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

A double-blind random study compared the effects of lorazepam and pantopon an intra-muscular premedication in healthy women for uterine curettage (D & C). Anxiety, as assessed by a self-rating test by the patient and by a trained observer, showed a significant reduction at one and one-half hours after lorazepam and a smaller reduction after pantopon, which was not significant. Sedation was satisfactory with no significant difference between the two drugs in the change before and after the premedication. Lorazepam showed much more amnesia than pantopon (p less than 0.001). The patients who had lorazepam required higher doses of thiopentone for the operation, and this, in part, led to longer intervals in recovery times after lorazepam. However, it is suggested that lorazepam itself was partly responsible for the longer recovery. Pantopon was followed by more nausea, vomiting and headaches, than lorazepam. The intra-muscular injection of lorazepam hurt more patients than did pantopon, but other local complications were negligible and comparable in both groups. The results of this study show that lorazepam produces better reduction of anxiety and much more amnesia than pantopon, with comparable sedation and much less nausea and vomiting. The only disadvantage of lorazepam is the lack of analgesia and, therefore, the need for more anaesthesia during the operation. The conclusion is that lorazepam is a very satisfactory premedication and warrants more use as such.
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PMID:Lorazepam as a premedication. 0 77

The incidence of the postpartum sequelae of headache, backache, pain in the legs and difficulties in micturiton, was studied in 219 normal vaginal deliveries. 135 of the parturients received continuous segmental epidural analgesia at the level of Th 10--12 for pain relief during the first stage of labour. The remaining 84 parturients served as controls. The results showed that segmental epidural analgesia did not increase the occurrence of postpartum sequelae either in primiparous or in multiparous parturients.
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PMID:Segmental epidural analgesia and postpartum sequelae. 15 Feb 49

The effects of Lidocaine and the new local anaesthetic carticaine in spinal anaesthesia were compared in a double blind study in 120 elderly male patients scheduled for small urological procedures. The variables investigated were: analgesia examined by pin prick method, loss of tactile sensation, motor block, and skin temperature on the big toe. Both local anaesthetics seem to act similarly, but the loss of tactile sensation and motor block began somewhat earlier with carticaine. The differences have hardly any clinical significance. The incidence of hypotension and postanaesthetic headache was similar in each group.
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PMID:A comparison of carticaine and lidocaine in spinal anaesthesia. 36 Sep 57

A study of 400 consecutive cases of bupivacaine spinal anaesthesia is presented. The anaesthesia was for surgery on the lower abdomen or on the lower limbs. The patients' ages ranged from 19--91 years with the majority (60%) being over 60 years old. The patients were graded according to the A.S.A. (American Society of Anaesthesiologists physical status grade and 43% of the patients were graded as III or more. The duration of surgery lasted up to 3 hours yet analgesia always outlasted the surgery. The quality of analgesia achieved was assessed and in 94% of patients this was either good or perfect. No serious complications was observed but a common sequela was hypotension which was easily controlled by etilefrine (Effortil). There were a few cases of post-spinal headache but this was never severe or long lasting.
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PMID:Bupivacaine in spinal anaesthesia. 36 49

A series of 443 spinal anaesthetics is described. The procedures included operative vaginal delivery, removal of retained placenta and a miscellaneous group common to most obstetric units. Failure to provide effective relief of pain occurred in 5.2% of patients. There was one potentially serious complication, but with this exception hypotension was not a feature. Headache following spinal analgesia was experienced by 16.3% of patients, the frequency being greater among those who received spinal analgesia at or shortly after delivery, but was unrelated to the size of the needle (23-gauge of 25-gauge) used. Extradural blood patch promptly and permanently cured the headache. The duration of sensory and motor loss after operation varied considerably with the local anesthetic agent used. The re-introduction of spinal analgesia into British obstetric anaesthetic practice is advocated.
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PMID:Experience with spinal analgesia in a British obstetric unit. 46 70

Directional characteristics of spinal injections delivered via a 22 gauge Whitacre needle were confirmed in twenty-one obstetric patients undergoing elective Caesarean section. Caudad injection was inadequate for elective Caesarean section, while cephalad or lateral injection provided good sensory levels for the duration of the surgery. It is speculated that along with the low incidence of postspinal headache and ease of administering the block with a more rigid 22 gauge needle, low dose caudally directed injections may provide a superior means of administering saddle block analgesia for obstetric patients.
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PMID:Directional spinals in obstetric analgesia. 63 77

Review of 1400 epidural anaesthesias during labour and delivery. The single shot method resulted in complete analgesia in 83.8% of the cases. There were 2.8% failures. With longer duration of albour 13.4% of the epidural anaesthesias had to be repeated. Epidural anaesthesia was tolerated well by the women in labour. Hypotension occurred in 21.6% of the cases and was corrected by intravenous infusion and positioning of the patient on the side. No adverse effects on the fetus were found. The duration of labour and delivery was not prolonged. The caesarean section rate was not increased by epidural anaesthesia. Because of the more difficult bearing down reflux during the second stage of labour, the incidence of vacuum extractions was increased by 1 to 3%. The incidence of forceps deliveries remained stable. There was no significant increase of abnormal vertex positions. Postpartum headaches because of decompression by loss of cerebrospinal fluid was seen in 2.2% of the cases. The headaches subsided on complete bed rest. One case of total spinal anesthesia with respiratory arrest is reported which necessitated immediate intubation. Another dangerous complication was noted in a Para 2 who suffered a complete uterine rupture below the level of the epidural anesthesia without any clinical signs and symptoms. Therefore continual internal fetal monitoring is considered to be essential in all cases with epidural anaesthesias. Previous caesarean sections or uterine operations are no contra-indications to epidural anaesthesia.
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PMID:[Epidural anaesthesia in obstetrics (author's transl)]. 83 61

