ABSTRACT
BACKGROUND: This study was undertaken to determine if thoracic epidural analgesia is of practical benefit after bowel resection. METHODS: Patients were prospectively randomized to receive either a thoracic epidural or patient-controlled analgesia for pain control after bowel resection. A standardized postoperative protocol was instituted after surgery. RESULTS: Pain scores were significantly lower in the epidural group. Return of bowel function, and interval to discharge was not different between groups. Cost and complication rates were significantly higher in the epidural group. CONCLUSIONS: Although pain scores were significantly lower in the epidural group, this did not translate into a quicker return of bowel function or earlier discharge of the patient. Furthermore, the epidural group had a significantly higher complication rate and cost. Therefore, while thoracic epidural analgesia provides superior pain control, it does not offer a significant advantage over patient-controlled analgesia in return of bowel function after bowel resection.
Subject(s)
Analgesia, Epidural , Analgesia, Patient-Controlled , Intestines/surgery , Costs and Cost Analysis , Elective Surgical Procedures , Female , Humans , Length of Stay , Male , Middle Aged , Pain Measurement , Postoperative Care , Postoperative Complications , Prospective Studies , ThoraxABSTRACT
A comparison is made of the use of three techniques for determining the effects of stimulated emission on the spectra of solid-statevibronic laser materials: peak single-pass gain, fluorescence band narrowing, and lifetime shortening. Each of these was used to obtain the pump energy density and population inversion at threshold, the stimulated emission cross section, and the gain coefficient for two potential vibronic laser materials. The difficulty and accuracy of each technique is discussed. Lifetime shortening is the easiest experimental measurement to make. These results were analyzed by using numerical techniques to solve the coupled set of rate equations describing the concentration of photons and population of excited states of ions in an optically pumped material under delta-function pulsed excitation. The solutions predict an effective shortening of the fluorescence lifetime at high excitation levels with a distinct threshold where stimulated emission processes become important. The observed band narrowing for the same type of pumping conditions is shown to be consistent with the theoretical predictions of the model developed by McCumber.
