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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Infraclavicular approach to the brachial plexus provides adequate anesthesia of the entire arm. Local anesthetics can be deposited over cords and branches of brachial plexus above the formation of musculocutaneous and axillary nerves. The approach can also easily block ulnar segment of medial cord and intercostobrachial nerve, which helps preventing tourniquet pain. However, distance to the plexus is deeper than the other approaches so that current blind method using anatomical landmarks requires anesthesiologists' delicate manipulation and experience. Through ultrasonography, the location of subclavian artery, as an anatomical landmark, can be easily identified. It is then very easy and safe to perform infraclavicular brachial plexus block. Our new method showed 89% (n = 9) successful rate. The time for the block was 4.2 +/- 1.5 min and there was an average of 3.2 +/- 0.6 needle penetrations. Thirty three percent (n = 3) had subclavian artery been punctured without formation of hematoma clinically. No patient had clinical postoperative pneumothorax.
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PMID:Ultrasound imaging aids infraclavicular brachial plexus block. 793 90

During the period March 3, 1992 to September 30, 1993 36 video-assisted thoracoscopic operations were performed at the Surgical Department of the University of Cologne. In 12 cases wedge resection of peripheral pulmonary nodules were carried out. Two of the patients underwent video-assisted thoracoscopic lobectomy of the left lower lobe due to peripheral primary bronchogenic carcinoma. In 6 cases biopsy of the lung or pleura was undertaken. Further indications were partial pleurectomy and resection of blebs (n = 12). Pleural effusion was drained under thoracoscopic vision twice. No intraoperative complications occurred. Two patients proceeded to thoracotomy after persistence of pneumothorax following thoracoscopic pleurectomy. The postoperative course of the remaining patients was uneventful and was especially characterized by the reduction in pain and disability. In accordance to the experience of other authors we believe that thoracoscopic surgery is a method with a promising future. Further investigations have to evaluate indications, different techniques, and long term results.
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PMID:[Preliminary experiences with thoracoscopic operations]. 795 33

The acceptance of operative therapy of spontaneous pneumothorax (SPT) has been tempered by the serious trauma of thoracotomy access. Development of videoequipment and miniaturized instruments allows now a thoracoscopic resection of bulla with minimal access. 25 patients with recurrent SPT (n = 15), primary resistant SPT (n = 5), and first SPT (n = 5) were treated from January 1991 thoracoscopically. Bullae resection was performed with an Roeder ligature or an Endo-GIA. Pleurodeses was induced by mechanical irritation or coagulation of the upper thoracic aperture with the argon beamer. Postoperative lung reinflation was rapid and without patchy collapse. The analgetic drug demand was dramatically reduced and patients were mobilised on the 1st postoperative day. Patients were discharged on the 4th postoperative day. Major complication were one hematothorax and one recurrence of SPT. The advantages of the thoracoscopic surgical treatment are rapid full expansion of the lung, decreased postoperative pain, short postoperative hospital stay and early return to normal activity.
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PMID:[Video thoracoscopic therapy of spontaneous pneumothorax. Technique and initial results]. 795 40

Thoracoscopy has assumed a major role in the management of a variety of surgical diseases of the chest. This technique, which was primarily devised for diagnostic purposes, has subsequently come to be used for therapeutic applications in most centers today. In this report we review 300 cases of therapeutic thoracic procedures in which a video-assisted technique was used. We describe mainly our own experience and the basic approach strategies we found helpful in the video-assisted procedures. No complications or deaths were attributable to these procedures. Our conclusions were as follows: (1) Video-assisted thoracic surgery can be as effective therapeutically as many formal thoracotomy. (2) Excellent exposure can be obtained by the use of double-lumen endotracheal tubes. (3) Video-assisted thoracic surgery is an excellent alternative treatment for pneumothorax, blebs, and bullous disease. (4) Video-assisted thoracic surgery allows safe, complete, visually guided wedge resection of lung lesions, lobectomy, pericardiectomy, removal of mediastinal tumor, esophagectomy, and reconstruction of the thoracic esophagus. (5) Video-assisted thoracic surgery also allows management of a broad scope of other general thoracic diseases such as empyema, pleural effusion, and chest trauma (hemothorax), as well as cancer staging. (6) Video-assisted thoracic surgery will not compromise the primary diagnostic and therapeutic goals set forth for the patient. (7) Because conventional instruments and extended manipulation incisions can be used, video-assisted thoracic surgery offers the promise of expediency, safety, minimal discomfort, less postoperative pain, quick functional recuperation, excellent cosmetic healing, shortened stays in the hospital, and therefore savings in cost. Accordingly, we are now using video-assisted thoracic surgery to treat the majority of patients with surgical diseases of the chest.
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PMID:Video-assisted thoracic surgery. The Chang Gung experience. 796 65

