Diamorphine analgesia after Caesarean section

Smith, I. D.; Klubien, Kristine; Wood, M.L.B.; MacRae, Duncan; Carli, Francesco

doi:10.1111/j.1365-2044.1991.tb09861.x

Cited by 12 publications

(3 citation statements)

References 14 publications

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“…Satisfactory analgesia was achieved (as ex-greater than at rest. There was no consistent timerelated effect on VAS, but a significant effect (P<0.01) pected [16,17]), in all patients within 30 min after the loading dose. The average consumption of dia-was detected in VRS.…”

Section: Discussionmentioning

confidence: 94%

“…The 43 values of The post-operative use of epidural diamorphine in-VRS at rest in each of the 22 patients were treated jections has been described for doses of 2 to 10 mg as interval data, with sleep or no pain allocated a in 5 to 10 mL saline [5,[9][10][11][12][13][14][15][16], with no obvious imvalue of 0, mild pain 1, moderate pain 2 and severe provement in quality or duration of analgesia from pain 3. Their time course was subjected to a curveexceeding 2 mg [16,17]. Prolonged analgesia can be fitting procedure in SAS that identified a polynomial provided by continuous infusion after a minimum with significant terms in the first five powers of loading dose [18,19], or by ePCA.…”

Section: Discussionmentioning

confidence: 99%

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Patient-controlled epidural diamorphine for post-operative pain: verbal rating and visual analogue assessments of pain

et al. 1996

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Twenty-two patients were studied while receiving epidural analgesia with diamorphine after major lower abdominal surgery under combined regional and general anaesthesia. Epidural PCA began when the intraoperative epidural block with bupivacaine wore off enough for the patient to request treatment. It was started with 2 mg of diamorphine and continued with a reducible background infusion that was initially set at 0.2 mg h-1 and supplemented by on-demand doses of 0.2 mg, with a lockout time of 15 min. The patients received routine post-operative monitoring and care, with pain at rest being assessed on a four-point verbal rating scale (VRS, none, mild, moderate, severe) at 5, 10, 15, 30, 45, 60, 90 and 120 min from the start of ePCA, then hourly until 24 h and then 2-hourly until 48 h. VRS on coughing and a 10 cm visual analogue score (VAS) at rest and on coughing were recorded at the same times at 4 h, then 4 hourly until 24 h and then at 48 h, at which times, blood samples were also taken to measure morphine concentrations by radioimmunoassay. Analgesia started promptly and reached a maximum at between 30 and 45 min, accompanied by maximum sedation. Thereafter clinically acceptable analgesia was maintained without undue sedation for 48 h, though pain on coughing was less well controlled than pain at rest. After the initial loading dose of diamorphine, the 95% confidence intervals (CI) for further consumption were 3.7 to 17 mg (average 9.7) in the first 24 h and 2.1 to 12.9 mg (average 6.7 mg) in the second 24 h. The plasma morphine concentrations rose to a plateau by about 15 min, with concentrations within 95% CI from 0 to 11 ng mliters-1 (average 5 ng mliters-1. The VRS and VAS pain scores were analysed by a conservative approach that treated them as ordinal data, and by a parametric approach that treated them as interval data. Both approaches conveyed broadly similar information about the post-operative analgesia.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Patient-controlled epidural diamorphine for post-operative pain: verbal rating and visual analogue assessments of pain

et al. 1996

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“…Literature Findings: Randomized controlled trials comparing epidural opioids with intermittent injections of IV or intramuscular opioids report improved postoperative analgesia for epidural opioids after cesarean delivery (Category A2-B evidence) [200][201][202][203][204][205][206] ; meta-analysis of RCTs report equivocal findings for nausea, vomiting, and pruritus (Category A1-E evidence). [200][201][202][203][204][206][207][208][209][210][211] RCTs report improved postoperative analgesia when PCEA is compared with IV patient-controlled analgesia (Category A2-B evidence) with equivocal findings for nausea, vomiting, pruritus, and sedation (Category A2-E evidence). 208,211 Survey Findings: The consultants and ASA members strongly agree that for postoperative analgesia after neuraxial anesthesia for cesarean delivery, selecting neuraxial opioids rather than intermittent injections of parenteral opioids should be considered.…”

Section: Neuraxial Opioids For Postoperative Analgesiamentioning

confidence: 99%