Effective Method Of Pain Relief Research Articles

The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.

Artificial pneumothorax for pain relief during microwave ablation of subpleural lung tumors.

When microwave ablation (MWA) is used for subpleural lesions, severe pain was the common side effect under the local anesthesia conditions during the procedure and postprocedure. To study the pain relief effect of artificial pneumothorax in the treatment of subpleural lung tumors with MWA. From February 2012 to October 2014, 37 patients with 40 subpleural lung tumors underwent MWA, including 17 patients of 19 sessions given artificial pneumothorax prior to MWA (group-I), and 20 patients of 21 sessions without artificial pneumothorax (group-II). Patient's pain assessment scores (10-point visual analog scale [VAS]) at during-procedure, 6, 12, 24, and 48 h after the MWA procedure and mean 24 h morphine dose were compared between the two groups. Complications of the artificial pneumothorax were also summarized. Pain VAS were 0.53, 0.65, 1.00, 0.24, and 0.18 at during-procedure, 6, 12, 24, and 48 h for group-I and 5.53, 2.32, 2.82, 1.21, and 0.21 for group-II, respectively. Pain VAS in group I was significantly decreased at during-procedure, 6, 12, and 24 h after the MWA (P < 0.001). No statistical pain VAS difference was observed at 48 h after the MWA between the two groups (P > 0.05). The mean 24 h morphine dose was 5.00 mg in group-I and 12.63 mg in group-II (P = 0.000). "Artificial pneumothorax" related complications occurred in two patients from group-I, including one pleural effusion and one minor hemoptysis. No patient in group-I and group-II died during the procedure or in 30 days after MWA. Artificial pneumothorax is a safe and effective method for pain relief during MWA of subpleural lung tumors.

Peripheral field stimulation for thoracic post herpetic neuropathic pain

ObjectivePost herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment. We present our experience with a series of 4 patients who underwent subcutaneous peripheral field stimulation for treatment of thoracic post herpetic neuropathic pain. MethodsFour patients with intractable thoracic post herpetic neuropathic pain were operated after maximum medical treatment and a neuropsychological evaluation. Multiple percutaneous electrodes were placed in the subcutaneous plane in the region of pain for a 7-day trial. Following a successful trial (more than 50% reduction of pain), the electrodes were then internalized and attached to a pulse generator. Visual analog scores (VAS) were studied during the preoperative, immediate postoperative and last follow-up visits. Long-term treatment results were determined by retrospective review of medical records. Average follow-up period was 28.2 months. ResultsAll 4 patients showed persistent improvement in their VAS pain scores with an average improvement of more than 75%. There were no treatment failures and no complication requiring re-operation was reported. ConclusionPeripheral field stimulation for the treatment of post herpetic neuropathic pain is a safe and effective method for pain relief for an extremely complex problem with very few solutions. Patient selection and proper lead placement is most important for the success of treatment.

Experience with conventional radiofrequency thermorhizotomy in patients with failed medical management for trigeminal neuralgia.

BackgroundTo evaluate the results of conventional radiofrequency thermorhizotomy (CRT) for trigeminal neuralgia (TN) in patients with failed medical management.MethodsPatients with Trigeminal neuralgia who were referred to us for 'limited intervention' during the time frame July-2011 to Jan-2013 were enrolled for this study. CRT was administered by the Sweet technique. Pain relief was evaluated by the principle investigator.ResultsEighteen patients were enrolled and completed a mean follow-up of 18.0 months. Pain relief was observed in 14 of 18 (77.8%) patients on the post-operative day, 14 of 18 (77.8%) at 1-month follow-up, 14 of 17 (82.4%) at 3-months follow-up, 12 of 15 (80%) at 6-months follow-up, 7 of 11 (63.6%) at 1-year follow-up and 2 of 6 (33.3%) 1.5 years of follow-up. Four patients required a repeat cycle of CRT; two at six months of follow-up and two at one year of follow-up. One patient was transferred for surgical intervention at six months of follow-up. Side-effects included facial hypoesthesia (n = 6); nausea/vomiting (n = 2), diminished corneal reflex (n = 13) and difficulty in chewing (n = 11). Severity of adverse effects gradually diminished and none of the patients who are beyond 6 months of follow-up have any functional limitation.ConclusionsCRT is an effective method of pain relief for patients with Trigeminal neuralgia. Successful outcome (excellent or good) can be expected in 66.7% of patients after first cycle of CRF. The incidence and severity of adverse effects is less and the procedure is better tolerated by the patients.

