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

Sixty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group IV received standard i.v. PCA with a bolus dose of morphine 20 micrograms kg-1 and a background infusion of 4 micrograms kg-1 h-1 while group SC received PCA by the s.c. route with a bolus dose of morphine 20 micrograms kg-1 and a background infusion of 5 micrograms kg-1 h-1. In both groups there was a lockout interval of 5 min. Group SC self-administered significantly less morphine (P < 0.05) and had a significantly (P < 0.01) greater percentage of valid demands for analgesia than group IV. There were no differences in pain scores between the groups at rest or during movement. Group IV suffered significantly (P < 0.01) more hypoxic episodes than group SC. There were no differences between groups in the incidence of postoperative nausea and vomiting or oversedation. S.c. PCA appears to be as effective and safe as i.v. PCA. By giving patients feedback on the occurrence of valid demands for analgesia, s.c. PCA may produce more appropriate and effective use of PCA.
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PMID:Comparison of patient-controlled analgesia in children by i.v. and s.c. routes of administration. 819 3

Using a randomized, double-blind, placebo-controlled design, we have investigated, in 40 patients undergoing major abdominal surgery, the effect of oral clonidine 300 micrograms, 1 h before and 12 h after surgery on postoperative morphine requirements (evaluated by PCA). During the 24 h of the study, pain scores measured every 6 h did not differ significantly. Morphine requirements tended to be reduced in the clonidine group but the difference was not significant. There were no significant differences also in mean arterial pressure, ventilatory frequency and the incidence of pruritus and nausea. Heart rate was significantly lower until 18 h after surgery and sedation was significantly more pronounced in patients receiving clonidine. We cannot recommend routine oral administration of clonidine before surgery to improve postoperative analgesia.
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PMID:Addition of oral clonidine to postoperative patient-controlled analgesia with i.v. morphine. 819 4

Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. This analgesic technique is however less efficacious than epidural analgesia and thus might essentially be useful in situations when the latter is contra-indicated. During labor, patient-controlled epidural analgesia (PCEA) may produce powerful pain relief and may reduce local anesthetic doses thus reducing motor blockade. After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.
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PMID:[The use of patient-controlled analgesia by the obstetrical patient]. 828

A retrospective chart review of the 198 postoperative subjects (patient-controlled analgesia [PCA] group = 100 and non-PCA group = 98) comparing analgesic usage and other variables was conducted. The PCA group used significantly more medication during the first 24 hours postoperatively and patients required more analgesic when a greater number of secondary diagnoses existed. No significant differences were found in length of stay or documentation.
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PMID:A comparison of patient-controlled analgesia versus traditional intramuscular analgesia in postoperative pain management. 830 5

Despite intravenous patient-controlled analgesia's (IV-PCA) increasing popularity, the psychological and pharmacological factors upon which patient satisfaction with IV-PCA are based are unknown. Sixty-eight women scheduled for abdominal hysterectomy completed a series of questionnaires measuring emotional distress, locus of control, perceived support, and optimism before their surgery. Postoperative ratings of pain intensity, emotional distress, anticipated recovery time, nightmares, and satisfaction with IV-PCA were taken 1 and 3 days after surgery. A nurse observer rated perceived anxiety, estimated recovery, and satisfaction with IV-PCA. Cumulative and hourly IV-PCA use and dose/demand ratio were obtained. Degree of dissatisfaction with IV-PCA was significantly correlated with pain intensity, nightmares, patient's perceptions of support, expectations of recovery, preoperative anxiety, and postoperative depression. Dose/demand ratio and hourly analgesic usage were significantly related to pre- and postoperative emotional distress factors. Perioperative management of anxiety, perceptions, and expectations may prove valuable in improving pain control and satisfaction with IV-PCA.
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PMID:Psychosocial and pharmacologic predictors of satisfaction with intravenous patient-controlled analgesia. 831 18

In a prospective study, 50 women who had undergone uncomplicated abdominal hysterectomy under general anaesthesia were allocated randomly to receive patient-controlled analgesia with either morphine alone or a mixture of morphine and droperidol. Bolus doses of morphine 1 mg and droperidol 0.05 mg were used with a lockout time of 5 min. During the first 24 h after surgery the mean (range) dose of droperidol in the droperidol group was 3.2 (1.9-6.0) mg. Significantly fewer patients in the droperidol group felt nauseated (P < 0.01) and significantly fewer vomited (P < 0.001). In the morphine alone group, 19 patients required additional antiemetic therapy, whereas in the droperidol group only one patient found this necessary (P < 0.001). Extrapyramidal side effects were not observed in any patient. Significantly more patients were of the opinion that PCA had provided excellent analgesia when droperidol had been used (P < 0.01).
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PMID:Patient-controlled analgesia with a mixture of morphine and droperidol. 819 21