Small caliber needle aspiration of lung lesions has been successfully and safely used for diagnostic purposes. We report our initial experience using computed tomography-guided fine needle percutaneous implantation for direct intralesional high-dose rate brachytherapy for malignant pulmonary lesions. Twenty patients with primary lung cancer or metastatic cancer which involved the lung or chest wall were treated with a high-dose rate remote afterloader. Eighteen of the 20 patients also received external beam radiation in conjunction with intralesional radiation therapy. Fourteen patients had primary lung cancer. A complete response was obtained in 5 of the 14 patients. Ten of the 14 patients with primary non-small-cell carcinoma of the lung showed a significant response to treatment (greater than 50 percent reduction in tumor measurement). Six patients with metastatic lesions also were treated. Five of the six showed a significant tumor response measured as either 50 percent reduction in tumor measurement or complete pain relief. The only significant complication was pneumothorax (6 of the 20), which did not prevent completion of any treatment plan.
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PMID:Percutaneous computed tomography-guided fine needle brachytherapy of pulmonary malignancies. 802 Feb 83

VATS was performed in 126 patients at the Medical Center of Delaware from December 1991 to August 1993, with no major complications and no mortality. A definitive diagnosis was made in all cases. Results with VATS therapeutic procedures appear to equal those of the standard open technique. Operating time was comparable to that with the open technique. Length of stay and pain and suffering were dramatically reduced when compared with those associated with the open technique. We now consider VATS to be the preferred procedure in cases of: 1. Undiagnosed pulmonary infiltrate in the nonventilator-dependent patient 2. Indeterminate pulmonary nodule 3. Undiagnosed disease of the pleural space 4. Recurrent or persistent pneumothorax 5. Mediastinal or pericardial cystic tumors 6. Thoracic sympathectomy 7. Selected patients requiring esophagocardiomyotomy. The utilization of VATS for resection of a pulmonary mass in patients with cardiopulmonary compromise (i.e., FEV < 1) is being studied. Further development of this technique and expansion to formal pulmonary resection and cardiovascular procedures must follow the philosophy presented in our conclusion. The place of VATS in the management of penetrating thoracic trauma has been studied at several centers, with excellent results when precise guidelines have been followed. Obviously, one-lung anesthesia is not well tolerated when a patient is in profound shock, but if the patient can be stabilized before thoracotomy, the introduction of a camera to diagnose a carotid or internal mammary artery laceration or to staple an easily accessible pulmonary tear could obviate the need for a thoracotomy and its consequences for the patient. Again, as in all surgical operations, common sense and good judgment must prevail.
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PMID:Video-assisted thoracic surgery: experience with 126 cases. 803 1

Thoracoscopy has become an important tool in the diagnosis and management of intrathoracic disease. Between April 1991 and October 1992, 93 patients underwent thoracoscopy. Lung resection was performed on nineteen patients for diagnoses of interstitial lung disease and on seven patients for pulmonary nodules. Eleven patients underwent therapeutic lung resection for management of pneumothorax or air leaks. Sixteen patients underwent thoracoscopy for pleural disease. This was to diagnose mesothelioma (2), to lyse benign adhesions (2), to drain empyema (2), and to evacuate loculated pleural effusion (10) thoracoscopically. Nine patients underwent thoracoscopic staging for lung cancer. Thirteen patients underwent thoracoscopic staging for esophageal cancer as part of a prospective trial. Other indications for thoracoscopy included pericardiectomy (6), sympathectomy (2), and resection of mediastinal mass (4). Thoracoscopy is an excellent option for patients at high risk from standard thoracotomy and may allow procedures to be performed which would prevent the need for open thoracotomy, resulting in shorter hospital stay and less postoperative pain.
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PMID:Efficacy and safety of thoracoscopy for diagnosis and treatment of intrathoracic disease: the University of Maryland experience. 804 59