Does intravenous ketamine enhance analgesia after arthroscopic shoulder surgery with ultrasound guided single-injection interscalene block?: a randomized, prospective, double-blind trial.

Ketamine has anti-inflammatory, analgesic and antihyperalgesic effect and prevents pain associated with wind-up. We investigated whether low doses of ketamine infusion during general anesthesia combined with single-shot interscalene nerve block (SSISB) would potentiate analgesic effect of SSISB. Forty adult patients scheduled for elective arthroscopic shoulder surgery were enrolled and randomized to either the control group or the ketamine group. All patients underwent SSISB and followed by general anesthesia. During an operation, intravenous ketamine was infused to the patients of ketamine group continuously. In control group, patients received normal saline in volumes equivalent to ketamine infusions. Pain score by numeric rating scale was similar between groups at 1, 6, 12, 24, 36, and 48 hr following surgery, which was maintained lower than 3 in both groups. The time to first analgesic request after admission on post-anesthesia care unit was also not significantly different between groups. Intraoperative low dose ketamine did not decrease acute postoperative pain after arthroscopic shoulder surgery with a preincisional ultrasound guided SSISB. The preventive analgesic effect of ketamine could be mitigated by SSISB, which remains one of the most effective methods of pain relief after arthroscopic shoulder surgery.Graphical

Conscious guardianship of normal birth: The art and science of intelligent structured intermittent auscultation (ISIA) of the fetal heart for low risk women

presentations. Epidural anaesthesia has become the most effective pain relief method used to help women cope with labour therefore contributing to the cascade of interventions. An alternative and effective method for relieving low back pain is the use of intradermal injections of sterile water. This method has been well researched and successfully used in general medicine for decades and was introduced into maternity care in the 1970s. A systematic reviewof the literature conducted in 2009 demonstrated the safety and efficacy of sterile water injections from randomised controlled trials. This review also found a significant reduction in the Caesarean Section ratewhen sterilewater injectionswere used for low back pain in comparison to other therapies. Further studies are still being conducted in Australia and overseas. The use of sterile water injections can also be beneficial for Maternity Units with limited access to anaesthetic services. It is a simple quick procedure, cost effective, having few side effects and appropriate for midwifery practice.

Pregnant women’s awareness and acceptance of epidural anesthesia and its influence on cesarean section rate control in China: A qualitative study

Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fear of childbirth and labor pain is supposed to be one predictable drive of high cesarean section rate in present China. Little qualitative information on women’s awareness and perceptions of epidural anesthesia was found, but conscious efforts should be focused on this part to help generate policy-making priority. Methods: This study was carried out under an exploratory descriptive design in Bao’an Maternity and Child Health Hospital. Those interested in participating would be invited to focus group discussion or individual interview according to a semi-structured open-ended guide after collecting the participants’ demographic characteristics. The thematic content analysis approach was used for data analysis. Results: Five major themes were identified: 1. the sources to gain information on epidural anesthesia; 2. clinical impact; 3. social impact on awareness; 4. association between epidural anesthesia and cesarean section; 5. attitudes and questions about the current service implementation. Discussions: The interplay between pregnancy knowledge, socio-economic conditions, social support, insurance policy environment, women’s judgment of health care quality influences the ways women acknowledge and utilize epidural anesthesia service. Conclusions: As maternal requested CS due to low pain tolerance emerges gradually, natural labor with epidural anesthesia is a more suitable childbirth option, which is also expected to function in reducing CS rate by service-providers and administrators in the health departments of China besides building up a pain-free labor environment.

