Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to assess the influence of iv tramadol on opioid requirement in the early postoperative period. The subjects were 90 patients scheduled for colon surgery (hemicolectomy) who received general anesthesia using the (N2O/O2) isoflurane technique. Thirty patients (group I) were administered 100 mg of tramadol iv before induction of general anesthesia (preemptive analgesia). Group II (30 patients) was administered 100 mg of tramadol iv immediately after peritoneal closure (preventive analgesia) and control group (30 patients) received 100 mg of tramadol iv immediately after operation. Following the operation, all patients were administered tramadol in the PCA-iv mode in order to treat postoperative pain. In the postoperative period, the following parameters were measured: pain intensity (using VAS), total consumption of tramadol, time until the first PCA activation, and frequency of side effects (drowsiness, nausea, vomiting). In patients of groups I and II who had received preemptive or preventive analgesia, a significantly lower total consumption of tramadol, as compared with control group, was observed in the early postoperative period. However, the time until the first PCA activation was significantly shorter in group I as compared to the other two groups. No significant differences between the groups were found regarding pain intensity and frequency of side effects.
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PMID:Influence of pre- or intraoperational use of tramadol (preemptive or preventive analgesia) on tramadol requirement in the early postoperative period. 1286 26

Gabapentin alleviates and/or prevents acute nociceptive and inflammatory pain both in animals and volunteers, especially when given before trauma. Gabapentin might also reduce postoperative pain. To test the hypothesis that gabapentin reduces the postoperative need for additional pain treatment (postoperative opioid sparing effect of gabapentin in humans), we gave 1200 mg of gabapentin or 15 mg of oxazepam (active placebo) 2.5 h prior to induction of anaesthesia to patients undergoing elective vaginal hysterectomy in an active placebo-controlled, double blind, randomised study. Gabapentin reduced the need for additional postoperative pain treatment (PCA boluses of 50 microg of fentanyl) by 40% during the first 20 postoperative hours. During the first 2 postoperative hours pain scores at rest and worst pain score (VAS 0-100 mm) were significantly higher in the active placebo group compared to the gabapentin-treated patients. Additionally, pretreatment with gabapentin reduced the degree of postoperative nausea and incidence of vomiting/retching possibly either due to the diminished need for postoperative pain treatment with opioids or because of an anti-emetic effect of gabapentin itself. No preoperative differences between the two groups were encountered with respect to the side effects of the premedication. However, 15 mg oxazepam was more effective in relieving preoperative anxiety than 1200 mg gabapentin.
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PMID:Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. 1527 65

Continuous thoracic epidural analgesia with an opiod-local anaesthetic mixture is the most appropriate strategy to control postoperative pain in thoracic surgery. Levobupivacaine, the pure S(-) enantiomer of racemic bupivacaine, has less cardiotoxic and neurotoxic potential but similar anaesthetic properties of its native agent. There are no studies in thoracic surgery that had established the minimal efficient concentration of this anaesthetic when used with an epidural opioid. The advantages of administering opioids in addition to local anaesthetics in the epidural space are the possibility to decrease dose and consequently side-effects of each drug and to exploit the documented synergy between these different categories of drugs in producing segmental epidural analgesia. In our departmental study (unpublished data), 2 different concentration of levobupivacaine (Group A: 0.125% and Group B: 0.0625%) combined with sufentanil (1 mg/mL) were administered in continuous epidural post-thoracotomy infusion to investigate quality of analgesia, motor block and side-effects. An intravenous PCA system has been used in the postoperative period to evaluate rescue morphine consumption. Preliminary results showed that patients of each group reported similar VAS at rest although a better pain control during cough resulted in group A. Patients receiving levobupivacaine at 0.125% presented low incidence of nausea, vomiting and pruritus probably because of the smaller amount of rescue morphine administered. At the concentration of 0.125% epidural levobupivacaine in combination with sufentanil allowed to obtain a good pain control with no adverse effects and motor block at all.
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PMID:Use of levobupivacaine for the treatment of postoperative pain after thoracotomies. 1588 99

The aim of this study was to retrospectively evaluate the efficacy and side effects of local anesthetic and opioid combinations in 457 patients who have received epidural patient-controlled analgesia (EPCA). Hemodynamic parameters, numeric rating scale, sedation scores, the degree of motor and sensory blockage, the presence of side effects, the parameters of PCA device were recorded from the postoperative pain records. 253 patients received 0.1 % bupivacaine + 3 microg/ml fentanyl (Group B1F3), 80 patients received 0.125 % bupivacaine + 3 microg/ml fentanyl (Group B12F3), 43 patients received 0.125 % bupivacaine + 4 microg/ml fentanyl (Group B12F4), 46 patients received 0.1 % bupivacaine + 0.1 mg/ml morphine (Group B1M1) and 35 patients received 0.125 % bupivacaine + 0.1 mg/ml morphine (Group B12M1). Nausea was significantly higher in group B1M1 compared to B12F3, in group B12M1 compared to B1F3 and B12F3 (p<0.05), vomiting was significantly higher in group B1M1 and B12M1 (p<0.05) compared to B12F3, pruritus was significantly higher in group B12F4 compared to B12F3 and B1F3, in group B1M1 compared to B1F3 and B12F3 and in group B12M1 compared to B1F3 and B12F3 (p<0.05). As a result, in EPCA, the combination of bupivacaine and fentanyl provides as effective analgesia as the combination of bupivacaine and morphine and 3 mg/ml fentanyl admixture may be preferred with less side effects such as nausea, vomiting and pruritus.
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PMID:[The comparison of the effects and side effects of local anesthetic and opioid combinations in epidural patient controlled analgesia]. 1597 93

