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

The effect of 20 mL of intraarticular bupivacaine (0.25%, with or without 1:200,000 epinephrine), morphine (0.03%, with or without 1:200,000 epinephrine), or normal saline on postoperative analgesia after arthroscopic knee surgery was studied in a randomized, prospective, double-blind trial in ASA I-III outpatients receiving general anesthesia (n = 112) or regional anesthesia (n = 27 [spinal (n = 25) or epidural (n = 2)]). The visual analogue pain scores in the postanesthesia care unit and 3, 6, 12, and 24 h after surgery, time to first analgesic use, and total 24-h analgesic requirements were recorded. In those who received general anesthesia, the visual analogue scores were significantly lower in the bupivacaine group compared with both the morphine- and placebo-treated patients (P less than 0.05). The time to first analgesic use was longer in both the bupivacaine and morphine groups when compared with the control group (P less than 0.05). No significant differences were detected in total 24-h analgesic requirements among the groups. Patients who had received regional anesthesia had lower visual analogue scores compared with patients who had received general anesthesia irrespective of the intraarticular treatment (P less than 0.05). Our results indicate that intraarticular injection of bupivacaine after arthroscopic knee surgery provides prolonged analgesia but that there is no significant prolonged analgesia provided by intraarticular morphine.
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PMID:Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective, double-blind study. 159 14

We report a case of mitral valve prolapse in which the first manifestation was the occurrence of arrhythmias during anesthesia. A 28 years old female patient, ASA I, without previous medical or surgical history was programmed for surgical repair of an anal fistula. Preoperative physical and laboratory examination were normal. During anesthetic induction with propofol and droperidol and coinciding with orotracheal intubation the patient developed ventricular premature beats, bigeminy, and runs of ventricular tachycardia which were controlled with intravenous lidocaine. Anesthesia was maintained with 66% of O2/N2O, 0.5 to 1% of isoflurane, alfentanil, and atracurium. At the beginning of the intervention the patient presented an episode of supraventricular tachycardia at a rate of 140 to 160 beats/min which did not respond to a deeper anesthetic level nor to the administration of 5 mg of verapamil. This arrhythmia was finally interrupted with 3 mg of propranolol and it did not relapse during the surgical procedure. We discuss the physiopathology of the lesion, the possible arrhythmic effect of the anesthetic agents used in this case, and the effects of several pathologic situations (anemia, pain, anxiety, hypovolemia, etc) documented in patient with this abnormality.
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PMID:[Intraoperative arrhythmias in a patient with mitral valve prolapse]. 159 53

The admixture of clonidine or epinephrine to lidocaine for brachial plexus block was studied with regard to duration of block, postoperative analgesia, and plasma concentrations of lidocaine. Thirty-three patients of ASA physical status I and II received an admixture of either clonidine (150 micrograms; n = 15) or epinephrine (200 micrograms; n = 18) to 40 mL of 1% lidocaine in a randomized, double-blind fashion. Bone surgery predominated in those patients receiving clonidine and soft-tissue surgery in those receiving epinephrine (P less than 0.05). Onset and duration of block were not different between the groups. With the admixture of clonidine, fewer patients were completely pain free for greater than 12 h (13.3%) and pain scores (visual analogue scale 0-10) were higher 6 h after the block (median 4; range 0-6) than with epinephrine (61.1%; median 2; range 0-7, respectively; P less than 0.05). In patients who had received clonidine, peak plasma concentrations of lidocaine were higher (10.29 +/- 2.96 mumol/L) and occurred earlier (23.7 +/- 9.3 min; mean +/- SD) than in those treated with epinephrine (6.9 +/- 1.71 mumol/L; 72.5 +/- 56.2 min; P less than 0.05). This indicates the absence of a local vasoconstrictor effect of clonidine and implies a reduced margin of safety with regard to local anesthetic toxicity. Although clonidine does not offer advantages compared with epinephrine, it may be a useful adjunct to local anesthetics in those patients in whom the administration of epinephrine is contraindicated.
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PMID:Comparison between clonidine and epinephrine admixture to lidocaine in brachial plexus block. 161 65

This case report describes a general anesthetic where ketorolac tromethamine was used instead of a narcotic. The patient was a 37-year-old male, ASA II category, who underwent general anesthesia for a cholecystectomy. The drug is discussed in terms of preoperative, intraoperative, and immediate postoperative effects. During the preoperative phase, no effect was demonstrated. Intraoperatively, the drug performed poorly to attenuate responses to intense stimulation as noted by an increase in pulse and blood pressure of greater than 20% during intubation, incision, and abdominal wall retraction. During the immediate postoperative phase, the drug performed well to provide analgesia related to incisional pain. Ketorolac has not been previously discussed in terms of intraoperative uses. The mechanism of action by which it provides analgesia is through the inhibition of prostaglandin synthesis. It is similar in structure to the other nonsteroidal anti-inflammatory drugs and may offer certain advantages over traditional agents used to provide analgesia, including the absence of respiratory depression, addictive potential, euphoria, a decrease in gastric motility, and cardiovascular effects. These properties may help in the management of certain types of patients who are at risk for respiratory depression or in those who have a contraindication to narcotics.
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PMID:Ketorolac tromethamine: a nonsteroidal anti-inflammatory analgesic used as an adjunct for general anesthesia. 163 59