Parent-controlled analgesia for paediatric pain management

Patient-controlled analgesia, when managed by a parent whose child cannot administer the analgesia themselves, is a safe and effective method of pain relief, according to a study reported in the Journal of Pediatric Hematology and Oncology.

RESEARCH EPIDURAL ANALGESIA TO PAIN RELIEF ON LABOR PROGRESS

Background: Pain during labor as pain in the fracture is not treated, chronic pain, so pain is very essential issues to be studied. Epidural anesthesia (NMC) has many advantages over spinal anesthesia in constant pain. Study objectives: 1. Assessing the effects analgesia by epidural anesthesia during labor. 2. Assessing progress and final results of labor for pregnant women and fetuses. Materials and Methods: The study described 37 pregnant from 38 to less than 42 weeks had a positive phase of labor to pain relief by continuous epidural anesthesia method, with cervical dilation between 3 cm and 4 cm. Results: Women feel very satisfied (67.5%) on methods of natural pain relief during labor. Most women deliver normally (73%). Evolution of the cervix takes place smoothly. Duration of labor within the normal birth. Breast sucking good condition accounted for 86.5% rate, the reflecting normal 94.6%. Conclusions: This is the effective method of pain relief during labor birth. Duration of labor in normal limits. Side effects occur less and can be well controlled. Keywords: epidural anesthesia; relief pain on labor.

Osteoarthritis year in review: rehabilitation and outcomes

Purpose: This review highlights seminal publications of rehabilitation and outcomes in osteoarthritis (OA) of the hip or knee. Methods: A systematic literature search was performed in Medline from July 2011 up to January 24, 2012 using the terms ‘osteoarthritis, knee’, ‘osteoarthritis, hip’ rehabilitation, physical therapy, exercise and preoperative intervention, outcomes. Trials evaluating rehabilitation interventions were included if they were randomized trials (RCT) or systematic reviews. Surgical interventions and pharmacology studies were excluded unless they included evaluation of a rehabilitation intervention. Outcome studies were included if they contributed methodologically to advancing outcome measurement. Results: The literature search identified 259 hits. 21 publications were selected and reviewed that related to cost-effectiveness of non-pharmacological and non-surgical interventions, interventions evaluating care processes, decision making and information, weight loss, exercise (balance training, walking, neuromuscular, combined with self-management, aquatic vs. landbased, adherence), bracing, whole body vibration, short wave therapy and acupuncture/moxibustion. One systematic review provided limited evidence for the cost-effectiveness of conservative treatments for the management of hip and/or knee osteoarthritis. This was supported by a large RCT showing patients randomized to exercise and self-management having a high probability of being cost-effective at 30 months. Another meta-analysis found low to moderate evidence from mostly small RCTs demonstrating that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. The increased focus on care strategies, decision-making instruments and patient information in osteoarthritis treatment was highlighted by several publications. A consensus-based strategy provided a framework for health care providers and patients with hip or knee osteoarthritis to discuss the optimal timing of the various treatment options. An audiovisual patient decision aid aiming at changing disadvantageous beliefs and encourage physical activity was associated with a small effect. The studies on exercise added information on treatment effect of important aspects such as type, combined treatments, and adherence to exercise. A single high quality RCT found low-energy-diet induced weight loss to relieve pain also at one year and lead to independent losses of leg muscle tissue and strength, indicating the need for exercise in conjunction with low-energy-diet induced weight loss programs. A systematic review failed to provide conclusive evidence for the effectiveness of moxibustion (warm acupuncture) compared with drug therapy in rheumatic conditions. The total number of RCTs included in this review and their methodological quality were low. An RCT found moxibustion combined with intra-articular injection of sodium hyaluronate to be more effective than intra-articular injection of sodium hyaluronate alone. A secondary analysis of 10 000 patients included in one of four RCTs for one of four chronic pain problems, including hip or knee osteoarthritis, found that age, education, duration of illness, baseline pain, and some concomitant diseases predicted treatment outcome in both groups (routine care with or without acupuncture). Patients' characteristics that enlarged the acupuncture effect were being female, living in a multi-person household, failure of other therapies before the study, and former positive acupuncture experience. A single high quality RCT among persons with symptomatic lateral PF OA found the effects of a specific realigning PF brace not to be of clinical or statistical significance. One RCT found pulsed shortwave treatment to be an effective method for pain relief and improvement of function and quality of life in the short term in women with knee OA. The 16 outcomes papers considered relevant did not add significantly to current knowledge. Conclusion: The current clinical focus on non-pharmacological and non-surgical treatment of hip or knee OA translates into research findings that increasingly are included in meta-analysis improving the evidence level for non-pharmacological and non-surgical treatments in hip or knee OA. Information, exercise and weight loss are supported as first line treatments and as adjunctive treatments prior to surgery.