Many systemic techniques, so-called "alternatives" to labor epidural analgesia, have been described: they are all poorly effective and some are associated with significant maternal and neonatal side effects. Nonetheless, these techniques can provide good maternal satisfaction. Accordingly, they are indicated when epidural analgesia is contraindicated or unavailable. Administration of systemic opioids mandates maternal respiratory supervision, oxygen supplementation and/or pulse oxymetry. Systemic opioids may also decrease fetal heart rate variability and produce neonatal respiratory depression; naloxone administration to the neonate is therefore widely indicated. Pethidine should be abandoned because it can produce prolonged neonatal respiratory depression. Nalbuphine produces less nausea/vomiting and less long lasting neonatal respiratory depression. Intravenous PCA fentanyl or sufentanil is presently the method of choice during early labor. Alfentanil seems less effective and may produce more neonatal side effects. Intravenous PCA remifentanil is the most effective technique, but safe administration may be problematic during intermittent supervision usually implemented in labour ward. Nitrous oxide 50% provides little pain relief. Nonetheless, it is associated with few side effects, quite good maternal satisfaction and can be quickly implemented during advanced painful labor. It is not recommended to add it to systemic opioid (except under continuous supervision by the anaesthetic team), because of an increased incidence of maternal desaturation. The use of a subanaesthetic concentration of sevoflurane has been described recently; it is more effective than nitrous oxide. However, guidelines for safe implementation in labor ward remain to be determined.
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PMID:[Alternative techniques to labour epidural analgesia]. 1611 46

In this study, we aimed to assess the effect of administration of ondansetron on morphine and tramadol consumptions. After approval by the ethics committee, 120 patients with ASA status I or II, who will undergo elective lower extremity surgery, were included in the study. Patients were randomly divided into 4 groups following the anesthesia induction. Group I received tramadol as PCA with an infusion of 0.3 mg/kg following a loading dose of 1.5 mg/kg administered 1 hour before the end of the surgery. Group II received ondansetron 0.1 mg/kg following induction of anesthesia, additionally. Group III received morphine as PCA with an infusion following a loading dose of 0.15 mg/kg administered 30 minutes before the end of surgery. Group IV received ondansetron 0.1 mg/kg following induction of anesthesia, additionally. Pain scores(VAS), nausea, vomitting and sedation scores, analgesic consumptions and adverse effects were recorded at 5th, 15th, 30th, 45th minutes and 4th, 8th, 12th and 24th hours postoperatively. Postoperative VAS, nausea, vomitting and sedation scores were similar among the groups. The analgesic consumption was found significantly higher at 4th, 8th, 12th and 24th hours in group II. No statistically significant difference was found in analgesic consumption between group III and IV at all times. We concluded that, ondansetron, when administered as nausea prophylaxis in patients receiving tramadol and morphine as PCA, did not effect morphine consumption whereas did increased tramadol consumption.
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PMID:[Effect of ondansetron in lower extremity bone surgery on morphine and tramadol consumption using patient controlled analgesia]. 1745 5

In a double-blind, randomized, placebo-controlled study, 86 patients (44 verum, 42 placebo), scheduled for knee-joint arthrotomies or minor orthopaedic operations received either naproxen, a nonsteroidal antiinflammatory analgesic, or placebo orally in three doses: the first immediately before the operation and the others 6 h and 12 h after the first. The verum group received 1250 mg naproxen in total. Postoperative pain intensity was measured by the category splitting procedure. All patients were allowed to self-administer piritramide from a PCA (patient-controlled analgesia) pump (Prominjekt, Pharmacia, Sweden) in 2-mg boluses every 5 min during a 6-h period and subsequently every 15 min for another 18 h after surgery. The patients receiving verum had significantly (P<0.05) less pain immediately after surgery and used a significantly lower cumulated dose of piritramide during the first 24 h after operation (24 mg vs 44 mg;P<0.05) than placebo-treated subjects. There were no significant differences in the incidence of side-effects between the two groups. The intensity of typical side effects of opioids and antipyretic anti-inflammatory analgesics (nausea, vomiting, stomachache, headache, vertigo) was low and they were easily controlled in all cases. Lowering of respiratory frequency was not observed. Perioperative administration of the nonsteroidal anti-inflammatory analgesic naproxen results in better pain relief and significantly lower opioid requirements (by about 46%) after minor orthopaedic surgery.
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PMID:[Reduced postoperative opioid requirement with perioperative administration of naproxen. A randomized study in 86 patients with intravenous on-demand analgesia after orthopaedic surgery.]. 1841 2

