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

This randomized, double-blind study compared the analgesic and respiratory effects of lumbar epidural morphine 5 mg, nalbuphine 10 mg, and nalbuphine 20 mg in repeated doses in patients after thoracotomy; the first dose was administered intraoperatively. Pre-and postoperative monitoring included continuous pulse oximetry, respiratory inductance plethysmography, and repeated arterial blood gas analysis. Postoperatively, visual analogue pain scores, somnolence scores, respiratory rate, and arterial blood gases were determined for 16 h. Preoperatively, episodes of apnea were common during sleep but were not associated with low hemoglobin oxygen saturation or increased arterial carbon dioxide tension (PaCO2). During sleep, some otherwise normal patients had increased PaCO2, and 2 of 15 patients had episodes of hemoglobin oxygen saturation of less than 90%. Postoperatively, 1 and 2 h after arrival in the recovery room, patients who received morphine had lower pain scores than did those who received nalbuphine 10 or 20 mg (P less than 0.05). All 6 patients who received morphine had satisfactory analgesia. Two of 4 patients who received nalbuphine 10 mg and all 5 who received nalbuphine 20 mg were withdrawn from the study because of inadequate analgesia (morphine vs. nalbuphine 10 mg, not significant; morphine vs. nalbuphine 20 mg, P less than 0.01). Two patients who received morphine had persistently increased PaCO2 postoperatively. Two patients who received morphine had episodes of apnea and slow respiratory rate, which were most frequent 6 h after arrival in the recovery room. We conclude that lumbar epidural nalbuphine does not provide adequate analgesia after thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in postthoracotomy patients. 206 65

The recurrent aphthous ulcer is a common oral ulcerative condition. Therapies are pharmaceutical in nature, remain palliative and do not alleviate pain. Carbon dioxide laser therapy was used to treat a minor form of the ulcer (canker sore); the laser therapy reduced or eliminated the pain and inflammation with normal wound healing.
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PMID:Managing aphthous ulcers: laser treatment applied. 206 20

Until recently, vulvar diseases have not been given sufficient attention by gynecologists. This might be attributable to the timidity of patients with chronic vulvar pruritus, tumor or dyspareunia, which delays diagnosis and treatment. In addition, the nomenclature of vulvar disease was complicated by having been adapted from various dermatological disorders. Only following the establishment of the International Society for the Study of Vulvar Disease (ISSVD) and of specialized clinics, has awareness increased and more attention is now being paid to vulvar disorders. The findings in 242 patients seen during the first year of operation of a vulvar clinic were analyzed. The most common presenting symptom was chronic vulvar pruritus. Non-neoplastic epithelial disorder (dystrophy) was the most common histological finding in the 79 women with pruritus, while 2 were diagnosed as having vulvar intraepithelial neoplasia, and 1 had basal cell carcinoma. In contrast, vulvar vestibulitis was the main diagnosis in 34 women referred for vulvar pain (vulvodynia). Vulvodynia was also associated with other inflammatory processes and with human papilloma virus (HPV) lesions (condylomata). The primary finding in 26 women referred for evaluation of a vulvar "tumor" was epidermal cyst. In only 55 (75.5%) of the 73 referred for suspected HPV lesions was the histologic diagnosis confirmatory. In addition, a few vulvar ulcers were associated with HPV. A single treatment with carbon dioxide laser eradicated the HPV lesions in 93% of the cases. The vulvar clinic contributes to the ambulatory gynecological service by concentrating diagnosis and treatment in a single specialized unit and increases understanding of, and interest in vulvar disease.
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PMID:[The vulvar clinic]. 207 59

The influence of two different doses of oral naltrexone on the adverse effects and the analgesia of epidural morphine were compared in a double-blind, placebo-controlled study. Forty-five patients undergoing cesarean section were provided postoperative analgesia with 4 mg epidural morphine. Five minutes later they received 6 mg naltrexone, 9 mg naltrexone, or placebo as an oral solution. Pain relief was assessed by the Visual Analog Scale (VAS) and by direct questioning of the patients. Requirement for additional analgesics and side effects were noted. Respiratory effects of epidural morphine and naltrexone were assessed using the ventilatory responses to CO2 and by monitoring O2 saturation (Spo2) using pulse oximetry. All patients in the placebo group had adequate analgesia. One of the 15 patients who received naltrexone 6 mg had inadequate analgesia versus five of the 15 patients who received naltrexone 9 mg (P less than 0.05), 9 mg versus placebo. Ten patients (67%) in the placebo group had pruritus while no patient in the 6 mg naltrexone group and one patient in the 9 mg group experienced mild pruritus (P less than 0.05), placebo versus other two groups. The CO2 response slopes were depressed compared to control values from 6-16 h in the placebo group, from 6-12 h in the 6 mg naltrexone group. No significant depression was noted in the 9 mg naltrexone group. The authors conclude that oral naltrexone 6 mg significantly reduces the incidence of pruritus associated with epidural morphine without affecting analgesia and that 9 mg naltrexone is associated with shorter duration of analgesia than 6 mg naltrexone.
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PMID:Prophylactic oral naltrexone with epidural morphine: effect on adverse reactions and ventilatory responses to carbon dioxide. 210 73