Efficacy of transcutaneous electrical nerve stimulation for pain relief in women undergoing office endometrial biopsy

To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) for decreasing pain related with office endometrial biopsy. In this prospective study, 65 women undergoing office endometrial biopsy were randomly allocated to receive 550 mg oral naproxen sodium plus active TENS (Group I, n = 33) or 550 mg oral naproxen sodium plus placebo TENS (Group II, n = 32). The intensity of pain perceived by the patients was measured using a 10-cm visual analog scale (VAS) before insertion of the speculum, when the cervix grasped, immediately after biopsy, and 15 min after the procedure. The effect of anxiety (Spielberger's state anxiety inventory) on pain scores was also investigated. There were no statistical significant differences between groups in age, weight, body mass index, gravidity, parity, education, and menopausal status (p > 0.05). The pain scores before insertion of the speculum, when the cervix grasped, and immediately after biopsy were similar in both groups (p > 0.05). But at 15 min after the procedure, there was a significant reduction of the mean VAS pain score in naproxen sodium plus TENS group, compared with the naproxen sodium plus placebo TENS group (0.14 ± 0.47, 1.44 ± 1.37, respectively, p < 0.0001). The mean anxiety scores were 48.19 ± 6.71 and 45.85 ± 6.22 in Group I and Group II, respectively. We did not find any significant correlation between anxiety and VAS pain scores (p > 0.05). TENS appears to be successful in decreasing pain only after the procedure undergoing office endometrial biopsy. It can be used as a simple, cheap, safe, and effective pain relief method.

Pulsed Shortwave Treatment in Women With Knee Osteoarthritis: A Multicenter, Randomized, Placebo-Controlled Clinical Trial

Several forms of conservative treatment have been the focus of many recent studies in knee osteoarthritis (OA). Among these techniques, the application of pulsed shortwave (PSW) treatment has been widely used, but the optimal dose and application time have not been well established. Objective The purposes of this study were: (1) evaluate the effect of PSW treatment in different doses and (2) to compare low-dose and high-dose PSW groups with control and placebo groups. Design This was a randomized clinical trial. Setting The study was conducted in the physical therapy department of 2 large urban hospitals. Patients One hundred twenty-one women (mean age=60 years, SD=9) with a diagnosis of knee OA participated in the study. Participants were distributed randomly into 4 groups: 35 participants did not receive any treatment (control group), 23 received a placebo treatment, 32 received low-dose PSW treatment (power of 14.5 W, treatment duration of 19 minutes, and total energy of 17 kJ), and 31 received high-dose PSW treatment (power of 14.5 W, treatment duration of 38 minutes, and total energy of 33 kJ). An 11-point numerical pain rating scale and the Knee Osteoarthritis Outcome Score were used to assess pain and function in 3 stages: at initial evaluation (pretreatment), immediately after treatment, and at 12-month follow-up. The 4 groups were homogeneous prior to treatment with respect to demographics, pain, and functional scale data. The results demonstrated the short-term effectiveness of the PSW at low and high doses in patients with knee OA. Both treatment groups showed a significant reduction in pain and improvement in function compared with the control and placebo groups (effect size: range=20.0-23.4 for the low-dose PSW group and range=15.7-16.5 for the high-dose PSW group). There were no differences in results between PSW doses, although a low dose of PSW appeared to be more effective in the long term. Limitations These results were achieved without physical exercise, which could have positively influenced the results. Pulsed shortwave treatment is an effective method for pain relief and improvement of function and quality of life in the short term in women with knee OA. On the basis of the results, application of PSW treatment is recommended in the female population with knee OA. However, conclusions regarding the 12-month follow-up should be analyzed carefully due to the high dropout rate.

Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods

Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing. A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing. Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (-2 and -2.4, respectively, vs 1.2; P < .02) compared with the other groups. Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.

Advances in labor analgesia.

The pain of childbirth is arguably the most severe pain most women will endure in their lifetimes. The pain of the early first stage of labor arises from dilation of the lower uterine segment and cervix. Pain from the late first stage and second stage of labor arises from descent of the fetus in the birth canal, resulting in distension and tearing of tissues in the vagina and perineum. An array of regional nerve blocks, systemic analgesic, and nonpharmacologic techniques are currently used for labor analgesia. Nonpharmacologic methods are commonly used, but the effectiveness of these techniques generally lacks rigorous scientific study. Continuous labor support has been shown to decrease the use of pharmacologic analgesia and shorten labor. Intradermal water injections decrease back labor pain. Neuraxial labor analgesia (most commonly epidural or combined spinal-epidural) is the most effective method of pain relief during childbirth, and the only method that provides complete analgesia without maternal or fetal sedation. Current techniques commonly combine a low dose of local anesthetic (bupivacaine or ropivacaine) with a lipid soluble opioid (fentanyl or sufentanil). Neuraxial analgesia does not increase the rate of cesarean delivery compared to systemic opioid analgesia; however, dense neuraxial analgesia may increase the risk of instrumental vaginal delivery.

Therapie chronischer Schmerzen

Pain is one of the major complaints leading to doctor visits. Therefore basic knowledge of frequent pain diagnoses and possible treatment approaches is essential. Numerous medical and interventional therapeutic options are available for causal or symptomatic treatment of pain. The treatment of neuropathic pain is often difficult and demands special knowledge. Antidepressants like amitriptyline and anticonvulsive drugs are the first choice in these cases. Also interventional approaches are useful, such as spinal cord stimulation for angina pectoris. For the treatment of complex regional pain syndrome and phantom pain the use of mirror feed-back is a new effective method for pain relief. The only way to prevent from development of chronic pain is the early and effective treatment of acute pain.

Bilateral Type 1 Complex Regional Pain Syndrome After Local Nerve Blocks for Palmar Hyperhidrosis

Botulinum toxin type A (BTX-A) is a recognized treatment for the temporary relief of refractory palmar hyperhidrosis. Unfortunately, intradermal injection of BTX-A can be painful. Several modalities to reduce the pain of injection have consequently been devised. Peripheral nerve blockade with lidocaine before BTX-A treatment of palmar hyperhidrosis is a safe and effective method of pain relief. Anesthesia of the palm can be achieved by injecting 4 to 6 mL of 2% lidocaine without epinephrine subcutaneously around the superficial branches of the radial, median, and ulnar nerves. Use of a short, bevelled needle is recommended to reduce the risk of iatrogenic nerve injury. The risk of nerve injury when using a 30-gauge needle in a conscious patient who can provide feedback concerning nerve puncture is remote.

