Effective Method Of Pain Relief Research Articles

Skin Temperature Following Total Knee Arthroplasty: A Longitudinal Observational Study

BackgroundTotal knee arthroplasty (TKA) is the most effective method of pain relief and increased functional status for end-stage knee arthritis. We aimed to assess in patients undergoing unilateral, primary TKA whether the temperature of the operated limb, compared to the nonoperative limb, remains elevated up to 1 year postoperatively. MethodsUsing a prospective, longitudinal, observational study design, 1,094 patients were enrolled, and 889 patients completed a minimum of 4 out of 5 follow-up appointments. There were 864 patients who had a normal postoperative course, while 25 patients were deemed to have a superficial or deep infection. Skin temperatures were measured using an infrared thermometer on the operated and nonoperated knees preoperatively, at 2, 6, 12 weeks, and 1 year postoperatively. A subgroup analysis was performed on the 25 patients deemed to have a superficial or deep infection. ResultsThere was a statistically significant increase in skin temperature in the operated versus nonoperated knee at every follow-up, with a P < .001. However, the effect size was small at the 1-year follow-up, with a mean difference in skin temperature of 0.3 °C. In the infected subgroup, there was a statistically significant difference in skin temperature at 2, 6, and 12 weeks, with a greater difference in skin temperature between the operated and nonoperated knees (4.05 versus 3.78 °C in the noninfected). However, there was little clinical difference (0.27 °C) at 2 weeks between infected and noninfected patients. ConclusionsThis study could improve postoperative interactions between patients and surgeons. It is normal for skin temperature post-TKA to increase initially and improve over time, but it can take up to 1 year before there is little clinical difference. Because of the small difference in the rise of skin temperature between infected and noninfected patients, there is little indication that skin temperature is a reliable indicator of infection.

Efficacy and safety of Dyna CT-assisted percutaneous balloon compression in the treatment of tumor-related trigeminal neuralgia: A single-center retrospective analysis

BackgroundPercutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia (TN). Patients with tumor-related TN are typically treated by tumor resection. However, when craniotomy is not feasible, PBC may serve as a simple and effective method for pain relief. Currently, there is limited literature on the use of this technique in treating patients with tumor-related TN. In this study, we aim to evaluate the efficacy and safety of Dyna CT-assisted PBC in the treatment of tumor-related TN. MethodsFrom January 2018 to December 2023, a total of 19 patients with tumor-related TN underwent Dyna CT-assisted PBC at our institution. The modified Barrow Neurological Institute Pain Intensity Grading Scale and sensory reduction scores were employed to assess treatment outcomes. A retrospective analysis was conducted on the clinical characteristics, surgical efficacy, postoperative complications, and follow-up results of all patients. ResultsImmediate and complete pain relief was observed in 18 patients following PBC, with one patient experiencing delayed recovery. Follow-up periods ranged from 4 to 62 months, revealing only 4 patients with pain recurrence at the last follow-up, and tumor-related TN patients with involvement of Meckel's cave were more prone to recurrence. No severe complications occurred throughout the follow-up period. Although facial numbness was reported in all 15 patients, jaw weakness in 8 patients, and postoperative headache in 7 patients, these symptoms resolved within a short period. There were no statistically significant differences in postoperative facial numbness and jaw weakness between tumor-related TN patients with or without Meckel's cave involvement. However, patients with Meckel's cave involvement were more likely to experience postoperative headaches. Patient satisfaction scores indicated a significant improvement in postoperative quality of life. ConclusionFor patients with tumor-related TN, when craniotomy is not feasible, Dyna CT-assisted PBC proves to be a safe and effective alternative treatment. Additionally, we observed varying postoperative clinical outcomes based on the different sites of tumor compression on the trigeminal nerve. Patients with tumor-related TN not involving Meckel's cave exhibited more enduring clinical efficacy compared to those with Meckel's cave involvement.

