Analgesia For Pain Relief Research Articles

Comparison between intermittent intravenous analgesia and intermittent paravertebral subpleural analgesia for pain relief after thoracotomy

In the present prospective double-blind randomized trial, the effects of intermittent paravertebral subpleural bupivacaine and morphine on pain management in patients undergoing thoracotomy were evaluated and compared with intermittent systemic analgesia. Forty-five patients undergoing elective lobectomy were included in the present study. Three randomized groups consisting of 15 patients each were compared. Those in the control group were administered intravenously with tramadol 100 mg plus metamizol 1000 mg every 4 h for 3 days. We placed the catheter just below the parietal pleura along the paravertebral sulcus at the level of T5-T7. At the end of the operation and every 4 h thereafter, the patients received either 1.5 mg kg(-1) bupivacaine (bupivacaine group) or 0.2 mg kg(-1) morphine sulfate (morphine group) with paravertebral subpleural catheter for 3 days. Data regarding demographics, visual analog pain scores, need for supplementary intravenous analgesia, pulmonary function tests, and postoperative pulmonary complications were recorded for each patient. Visual analog pain scores (visual analog scale (VAS)) were lower in the morphine and bupivacaine groups compared with control group at all postoperative time points. The mean postoperative VAS was significantly different between the control and bupivacaine groups at postoperative hour 12, the control and morphine groups at postoperative hours 6, 12, 48, and 72, and the bupivacaine and morphine groups at postoperative hours 6 and 24 (p<0.05). In the control group, additional analgesic requirement was significantly higher than in the bupivacaine and morphine groups (p<0.05). Postoperative pulmonary complications occurred in three patients (20%) in the control group, in two patients (13%) in the bupivacaine group, and in one (6%) in the morphine group. The patients undergoing lung resection through a thoracotomy were observed with reduced postoperative pain and better surgical outcomes with respect to the length of hospital stay, postoperative forced expiratory volume in the first second, pulmonary complications, and need for bronchoscopic management, when paravertebral subpleural analgesia was induced by morphine.

Body Art Causing Radiological Artifact: A Case Study

An otherwise healthy 26-year-old pregnant woman in active labor requested epidural analgesia for pain relief. Her history was significant for scoliosis, having undergone surgical correction with Harrington rods in the thoracic spine 10 years earlier. A well-healed midline surgical scar was apparent between her scapulae. The lumbar area of the back was free of any obvious surgical scars. She offered spine radiographs, taken 5 years earlier, to confirm location of surgical hardware. Examination of the radiographs (Figure 1) did indeed confirm thoracic spinal hardware, but also raised concern for possible lumbar spinal instrumentation, which could potentially complicate the epidural anesthetic. On further questioning, a piece of dangling navel jewelry, also known as a ‘‘belly button’’ ring, was the cause for this radiological artifact. Epidural analgesia for her labor proceeded without difficulty. The practice of body piercing and tattooing goes back to ancient civilizations. Historically, body art was often considered deviant or rebellious behavior, relegated to a nonmainstream segment of the population. However, recent data indicate that this practice has spread throughout all socioeconomic classes and age groups (Laumann & Derick, 2006; Stirn, 2003). The popularity of body art has increased in prevalence over recent years with some data suggesting 25% to50%of the population with some form of body art, either piercings (other than

Prise en charge anesthésique d’un accouchement chez une patiente atteinte d’un déficit en inhibiteur de C1 estérase

Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows.

Effects of Epidural Anesthesia on Labor Progress

Abstract Although delivery is a normal physiologic process, it causes a certain level of pain in women. Today, the most frequently preferred and the most used method is epidural anesthesia. The objective of the present study was to review the reasons, effects, and risks associated with epidural analgesia for pain relief. The study was conducted at Akdeniz University Hospital, Antalya, Turkey, between October 2004 and July 2005. Epidural analgesia was administered to 51 pregnant women in the experimental group, and 51 pregnant women in the control group did not receive analgesia. Data were collected by questionnaire and observation forms. Epidural anesthesia was chosen by 76.5% of the participants because they wanted to experience a pain-free childbirth, 66.7% because they were afraid of the process of delivery, 25.5% because they had had a previous bad labor experience, 35.3% because they had people around them with positive experiences, 29.4% because they wanted to have a normal delivery, and 31.4% because they wanted first to see their baby. The overwhelming majority of the participants (94.1%) experienced nervousness before the administration of epidural analgesia. It was determined that epidural analgesia extended the time of labor and increased oxygen and oxytocin requirement but did not increase the risk for interventional delivery and cesarean. To give better obstetric care and control of labor pain, it is of clinical importance to know obstetric anesthesia and analgesics.

