Analgesia postoperatoria por administracion de meperidina por via subdural vs. peridural / Postoperative analgesia by meperidina via subdural vs peridural

Se estudiaron 90 pacientes programados para cirugia que requerian anestesia conductiva en el H.O. y H.S.G. de la ciudad de La Paz. Los objetivos del estudio fueron, determinar la analgesia postanestesica administrando meperidina por via peridural y subdural, evaluar su duracion ademas de los efectos indeseables y su tratamiento. El estudio fue prospectivo longitudinal comparativo, dividido en tres grupos; al grupo A se administro lidocaina al 5 por ciento via subdural; al grupo B lidocaina al 5 por ciento mas meperidina tambien subdural y al grupo C Bupivacaina al 0.5 por ciento mas meperidina por via peridural. Como conclusiones se observo que la meperidina prolonga el efecto analgesico del anestesico de base, aparentemente la via subdural es la que prolonga un mayor tiempo esta analgesia, pero no en la totalidad de pacientes. La meperidina por via conductiva ocasiona en la mayoria de los pacientes efectos secundarios como nauseas, vomitos, sedacion, somnolencia, los dos ultimos pueden ser efectos deseables y los dos primeros son suceptibles de ser tratados efectivamente

Epidural tramadol for post-operative analgesia

The present study was conducted to examine the efficacy of tramadol injected epidurally at the end of surgery in releive of post operative pain. Of those patients who underwent surgery under epidural anaesthesia, 150 patients were included. At the end of surgery, 50 mg. tramadol was injected through the epidural catheter. Fifty four [36%] patients did not require any other analgesia in the first 24 hours of the post operative period. Ninety six [64%] patients required analgesia after an average postoperative time of 10 hours. Side effects were limited and included; nausea, vomiting, dizziness, dryness of mouth and urinary retension. None of the patients developed clinically significant respiratory depression. In conclusion, epidural adminstration of tramadol is an efficient and safe method for control of postoperative pain and should be considered especially in patients undergoing epidural anesthesia

Epidural nalbuphine for the relief of post cesarean section and labour pain

Eighty pregnant patients ASAI and II were included in this study to evaluate the efficacy and safety of epidural analgesia by nalbuphine compared to epidural morphine for both post operative pain relief following caesarean section and pain relief during the first stage of labour. Patients were divided into 4 groups of 20 patients each. Both epidural nalbuphine and morphine provided good or excellent pain relief in 80% and 90% of the patients respectively following C.S. However morphine was totally inadequate for pain relief during labour as 90% of the parturients requested further analgesia. On the other hand nalbuphine produced excellent analgesia in 80% of the patients. In all the four groups no clinically significant changes occurred in maternal vital signs. Blood gas tensions 12 hr. after epidural injection showed no evidence of respiratory depression except one of the forty patients received morphine. Also there was no evidence of foetal distress or neonatal depression in all cases. Drowsiness was the predominate side effect in patients receiving epidural nalbuphine being reported in 40% of patients compared to 30% in the morphine groups. Pruritis was the most common side effect observed in patients receiving epidural morphine. It was mild in 35% of patients, moderate in 15% and severe in 10%. Also herpers simplex occurred in 10% of the morphine groups. There was no significant difference between all groups as regards nausea and vomiting