Does Early Initiation of Labor Epidural Analgesia Affect Labor Outcomes? A Randomized Clinical Trial

Background: Although epidural analgesia (EA) is a popular and effective method for pain relief during labor, significant controversy exists in terms of the impact of EA on labor outcomes and the best time for initiation of EA. Here, we aim to explore the effects of early initiation EA on the labor process in nulliparous at-term pregnant women.&#x0D; Methods: A total of 240 nulliparous women enrolled in this study. The early epidural (EE) group (n=120) consisted of women in the latent phase of labor and the late epidural (LE) group (n=120) were in the active phase of labor. Each group received 16 ml of 0.125% preservative-free isobaric bupivacaine with 50 µg fentanyl (total: 17 ml) as a primary bolus dose in the epidural space for labor analgesia and an intermittent bolus of 5-10 ml of the primary solution was administered via a catheter. The length of labor, rate of cesarean section (CS), neonatal well-being, and infant Apgar scores were recorded.&#x0D; Results: There were no statistically significant differences between the two groups regarding the duration of the first (p=.43) and second (p=.54) phases of labor. No statistically significant differences were observed between the two groups in terms of the rate of CS (p=.21), causes for CS (p=.24), and neonatal Apgar scores (p=0.84).&#x0D; Conclusion: Initiation of EA during early labor did not result in increased CS or instrumental vaginal deliveries, and did not prolong labor duration.

Subcutaneous vs intravenous fentanyl for labor pain management: a multicenter randomized controlled trial

Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.

Awareness of Epidural Analgesia Among Childbearing Women in Western Region of Saudi Arabia: A Cross-Sectional Study.

Background Labor pain is one of the most excruciating experiences that women can go through. Epidural anesthesia (EDA) is the most prevalent form of labor analgesiaconsidered as a secure and effective method of pain relief for women during active labor. The EDA works by numbing the nerves that cause pain. To our knowledge, only a few studies have been conducted on the use of EDA in Saudi Arabia. Objectives The purpose of this study was to assess the awareness of EDA among childbearing women in the western region of Saudi Arabia. Methods We carried out a cross-sectional study using a self-administered online questionnaire to measure awareness about EDA. The study targeted the general population of women from the western region of Saudi Arabia who were aged between 18 and 50 years. A total of 1,137 questionnaires were returned and analyzed. Results This study assessed the perspectives of 1,137 women. The results revealed that 52.6% of women who received EDA showed a good level of knowledge of the procedure, while 26.1% of women had not experienced EDA (P = 0.001). Good knowledge of EDA was detected among 39.3% of women aged 36-50 years. This rate was significantly higher than that of women younger than 20 years old, of which 24.3% had good knowledge (P = 0.038). Conclusion This study shows that women in this particular region have a lack of knowledge about EDA. Therefore, it is recommended that more education about EDA be provided during antenatal visits to improve awareness.

WOMEN’S SOURCES OF INFORMATION AND KNOWLEDGE ABOUT EPIDURAL ANALGESIA

Labor pain is one of the greatest pains experienced by women throughout their life. Relief of this pain is an important issue for women in labor [1]. Epidural analgesia is the most effective pain relief method and is considered the gold standard of labor analgesia [2]. Nevertheless, scientific studies reveal limited parturient knowledge about epidural anesthesia [3,4]. This study has been conducted to assess the knowledge, sources of information, and attitudes regarding epidural analgesia among young mothers. The study was conducted at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. The study took place in November 2022 by using a pre-designed questionnaire. A total of 102 questionnaires were distributed to parturient and 100 were returned, the response rate was 98%. The study shows that more than two-thirds of women agree that epidural analgesia is the most effective method for labor pain management. The internet remains the main source of information for women. The demographic variables were not associated with the desire to request epidural analgesia in the future. Women who know about the effectiveness of epidural analgesia are more likely to choose an epidural in the future. Therefore, it is important to provide more information about the methods of labor pain relief to women during pregnancy.

Supporting young women with menstrual pain – Experiences of midwives working at youth clinics

BackgroundMenstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems. ObjectiveThe objective of the study was to describe midwives’ experiences of supporting girls with menstrual pain. MethodsThis is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held inSeptember 2021. The recordings were transcribed and analyzed using thematic analysis. ResultsTwo main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young women’s knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed. ConclusionThe results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young women’s knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals.

Pericapsular Nerve Group Block of the Hip Joint After Arthroplasty

We report a case of postoperative pain relief in a patient after total cement arthroplasty of the right hip joint in the early postoperative period. Pericapsular nerve group block (PENG-block) of the hip joint was suggested to provide adequate pain relief and reduce the risk of postoperative complications. This clinical case shows an example of effective pain relief in a patient in the early postoperative period after reconstructive plastic restoration of the right hip joint, performed for a fracture of the femoral neck. Severe pain syndrome, restriction of movements, forced position and volume of surgical intervention are risk factors for the development of thromboembolic complications. According to the literature, the incidence of thromboembolic complications after total cemented hip arthroplasty varies from 9.3 to 20.7%. Our observation indicates that pericapsular block of the hip joint is an effective method of pain relief in the early postoperative period after total hip replacement.

