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

Ambulatory laparoscopic cholecystectomy is an established practice in our institution, with an experience of more than 800 cases. The present study is conducted to evaluate the contemporary outcomes of day-case laparoscopic cholecystectomy in the setting of a major teaching hospital. A retrospective analysis of 200 patients who underwent ambulatory laparoscopic cholecystectomies was performed to evaluate the postoperative morbidity, unplanned admission, and readmission rates. Causes for unanticipated admission and readmission were analyzed. Uneventful recovery was attained in 185 (92.5%) patients. The mean length of the operation was 56 +/- 20 (SD) minutes. There was no hospital mortality, and no patient required conversion to open cholecystectomy. Nine patients were admitted overnight after operation because of nausea and vomiting (n = 3), pain (n = 2), urinary retention (n = 2), medical observation n = 1), and patient's preference (n = 1), leading to an unanticipated admission rate of 4.5%. Six patients required readmission because of postoperative complications (n = 4) and abdominal pain (n = 2), giving a readmission rate of 3%. The overall postoperative morbidity rate was 3% (n = 6), including retained stones n = 4), bile leakage (n = 1), and hepatic subcapsular hematoma (n = 1). Ambulatory laparoscopic cholecystectomy is a safe practice in appropriately selected patients. Postoperative nausea and vomiting was the commonest reason for unanticipated admission after operation, and retained stones was the most frequent postoperative morbidity necessitating readmission.
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PMID:Contemporary outcomes of ambulatory laparoscopic cholecystectomy in a major teaching hospital. 1220 40

Alternative forms of anesthesia in breast cancer patients have been sought to reduce the untoward effects of general anesthesia. The purpose of this study was to compare paravertebral block (PVB) and general anesthesia (GA) in terms of pain control, postoperative nausea and vomiting, and resumption of diet in patients undergoing operations for breast cancer. A retrospective chart review was performed on all patients (289) undergoing breast cancer surgery from May 1, 1999 through December 31, 2000 with PVB or GA. The PVB (n = 128) and GA (n = 100) groups had similar demographics. Postoperative narcotics were given to 80.8 and 93 per cent of PVB and GA patients, respectively (P < 0.01), after an average of 216 and 122 minutes from the end of surgery (P = 0.028). The PVB group received 6.2 narcotic units compared with 10.1 in the GA group (P = 0.04). Postoperative nausea and vomiting was present in 16.8 and 24 per cent of patients in the PVB and GA groups, respectively (P = 0.12). A diet was tolerated on the same day of surgery by 98.4 and 82 per cent of PVB and GA patients, respectively (P < 0.01). The complication rate of PVB was 1.8 per cent. PVB resulted in better postoperative pain control and earlier resumption of diet compared with GA. The good success rate and low complication rate of PVB make it well suited for breast cancer surgery and can eliminate the need for GA in patients with serious comorbidities.
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PMID:Paravertebral block: an alternative to general anesthesia in breast cancer surgery. 1267 77

Ambulatory surgery provides quality care that is cost-effective. The use of innovative surgical and anesthetic techniques will allow larger numbers of patients to take advantage of the benefits of undergoing an elective operation on an ambulatory basis. Anesthesiologists will be faced with more complex surgery, which will require careful selection and assessment of patients to ensure continuity of the excellent safety record of ambulatory anesthesia. Minor adverse events, such as pain and PONV, are still common. The occurrence of these minor adverse advents is now the major area of quality assessment and an area where improvement could be targeted. Fast tracking facilitates earlier discharge, but we must ensure this has benefit to the patient as speedy discharge may mask the true incidence of adverse minor symptoms. This can lead to patient dissatisfaction and a poor impression of ambulatory surgery.
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PMID:Postoperative recovery and discharge. 1281 1

