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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to establish whether a powerful analgesic such as pentazocine administered during birth may damage the child or have negative influence on the course of birth, the course of delivery was studied in 40 patients, 20 of whom were given a single dose of 30 mg pentazocine administered intramuscularly. There were no differences in duration of birth, CTG, blood gases post partum, or Apgar scores as compared to the untreated control group. As regards the pharmacokinetics, the serum pentazocine levels of the gravidae corresponded to those found in non-pregnant subjects; the levels found in blood from umbilical cords and new-borns were at the lower limit of detectability. Almost all of the gravidae described the obstetric analgesia as good or adequate. The principal side effect, mentioned by one-third of the pentazocine group, was slight fatigue. As regards the newborns, the fetal outcome in the two groups was the same.
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PMID:[Medicamentous obstetric analgesia with pentazocine in comparison with an untreated control group]. 314 51

We studied 24 patients undergoing elective cholecystectomy and randomized to either conventional postoperative pain treatment, with intermittent nicomorphine (10 to 15 mg) and acetaminophen (1 gm) on request, or thoracic epidural analgesia with plain bupivacaine for 48 hours and epidural morphine 4 mg every 8 hours for 96 hours plus systemic indomethacin 100 mg every 8 hours for 96 hours. Epidural analgesia for pin prick extended from the fourth thoracic to the first lumbar nerve for 48 hours. Assessments of pain, various injury response parameters, peak flow, and subjective feeling of fatigue were performed preoperatively, 3 and 6 hours after skin incision, and 1, 2, 4, and 8 days postoperatively. The epidural analgesia-systemic indomethacin treatment eliminated postoperative pain during rest and coughing. In contrast, only a minor and clinically unimportant modulation of the conventional perioperative and postoperative changes in plasma cortisol, glucose, transferrin, orosomucoid, leukocyte and differential counts, rectal temperature, peak flow, and fatigue was observed. Our results suggest that factors other than pain per se must be controlled in order to reduce postoperative morbidity.
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PMID:Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. 334 86

50 consecutive women having laparoscopic sterilization at Hinchingbrooke Hospital, Hungtingon, England, were surveyed along with their general practitioners regarding undergoing the operation as outpatient day cases in contrast to a longer hospital stay. The operation was performed by 1 of 2 consultant gynecologists. Patients were counseled about the sterilization procedure by the general practitioner and usually also by the consultant gynecologist. The procedure involved the application of silastic rings over the fallopian tubes. Patients spent between 6-10 hours in the unit after the operation. The procedure is known to cause considerable pain for 4-6 hours afterwards, and opiate analgesia was used freely during this time. The survey of the women's and the general practitioners' views was carried out retrospectively between 1-4 months after the operation. Of the 50 women in the study, 5 needed or wanted to stay in the hospital following the operation, and 1 woman was discharged but readmitted the next day. Questionnaires were mailed to the women and their general practitioners. The women reported a range of conditions during the period following the operation; 10 women seemed to be comfortable during this time, 18 mentioned feeling some pain or experiencing tiredness or nausea, and 8 women reported feeling quite ill or considerable pain. 11 (31%) women now wished they had stayed in the hospital. Only 1 general practitioner reported being called for advice during the first 24 hours. 4 general practitioners reported that they subsequently had received calls or requests connected with the procedure. 15 general practitioners made favorable comments including reference to apparent acceptability to the patients, conservation of hospital resources, and the efficient system. Of the 9 general practitioners responsible for the care of the 11 women who indicated they would rather have stayed in the hospital, only 2 made comments indicating awaress of their patients' feelings.
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PMID:Day case laparoscopic sterilization--time for a rethink? 358 Mar 28

7,500 deliveries occurred from the date of opening of the Maternity Hospital Jean-Rostand. 3,500 of these were conducted under epidural anaesthesia. At different stages prospective studies were carried out to recall the effect of adding fentanyl to bupivacaine when the epidural injection was made. A pharmacokinetic study. This shows that the levels in the mother and the fetus begin to coincide more with the number of doses that are given and pass from 0.3 after 50 micrograms have been administered to 0.5 after 100 micrograms have been administered and 0.7 after 150 micrograms have been administered. The fetal levels are far lower than those required to depress respiration. The half life of distribution through the circulation has been worked out at 4 minutes and the half for elimination of the drug at 460 minutes. The maternal levels show great fluctuations and late alterations. Analgesia is earlier, more complete and more prolonged when fentanyl is added. Fentanyl also masks irregularities. Undesirable effects such as tiredness, pruritus, nausea, vomiting and urinary retention occur infrequently and last only for short periods of time. No mother had respiratory depression. The doses of bupivacaine that had to be given were as a whole less when fentanyl was added. In 40% of cases it only required one injection to achieve analgesia throughout the whole labour. The length of labour and the number of caesarean operations carried out did not change.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fentanyl in peridural obstetrical analgesia. Evaluation after 4 years' use]. 358 62

