had or have pain in the back (p.e. lumbago) and those with ossified ligaments we found significantly more pain during operation although analgesia was tested before. In these three abnormalities of the vertebral column we recommend to judicously balance advantages against disadvantages of epidural anaesthesia and alternative anaesthetic procedures.
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PMID:[The influence of abnormal vertebral column on failure in epidural anaesthesia (author's transl)]. 14 69

The anaesthetic management of patients requiring surgical correction of idiopathic scoliosis using the Harrington Rod Instrumentation Technique is discussed. Special emphasis is made of the need to minimise blood loss, to limit homologous blood transfusions and to provide adequate postoperative analgesia.
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PMID:Practical anaesthesia: the anaesthetic management of major spinal surgery in children. 50 53

We performed a randomized nonblinded, cross-over comparison of patient-controlled analgesia (PCA) with conventional intramuscular analgesia in 10 adolescents (13-18 years) undergoing spinal fusion for idiopathic scoliosis. PCA use afforded more effective pain control (p < 0.02) on a 10-point linear pain intensity scale than did intramuscular injections, while causing an equal amount of sedation and no side effects. PCA appears to be a promising technique for providing postoperative pain relief in this group of adolescents. Further studies are needed to define its role for other pediatric conditions.
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PMID:Patient-controlled versus conventional analgesia for postsurgical pain relief in adolescents. 130 44

We report postoperative pain management of two adolescents after upper abdominal procedures, one with Hurler-Scheie syndrome and a second with Duchenne muscular dystrophy, and both had progressive spinal scoliosis with poor pulmonary function. A combined technique of subarachnoid and general anesthesia was used during surgery. Postoperative administration of small intermittent doses of subarachnoid morphine produced profound analgesia, which eliminated the need for systemic opioids, restored preoperative arterial oxygenation within 48 hours after the operation, and expedited postoperative recovery.
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PMID:Continuous subarachnoid analgesia in two adolescents with severe scoliosis and impaired pulmonary function. 177 18

For the treatment of postoperative (p.o.) pain following vertebral surgery, systemic analgesics are frequently used in high doses with a variety of side effects. It was the aim of this study to investigate p.o. epidural catheter analgesia in 20 patients following surgical correction of scoliosis using the Cotrel and Dubousset technique. METHODS. The patients received balanced general anesthesia with fentanyl and isoflurane. At the end of the operation, before closing the fascia, an epidural catheter was placed by the orthopedic surgeon. After extubation and following evaluation of the motor function of all extremities. 6-10 ml bupivacaine 0.25% was injected into the epidural catheter followed by continuous administration of 0.25% bupivacaine 4-8 ml/h. Analgesic level and hemodynamic parameters were monitored. Pain was measured by the visual analogue scale. If analgesia was not sufficient, the patients received tramadol or piritramide intravenously. RESULTS. In 11 of 20 patients epidural analgesia was rated adequate; 5 needed additional systemic analgesics, and in 4 effective analgesia was not achieved with either epidural analgesia or systemic opioids. No complications were observed. DISCUSSION. The pilot study documented that epidural analgesia using an intraoperatively placed epidural catheter can be used for p.o. pain relief after vertebral surgery using the Cotrel and Dubousset technique. Additional studies will compare the method described to other pain-relieving procedures.
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PMID:[Postoperative analgesia following spondylodesis using a peridural catheter placed during surgery. Results of a pilot study]. 205 26

This five-year retrospective study reviews our experience with epidural obstetric analgesia in patients with previous Harrington rod instrumentation (HRI) for correction of idiopathic scoliosis. Patients were identified by the presence of an antepartum anaesthetic consultation for HRI. The anaesthetic record was examined to determine the frequency of epidural catheter insertion and any problems related to this procedure. Nine epidural insertions were attempted in the 16 patients identified. Five were uncomplicated but four were complicated by one or more of: failure to identify the epidural space, blood vessel trauma, dural puncture, failure to obtain analgesia or the need for multiple attempts before successful insertion. There were no sequelae related to epidural insertion. There were no sequelae related to epidural insertion. We conclude that patients with HRI may be offered epidural anaesthesia for labour and delivery provided that they are informed of the increased risk of complications.
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PMID:Obstetric epidural anaesthesia in patients with Harrington instrumentation. 220 54