Postoperative nausea and vomiting (PONV), a major complication in children, is responsive to IV and oral ondansetron. Because these routes are not always available, we studied the acceptability and efficacy of ondansetron oral disintegrating tablets (ODT). In this double-blind, randomized, placebo-controlled study, 62 patients undergoing adenotonsillectomy, aged 5 to 11 years, preoperatively received ODT (4 mg) or placebo. Patients assessed the medication for taste and sensation. Anesthesia was induced with sevoflurane, maintained with desflurane, and supplemented with fentanyl 2.5 microg/kg and dexamethasone 0.5 mg/kg (maximum dose, 12 mg). An observer blinded to treatment evaluated patients for pain, agitation, and PONV. Postoperative treatment consisted of fentanyl 1 microg/kg for pain and agitation and metoclopramide 0.15 mg/kg (maximum dose, 10 mg) for PONV. There were no significant differences between study groups with regard to age, weight, recovery time, agitation, or pain. Approximately 90% of the subjects found the ODT to taste good. No subject rejected the study medication, but the ondansetron-containing tablets were found to be less palatable than the placebo. The incidence of vomiting was significantly less in the ondansetron-medicated group.
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PMID:Ondansetron oral disintegrating tablets: acceptability and efficacy in children undergoing adenotonsillectomy. 1597 6

We compared methylprednisolone 125 mg IV (n = 68) and parecoxib 40 mg IV (n = 68) with placebo (n = 68) given before breast augmentation surgery in a randomized, double-blind parallel group study. Surgery was performed under local anesthesia combined with propofol/fentanyl sedation. Methylprednisolone and parecoxib decreased pain at rest and dynamic pain intensity from 1 to 6 h after surgery compared with placebo (mean summed pain intensity(1-6 h): methylprednisolone [17.25; 95% confidence interval [CI], 14.85-19.65] versus placebo [21.7; 95% CI, 19.3-24.1]; P < 0.03; parecoxib [15.25; 95% CI, 13.25-17.25] versus placebo; P < 0.001; mean summed dynamic pain intensity(1-6 h): methylprednisolone [22.7; 95% CI, 20.1-23.3] versus placebo [28.4; 95% CI, 26.0-30.8]; P < 0.01; parecoxib [20.9; 95% CI, 18.6-23.2] versus placebo; P < 0.001). Both rescue drug consumption and actual pain (all observations before and after rescue) during the first 6 h were similar in the two active drug groups and significantly reduced compared with placebo. Using a composite score of actual pain intensity and rescue analgesic use, the active drugs were significantly superior to placebo (P < 0.001 for both active drugs). Postoperative nausea and vomiting was reduced after methylprednisolone administration (incidence, 30%), but not after parecoxib (incidence, 37%), during the first 24 h compared with placebo (incidence, 60%; P < 0.001). Fatigue was reduced by methylprednisolone (incidence, 44%), but not by parecoxib (incidence, 59%), compared with placebo (incidence, 66%; P < 0.05). In conclusion, methylprednisolone 125 mg IV given before breast augmentation surgery had analgesic and rescue analgesic-sparing effects comparable with those of parecoxib 40 mg IV. Methylprednisolone, but not parecoxib, reduced nausea, vomiting, and fatigue.
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PMID:Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a single-dose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo. 1642 36

This review summarizes and critically appraises important and clinically relevant publications dealing with postoperative pain therapy. Several consequences can be drawn from these studies: i) women anticipate postoperative pain more realistically and it occurs more often than in man; however, pain intensity and analgesic consumption are not different; ii) placebos elicit psychological phenomena (e. g. expectation) that trigger neurobiological processes (e. g. activation of endogenous opioid system); iii) COX-2 inhibitors increase the risk for thromboembolic complications (e. g. myocardial infarction, apoplex, pulmonary embolism) and perioperative mortality in patients undergoing aortocoronary bypass surgery; iv) NSAID as supplement to postoperative PCIA with opioids reduce the risk for PONV and sedation; v) preoperative administration of gabapentin reduces preoperative anxiety and postoperative pain; vi) epidural catheters situated at the site of major spinal surgery are promising approach to provide efficient postoperative analgesia; vii) in the literature contradictory results have been reported regarding the effect of perioperative acupuncture on intra- and postoperative consumption of anesthetics or analgesics; acupuncture appears to decrease the incidence of PONV, but no reduction in the postoperative use of antiemetic agents has not been shown yet; viii) laparoscopic versus open colectomy in patients with colon carcinoma results in prolongation of surgery, reduction of postoperative pain and analgesics, earlier mobilization and a reduced hospital stay, if conventional systemic opioid-based pain therapy was used postoperatively.
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PMID:[New aspects in postoperative pain therapy]. 1655 49