A total of 56 women 18-45 years of age weighing 40-100 kg schedules for elective laparoscopic sterilization with or without uterine curettage were randomized into 2 groups, and 25 were subsequently analyzed in each data set. They received either 2 suppositories of 100 mg indomethacin each (Indocid) (Group 1), or 2 identical placebo suppositories (Group 2). At the same time, all patients received a premedication of temazepam 10 mg orally 2 hours preoperatively. General anaesthesia consisted of droperidol 1.25 mg IV, fentanyl 1.5 mcg/kg IV. Filshie clips were used exclusively. Analgesia consisted of 25 mg aliquots of pethidine iv in the recovery room and on the ward by using 1.0 mg.kg of in pethidine, 2-hourly if requested. There was no difference between groups with respect to patient characteristics. In the recovery room, the rating of no pain was lower with 28% in the indomethacin group (group 1) versus 18% in group 2, but the difference was not significant (p = .29). At 30 minutes postoperatively, 54% of those receiving indomethacin compared to 47% of the placebo groups had a pain score less than 30 (p = .09); and 96% compared to 72% had a score less than 70 (p = .07), but these differences were not significant. 48% in group 1 and 32% in group 2 did not require any postoperative pethidine (p = .39). The mean dosage of pethidine used was 24 mg +or- 27 mg in the indomethacin group and 42 mg +or- 44 mg in the placebo group. The Wilcoxon Rank Sum test also showed a nonsignificant trend for lower pethidine dose requirements in the indomethacin group, and in the Log Rank test this difference almost reached statistical significance. The incidence of preoperative (postmedication) nausea, headache and abdominal pain did not differ between the groups. There was a consistently lower incidence of postoperative symptoms or side-effects in the indomethacin group, but this was not statistically significant.
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PMID:Preoperative rectal indomethacin for analgesia after laparoscopic sterilisation. 138 3

A number of recent studies have suggested that the analgesic effects of highly lipid-soluble opioids are similar when these agents are administered either epidurally or intravenously. We sought to test whether the lipid-soluble opioid sufentanil was more effective when administered intrathecally than when administered epidurally or intravenously. Twenty-four women during active labor received sufentanil 10 micrograms either intrathecally (n = 9), epidurally (n = 8), or intravenously (n = 7), using a combined spinal-epidural technique. The sufentanil was administered alone, without concomitant local anesthetics. Analgesia was assessed using the visual analogue score as well as the time elapsed from the administration of study drug to the patient's request for additional analgesia via the epidural catheter (bupivacaine 0.25%). The median duration of analgesia (median, interquartile range) was 84 (70-92) min in the intrathecal group, 30 (23-32) min in the epidural group, and 34 (17-30) min in the intravenous group (P < 0.001). The intrathecal group showed rapid and significant decrease in visual analogue scale scores, whereas visual analogue scale scores in the other two groups did not decrease and remained significantly elevated compared to those of the intrathecal group at all observation points. Side effects were limited to pruritus in 3 patients (2 moderate and 1 severe) in the intrathecal group. No patient developed post-dural puncture headache. We conclude that sufentanil 10 micrograms intrathecally provides rapid and effective analgesia of 1-2-h duration during labor. Epidural and intravenous use of this dose of sufentanil did not provide evidence of satisfactory analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia. 144 41

We have studied 150 women undergoing elective Caesarean section under spinal anaesthesia. They were allocated randomly to have a 22-gauge Whitacre, a 25-gauge Whitacre or a 26-gauge Quincke needle inserted into the lumbar subarachnoid space. The groups were compared for ease of insertion, number of attempted needle insertions before identification of cerebrospinal fluid, quality of subsequent analgesia and incidence of postoperative complications. There were differences between groups, but they did not reach statistical significance. Postdural puncture headache (PDPH) was experienced by one mother in the 22-gauge Whitacre group, none in the 25-gauge Whitacre group and five in the 26-gauge Quincke group. Five of the six PDPH occurred after a single successful needle insertion. Seven of the 15 mothers in whom more than two needle insertions were made experienced backache, compared with 12 of the 129 receiving two or less (P < 0.001). We conclude that the use of 22- and 25-gauge Whitacre needles in elective Caesarean section patients is associated with a low incidence of PDPH and that postoperative backache is more likely when more than two attempts are made to insert a spinal needle.
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PMID:Spinal anaesthesia for caesarean section: comparison of 22-gauge and 25-gauge Whitacre needles with 26-gauge Quincke needles. 146 2


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