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

The death rates associated with all forms of surgical illness increase consistently with age but appear more closely related to physiologic and medical status than to age per se. Changes in physiologic function with advancing age are marked by a decreased sensitivity to perturbations and a decreased efficiency of homeostatic mechanisms. Recognition of the heterogeneity of the aging process is fundamental to appropriate decision-making in the elderly surgical patient and thus to avoiding complications. Careful preoperative assessment of medical problems and potential age-related changes in physiologic function, preoperative orientation and teaching, consideration of deep venous thrombosis prophylaxis, effective pain management, early postoperative mobilization and careful attention to drug and fluid and electrolyte therapy are essential in management of the elderly surgical patient.
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PMID:Preventive measures in the elderly surgical patient. 174 32

Fifteen patients undergoing total hip and total knee replacement were studied prospectively to evaluate postoperative pain relief provided by an epidural infusion of fentanyl citrate, with and without lidocaine hydrochloride, and changes in arterial flow to the lower extremities. The patients were randomly placed in three groups: group 1 received epidural fentanyl, 5 micrograms/mL; group 2 received epidural fentanyl, 5 micrograms/mL with 0.75% solution of lidocaine; and group 3 received epidural fentanyl, 5 micrograms/mL with 1.0% solution of lidocaine. All patients received 1.5% solution of epidural etidocaine hydrochloride with epinephrine 1:200,000 for intraoperative anesthesia. No clinical evidence of deep vein thrombosis, tachyphylactic reaction to lidocaine, orthostatic hypotension, or motor block was demonstrated in any patient. The addition of lidocaine to the epidural fentanyl infusion did not improve pain relief or allow a decrease in the rate of infusion. Patients in all groups had improved arterial flow to the lower extremities 24 hours postoperatively.
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PMID:Combining epidural fentanyl and lidocaine for postoperative pain. 180 Apr 68

A follow-up study is reported on 49 patients with acute deep vein thrombosis (DVT) treated on an ambulatory basis. Venography had shown crural DVT in 27 % and proximal extension in 73 %. The initial treatment consisted of heparin (7,500 U iv, 40,000 U sc), ethylbiscoumacetate (900 mg), phenprocoumon (9 mg), and a ready made compression stocking for the calf. The patients were advised to undertake frequent strolls, the first when leaving the office. Pain, swelling and incapacity for walking vanished within two days. The partial thromboplastintime was prolonged 2.4-times on the first day and the thromboplastintime was in the therapeutic range on the second day already. Until follow-up 4 patients died of other diseases. There was no clinical pulmonary embolism, no secondary hospitalisation and only one new DVT. Of 844 months of patients at risk of recurrence 50 % passed under anticoagulants and 70 % with compression therapy. At an average of 19 months, 82 % of patients were asymptomatic and 45 % showed mild chronic venous insufficiency. In contrast, impaired drainage function (by lightreflectionrheography) was found in 79 % overall and in 100 % after DVT of the proximal veins. The discrepancy is explained by the compliance with compression therapy.
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PMID:Ambulatory care for ambulant patients with deep vein thrombosis. 186 Nov 6

A 59 year old patient with leg pain and dyspnea was hospitalized for suspected deep venous thrombosis and pulmonary embolism. The clinical, scintigraphic and radiological findings confirmed the diagnosis. Immediate therapy with heparin and oral warfarin resulted in an improvement of pain and dyspnea within a few days. The strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism is discussed.
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PMID:[Leg pain, dyspnea]. 186 61

One hundred thirty-seven consecutive posterior stabilized total knee arthroplasties (TKAs) were reviewed. Average age of the patient was 61.1 years and length of postoperative follow-up period was 29.2 months. Patients were evaluated using the Hospital for Special Surgery (HSS) knee rating scores. Average preoperative scores improved from 52 to 92, postoperatively. Ninety-eight percent of patients had no pain or mild occasional pain postoperatively compared with 99% of patients experiencing severe to disabling pain preoperatively. Complications included one myocardial infarction, two deep venous thrombosis, one urinary tract infection, one patellar dislocation, and four wound problems. There were two incidences of seroma, one hematoma, and one deep infection requiring revision after joint debridement and systemic antibiotics. Also noted was one incidence of ligamentous laxity and one patella fracture.
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PMID:Results of total knee arthroplasty using the posterior stabilized condylar prosthesis. A report of 137 consecutive cases. 186 57

One hundred forty-nine consecutive patients requiring lower extremity total joint arthroplasty were randomized to either coumadin (52 patients) or intermittent pneumatic compression (48 patients) as prophylaxis against deep vein thrombosis (DVT). Forty-nine patients were excluded. When fully ambulatory, the presence or absence of DVT was diagnosed by ascending venography (90% of patients), nuclear venography, venous dopplers, or impedence plethysmography. The two groups were similar in average age (64 years), indication for arthroplasty (pain because of arthritis in 90%), gender (98% male), and average number of risk factors (2.4). Twenty-five percent of patients on coumadin and 25% of patients on intermittent pneumatic compression (IPC) developed DVT. IPC was more effective than coumadin following primary total hip arthroplasties (THAs) (16% versus 24% incidence DVT); coumadin was more effective than IPC following primary total knee arthroplasties (TKAs) (19% versus 32% incidence of DVT). DVT developed in 36% of patients following revision arthroplasty. Seventy-five percent of all thrombi were proximal. Both IPC and coumadin were found to be safe; there was no increased perioperative bleeding in the coumadin group. Of three postoperative deaths, one was possibly due to pulmonary embolism (PE).
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PMID:Intermittent pneumatic compression versus coumadin. Prevention of deep vein thrombosis in lower-extremity total joint arthroplasty. 186 61

