Epidural Narcotic and Patient-Controlled Analgesia for Post-Cesarean Section Pain Relief

Harrison, D. M.; Sinatra, Raymond S.; Morgese, L.; Chung, James H.; James, Francis M.

doi:10.1097/00132582-198810000-00036

Cited by 37 publications

(63 citation statements)

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“…As already mentioned, we believe that the lower quality of pain relief obtained in the CAT group is not attributable to the lack of effective analgesic agents but rather to the inappropriate manner in which these agents are delivered. 3,4 The incidence of ischaemic episodes seen in this study was similar to those previously reported. 23-25 Although there was a lower incidence in the number of myocardial ischaemic episodes in the PCA patients (Table V) on the third postoperative day, no difference in maximum ST ischaemie changes, duration, heart rate, and severity (AUC) were observed.…”

Section: Discussionsupporting

confidence: 91%

Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

et al. 1994

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Section: Discussionsupporting

confidence: 91%

Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

et al. 1994

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“…This suggestion is supported by studies comparing either interpleural blockade with PCA [27] or epidural analgesia with systemic opioids [28,29]; in all these studies, the regional block gave better pain relief than the opioid administration. Our results are nearly identical to those from a controlled study by Mahoney et al who found good to excellent pain relief in 88% of their patients with epidural infusions and in 61% of their patients receiving opioids after total knee arthroplasty [2] and those from a controlled study on post Caesarean section pain @So/, vs 60%) [30]. That this excellent pain relief at rest was maintained for the whole observation period might again reflect the hypothesised preventive character of regional analgesia as proposed by Wall [31].…”

Section: Discussionsupporting

confidence: 88%

“…Although 1.2% of patients complained about unpleasant paraesthesia under continuous regional analgesic techniques, this group was more satisfied with their analgesia than that receiving systemic opioids via PCA. This contrasts with the assumption that PCA increases patient satisfaction because of the psychological benefit of 'feeling in control' [30,39]. A contributing factor for the success of regional analysis may be that patients in four bed units compare notes with other patients receiving other analgesic regimens.…”

Section: Discussionmentioning

confidence: 98%

Continuous regional analgesia in comparison with intravenous opioid administration for routine postoperative pain control

Schug

Fry

1994

Anaesthesia

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summaryThis study compares retrospectively the postoperative analgesia provided via intravenous opioids with continuous regional techniques (interpleural and epidural infusions) administered as a clinical routine by an anaesthesia-based Acute Pain Service. In 2630 patients no severe complications resulting in morbidity or mortality occurred; the rate of potentially serious complications was in the 0.5% range and comparable between the techniques. A detailed analysis of a randomised subsample of 340 patients revealed better analgesia at rest and better compliance with physiotherapy under continuous regional analgesia. Techniques of continuous regional analgesia also resulted in fewer incidents of &saturation and fewer side eflects. Patient satisfaction with these techniques was higher than with intravenous opioid administration. In conclusion, continuous regional analgesia in a routine clinical setting is comparable to intravenous opioid administration with regard to safety, but results in signijicantly better analgesia with fewer side effects. Key wordsPain; postoperative. Pharmacology; opioids. Complications.There is increasing evidence in the medical literature that techniques of local and regional anaesthesia reduce postoperative pain [l]. The use of prolonged postoperative regional blockade has also been shown to reduce morbidity and hospital stay [2], costs and mortality [3], stress response to surgery [4], duration of ileus [5,6], and even development of chronic pain states [7,8]. For reasons of safety and efficacy, most studies favour a continuous infusion rather than a bolus for maintaining neural blockade [9-111. The combination of opioids with local anaesthetic solutions appears to potentiate the effects of the latter in the epidural space [ 121.Based on these studies, an Acute Pain Service was established at Auckland Hospital in 1989 with provision for the administration of continuous regional analgesia as well as intravenous opioids to manage postoperative pain.This retrospective study was performed using data collected since 1989 on all consecutive patients treated by the service. One aim of the study was to assess the safety of continuous regional analgesia as a clinical procedure in comparison with the well established techniques of intravenous opioid administration in a routine postoperative setting. Another aim was a comparison of efficacy in terms of pain relief achieved, ability to comply with physiotherapy, occurrence of hypoxaemia and side effects, and patient satisfaction. MethodsPostoperative patients under the care of the Acute Pain Service of Auckland Hospital included in this survey were managed with continuous regional analgesia or with intravenous administration of opioids. The specific analgesic technique used for each patient was selected by the anaesthetist providing intra-operative care based on patient suitability, clinical factors and his or her experience with techniques available. Regional analgesia was performed by continuous infusion via epidural and interpleural catheters. ...

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“…In their assessment of PCA morphine for Caesarean section, Harrison et al 2 postulated that an agent with a more rapid onset, less sedation and fewer adverse effects might be preferable. This study was designed to investigate whether the PCA use of fentanyl would be associated with higher levels of analgesia and satisfaction, and less side effects than morphine.…”

mentioning

confidence: 99%

Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine

et al. 1995

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Epidural Narcotic and Patient-Controlled Analgesia for Post-Cesarean Section Pain Relief

Cited by 37 publications

References 0 publications

Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

Continuous regional analgesia in comparison with intravenous opioid administration for routine postoperative pain control

Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine

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