Postoperative pain is a distressing and disabling feature of scoliosis surgery. Epidural morphine has recently been advocated to reduce the frequency and severity of postoperative pain in adults. A retrospective study of 35 patients was conducted to determine whether epidural administration of morphine is useful in the management of postoperative pain in children and adolescents following posterior spinal fusion. The derived data included dose and frequency of narcotic administration on the day of surgery and during the subsequent three days. On the first postoperative day, the total morphine given averaged only 16.4 mg in patients receiving epidural morphine compared to 27 mg in those receiving only conventional parenteral morphine. Similar significant differences persisted through the second postoperative day. Intermittent epidural injection of small doses of morphine can give satisfactory and prolonged analgesia for early postoperative pain management.
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PMID:Efficacy of intermittent epidural morphine following posterior spinal fusion in children and adolescents. 258 72

The use of patient-controlled analgesia is described for forty children who had undergone major orthopaedic or general surgery. Ages ranged from 6 to 18 years (mean 11.4 years) and PCA was used for an average of 46.2 hours postoperatively. Morphine requirements overall averaged 40.5 micrograms/kg/hr (SD 22.6). Requirements for the first six hours were not significantly different to a similar period 24 hours later. There was a large individual variation for patients undergoing similar procedures. Patients undergoing scoliosis surgery required significantly more morphine than any other group of patients. Problems with patient-controlled analgesia have been of a minor nature. We conclude that patient-controlled analgesia is a suitable and safe method of pain relief for paediatric patients and that the lower age limit is that at which a child can understand the concept after suitable explanation. In this study children as young as six years were able to successfully use the method.
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PMID:Patient-controlled analgesia in children. 277 44

Fentanyl, though generally regarded as a short-acting narcotic analgesic, can give unexpected respiratory depression several hours after the last dose. This potentially very dangerous effect is explained in pharmacokinetic studies by a mobilisation of fentanyl from tissue stores. In this report we describe a patient who, following a Harrington correction for scoliosis done with neurolept analgesia, developed a severe respiratory depression 5 h after the last dose of fentanyl.
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PMID:Recurrence of respiratory depression following neurolept analgesia. 711 33

Both epidural and intravenous clonidine are used to provide postoperative analgesia, but in predetermined doses. This double-blind randomized study was designed to 1) determine the clonidine dose inducing pain relief after major orthopedic surgery, when controlled by patient, either intravenously or epidurally; and 2) assess whether these two administration routes are clinically equivalent. At the first complaint of pain after scoliosis correction, patients received an initial dose of 8 micrograms/kg clonidine during 30 min either intravenously (n = 12) or epidurally (n = 12). Then, clonidine was given using a patient-controlled analgesia pump via the corresponding administration route. In both cases, the bolus dose was set at 30 micrograms and the lockout interval at 15 min. Pain (0-100 scale), clonidine requirements, sedation (0-4 scale), and hemodynamics (by fiberoptic pulmonary artery catheter) were measured before and 15, 30, 120, 240, 360, 480, and 600 min after the loading dose was started. Plasma clonidine concentrations and arterial blood gases were determined at the 15th, 30th, 240th, and 480th min. Self-administered and total clonidine doses were larger in the intravenous group than in the epidural group (at 600 min: 372 +/- 110 vs 235 +/- 144 micrograms, and including the initial dose, 814 +/- 114 vs 652 +/- 187 micrograms; mean +/- SD). Clonidine administration resulted in pain relief and sedation in both groups but, for comparable pain relief, sedation scores were lower in the epidural group. No intergroup differences in hemodynamic data were observed, although the decrease in blood pressure occurred earlier in the intravenous group. Plasma clonidine concentrations were higher in the intravenous group than in the epidural group (2.5 +/- 0.6 vs 1.5 +/- 0.5 ng/mL after the initial dose and 2.1 +/- 0.5 vs 1.5 +/- 0.4 ng/mL during self-administration; mean +/- SD). We conclude that analgesia can be achieved postoperatively by both epidural and intravenous clonidine administration. The epidural route is associated with significant reductions in self-administered clonidine dose, and thus in the plasma clonidine concentration, and the level of sedation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of intravenous and epidural clonidine for postoperative patient-controlled analgesia. 757 98


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