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

In a controlled study a single segment combined spinal epidural (CSE) block was compared with epidural block for cesarean section. Thirty healthy parturients were randomly divided into two groups. In both groups a T4 block was aimed at. Bupivacaine was used to provide analgesia in both groups. All patients receiving CSE block had good to excellent analgesia, while 11 patients (74%) receiving epidural block had similar pain relief. This was reflected in the requirement for additional analgesics, sedatives or N2O anesthesia. The muscular relaxation was also better following CSE block. The total dose of bupivacaine for a T4 block was three times larger in patients receiving only epidural block. The maternal and fetal blood bupivacaine levels were correspondingly about three times higher in the epidural group. Additionally, the incidence of maternal hypotension was higher in patients receiving epidural block. Apgar scores, blood gases and neurobehavioural evaluation did not show any differences between the two groups of neonates. No postspinal headache was noted. CSE block appears to combine the reliability of spinal block and the flexibility of epidural block while minimizing their drawbacks.
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PMID:Epidural versus combined spinal epidural block for cesarean section. 281 42

We compared the efficacy and side-effects of continuous infusion versus repeated injections of epidural bupivacaine-fentanyl during labour. Forty-four parturients were randomly distributed into two groups balanced for population size, morphology and parity. Analgesia was begun at the same stage of labour with a mixture of 20 ml 0.25 per cent plain bupivacaine and 2 ml (100 micrograms) fentanyl. In Group I the initial dose ranged from 8-12 ml as a function of height; an injection of the same dose was repeated immediately upon recurrence of pain. In Group II, after an initial dose of 5-7 ml, a continuous infusion of 3 ml.h-1 was begun, and continued until full dilatation. Analgesia was rated using a pain scale; effects on maternal blood pressure, respiratory rate and neonatal status were noted. Bupivacaine and fentanyl assays were carried out on maternal venous blood in 30 parturients during the course of labour. There was a longer latency to onset of analgesia in Group II (approximately five minutes), followed by a more constant degree of analgesia. This better analgesia cannot be accounted for by a difference in dosage; doses were significantly lower in Group II, despite the fact that labour was of the same duration. The course of labour, and maternal and neonatal status were comparable in the two groups. Assays showed no difference in bupivacaine blood concentrations between the two groups nor signs of drug accumulation. The constant infusion technique is advantageous since it provides a more regular degree of analgesia with lower doses than those required for patients having repeated injections.
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PMID:Epidural analgesia with a bupivacaine-fentanyl mixture in obstetrics: comparison of repeated injections and continuous infusion. 335 49

The effect of high thoracic epidural analgesia (TEA) on the cardiovascular system was investigated in 10 patients (5 with cardiovascular disease and 5 without known cardiovascular disorder), who were scheduled for a thoracotomy. An epidural catheter was inserted at T1-T2 level. Plain bupivacaine (Marcaine) 0.5%, 4 to 6 ml was used and resulted in a mean analgesic level from C7 to T5. TEA did not significantly affect the following parameters: heart rate, mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary wedge pressure, stroke volume index, systemic vascular resistance, pulmonary vascular resistance, right and left ventricular stroke work index. From this study it is concluded that high TEA with bupivacaine has only minor effects on the cardiovascular system.
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PMID:The influence of high thoracic epidural analgesia on the cardiovascular system. 336 71

A double-blind study was carried out in 20 patients to compare 5% hyperbaric lignocaine and 0.5% hyperbaric bupivacaine for subarachnoid block. The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects and the frequency of side effects were studied. Cephalad spread of analgesia was high (T4-5) with both solutions. Bupivacaine produced a longer duration of action in the lumbar and sacral segments but the duration in the thoracic segments was similar. There was a considerable degree of hypotension in both groups but this responded readily to ephedrine. Hyperbaric lignocaine is an alternative to hyperbaric bupivacaine and its shorter duration of action in the lumbar and sacral segments is advantageous when a fast recovery is desirable.
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PMID:Subarachnoid block with hyperbaric lignocaine. A comparison with hyperbaric bupivacaine. 343 39

Since its introduction to North America in 1942, the use of epidural catheter analgesia has increased dramatically. Improved equipment, methods and medications have broadened its application to include among others, surgical anesthesia, chronic pain relief and the management of postoperative pain. Numerous techniques for epidural puncture and insertion of the catheter have been described. Although complications have been associated with placement of an epidural catheter, these are rare when performed by an experienced anesthesiologist. Epidural analgesia was first accomplished by blockade with local anesthetics. Bupivacaine has been called the local anesthetic of choice for epidural infusion. Bolus administration of epidural local anesthetics gives effective analgesia; however, its use is limited by brief duration and occasionally severe hypotension. Epidural local anesthetics have been administered by continuous infusion in an attempt to minimize side effects. Nevertheless, hypotension, as well as motor block, numbness, nausea and urinary retention have occurred. Epidural analgesia with local anesthetics is effective in relieving postoperative pain, but its safety and feasibility have been questioned because of the frequent, potentially serious side effects. These problems led to trials of epidural narcotics for postoperative pain management. The exact site of action of epidural narcotic analgesics is debatable; however, the bulk of evidence supports a direct spinal action. Epidural narcotics appear to specifically inhibit nociceptive stimuli. The prolonged and profound analgesia that occurs with epidural narcotics relative to parenteral administration is due to a higher concentration of drug reaching the CSF through the epidural route. Since nervous transmission is not completely blocked this technique cannot provide anesthesia during operation. Morphine has been the most frequently used narcotic for epidural analgesia. Results of several recent, randomized double-blind studies have shown that epidural narcotics give adequate analgesia comparable with that observed with epidural bupivacaine. Epidural morphine provides a greater duration of analgesia and may cause fewer side effects. Improved analgesia has been reported when epidural narcotics are used in combination with local anesthetics. Continuous administration of low dosage epidural narcotics has been shown to have less frequent side effects than bolus administration. Nevertheless, pruritus, urinary retention, hypotension and severe respiratory depression have been reported with both methods.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Epidural catheter analgesia for the management of postoperative pain. 351 98