A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. The incidence of deep venous thrombosis (125I-fibrinogen scan) was 32% after general anaesthesia and low-dose heparin and 34% after epidural analgesia with no prophylactic antithrombotic treatment (P greater than 0.9). Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.
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PMID:A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery. 408 79

Epidural buprenorphine was investigated as a postoperative analgesic in a randomized double-blind study of 158 patients given epidural analgesia with mepivacaine or bupivacaine for orthopedic surgery of the lower extremity. At the end of surgery, patients were given either 0.15 mg of epidural buprenorphine (n = 38), 0.3 mg (n = 37) in 15-ml saline, or no further epidural injections (n = 47, control group) after 2% mepivacaine for intraoperative anesthesia. A fourth group (n = 36) received 0.3 mg of buprenorphine in 15-ml saline, after the intraoperative use of 0.5% bupivacaine. The patients rated postoperative pain. The need for additional analgesics as well as side effects were recorded. Analgesia after 0.15 mg buprenorphine was superior to that after no reinjection for 6 hr after surgery (P less than 0.05). Buprenorphine (0.3 mg) was superior both to no reinjection and to 0.15 mg of buprenorphine until the twelfth hour (P less than 0.05). Analgesia after bupivacaine followed by 0.3 mg of buprenorphine was not significantly different than analgesia seen after mepivacaine followed by 0.3 mg of buprenorphine. There was an increase of PaCO2 of 2-5 mm Hg between 1.5-3.5 hr after 0.3 mg of buprenorphine without any evidence for late respiratory depression. Other side effects, e.g., disturbances of micturition, pruritus, nausea, vomiting, fatigue, and headache, were comparably common in all groups. The epidural administration of 0.3 mg buprenorphine may be recommended for postoperative analgesia following orthopedic surgery of the lower extremity.
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PMID:Epidural buprenorphine--a double-blind study of postoperative analgesia and side effects. 637 65

Postoperative analgesia and the side effects of epidurally injected morphine were investigated in a double-blind study. Following lumbar epidural anesthesia for orthopedic operations, 174 patients received, in a randomized, double-blind fashion, either 0.1 mg/kg of morphine epidurally, 0.1 mg/kg of morphine intramuscularly, or saline epidurally at the end of surgery. Following epidural morphine, postoperative pain was les frequent, less intense and of shorter duration, use of analgesics and sedative was less frequent; and the postoperative feeling of well-being rated better than after systemic morphine or epidural saline. These effects were more frequent when bupivacaine was used for operative epidural anesthesia than when mepivacaine was used. The results were age independent. Side effects following epidural morphine included pruritus and disturbances of micturition. Nausea, vomiting, fatigue, and headache were of comparable frequency in the three groups.
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PMID:Epidural morphine for postoperative analgesia: a double-blind study. 719 36

Non-steroidal anti-inflammatory drugs (NSAIDs) play an important part in postoperative relief of pain. Non-steroidal anti-inflammatory drugs and paracetamol should act as non-opioid basis analgesics in the postoperative period, leading to reduced need of opioid analgesia. This is beneficial, since it may reduce possible dosage-dependent side-effects of opioids such as nausea, tiredness and respiratory depression. The inhibition of prostaglandin synthesis by non-steroidal anti-inflammatory drugs also affects haemostasis, and the combination of these drugs with prophylaxis against postoperative thrombosis with heparin is controversial. We refer to a case history which illustrates this controversy. We also discuss the effect of non-steroidal anti-inflammatory drugs on pain and inflammation. Possible side-effects of these drugs and their interaction with heparin are reviewed.
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PMID:[Combination of low molecular weight heparin and non-steroidal anti-inflammatory agents]. 764 3

The rate of postoperative recovery is determined by pain, stress-induced organ dysfunction, and limitations in conventional postoperative care. We attempted to provide "stress-free" colonic resection for neoplastic disease in eight elderly high-risk patients by a combination of laparoscopically assisted surgery, epidural analgesia, and early oral nutrition and mobilisation. Effective pain relief allowed early mobilisation, and hospital stay was reduced to 2 days without nausea, vomiting, or ileus. Postoperative fatigue and impairment in functional activity were avoided. Major advances in postoperative recovery can be achieved by early aggressive perioperative care in elderly high-risk patients undergoing colonic surgery.
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PMID:Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. 789 89

Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does not per se lead to important improvements in convalescence and hospital stay.
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PMID:The effect of balanced analgesia on early convalescence after major orthopaedic surgery. 806 18


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