A Comparative Study on the Effectiveness of Paracervical Block and Diclofenac Versus Paracervical Block and Pentazocine for Analgesia During Manual Vacuum Aspiration

Management of incomplete abortion with the use of manual vacuum aspiration is associated with pain. A good pain relief option is necessary during the procedure to improve the outcome and increase patients’ satisfaction. The study was aimed atdetermining and comparing the effectiveness of combining paracervical block with pentazocine and paracervical block with diclofenac as pain relief during manual vacuum aspiration for first-trimester incomplete abortion. This study involved 100 eligible women with the diagnosis of first-trimester incomplete abortion. Half of the participants were given paracervical block and intramuscular pentazocine 60 mg stat while the other half were given paracervical block and intramuscular diclofenac 75 mg stat before the manual vacuum aspiration procedure. The intensity of pain during the procedure was assessed using the Visual Analogue Scale (VAS). The level of significance was set at p value&lt;0.05. The mean pain intensity was significantly higher in the diclofenac group than in the pentazocine group. From the study it was concluded that intramuscular pentazocine used as an adjunct to paracervical block during manual vacuum aspiration when compared to intramuscular diclofenac as an adjunct to paracervical block was found to be a more effective method of pain relief. The patient’s level of satisfaction was same in both study arms. However, participants in the pentazocine arm had more side effects.

Acupuncture for Pain Management in Pediatric Patients with Sickle Cell Disease.

Pain management in an acute vaso-occlusive episode for pediatric patients with sickle cell disease (SCD) is challenging and often is focused on opioids, IV fluids, regional anesthesia, ketamine infusions, and non-steroidal anti-inflammatory drugs (NSAIDs). Acupuncture has long been studied as an effective method of pain relief, although the use of acupuncture in pediatric patients with SCD during an acute vaso-occlusive pain episode is vastly understudied. This article provides a review of current research regarding the use of acupuncture as a pain treatment strategy for pediatric patients with SCD experiencing acute pain. A literature review of scientific papers published within the last ten years was conducted on the topic. Five primary literature articles on acupuncture for pain management in pediatric patients with SCD were reviewed. Acupuncture is feasible and acceptable, with statistically significant findings for effectiveness as an adjunct treatment for pain in this setting. It is concluded that acupuncture is a promising and understudied therapy for the treatment of pain during an acute pain episode in pediatric patients with SCD. Hopefully, this paper stimulates interest in this specific area of medicine and prompts future research studies to be conducted to reveal conclusive outcomes.

Comparative evaluation of the use of femoral nerve block and adductor canal as a component of early patient activation after knee arthroplasty

BACKGROUND: The number of surgical interventions for the knee joint increases annually due the increase in the total number of patients and the improvement of operation techniques. The provision of modern anesthesiology and intensive care is associated with a positive treatment outcome, which is based on adequate pain relief in the perioperative period, suppressed complications, and reduction in hospital stay. Regional analgesia is a modern and effective method of pain relief after knee surgery. However, the location of peripheral blockade may affect the timing of activation and rehabilitation in these patients.&#x0D; AIM: This study aimed to evaluate the use of femoral nerve and adductor canal blockade in the framework of the accelerated recovery program after knee arthroplasty.&#x0D; MATERIALS AND METHODS: A prospective, randomized, single-center study included 80 patients who underwent primary knee arthroplasty and were randomly assigned to two clinical groups. Group 1 (n=40) included patients who underwent femoral nerve blockade in the postoperative period, and group 2 (n=40) included patients who underwent adductor canal blockade in the postoperative period. In the postoperative period, the level of pain at rest and during movement was analyzed using a visual analog pain level scale after 6, 12, 24, and 48 hours. The amount of prescribed narcotic analgesic in the postoperative period was recorded, and the total distance that patients were able to walk after 6, 12, 24, and 48 hours was measured.&#x0D; RESULTS: For the level of pain at rest and during movement, no significant differences at all time intervals were observed for both groups (p 0.05). No additional prescription of narcotic analgesics was required. Compared with group 1, group 2 covered a significantly greater distance in the first 24 after the operation. After 48 hours, no significant differences were found between the two groups (p 0.05).&#x0D; CONCLUSIONS: Femoral nerve and adductor canal blockades provide an adequate level of analgesia after knee arthroplasty. In particular, adductor canal blockade significantly increase the distance of movement by patients in the first 24 hours after surgery.