Combined spinal-epidural analgesia vs. intermittent bolus epidural analgesia for pain relief after major abdominal surgery. A prospective, randomised, double-blind clinical trial

The primary aim of this study was to compare the efficacy of combined spinal-epidural (CSE) analgesia vs. intermittent bolus epidural analgesia (EA) for pain relief after major abdominal surgery. The secondary aim was to assess the effects of fentanyl addition to subarachnoid morphine and bupivacaine. This was a prospective, randomised, double-blind trial; 160 patients scheduled for major abdominal surgery enrolled. All patients had a thoracic epidural catheter for administration of intra-operative and postoperative analgesia. Patients were assigned to one of four groups: (i) subarachnoid morphine, bupivacaine and fentanyl (MBF group); (ii) morphine and bupivacaine (MB group); (iii) morphine (M group) and (iv) normal saline (EA group). Use of additional intravenous (i.v.) fentanyl and epidural bupivacaine was recorded to measure the need for supplemental intra-operative analgesia. Pain at rest, with movement, and with cough (measured with a visual analogue scale), additional analgesia requests, and side effects were recorded over 72 h postoperatively. Compared with the EA group, the MBF group had significantly reduced pain with cough and lower analgesia requirements during the first 24 h (p<0.001) and after EA discontinuation (p=0.041). The MBF group required less intra-operative epidural bupivacaine compared with all other groups (p<0.001), and less intra-operative i.v. fentanyl compared with group M (p<0.001). Combined spinal-epidural improved intra-operative analgesia and reduced pain with cough in the immediate postoperative period. The addition of fentanyl to subarachnoid morphine and bupivacaine decreased the need for additional i.v. fentanyl and epidural bupivacaine analgesia.

Current Concepts in Menthol-based Topical Analgesics for Pain Relief

Current Concepts in Menthol-based Topical Analgesics for Pain Relief

Transient Diaphragmatic Paralysis by Continuous Para-Phrenic Infusion of Bupivacaine: A Novel Technique for the Management of Residual Spaces

Space problems are a common complication after thoracic surgery. Different procedures have been used to manage them. We describe a novel technique using transient diaphragmatic paralysis by continuous para-phrenic infusion of bupivacaine.

120: Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour

120: Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour

Incisional and epidural analgesia after caesarean delivery: a prospective, placebo-controlled, randomised clinical study

Background This study evaluated efficacy, safety and patient satisfaction with incisional analgesia with a subfascial catheter compared to epidural analgesia for pain relief following caesarean section. Methods Forty patients were randomised after elective caesarean section to receive either intermittent 10-mL boluses of 0.125% levobupivacaine into the epidural space and physiologic saline into the surgical wound or intermittent 10-mL boluses of 0.25% levobupivacaine into the wound and epidural saline with a repeated 10-dose regimen. Analgesic efficacy was evaluated by numerical pain scores (0-10, 0 = no pain, 10 = worst pain) and based on the consumption of supplemental opioid. Side effects, patient satisfaction and plasma concentrations of levobupivacaine were recorded. Results In the epidural group average pain scores were lower (1.8 vs. 3, P = 0.006) and the consumption of local anaesthetic (29 mL vs. 38 mL, P = 0.01) was smaller during the first four postoperative hours, after which both groups had pain scores of 3 or less at rest. All parturients were able to walk after the 24-h study period. The total consumption of rescue opioid oxycodone (32 vs. 37 mg, P = 0.6) during the whole 72-h study period was low in both study groups. Side effects were mild and rare. Satisfaction scores were equally high in the two groups. Peak plasma concentrations of levobupivacaine were below the toxic range. Conclusion Incisional local analgesia via a subfascial catheter provided satisfactory pain relief with patient satisfaction comparable to that seen with epidural analgesia. This technique may be a good alternative to the more invasive epidural technique following caesarean section as a component of multimodal pain management.