In a double-blind, randomized, placebo-controlled study, 112 patients scheduled for knee-joint arthrotomies or minor orthopaedic operations received 75 mg diclofenac, 600 mg apazone, the combination of 75 mg diclofenac and 600 mg apazone, or placebo (50 ml NaCl 0.9%) as a single i.v. dose immediately after operation. Postoperative pain intensity was measured by a numeric rating scale. All patients were allowed to self-administer piritramide from a PCA (patient-controlled analgesia) pump (Prominjekt, Pharmacia, Sweden) in 2-mg boluses every 5 min during the first 6 h and subsequently every 15 minfor another 18 h after surgery. The patients receiving diclofenac, apazone, or the combination of diclofenac and apazone required a significantly lower cumulated dose of piritramide during the first 24 h after operation than did placebo-treated subjects (38 mg vs 39 mg vs 27 mg vs 67 mg;P<0.05), but there were no significant differences among the former three groups of patients. The incidence of typical side effects of opioids and antipyretic anti-inflammatory analgesics (nausea, vomiting, stomach ache, headache, vertigo) was low, and they were easily controlled in all cases. Postoperative combined application of the nonsteroidal anti-inflammatory analgesics diclofenac and apazone results in a significantly lower opioid requirement (about 60%) after minor orthopaedic surgery. The opioid-sparing effect appears to be superior to that of diclofenac (44%) or apazone (42%) alone, but this was not statistically significant.
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PMID:[Combined intravenous administration of diclofenac and apazone for postoperative analgesia A randomized study of 112 patients with access to i. v. on-demand analgesia after minor orthopaedic operations.]. 1841 63

The healthy condition of living donors makes their tolerance to pain particularly low, and clinicians are often challenged to come up with an analgesic technique that is effective yet ensures donor safety. This study compared, in donor right hepatectomy, the efficacy and safety of preoperative intrathecal morphine (ITM) combined with intravenous patient-controlled analgesia (IV-PCA) with IV-PCA alone. Forty adult patients were randomly allocated into 2 groups: ITM+IV-PCA group (n = 20) and IV-PCA-only group (n = 20). Patients in the ITM+IV-PCA group received morphine sulfate (400 microg). The visual analog scale (VAS) at rest and when coughing and supplementary meperidine and IV-PCA (fentanyl) consumption were assessed at 2, 4, 6, 8, 10, 12, 18, 24, 30, 36, 42, 48 56, 64, and 72 hours after surgery. Also, side effects such as sedation, dizziness, nausea, vomiting, pruritus, and respiratory depression were evaluated. The ITM+IV-PCA group showed significantly less pain at rest and when coughing for up to 30 hours and 24 hours, respectively. Cumulative postoperative consumption of meperidine and IV-PCA (fentanyl) were significantly less in the ITM+IV-PCA group. The incidence of side effects were comparable between the 2 groups except for pruritus; its incidence was significantly higher in the ITM+IV-PCA group during the first 24 hours, but no treatment was required due to its mild severity. The results of our study suggest that preoperative ITM combined with IV-PCA may be considered as an effective and safe pain management regimen in living liver donors who have characteristics of low tolerance to pain and postoperative coagulation derangement.
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PMID:Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors. 1932 22

A 69-year-old woman (156 cm, 53 kg) underwent a Miles' operation, total hysterectomy, resection of vagina, and thigh flap to vulva for rectal cancer. Before general anesthesia, an epidural catheter was inserted at T11-12 interspace, and 1.5% mepivacaine 7ml was administered. Sensory block level spread from T4 to L1. Anesthesia was induced with propofol and maintained with sevoflurane in air oxygen mixture. Operation was performed uneventfully. After the operation, postoperative analgesia was achieved with patient-controlled epidural analgesia (PCEA). The epidural solution of 0.06% ropivacaine with 4 microg x ml(-1) fentanyl and 20 microg x ml(-1) was connected to a PCA pump (i-Fuser, JMS, Japan) that was programmed as an 8 ml initial bolus, 4 ml x hr(-1) basal infusion, 2 ml bolus dose, and 10-min lockout interval. Although abdominal pain was well controlled by PCEA, intractable pain in the pelvic nerve region existed. Patient-controlled intravenous analgesia (IV-PCA) with fentanyl, ketamine, and lidocaine was added to PCEA. Then excellent pain relief was obtained without any side effects such as nausea, vomiting, drowsiness, and respiratory depression. It could be useful to use IV-PCA together with PCEA when wide spread postoperative analgesia is necessary.
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PMID:[Patient-controlled epidural analgesia combined with patient-controlled intravenous analgesia for postoperative analgesia after Miles' operation for rectal cancer]. 2186 22


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