Does Intrapartum Epidural Analgesia Increase the Risk of Autism Spectrum Disorder in Offspring? Most Likely Not

There is no doubt that epidural analgesia is one of the most effective methods of pain relief in labor,1 with up to 7 of every 10 women receiving such analgesia during delivery.2 Local anesthetic with or without adjunct opioid is therefore one of the most common prenatal drug exposures.

Knowledge and Awareness of Labor Analgesia Services Available in Our Tertiary Hospital among the Pregnant Women

Abstract Background: Knowledge regarding labor analgesia is poor among the pregnant women. This hinders them from utilizing the services in centers where it is available. In this study, we tried to analyze the awareness and knowledge of the antenatal women and their beliefs regarding labor analgesia. Patients and Methods: This prospective, observational study done in antenatal clinic for 1 month. Antenatal women who attended the clinic voluntarily filled the semi-structured questionnaire after the written and informed consent. Results: A total of 170 women filled the questionnaire out of 1099 antenatal visits. 68.8% were multipara and 50.58% had previous vaginal delivery. 63.3% study population had prior information of labor analgesia; while only 42.6% had information that labor analgesia services are available in our hospital (P = 0.002). Age, education, and parity were considered as predictors; however, parity is the only predictor for knowledge of labor analgesia odds ratio = 2.368 (95% CI–1.24, 4.51; P = 0.009). Majority (60.23%) of the study sample believe that there is no effective method of pain relief during labor. Binary logistic regression and Chi-square test used for the statistical analysis. Conclusion: Antenatal women still believe that there is no effective method of labor analgesia. Women prefer obstetrician advice for getting information regarding labor analgesia. In our study, the level of education has no impact on awareness of labor analgesia. Only parity is a predictive factor for knowledge of labor analgesia.

Awareness and Utilization of Obstetric Epidural Analgesia in Labour Among Pregnant Women in Wesley Guild Hospital Ilesha, Nigeria.

Epidural analgesia is widely used as an effective method of pain relief in labor. This study was therefore designed to investigate the awareness and level of utilization of obstetric analgesia in labour among pregnant women in Wesley Guild Hospital Ilesha, Nigeria. The descriptive study involving 110 pregnant women revealed that about half (41.8%) of the respondents had poor knowledge score, 37.3% had fair knowledge, while 20.9% had good knowledge score on obstetric epidural analgesia. Only 10.9% of the respondents had used epidural analgesia and 83.3% were satisfied with the use. There was a significant relationship between knowledge of respondents and the use of obstetric epidural analgesia. Moderate awareness, poor knowledge and low level of utilization of obstetric epidural analgesia were documented. There is a need for adequate awareness programs to enhance the knowledge of epidural analgesia and its utilization among pregnant women in order to reduce the excruciating labour pain.

Erector Spinae Plane Fascial Block in Multiple Rib Fractures (Case Report)

The aim of the study: to improve the efficacy of erector spinae plane (ESP) fascial block for pain management in patients with multiple rib fractures. Materials and methods. We observed 4 patients with multiple rib fractures who were treated with ESP fascial block with subsequent prolonged administration of local anesthetic for pain relief. To evaluate the efficacy of the ESP block, the visual analogue scale (VAS) for pain intensity, cough performance index and forced vital capacity (FVC), as well as a modified 3-item scale were used. The distribution of local anesthetic (10% lidocaine solution) and contrast (iohexol solution, 350 mg iodine/ml) media was analyzed by computed tomography and correlated with the data on reduced pain perception according to the thoracic vertebrae (Th) levels.Results. After the ESP block in patients with multiple rib fractures, we found a decrease in VAS pain intensity at rest by 3-4 points and on coughing by 3-6 points, an increase in cough performance by 1 point and in the modified 3-item scale by 1-3 points. The distribution of the local anesthetic solution was registered mainly in the cranial-caudal and anterior direction to the intertransversal space without significant leakage in lateral and medial directions. In all 4 cases the local anesthetic and contrast media spread from the catheter tip cranially several levels of thoracic vertebrae farther than in caudal direction.Conclusion. ESP block in patients with multiple rib fractures is a reasonably effective method of pain relief. Catheterization of the fascial plane of erector spinae muscle should be performed at the level of vertebra corresponding to the underlying fractured rib. The data obtained may serve as a basis for further studies with more patients included.