Analgesia for labour pain – analysis of the trends and associations in the Grampian region of Scotland between 1986 and 2001

BackgroundAlthough intrapartum analgesia has been in use since Victorian times, there have been few attempts to study its usage from routinely collected data. This population based epidemiological study aimed to analyse retrospective data on the distribution of different types of labour analgesia used by women in the Grampian region of Scotland between 1986 and 2001 in order to examine time trends and associations.MethodsData records on all deliveries occurring in the years 1986 to 2001 were extracted from the Aberdeen Maternity and Neonatal Databank.The rates of the use of epidural, opioid and Entonox or no analgesia for pain relief in labour in each year were calculated.Maternal, pregnancy, labour and delivery characteristics were compared among the users of three different analgesics by univariate and multivariate analyses.ResultsA total of 81,418 deliveries were analysed. Of these, 12,659 (15.5%) women had epidural, 33,819 (41.5%) had used opioids and 26,974(33.1%) received either Entonox or no analgesia at all. The women who received epidural analgesia were younger, shorter and heavier and had larger babies (OR = 1.05, 95% CI 1.01, 1.08). Three quarters of them were primigravidae and had longer periods of gestation. They were also more likely to have suffered pregnancy related complications (OR = 2.11, 95% CI 1.8, 2.4). Labour was more likely to have been induced (OR = 2.8, 95% CI 2.6, 2.9) and to have lasted longer in this group of women. Women in this group were 5 times more likely to have an instrumental delivery (95% CI 4.9, 5.1) and 7 times more likely to have a Caesarean section (95% CI 5.7, 9.3).ConclusionNon epidural analgesia was found to be the most popular choice for pain relief in labour in the Grampian region between 1986 and 2001, although an increase in the uptake of epidural services is starting to occur. The type of labour analgesia used is associated with the epidemiological characteristics of the women's pregnancy, labour and delivery.

Comparison of computer integrated patient controlled epidural analgesia vs. conventional patient controlled epidural analgesia for pain relief in labour

Computer integrated-patient controlled epidural analgesia (CI-PCEA) is a novel drug delivery system. It automatically titrates the background infusion rate based on the individual parturient's need. In this randomised trial, we compared the local anaesthetic consumption by parturients using CI-PCEA with demand only patient controlled epidural analgesia (PCEA) for labour analgesia. We recruited 40 parturients after approval by the ethics committee. Group PCEA (n = 20) received demand only PCEA. Group CI-PCEA (n = 20) received a similar PCEA regimen but the computer integration titrated the background infusion to 5, 10 or 15 ml x h(-1) if the patient required one, two or three demand boluses, respectively, in the previous hour. The background infusion decreased by 5 ml x h(-1) if there was no demand bolus in the previous hour. The sample size was calculated to show equivalence in local anaesthetic used. The time weighted consumption of local anaesthetic was similar in both groups (mean difference 0.7 mg x h(-1), 95% confidence interval [CI: -2.5, 1.1]; p = 0.425). The CI-PCEA group had higher maternal satisfaction scores: mean (SD) 93 (7) vs. 86 (11), p = 0.042. CI-PCEA does not increase the use of local anaesthetic when compared with demand only PCEA but does increase patient satisfaction.

Effect of Availability of a Parturient-elective Regional Labor Pain Relief Service on the Mode of Delivery

Regional analgesia for labor pain relief is effective and widely used. This study evaluated the controversial association between mode of operative delivery and patient-elective labor regional analgesia. We retrospectively compared the rates of instrumental vaginal and cesarean deliveries in parturients before the introduction, in the first 15 months after, and in the subsequent 36 months after the implementation of an elective labor regional analgesia service. A total of 9779 low-risk singleton cephalic pregnancies above 36 weeks of gestation were included. The maternal and fetal outcomes for parturients before the service was implemented and in those with or without pain relief service in the two postimplementation periods were analyzed. Multivariate logistic regression analyses were used to investigate the effects of maternal age, gestational weeks and newborn weight, in addition to regional analgesia, on the mode of delivery in nulliparous women. After adjusting for maternal age, gestational weeks, and newborn weight, no significant association was found between regional analgesia and cesarean delivery in nulliparas. Further, this lack of association was not affected by the receipt of regional analgesia in the early period of program implementation or in the period after staff had become familiar with the service. A higher rate of instrumental vaginal delivery was noted in nulliparas given regional analgesia. Regional analgesia for pain relief increased the likelihood of instrumental vaginal delivery, but did not increase the likelihood of cesarean delivery.