A sensitive and selective high-performance liquid chromatographic (HPLC) method for the determination of bupivacaine and its two metabolites, desbutyl- and 4'-hydroxybupivacaine, in human serum and urine is described. Bupivacaine, both metabolites and the internal standard, etidocaine, are extracted with diethyl ether and then back-extracted into an acidic aqueous phase. After subsequent extraction into diethyl ether, evaporation and reconstitution in the mobile phase, bupivacaine and the metabolites are determined by HPLC using a reversed-phase C8 column with tetrahydrofuran-potassium phosphate buffer (8:92, v/v, pH 2.4) as the mobile phase. The sensitivity of the method is 10 micrograms/l for bupivacaine and both metabolites and the extraction efficiencies are 95, 54 and 92% for bupivacaine and desbutyl- and 4'-hydroxybupivacaine, respectively. The reproducibility of the method is good, the coefficients of variation varying between 1.8 and 7.4% in the concentration range 0.10-2.00 mg/l. The procedure was applied to human serum and urine samples from two elderly women who had been operated on under epidural analgesia (plain bupivacaine, 1.5 mg/kg) because of uterine prolapse.
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PMID:Simultaneous determination of bupivacaine and its two metabolites, desbutyl- and 4'-hydroxybupivacaine, in human serum and urine. 355 65

In a retrospective study clinical experience with epidural Bupivacaine 0.75% for laparoscopy is presented; the main interest of the study is focused on the relaxation of the abdominal wall musculature as expressed by compliance: volume of CO2-insufflation/pressure. Data of 55 patients were collected (= Group A) divided into 3 subgroups according to dosage: subgroup I = 15.0 ml = 112.5 mg (n = 12), II = 17.5 ml = 131.25 mg (n = 16), III = 20.0 ml = 150.0 mg (n = 27). These 55 patients are compared with two other groups of patients: group B = epidural anaesthesia with etidocaine 1.5% (n = 14) and group C = general anaesthesia with pancuronium as muscle relaxant 0.08 mg/kg (n = 7). Within group A the 3 subgroups do not show much difference except for one significant difference (p less than 0.05): between subgroup I and III concerning the upper limits of analgesia (1.5 segments: T 7 vs T 5/6), in the lowest dose-group the patients having the lowest weight (p less than 0.05). There was interdependence only with respect to two items: spread of analgesia (upper limit) depending on total dose (p less than 0.01) and on age (p less than 0.05), as well as dose/segment depending on age (p less than 0.01); despite statistical significance the correlation was rather weak.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Epidural anesthesia with bupivacaine 0.75% for pelviscopic intervention. Clinical results of a 6-month study]. 357 12

The authors examine a technique that is performed for control of postoperative pain. Sixty-eight patients were evaluated who had received a combination of Marcaine with no epinephrine, plus Hexadrol, at the surgical site immediately postoperatively. It was found that 65% did not require any form of analgesia within the first 4 hours postsurgically; 44% the first 8 hours, and 28% the first 12 hours. Sixteen percent of the patients required no form of analgesia during their entire hospital stay.
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PMID:Control of postoperative pain in foot surgery using a combination of anesthetic and steroid for local infiltration. 361 26

Continuous lumbar epidural analgesia (L.E.A.) is considered to be the most effective technique for providing pain relief during labour and delivery. A prospective randomized study of 52 patients with pre-eclamptic toxemia in labour was carried out to investigate various aspects of the use of L.E.A. in view of the considerable disagreement concerning its effect. The results were compared to a control group (n = 52) receiving i.v. infusion of Hydralazine (Apresoline) and MgSO4 according to Zuspan recommendations. The results were evaluated statistically. The incidence of neonatal jaundice was higher in the control group (P less than 0.005). Maternal postpartum complications were similar in both groups. There were fewer forceps deliveries in the control group (P less than 0.05). The decrease in systolic BP after L.E.A. is well documented up to 120 min after the first injection of Marcaine (P less than 0.001-0.025), while after 120 min, by which time the Marcaine effect has finished, the systolic BP rises again (time for topping up). The decrease in the average diastolic BP as compared to the control group is statistically significant (P less than 0.001-0.01) until 180 min after initiation of the L.E.A. After that, the average diastolic BP rises again, unless Marcaine is topped up. Our results favour L.E.A. as the obstetric analgesic method of choice in cases of severe pre-eclampsia.
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PMID:Lumbar epidural analgesia in hypertensive patients during labour. 372 Oct 47

A femoral nerve block was performed as a postoperative analgesic technique in 50 patients after knee surgery; this surgery is a very painful one. The technique used was the inguinal route, as described in the textbooks. Bupivacaine was used: 1.5 mg X kg-1 without exceeding 150 mg. The result was good in 46 patients, with four failures. The average duration of analgesia was 600 min, the shortest being 300 min, the longest being 1,200 min. This technique can be recommended after surgery of the knee as safe and reliable.
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PMID:[Femoral nerve block as a postoperative analgesia technic in surgery of the knee]. 381 43


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