Showing papers on "Pain medicine published in 1969"
TL;DR: A method of measuring blood loss which has proved practical as a routine operating room procedure is described and the usefulness of careful monitoring of the central venous pressure has been clearly shown.
Abstract: Many factors influence bleeding during transurethral prostatic surgery. Some of these are unavoidable, while others can be avoided or corrected if the patient is carefully monitored by the anaesthetist. In many instances the resectionist can be given early warning of changes which are occurring so that he may bring the operation to an end.
20 citations
TL;DR: An epidural block using dibucaine 1:1500 with epinephrine 1:200,000 will give analgesia during labour lasting up to six hours, usually long enough to carry most patients through their first stage of labour in comfort with no physiological changes in mother or baby.
Abstract: Too OFTEN, before she even meets the anaesthetist, the woman in labour has already experienced the greatest part of the pain associated with having her baby. She then receives an epidural block, a saddle block, or other form of anaesthetic for the final half hour or so of labour. The first stage is often a trying, unpleasant, and painful episode. In the past this has been dealt with relatively inadequately by the use of powerful depressants such as narcotics and ataractics, drugs which often do little good for the mother and some harm to the baby. A]though it has been known for more than forty years flaat a lumbar sympathetic block of T-10 to L-1 will result in painless uterine contractions, little has been done to take advantage of this fact to relieve the pain of the first stage of labour. Many techniques have appeared to block the outflow from T-10 to L-l: superior hypogastric plexus injection, bilateral T-11 to T-12 nerve root blockade, paravertebral blockade by either continuous or single injection, continuous caudal analgesia, continuous epidural anaesthesia, and the presently very popular paracervical block. In our efforts to provide first stage analgesia, we have found the injection of dilute, long-acting local anaesthetics in the lumbar epidural space, preferably by the continuous catheter technique, to be a most satisfactory method not only for maternal comfort but also for foetal and maternal safety. This paper describes the evolution of this method. PI-IYSlOLOGIC AND ANATOMIC CONSI~TIONS There are two types of pain associated with labour: 1. Visceral pain caused by uterine contraction and the dilatation and effacement of the cervix. 2. Somatic pain associated with vaginal stretching and direct pressure on the bony pelvis. Visceral pain The mechanism of uterine pain is still poorly understood. Some physiologists think that the pain is due to acidosis resulting from the anaerobic metabolism in uterine muscle, accompanying hypoxia caused by reduced blood flow during prolonged contractions. A similar phenomenon occurs during stretching of the cervical os. The painful sensation, whatever its cause, is transmitted by uterine afferent nerves. These are visceral afferent "C" fibres. They range from 1.3 to .9. microns in diameter and transmit sensation at the rate of .6 to 2.3 m/sec, tim so-called slow pain component. These afferent fibres from the uterus lie along