We compared the efficiency of continuous epidural analgesia with ropivacaine and bupivacaine in patients with lung carcinoma stages IIIB and IV. We studied 25 patients aged 48-70 years, divided in two groups A (13 patients) and B (12 patients). Group A received continuous epidural infusion with ropivacaine 0.2%, 6 ml/h and group B received continuous epidural infusion with bupivacaine 0.2%, 6 ml/h. Pain level, neuromuscular block intensity and PONV incidence were similar in both groups during the first 72 hours. The ropivacaine group needed more nonopioid analgesic (Dinastat).
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PMID:[Comparison between continuous epidural instillation of ropivacaine and bupivacaine in patients with lung cancer]. 1706 19

Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.
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PMID:Pharmacological prophylaxis and management of adult postoperative/postdischarge nausea and vomiting. 1716 48

This randomized double-blind study was undertaken to evaluate the efficacy of ondasetron and dexamathesone in reducing the incidence of postoperative nausea and vomiting after laparoscopic cholecystectomy. The study covered 60 patients (ASA I/II) who had undergone laparoscopic cholecystectomy under general anesthesia. The patients were divided into two groups: 1) 30 patients who received dexamethasone, 4 mg i.v.; and 2) 30 patients who took ondansetron, 4 mg i.v., prior to general anesthesia. Postoperatively, nausea, vomiting, and severe pain (VAS) were observed every 6 hours within the first 24 hours. Postoperative nausea and vomiting occurred in 6 (20) patients in Group I and in 13 (43.33) patients in Group 2 (p < 0.05), while vomiting did only in 5 (16.66%) patients in Group I and 4 (13.33%) in Group 2 (p > 0.05). The least intensity of postoperative pain was observed in Group 1, but the difference between the study groups was insignificant. It is concluded that dexamethasone is more effective in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy than ondansetron. This is mainly determined by a significant reduction in the incidence of postoperative nausea.
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PMID:[Procedures for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: dexamethasone and ondansetron]. 1756 2

Postoperative nausea and vomiting (PONV) constitutes a major unpleasant symptom in the postoperative period. The prevention of PONV is judged equally important as the prevention of postoperative pain. Therefore, a working PONV-algorithm should be as self-evident as the approach to prevent and treat postoperative pain. None of the currently available pharmacological interventions is able to totally abolish PONV. However, using a multimodal approach with the combination of various antiemetic interventions, a substantial reduction or even elimination of PONV is already feasible. As a rule of thumb, each effective antiemetic intervention will lead to a relative risk reduction of approximately 30 %. Well documented interventions in terms of the aforementioned efficacy are the administration of ondansetron 4 mg, dexamethasone 4 mg, droperidol 1,25mg and dimenhydrinate 62 mg, as well oral Aprepitant. Metoclopramide may play a role for instance in a multimodal approach. Apart from the administration of antiemetics, the avoidance of inhalational anaesthetics by using propofol is associated with a comparable risk reduction. In general, using a risk-dependent approach, e.g. based on a simplified risk score, allows to avoid administering antiemetics to patients at low risk. However, due to the difficulties associated with the implementation of risk-score based algorithms and the inherent weaknesses of clinical risk scores to predict PONV in an individual patient, a general (multimodal) approach seem to be justified as well. Considering the fact that the currently available antiemetics are associated with few side effects, the administration of prophylactic antiemetics should not be associated with a high hurdle in the clinical setting. In case of any doubts regarding the individual risk, it seems justified to expand the (multimodal) prophylaxis rather than to wait until PONV occurs and impairs patient comfort.
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PMID:[Postoperative nausea and vomiting: rational algorithms for prevention and treatment based on current evidence]. 1936 33


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