Post operative analgesia with continuous epidural infusion

Forty eight ASA I or II patients of either sex between 20-70 years undergoing major upper abdominal surgery were grouped into sixteen each, on complaint of pain. They received an epidural bolus dose, followed by infusion of the assigned drug at 4m1 per hour through BARD PCA I pump. Pain assessment, for the first four hours, was hourly, and subsequently at 10[th], 16[th], 22,[nd] 28[th], 36[th] and 40[th] hour by VAS and VRS. The groups matched for demographic distribution. All groups had lower mean pain scores at first hour by VAS and VRS. In Group II and Group III, the difference was significant [<0.05] at the 2[nd] [VAS] and 4[th] [VRS] hours. From 16[th] [VAS] and 22[nd] [VRS] hours, the mean pain score was less and significant [<0.05] in Group III. In all groups sedation ranged from 0-1. There was hypotension in Group I [2/16],urinary retention in Group II[8/9 not catheterised]; unilateral sensory impairment and motor weakness in Group 1[3/16] and Group III [1/16]. This study showed that continuous infusion of low dose morphine with bupivacaine provides better quality post operative analgesia with fewer side effects than bupivacaine or morphine alone

Transcutaneous electrical nerve stimulation and labor pain

To investigate the efficacy and safety of Transcutaneous Electrical Nerve Stimulation [TENS] on uterine activity, duration of labor, intrapartum fetal heart rate and Apgar score, in relieving the pain of parturition. A controlled study to investigate the role of TENS to relieve the pain of parturition at Department of Obstetrics, Kasturba Medical College Hospital, Manipal, India. Seventy gravid women with cephalic presentation in active labor, with no obstetric or medical complications were studied. Fifty women in GROUP I [Study group] [25 primi and 25 multigravida] received TENS stimulation and Twenty women [10 primigravida and 10 multigravida] in GROUP II [Control group] received SHAM TENS [placebo]. Fifty two percent [primi] and 64 percent [multi] gravida in Group I and 8 percent in the Group II experienced good to excellent relief of back pain. Eight percent in primi and 12 percent in multigravida had no relief in Group I. Few had benefit in the second stage. The duration of labor was reduced by 120 minutes in multi and by 77 minutes in primigravida in group I [P value <0.001]. There was no change in the intrapartum fetal heart rate in both the groups and none required immediate resuscitation. TENS seems an effective, simple to administer method of pain relief with no side effects on the mother or the child. It is effective in relieving the low back pain in 50 percent, but has no effect on the lower abdominal pain with the present stimulation technique