Implantation of an Intrathecal Drug Administration System -A report of two cases-

Opioids profoundly inhibit evoked discharges of spinal nociceptive neurons, thereby inhibiting the transmission of pain. Intrathecal administration of opioids using implantable continuous infusion systems is an effective method of pain relief when other treatments have failed, as well as for patients with adequate analgesia on high dose therapy that produces unacceptable side effects. We report two cases of intrathecal pump implantation performed in patients suffering from intractable chronic pain. A test dose of 3 mg morphine was injected into the epidural space. No side effects were noted and patients experienced considerable pain relief. Implantation was performed one day after the test. The initial intrathecal morphine delivery dose was half of the equivalent dose of daily oral intake opioids and the infusion rate was increased gradually under close observation for opioid side effects. Two days post-implantation, both patients were discharged without any complications.

Continuous intravenous lidocaine controls abdominal pain secondary to peritoneal carcinomatosis as a consequence of diffusion into ascites

9031 Background: Our team reported at the 42nd ASCO meeting that continuous, low-dose intravenous (IV) lidocaine is an effective method for pain relief in terminal patients with peritoneal carcinomatosis. Our aim was to explore the mechanism by which abdominal pain of terminally-ill patients with peritoneal carcinomatosis was improved by continuous IV lidocaine. Methods: 48 patients with peritoneal carcinomatosis due to GI (46) and GYN (2) malignancies were administered lidocaine at low-doses (0.4 and/or 0.8mg/kg- h) for &gt;24 hours, because opiates, NSAIDs, and other adjuvants were ineffective in relieving their abdominal pain. Pain (faces rating scale; 0-no pain, 5-worst pain), oral intake, side effects, and activities of daily life were quantified. Two days after beginning lidocaine, ascites was sampled to measure ascitic concentration of lidocaine, tumor markers and cytology. Results: Mean age (±SE) was 60±2. The volume of ascites was estimated to be 2,700±400ml by the ultrasound 5 points methodology. Abdominal symptoms improved in 1.5±0.2days after beginning lidocaine, and the pain scale decreased from 1.9±0.2 to 0.5±0.1; p&lt;0.001; 75% of patients had improvement in pain of whom 78% had complete relief of pain. Oral intake increased from 18% to 49% of baseline (p&lt;0.001), and 67% in those with improvement in pain had an increased volume of oral intake. There were no obvious differences in response to 0.4 and 0.8 mg/kg-h in patients receiving both doses. Serum concentrations of lidocaine at 0.4 and 0.8 mg/kg-h were 1.7±0.2 and 3.2±0.2 μg/ml, respectively; lidocaine concentrations in the ascites were 1.2±0.2 and 2.1±0.2 μg/ml. No patient complained of pain at the time of peritoneal puncture. Side effects included bradycardia of &lt;60 beats per minutes (3 patients). The duration of lidocaine administration was 23±3 days; 43% of patients were able to be discharged home for end-of-life care, with parenteral nutrition and continuation of lidocaine administration or oral mexiletine (300–450 mg/day) for adjuvant analgesia. Conclusions: Lidocaine diffuses into ascites and almost equilibrates with serum concentrations acting as a peritoneal anesthesia which, as a result, controls abdominal pain in patients with peritoneal carcinomatosis. No significant financial relationships to disclose.

EPIDURAL VS NON-EPIDURAL ANALGESIA IN LABOUR

Objectives: To determine the effects of epidural analgesia compared with non-epidural forms of pain relief in labour. Design Randomised controlled trials comparing epidural analgesia with alternative forms of pain relief in labour. Setting Combined Military Hospital Rawalpindi. Period. March 2002 to Feb 2003. Results: Epidural analgesia was more effective than nonepidural methods in providing pain relief. Adverse effects suggested by the rather small trials reviewed include motor blockade, longer first and second stages of labour, increased oxytocin use, malrotation, instrumental delivery and Caesarean section (particularly for dystocia). Conclusions: Epidural analgesia is an effective method of pain relief during labour. Further research is needed to define the adverse effects more accurately, particularly potential long-term adverse effects, and to evaluate different regional analgesia techniques.

Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics

To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.