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Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section A randomized controlled study

Weigl, Wojciech (författare)
Uppsala universitet,Anestesiologi och intensivvård,Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.
Bierylo, Andrzej (författare)
Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.
Wielgus, Monika (författare)
Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.;Prof Gruca Teaching Hosp, Dept Anaesthesiol & Intens Care, Postgrad Med Educ Ctr, Konarskiego 13, Otwock, Poland.
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Krzemien-Wiczynska, Swietlana (författare)
Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.
Szymusik, Iwona (författare)
Med Univ Warsaw, Dept Obstet & Gynaecol 1, Warsaw, Poland.
Kolacz, Marcin (författare)
Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.
Dabrowski, Michal J. (författare)
Polish Acad Sci, Inst Comp Sci, Jana Kazimierza 5, PL-01248 Warsaw, Poland.
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 (creator_code:org_t)
2016
2016
Engelska.
Ingår i: Medicine (Baltimore, Md.). - 0025-7974 .- 1536-5964. ; 95:24
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage. This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 mg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain. Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9-51.6). The requirement for postoperative analgesics is greatest during the first 12hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.

Ämnesord

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

cesarean section
fentanyl
intrathecal
opioids
postoperative pain
spinal anesthesia

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