scholarly journals Patient-Controlled Epidural Analgesia in Labour — is a Continuous Infusion of Benefit?

1992 ◽  
Vol 20 (1) ◽  
pp. 15-20 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Self Administration ◽  
High Quality ◽  
Active Labour ◽  
Background Infusion ◽  
Significant Difference ◽  
Continuous Background ◽  
Single Blind

A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia — bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P < 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.

scholarly journals Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia – A Randomized Controlled Trial

PRILOZI ◽  
2019 ◽  
Vol 40 (3) ◽  
pp. 99-108
Author(s):  
Dafina Karadjova ◽  
Mirjana Shosholcheva ◽  
Еmilija Ivanov ◽  
Аtanas Sivevski ◽  
Ivo Kjaev ◽  
...  
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Patient Controlled Analgesia ◽  
Obstetric Anaesthesia ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Remifentanil Group

Abstract Introduction: Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery. Material and methods: This study included 155 pregnant women in term for birth, divided into 2 groups: a remifentanil group (RG), and an epidural group (EG). Patients in the RG received intravenous PCA with remifentanil, while patients in the ЕG received epidural analgesia with programmed intermittent bolus dosing. Our primary outcome was maternal safety; the secondary outcome was neonatal safety. Results: The results present a significantly lower SaO2 value of the parturients in the RG (96.95 ± 1.4 vs 98.22 ± 0.6), and a significantly higher respiratory rate per minute in the EG at all time points after the onset of analgesia (20.85 ± 1.4 vs 18.67 ± 0.9). There was more frequent sedation, nausea and vomiting in the RG, while in the EG there was a more elevated temperature, itching and irregularities in the CTG record. Regarding the newborn, there was no significant difference between the two groups in the Apgar scores, pH, pCO2, pO2, and bicarbonate, while there was a significantly lower value of the base excess in the RG group. Conclusion: PCA with remifentanil is safe for the mother, foetus and the newborn, with minimal side effects. Continuous respiratory monitoring, oxygen supply and following of all consensus recommendations are mandatory.

scholarly journals Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shin-Yan Chen ◽  
Feng-Lin Liu ◽  
Yih-Giun Cherng ◽  
Shou-Zen Fan ◽  
Barbara L. Leighton ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Epidural Analgesia ◽  
University Hospital ◽  
Control Regimen ◽  
Background Infusion ◽  
Continuous Background ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

Study of a New Analgesic Compound in the Treatment of Tension Headache*

1976 ◽  
Vol 4 (1) ◽  
pp. 74-78 ◽  
Author(s):  
J Borges ◽  
C Zavaleta
Keyword(s):  
Side Effects ◽  
Pharmacological Activity ◽  
Clinical Success ◽  
Tension Headache ◽  
Symptomatic Treatment ◽  
Blind Study ◽  
Effective Combination ◽  
Significant Difference ◽  
Starting Dose ◽  
Single Blind

The effect of a new analgesic compound ( propoxyphene, acetaminophen, caffeine, hydroxyzine) was investigated in a single-blind study comparing it with plain acetaminophen administered to forty patients with tension headache. For the study, patients were assigned to one of two groups of twenty each. Starting dose for each group was one to two tablets followed by one tablet every four to six hours. The results show that 90% clinical success was obtained with the analgesic compound, while a 45% success was obtained with plain acetaminophen. This is a statistically significant difference. Side-effects observed with analgesic compound were primarily drowsiness and dizziness of mild intensity; acetaminophen caused gastro-intestinal alterations ( nausea, vomiting) and dizziness of greater severity. Therapy was withdrawn in 20% of patients taking acetaminophen because of side-effects. The dosage of analgesic compound required to control each episode of tension headache way smaller than that of acetaminophen. These results can be explained by a possible potentiation of pharmacological activity of the compound's components. It can be concluded that the analgesic compound is a new and effective combination for the symptomatic treatment of tension headache.

scholarly journals Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

2020 ◽  
Vol 9 (1) ◽  
pp. 211 ◽  
Author(s):  
Jihoon Hwang ◽  
Sang Kee Min ◽  
Yun Jeong Chae ◽  
Gang Mee Lim ◽  
Han Bum Joe
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Postoperative Pain Management ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Background Infusion ◽  
Randomised Controlled

Owing to a lack of studies investigating the effect of adjustments in fentanyl background infusion (BI) with patient-controlled analgesia (PCA) on postoperative analgesia, we evaluated three BI regimens with fentanyl PCA for acute postoperative pain management. This randomised controlled trial enrolled 105 patients, who were assigned to three parallel groups: constant rate BI of 2 mL/h (CRBI group); time-scheduled decremental BI of 6, 2 and 1 mL/h (TDBI group); and BI rates optimised to the demand of PCA (POBI group). The incidence of insufficient analgesia, visual analogue scale (VAS) pain score and side effects were evaluated. The incidence of insufficient analgesia in the post-anaesthesia care unit was lower in the TDBI and POBI groups than the CRBI group. Incidence of insufficient analgesia in the ward was lower in the POBI group than the CRBI group. Postoperative VAS scores were significantly lower in the TDBI and POBI groups for up to 4 h and 24 h, respectively, compared with the CRBI group. Side effects and infused fentanyl dose were highest in the CRBI group. Adjusting BI rate based on time or patient demands could improve postoperative analgesia and reduce side effects. Compared to a constant BI rate, PCA-optimised BI achieved higher patient satisfaction.

Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia

2017 ◽  
Vol 71 (2) ◽  
pp. 99-104
Author(s):  
Dafina Karadjova ◽  
Mirjana Shosholcheva ◽  
Atanas Sivevski ◽  
Emilija Ivanov ◽  
Ivo Kjaev ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Epidural Analgesia ◽  
Labor Analgesia ◽  
Nausea And Vomiting ◽  
Pain Patient ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Pain ◽  
Remifentanil Group

Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.

Effect of Combining Naloxone and Morphine for Intravenous Patient-controlled Analgesia

2003 ◽  
Vol 99 (1) ◽  
pp. 148-151 ◽  
Author(s):  
James B. Sartain ◽  
John J. Barry ◽  
Christopher A. Richardson ◽  
Helen C. Branagan
Keyword(s):  
Side Effects ◽  
Controlled Trial ◽  
Symptomatic Treatment ◽  
General Anesthetic ◽  
Patient Controlled Analgesia ◽  
Double Blind ◽  
Pain Scores ◽  
Patient Recall ◽  
Background Infusion ◽  
Pain At Rest

Background An early study showed that a naloxone infusion decreased the incidence of morphine-related side effects from intravenous patient-controlled analgesia. The authors tested the hypothesis that a more convenient combination of morphine and naloxone via patient-controlled analgesia would decrease the incidence of side effects compared to morphine alone. Methods Patients scheduled for hysterectomy under general anaesthesia were enrolled in a double-blind, randomized, placebo-controlled trial. Patients received a standardized general anesthetic and postoperative patient-controlled analgesia. They were randomized to receive 60 mg patient-controlled analgesia morphine in 30 ml saline or 60 mg morphine in 30 ml saline with naloxone 0.8 mg. Parameters for patient-controlled analgesia were a 1-mg bolus of morphine with a 5-min lockout and no background infusion. Patient recall of nausea, vomiting, itching, and pain (at rest and with movement) were assessed at 6 and 24 h postoperatively by verbal rating score. Pain was also assessed by a 0- to 100-mm visual analog score, and sedation was assessed by an observer. The amount of morphine used and the requirements for symptomatic treatment were also recorded. Results Ninety-two patients completed the study, with no significant differences in outcomes between groups. At 24 h, the incidence of nausea was 84.8% in each group; the incidence of pruritus was 56.5% in the naloxone group and 58.7% in the placebo group. There were also no differences in symptomatic treatment requirements, pain scores, morphine use, or sedation between groups. The median dose of naloxone received equated to 0.38 microg x kg-1 x h-1 over 24 h. Conclusions There was no benefit from administering naloxone combined with morphine via patient-controlled analgesia.

scholarly journals Postoperative Patient-Controlled Thoracic Epidural Analgesia: Importance of Dose Compared to Volume or Concentration

2008 ◽  
Vol 36 (6) ◽  
pp. 814-821 ◽  
Author(s):  
M. Dernedde ◽  
M. Stadler ◽  
N. Taviaux ◽  
J. G. Boogaerts
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Sensory Block ◽  
Morphine Consumption ◽  
Motor Blockade ◽  
On Demand ◽  
Background Infusion ◽  
Lockout Interval ◽  
Epidural Catheters

This randomised and blinded study evaluated the quality of analgesia and the incidence of side-effects of two concentrations of levobupivacaine (0.15% and 0.5%) given as an equal mg-bolus-dose (5 mg) via patient-controlled epidural analgesia after lower abdominal surgery. The patients were randomly assigned into two groups to receive either 0.15% levobupivacaine as a 3.3 ml bolus on demand, with a lockout interval of 30 minutes (n = 30), or 0.5% levobupivacaine as a 1 ml bolus on demand, with a similar lockout interval (n = 30). For both groups we combined the bolus on demand with a background infusion of 5 mg/hour levobupivacaine, i.e. 3.3 ml/hour 0.15% or 1 ml/hour 0.5% of levobupivacaine. The epidural catheters were inserted in a lower thoracic intervertebral space before induction of general anaesthesia. The following variables were registered in the 48 hours after surgery: upper and lower sensory block, pain scores at rest and after coughing, rescue morphine consumption, motor blockade, haemodynamic (arterial blood pressure and heart rate), nausea and vomiting, and patient satisfaction ratings. The two groups had similar sensory block, quality of analgesia, rescue morphine consumption requirement, motor blockade and side-effects, and both had a high satisfaction rate. These findings indicate that administering the same dose of levobupivacaine in either a low or high concentration via the patient-controlled epidural analgesia mode, combined with a background infusion, provides an equal quality of analgesia for low thoracic level epidurals with no difference in the incidence of side-effects.

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