Until recently, the clinical significance of post-surgical pain and its undertreatment were for the most part unappreciated. Recognition that inadequate analgesia adversely affects the patient's cardiovascular, pulmonary, and emotional status has spurred development of new and highly effective methods of controlling pain. With the introduction of spinal opioid and patient-controlled analgesia (PCA) came the realization that, while such forms of therapy provided superior pain relief, they were not without their own unique and occasionally serious side effects. For this reason, both techniques are more safely provided by highly trained members of a dedicated acute/post-surgical pain service. Although spinal opioid (epidural, intrathecal) techniques are invasive and require patient cooperation, they have a high degree of safety in low-risk populations (ASA 1 and 2). The major therapeutic advantage of spinal opioids is their ability to prevent pain from being perceived. PCA permits patients to titrate intravenous opioids in proportion to their particular level of pain intensity. Although PCA provides effective pain "relief," the technique is incapable of preventing pain from being appreciated. A number of studies have observed that pain scores in patients successfully employing PCA were significantly higher than those noted in individuals treated with epidural opioids. Nevertheless, the control gained by self-administration, uniformity of analgesia, and low level of adverse results associated with PCA provides higher patient satisfaction and decreased sedation when compared with traditional intramuscular dosing. The effectiveness of PCA may be improved by adjusting for patient variables, utilizing opioids having rapid onset, the addition of a basal infusion, and supplementation with non-steroidal anti-inflammatory agents. Interpleural analgesia represents an important therapeutic option in patients sensitive to opioid-induced respiratory depression. The technique is more effective when local anesthetic solutions are continually infused. Analgesic efficacy may be further enhanced by the addition of "low-dose" PCA.
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PMID:Current methods of controlling post-operative pain. 166 60

Thirty-five ASA Grade I-II females received tramadol 150 mg intravenously followed randomly and double-blind by an infusion of either tramadol 15 mg h-1 (Group I) or saline (Group II) and tramadol 100 mg bolus on demand for the treatment of post-operative pain. Patients in Group I required 60% less tramadol on demand (P less than 0.01) and had better pain relief after operation (P less than 0.05) than those in the group given saline. Total tramadol consumption, however, was about 30% higher in Group I (P less than 0.05) and was associated with an increased incidence of minor side-effects. In both groups median serum tramadol concentrations peaked at 15 and 60 min and decreased after the second peak steadily (P less than 0.001). Tramadol failed to relieve pain within 2 h after the beginning of treatment in 6% (Group I) and 20% (Group II) of the patients. It is suggested that use of an i.v. maintenance tramadol infusion in addition to on-demand i.v. tramadol boluses is a safe and recommended mode of post-operative intravenous pain therapy.
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PMID:Intravenous tramadol for post-operative pain--comparison of intermittent dose regimens with and without maintenance infusion. 173 95

Analgo-sedation for ESWL treatment has been associated with a variety of problems. Minimal invasiveness of this technique should combine with haemodynamic stability as well as with adequate oxygenation. Patient acceptance has to be considered as another important aspect. Our study demonstrates the effectiveness of an analgosedative regimen with regard to these aspects. 50 ASA I-III patients scheduled for ESWL treatment were randomly allocated to receive either no premedication (n = 25) or chlorazepam as oral premedication (n = 25). The analgosedative technique was identical in both groups, consisting of atropine 0.25 mg, droperidol 5 mg (2.5 mg, if body weight less than 60 kg), and alfentanil 10 micrograms/kg intravenously. If necessary, repeated boluses of alfentanil 5 micrograms/kg were administered up to a maximum of 2 mg. Heart rates, arterial blood pressures, and peripheral oxygen saturation were measured during treatment. Post-treatment, patients were interviewed to assess the quality of analgesia. The results showed that our analgo-sedative regimen is suitable for ASA I-III patients. Stable heamodynamic conditions and adequate oxygenation were achieved in all patients. Patient acceptance was good. Patients with anxiolytic premedication benefited in terms of reduction in blood pressure and heart rate. The study also showed that anaesthesiologists may underestimate the pain intensity experienced and assessed by the patient.
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PMID:[Optimized analgesic sedation techniques for ESWL]. 175 51