In a prospective comparison, 60 patients suffering from complicated spontaneous pneumothorax were randomly allocated to receive treatment by a video-assisted thoracoscopic surgery (VATS) technique or by thoracotomy. Thirty patients underwent bullectomy and apical pleurectomy by VATS performed through three 2-cm incisions (group V) and 30 patients underwent a similar surgical procedure through a posterolateral thoracotomy (group T). The median operating time was significantly longer in group V (45 versus 37.5 minutes; p < 0.05), but the postoperative analgesic requirement and hospital stay were less than those in group T. On the third postoperative day, the reductions in the forced expiratory volume in 1 second and forced vital capacity were significantly lower in group V than in group T (p < 0.05 and p < 0.01, respectively). Initial treatment of the spontaneous pneumothorax was effective in 27 patients (90%) in group V and in 29 patients (97%) in group T. There have been two late recurrences in group V and one in group T at a median follow-up of 15.1 months and 16.3 months, respectively. Within the study group, 30 consecutive patients presented with primary spontaneous pneumothorax. In this subgroup there was no significant difference in the operating time between VATS and thoracotomy, but postoperative pain, hospital stay, and pulmonary dysfunction were all less for those undergoing VATS. All treatment failures were in the subgroup of 30 consecutive patients who presented with secondary spontaneous pneumothorax, and the hospital stay in this group was prolonged by the use of VATS. We conclude from our findings that VATS is superior to thoracotomy in the treatment of primary spontaneous pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. 788 43

Endoscopic techniques have established themselves as an important means for reducing the traumatic impact of thoracic surgery on the patient. They considerably lighten postoperative pain and are cosmetically much more pleasing. Procedures such as lung biopsy, pericardial window, treatment of spontaneous pneumothorax, mediastinal benign tumour excision and sympathectomy have become routine, other such as oesophagectomy require further evaluation. Advanced procedures such as lobectomy and pneumonectomy require further clinical and technological development prior to a conclusive assessment.
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PMID:Thoracic surgery: the irreversible evolution toward endoscopic surgery. 808 91

A sick premature baby who requires intensive care will undergo many uncomfortable procedures. It is now accepted that such babies perceive pain and need adequate analgesia, but little is known about the effects of sedation in these patients. We investigated the use of morphine to provide analgesia and sedation for ventilated preterm babies in a randomised, double-blind, placebo-controlled trial. 41 mechanically ventilated babies who had been treated with surfactant (Curosurf) for hyaline membrane disease were randomly assigned morphine in 5% dextrose (100 micrograms/kg per h for 2 h followed by 25 micrograms/kg per h continuous infusion) or 5% dextrose (placebo). Plasma catecholamine concentrations were measured 1 h after the first dose of surfactant and 24 h later. Blood pressure was measured at study entry and after 6 h. The morphine and placebo groups showed no differences in method of delivery, Apgar scores, birthweight, gestation, or catecholamine concentrations at baseline. Morphine-treated babies showed a significant reduction in adrenaline concentrations during the first 24 h (median change -0.4 [95% CI -1.1 to -0.3] nmol/L p < 0.001), which was not seen in the placebo group (median change 0.2 [-0.6 to 0.6] nmol/L, p = 0.79). There was a non-significant reduction in noradrenaline concentration in the morphine group. Blood pressure showed a slight but non-significant fall (median -4 mm Hg) in morphine-treated babies. The incidence of intraventricular haemorrhage, patent ductus arteriosus, and pneumothorax, the number of ventilator days, and the numbers of deaths did not differ significantly between the groups. Morphine, in the dose regimen we used, is safe and effective in reducing adrenaline concentrations in preterm ventilated babies.
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PMID:Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated pre-term babies. 810 52


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