The history, physical examination, chest radiograph, electrocardiogram and blood gases were evaluated in patients with suspected acute pulmonary embolism (PE) and no history or evidence of pre-existing cardiac or pulmonary disease. The investigation focused upon patients with no previous cardiac or pulmonary disease in order to evaluate the clinical characteristics that were due only to PE. Acute PE was present in 117 patients and PE was excluded in 248 patients. Among the patients with PE, dyspnea or tachypnea (greater than or equal to 20/min) was present in 105 of 117 (90 percent). Dyspnea, hemoptysis, or pleuritic pain was present in 107 of 117 (91 percent). The partial pressure of oxygen in arterial blood on room air was less than 80 mm Hg in 65 of 88 (74 percent). The alveolar-arterial oxygen gradient was greater than 20 mm Hg in 76 of 88 (86 percent). The chest radiograph was abnormal in 98 of 117 (84 percent). Atelectasis and/or pulmonary parenchymal abnormalities were most common, 79 of 117 (68 percent). Nonspecific ST segment or T wave change was the most common electrocardiographic abnormality, in 44 of 89 (49 percent). Dyspnea, tachypnea, or signs of deep venous thrombosis was present in 107 of 117 (91 percent). Dyspnea or tachypnea or pleuritic pain was present in 113 of 117 (97 percent). Dyspnea or tachypnea or pleuritic pain was present in 113 of 117 (97 percent). Dyspnea or tachypnea or pleuritic pain or atelectasis or a parenchymal abnormality on the chest radiograph was present in 115 of 117 (98 percent). In conclusion, among the patients with pulmonary embolism that were identified, only a small percentage did not have these important manifestations or combinations of manifestations. Clinical evaluation, though nonspecific, is of considerable value in the selection of patients in whom there is a need for further diagnostic studies.
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PMID:Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. 841 19

A prospective randomized double-blind trial was performed comparing conventional low-dose heparin with a LMWH fragment (Kabi 2165, Fragmin) for thromboprophylaxis in elective general abdominal surgical patients. The first dose of the fragment was given in the evening before surgery, and thereafter every evening. There were 1002 analyzable patients, 826 having received correct prophylaxis. Sixty three percent of the patients were operated on for malignant diseases. The frequency of DVT was significantly reduced among patients with correct prophylaxis with the heparin fragment (9.2 to 5.0%, p = 0.02). In patients with malignancies the reduction was from 11.2 to 6.4% (p = 0.06). The frequency of bleeding was 6.7% among the heparin fragment patients and 2.7% among the patients given conventional heparin (p = 0.01). The corresponding frequencies for patients with malignancies were 3.2 and 2.8%, respectively (p = 0.28). All bleedings were minor and of no clinical significance. Local pain at the injection site was reported significantly less often among patients with the fragment. Twenty patients died, 13 with malignant disease, mortality being the same in the two groups. It is concluded that heparin fragment administered in the evening before surgery and then every evening is a practically acceptable alternative to prevent postoperative DVT in patients undergoing elective abdominal surgery, also when the histology shows malignancy. Thus, the advantages of using LMWH compared with conventional low-dose heparin are simplified administration routines, better thromboprophylactic effect, and less local pain at injection sites. A disadvantage is the slight increase in hemorrhagic side effects, all of minor clinical importance and not seen in patients undergoing surgery for malignancy.
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PMID:Thromboprophylactic effect of low molecular weight heparin started in the evening before elective general abdominal surgery: a comparison with low-dose heparin. 196

Although there is a critical need for effective contraception in the immediate postpartum period for women who are not breastfeeding, this need must be balanced against the inherent risks. The most effective form of contraceptive protection--oral contraceptives (OCs)--can present an increased risk of thromboembolism in the period after delivery. The thrombotic changes associated with pregnancy, and the statistics and vascular damage following a delivery, can combine to create greater potential for thromboembolism after delivery than during pregnancy. Reported here is the case of a 21-year-old woman who, 4 weeks postpartum, developed pain and swelling in the right lower calf and mottled discoloration extending from the proximal thigh to the toes. A diagnosis of deep venous thrombosis was made and heparin was administered. In the hospital, the patient experienced pleuritic chest pain and diaphoresis. A ventilation-perfusion scan indicated a pulmonary embolism. 1 week after delivery, the patient had initiated use of Triphasil. Although this woman had other risk factors (obesity, light cigarette smoking, and a sedentary life-style), OC use in the immediate postpartum period may have been the final factor precipitating the thromboembolic event. It is recommended that OC use should be delayed until at least 2 weeks postpartum in women without other risk factors for thromboembolism and until 4-6 weeks postpartum in those with such factors.
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PMID:Oral contraceptives in the immediate postpartum period. 201 Jul 44

Of a random sample comprising 4581 subjects from The Copenhagen County, 3608 (79%) attended an interview and a general health examination. The subjects were defined as suffering from subjective postphlebitic syndrome if they claimed of lower extremity pain or cramps at rest and from objective postphlebitic syndrome if varicose veins, edema, lower extremity ulcers, or skin changes were present. By means of logistic regression analysis, subjective postphlebitic syndrome was found independently associated with previous thromboembolism, obesity, increasing age, female sex, hormonal therapy, varicose veins, and previous major abdominal surgery. Objective postphlebitic syndrome was associated with previous thromboembolism, obesity, former birthgiving, and high social status. The findings support the view that subclinical deep venous thrombosis in connection with previous surgery may give rise to symptoms in the lower extremities.
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PMID:Postphlebitic syndrome and general surgery: an epidemiologic investigation. 203 91


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