The purpose of this study was to compare the effects of ilioinguinal/iliohypogastric (IG/IH) nerve block and intravenous fentanyl for pain control following inguinal herniorrhaphy in pediatric outpatients. Seventy-five ASA physical status I and II children (aged 1 to 10 yr) with unilateral inguinal herniorrhaphy under general anesthesia were randomly divided into three groups. Group A received IG/IH nerve block, using 0.25% bupivacaine (1 mg/kg) immediately after induction. Group B received intravenous fentanyl (1 microgram/kg) immediately after induction. Group C received only general anesthesia as control. At postanesthetic care unit (PACU), we recorded the degree of pain/or discomfort at 5, 15, 30, 45 and 60 min using modified Hannallah's scoring system after the patient was fully awake. The degree of recovery was also evaluated using Steward's scoring system. After discharge, the parents were interrogated about the condition of child within 24 h by telephone. Follow-up items raised included vomiting, drowsiness, pain and shivering. Our results showed that children in both study groups had lower pain score than those in the control group, and in the fentanyl group children had lower pain score than in the nerve block group during the first 30 min at PACU. The recovery time was also longer in the fentanyl group. There was no significant difference among the three groups regarding the raised items over telephone interrogation. In sum, inguinal nerve block was effective for postoperative pain relief in children undergoing inguinal herniorraphy. We also suggested that small dose of intravenous fentanyl would serve as an easy, simple and effective means for relieving postinguinal herniorrhaphy pain during the first 30 min of the initial postoperative period.
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PMID:Comparison of inguinal nerve block and intravenous fentanyl in relieving postinguinal herniorrhaphy pain for pediatric outpatients. 175 50

The patients received thoracotomy usually suffered from significant severe pain postoperatively, which accompanied with impaired pulmonary function or increased incidences of atelectasis and pneumonia. So adequate analgesia for those patients is indicated. The purpose of this study is to investigate the efficiency of patient-controlled analgesia (PCA) and determine whether it is better than conventional analgesia or not. Twenty-six patients, ASA physical status class I and II, were randomized into two groups: PCA and intramuscular (IM). The effect on pain relief was assessed by a visual analogue pain scale (VAPS) q 4 h postoperatively for two days. Forced vital capacity (FVC) and the questionnaire of nocturnal sleep disturbance by pain were evaluated preoperatively, the first, second postoperative mornings. As result of this study, the patients of PCA group get less pain than IM group after the first and second days of surgery. VAPS values are 3.7 +/- 1.1, 2.8 +/- 0.8 and 6.1 +/- 0.9, 5.3 +/- 1.1 respectively pertaining to PCA and IM groups (p less than 0.05). The patients of IM group get more disturbance of nocturnal sleep than PCA group at initial two nights of postoperation as well (p less than 0.05). It is manifest to look out the significant difference between these two groups in accordance with FVC ratio records of post-surgery vs presurgery at initial two days after surgery on the subject of respiratory function recovery. PCA group are 46.46 +/- 7.29%, 52.25 +/- 8.32% in a condition of more progress on lung function recovery than IM group of 38.13 +/- 10.25%, 42.15 +/- 7.82% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficiency of patient-controlled analgesia versus conventional analgesia in patients after thoracotomy]. 175 53

Various studies have shown that bupivacaine nerve blocks provide prolonged post-operative analgesia. We studied the efficacy of a 0.5% bupivacaine infraorbital nerve block as post-operative analgesia in a random, prospective, double blind manner in children undergoing cleft lip repair. Following the induction of anesthesia with ketamine 2-4 mg/kg im, 60 patients, aged 2-13 years, ASA I and II were equally divided: Group A received 1-1.5 ml bupivacaine, 0.5% with 1:200,000 epinephrine; Group B received 1-1.5 ml saline injected into the vicinity of the infraorbital foramina. In every patient, the surgeon infiltrated the lip with 4-7 ml of 1% lidocaine with 1:100,000 epinephrine for both anesthesia and hemostasis. Post-operative evaluations were completed after 4, 8, and 12 to 24 hours and were based on a visual analogue scale for pain. Similarly, the nurses and the parents also evaluated post-operative discomfort using specific criteria. All the observers were kept unaware of the solutions used for the block. The results showed that Group A was pain free for a mean duration of 19.4 +/- 5.06 (SD) hours in contrast to 11.7 +/- 6.19 hours for Group B, (p less than 0.001). Group A required no other analgesic whereas a total of 17 patients in Group B required analgesic medication starting at four hours post-operatively, (p less than 0.001). Both the nurses and the parents confirmed that those who received infraorbital block were more comfortable than those who did not. One-way analysis of variance indicates that the mean scores for both groups differs significantly at all levels of comparison, (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bilateral infraorbital block with 0.5% bupivacaine as post-operative analgesia following cheiloplasty in children. 178 Jul 23


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