Programmed Intermittent Epidural Bolus Technique for Maintenance of Labor Analgesia: Does It Work for Everyone?

(Br J Anaesth. 2019;123:e190–e193) Care providers have always worked to provide adequate pain management during childbirth, and neuraxial labor analgesia has been found to be the most effective method of pain relief. Because this delivery method is maintained over long periods of time during labor and delivery, there has been much discussion on the effect of labor analgesia on labor outcomes. While neuraxial labor analgesia has not been found to elevate the risk of cesarean delivery, there is a greater risk for instrumental vaginal delivery due to motor block of the abdominal or pelvic muscles. Wong and colleagues argued that there are many factors involved with epidural analgesia such as anesthetic agents, adjuvant drugs, differing dosages, and various maintenance techniques, and that altering these factors to meet individual needs can reduce the risk of instrumental vaginal delivery and improve labor outcomes.

On‐Demand Printing of Wearable Thermotherapy Pad

Thermotherapy is an effective method for pain relief, recovery from injury, and general healthcare. The ordinary heat pad used for thermotherapy at home is not usually tailored to the individual but supplied in a few different pre-fixed sizes and shapes for mass marketing. A customized wearable heat pad often requires expert support. Herein, an instant, custom-fit, and on-demand heat pad for thermotherapy is demonstrated. The heater is directly printed using silver nanoparticle ink on an off-the-shelf medical grade tape by inkjet technology. By coating the tape with silica nanoparticles as ink-absorbing layer and chloride ions as chemical sintering agent, stable heater patterns are printed without the need for subsequent high temperature sintering process. A 3D scanner is used to acquire body information, and a customized heater is produced using the information. The printed heat pad is attached to the shoulder and the effect of thermotherapy is verified objectively through electroencephalography and subjectively through survey. This printed heat pad produced by simple and low-cost fabrication provides wearable medical devices for personal thermotherapy.

Effect of epidural labor analgesia on fetal heart rate and neonatal outcome

Introduction: Epidural analgesia does not affect the neonatal outcome as shown in this study by the similar APGAR scores and neonatal intensive care unit (NICU) admissions when compared with normal delivery without epidural analgesia. Aims: This study aims to find the fetal heart rate variability and neonatal outcome in women, who are opting for epidural anesthesia in comparison to women without any pain reliving modality. Subjects and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Datta Meghe Institute of Medical Sciences, Wardha, over period of 2 years from September 2017 to August 2019 after taking approval from Institutional Ethical Committee. One hundred women who fulfilled the inclusion criteria were included in the study, 50 women received epidural analgesia for relief of labor pain at =4 cm and 50 women were left for spontaneous delivery. The factors studied were fetal heart rate (FHR) variability and NICU admissions in both the groups. Statistical Analysis Used: SPSS version 19; Chi-square test and Student's t-test. Results: Epidural analgesia was associated with transient fetal heart variability which however was not statistically significant and was comparable with nonepidural group. Conclusions: Epidural analgesia is an effective method of pain relief and it must be an option available to all laboring women. There are no significant effects on FHR variability and does not affect neonatal outcome.

Efficacy and safety of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia in Chinese surgical patients: A systematic review and meta-analysis.

Background:Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data.Methods:The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety.Results:Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI −0.92 to −0.62; WMD48h = 0.51, 95% CI −0.66 to −0.38; all P < .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI −0.14 to −0.02; WMD48h = 0.09, 95% CI −0.11 to −0.07; all P < .05), and less postoperative tramadol consumption (WMD0–24h = −102.59 mg, 95% CI −149.68 to −55.49; WMD0–48h = −152.91 mg, 95% CI −259.93 to −45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P < .05).Conclusion:According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.

Patient-controlled epidural analgesia for labor – a step forward in Ukrainian obstetrics

Labour pain is recognized by some women as the most severe pain that they have ever felt in their life. Epidural analgesia is an effective method of pain relief in labour and is considered as the gold standard of analgesia for delivery. Traditionally, epidural analgesia in Ukraine is performed without the ability for the patient to control the process of anesthesia. The authors became interested in the delivery of local anesthetics by patient­controlled epidural analgesia instead of the traditional physician methods. In randomized controlled studies there is an evidence that the PCEA method tends to improve the quality of pain relief and increase the patient satisfaction.