A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural With Intravenous Analgesia for Pain Relief in Labor

Survey of Anesthesiology: October 2005 - Volume 49 - Issue 5 - p 257-258 doi: 10.1097/01.sa.0000177152.99605.5f

A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural with Intravenous Analgesia for Pain Relief in Labor

A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural with Intravenous Analgesia for Pain Relief in Labor

A Multicenter Randomized Controlled Trial Comparing Patient-Controlled Epidural with Intravenous Analgesia for Pain Relief in Labor

In this multicenter, randomized, controlled trial, we sought to determine whether patient-controlled epidural analgesia (PCEA) for labor affected the incidence of cesarean delivery when compared with patient-controlled IV opioid analgesia (PCIA). Healthy, term nulliparous patients in 4 Canadian institutions were randomly assigned to receive PCIA with fentanyl (n = 118) or PCEA with 0.08% bupivacaine and fentanyl 1.6 microg/mL (n = 124). There was no difference in the incidence of cesarean delivery-10.2% (12 of 118) versus 9.7% (12 of 124)-or instrumental vaginal delivery-21.2% (25 of 118) versus 29% (36 of 124)-between groups. The duration of the second stage of labor was increased in the PCEA group by a median of 23 min (P = 0.02). Fifty-one patients (43%) in the PCIA group received epidural analgesia: 39 (33%) because of inadequate pain relief and 12 (10%) to facilitate operative delivery. Patients in the PCIA group required more antiemetic therapy (17% versus 6.4%; P = 0.01) and had more sedation (39% versus 5%; P < 0.001). Maternal mean pain and satisfaction with analgesia scores were better in the PCEA group (P < 0.001 and P = 0.02, respectively). More neonates in the PCIA group required active resuscitation (52% versus 31%; P = 0.001) and naloxone (17% versus 3%; P < 0.001). These observations support the hypothesis that PCEA does not result in an increased incidence of obstetrical intervention compared with PCIA. PCEA provides superior analgesia and less maternal and neonatal sedation compared with PCIA.

Patient controlled regional analgesia (PCRA) versus traditional analgesia for pain relief following ambulatory breast augmentation surgery

Patient controlled regional analgesia (PCRA) versus traditional analgesia for pain relief following ambulatory breast augmentation surgery

Patient controlled regional analgesia (PCRA) versus traditional analgesia for pain relief following ambulatory breast augmentation surgery

Patient controlled regional analgesia (PCRA) versus traditional analgesia for pain relief following ambulatory breast augmentation surgery

Commentary on Nystedt A., Edvardsson D. and Willman A. (2004) Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach. Journal of Clinical Nursing 13, 455-466.

Commentary on Nystedt A., Edvardsson D. and Willman A. (2004) Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach. Journal of Clinical Nursing 13, 455-466.

Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach.

Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence-based knowledge for midwives. This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth. A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH-terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non-randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three-grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III). Twenty-four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth. Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.

The rise in maternal temperature associated with regional analgesia in labour is harmful and should be treated

Fusi et al. in 1989 first reported the association of raised maternal temperature with the use of epidural analgesia in labour when compared to women receiving opioid analgesia.1 Since then a number of observational and randomised studies have confirmed this association.2–10 About 6–23% of women in labour with epidural analgesia will develop clinical pyrexia >38°C. The degree of rise has been estimated to be 1°C for every seven hours of exposure to epidural analgesia.1 Thus, the clinical observation of pyrexia in labour becomes more likely after five hours of exposure to epidural analgesia. The effect is also more likely to be observed in nulliparous women because they have longer labours. Although the rate of fever with epidural analgesia varies in different studies, the association has been consistent, suggesting a causal link. The variation in reported rates is probably explained by variations in the parity of the population studied (and hence in the mean duration of labour), in baseline rates of fever in women without epidural analgesia due to differences in the susceptibility of various populations to infection, and variations in the ambient temperature. The hotter the labour and delivery room, the greater the effect is likely to be. Whatever the background rate of pyrexia in a given population, it is evident from the studies that among nulliparous women, an additional 10–15% will become febrile if they are using epidural analgesia for pain relief.11