Advances in the technology of infusion pumps and ports have opened a new spectrum of indications. The choice of the device is dependent on the specific indication. The PCA concept (patient-controlled analgesia) has made a more individualized pain therapy possible. Recent developments are aimed at substituting the individual on-demand bolus with adaptations in steady-state serum concentrations of analgesics using BET (bolus-elimination transfer) programming. As demonstrated in several studies, ports can be safely used for chronic pain treatment. However, as with the use of infusion pumps, the indications for use must be evaluated carefully and especially-trained staff is a prerequisite for success.
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PMID:[Pumps and access ports in the drug therapy of pain]. 846 Feb 92

This double-blind prospective study was designed to determine the best dose variables for patient-controlled epidural analgesia (PCEA) and to compare bolus-only PCEA with continuous infusion epidural analgesia (CIEA) during the first stage of labour. Five groups of parturients self-administered 0.125% bupivacaine with 1:400,000 epinephrine and fentanyl 2.5 micrograms.ml-1 using PCA pumps programmed as follows: Group A, 2 ml bolus/10 min lockout interval (LI); Group B, 3 ml bolus/15 min LI; Group C, 4 ml bolus/20 min LI; Group D, 6 ml bolus/30 min LI; Group E, 8 ml.hr-1 continuous infusion. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, bupivacaine and fentanyl consumption. Blood samples were collected at birth for maternal and fetal fentanyl concentrations. Data from 68 patients showed no differences among groups in pain relief or maternal satisfaction. Most patients received excellent analgesia and those requiring extra epidural supplements were evenly distributed across groups. There was higher consumption of bupivacaine and fentanyl in Group E than in any of the other four groups: bupivacaine mg.hr-1, mean (SD), 9.4 (2.7) in Group E vs 5.2 (1.7) in Groups A-D inclusive (P < 0.0001); fentanyl microgram.hr-1, 19.6 (4.6) in group E vs 12.6 (7.5) in Groups A-D inclusive (P < 0.05). Motor block was minimal, whereas sensory levels were higher at the 3- and 4-hour assessments in Groups D and E than in all other groups (P < 0.05). Plasma fentanyl concentrations were < 0.5 ng.ml-1 in all samples and no sequelae from fentanyl were observed, apart from mild pruritus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval. 846 42

Ketorolac tromethamine (Toradol [Syntex, Palo Alto]), a new commercially available nonsteroidal antiinflammatory drug (NSAID), has appropriate solubility and minimal tissue irritation, making it suitable for intramuscular injection. Previously, NSAID have only been available for oral use in the United States for the treatment of pain. Ketorolac, the most potent NSAID known, relieves pain through inhibition of arachidonic acid synthesis at the cyclooxygenase level and has no central opioid effects. The results of previous studies using parenteral ketorolac in combination with patient administered narcotics have shown a 40 percent reduction in narcotic requirements. However, ketorolac is presently only approved for intramuscular injection and oral use in the United States. In a prospective, randomized study, we compared intramuscular ketorolac in combination with patient controlled intravenous narcotic analgesia (morphine) (PCA-M) to PCA-M alone for the control of pain after extensive colonic resections. The combination of intramuscular ketorolac and PCA-M provided equal pain relief with no increased side effects when compared with narcotics alone. However, narcotic requirements of the patients were decreased by an average of 45 percent. Ketorolac and narcotics in combination provide effective postoperative pain relief and significantly decrease narcotic requirements. This combination may be particularly beneficial in the subpopulation of patients especially prone to narcotic related complications.
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PMID:Ketorolac and patient controlled analgesia in the treatment of postoperative pain. 848 Feb 64

In a prospective, randomized, double-blinded study, 23 patients who had undergone Caesarean delivery under epidural anaesthesia were assessed to evaluate the effectiveness of patient-controlled epidural analgesia (PCEA) with fentanyl compared with a single dose of epidural morphine for postoperative analgesia. Group A (n = 11) received epidural fentanyl 100 micrograms intraoperatively then self-administered a maximum of two epidural fentanyl boluses 50 micrograms (10 micrograms.ml-1) with a lockout period of five minutes for a maximum of two doses per hour. Group B (n = 11) received a single bolus of epidural morphine 3 mg (0.5 mg.ml-1) intraoperatively and received the same instructions as Group A but had their PCA devices filled with 0.9% NaCl. Patients were assessed up to 24 hr for pain, satisfaction with pain relief, nausea and pruritus using visual analogue scales (VAS). The treatments for inadequate analgesia, nausea and pruritus as well as time to first independent ambulation were recorded. The ventilatory response to carbon dioxide challenge was measured at four and eight hours. Pain relief, satisfaction with pain relief, and the use of supplemental analgesics were similar in both groups. The mean 24 hr dose of epidural fentanyl used by group A patients was 680 micrograms. Pruritus was less common in Group A patients at the 8 and 24 hr observation periods (P < 0.0125). Both groups experienced the same degree of nausea and clinically unimportant respiratory depression. We conclude that PCEA with fentanyl provides analgesia equal to a single dose of epidural morphine and may be suitable for patients who have experienced considerable pruritus after epidural morphine administration.
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PMID:A comparative study of patient-controlled epidural fentanyl and single dose epidural morphine for post-caesarean analgesia. 851 20


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