To elucidate the sensitivity to pain stimuli in patients with cortical reflex myoclonus, pain-related somatosensory evoked potentials (pain SEPs) following CO2 laser stimulation and conventional electrically-stimulated SEPs (electric SEPs) were compared in four patients with cortical reflex myoclonus. The P25 peak of electric SEPs was considerably enhanced but the P320 potential of pain SEPs was of normal amplitude in all patients. After medication, myoclonus was reduced and the amplitude of P25 was decreased, but P320 showed no change. In our previous study of the scalp distribution in normal subjects, a subcortical site, probably the thalamus, was considered to be the generator source of P320. Because most pain stimuli do not reach the cortex, patients with cortical reflex myoclonus are not sensitive to pain stimuli and P320 in pain SEPs is not enhanced.
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PMID:Pain-related somatosensory evoked potentials in cortical reflex myoclonus. 210 12

Experiences obtained in the course of laser surgical treatment of 126 mouth cavity leukoplakias are summarized. The elaborated, differentiated method ensures, besides safe removal of tissues infected by leukoplakia, a possibility for significantly preserving the functions of the mouth cavity. In case of simplex leukoplakia coagulation by means of defocused laser beam of 5 W energy, in case of verrucosus vaporization by means of focused beom of 10 to 15 W, and in erosiv cases excision in carried out by means of focused beom of 20 to 25 W energy. After laser treatment out of 126 patients 118 were free of symptoms. After operation emberging pain, oedema are minimal. (As a rule, the patients are capable of work the other day.) It is stated that the leucoplakias represent one of the most important fields of the oral surgical employment of the CO2 laser beam.
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PMID:[Use of the carbon dioxide laser in the treatment of leukoplakia]. 210 79

In a double-blind study the relative postoperative respiratory and analgesic effects of perioperatively administered nalbuphine and fentanyl were compared in 60 females undergoing gynecological surgery under i.v. anesthesia. One milliliter (10 mg) nalbuphine was considered equipotent to 1 ml (100 micrograms) fentanyl. In the recovery period pain was assessed by visual analog score (VAS) and recovery by Pegboard scoring. Respiratory function was evaluated by continuous monitoring of respiratory frequency and end-tidal CO2 (ETCO2) and by frequent arterial blood gas analyses. The total volume of analgesic required for surgical analgesia was similar in the two groups. Patients in the nalbuphine group showed mild to moderate increases in pulse rate during the intubation phase and in blood pressure during surgery. Fentanyl was more effective in suppressing these cardiovascular responses. Within the first 15 min following recovery, increasing PaCO2 and ETCO2 as well as respiratory rates below 10/min were noted in 8 patients, who all belonged to the fentanyl group; in 4 of these patients i.v. naloxone had to be administered to reverse respiratory depression. Prolonged sedation was a common feature in patients receiving nalbuphine. It was concluded that fentanyl was superior to nalbuphine in attenuating the pressor responses to intubation and surgery. However, fentanyl was associated with respiratory depression in a considerable number of patients. The quality and duration of postoperative analgesia were similar in the two groups.
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PMID:Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia. 211 27

Recalcitrant periungual verrucae (24 lesions) in 17 patients were vaporized with the carbon dioxide laser. The lesions had been present for 1 to 15 years and treated an average of nine times previously. Vaporization of these warts, in combination with partial or complete nail avulsion, resulted in complete cures in 71% of patients who had one or two treatments. The cure rate was 94% when the patients who had clearing after one or two laser treatments in combination with other therapies are included. Further follow-up indicates that infection and significant onychodystrophy are uncommon. Pain occurs, but in most cases it is short lived and manageable.
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PMID:Recalcitrant periungual verrucae: the role of carbon dioxide laser vaporization. 179 Dec 32

A double-blind, placebo-controlled study has been made of the analgesic and respiratory effects of constant rate infusions of meptazinol and morphine in 30 patients after abdominal surgery. Group I received meptazinol, loading dose 50 mg followed by i.v. infusion 0.5 mg.kg-1.h-1, Group II received morphine, loading dose 5 mg and then an infusion of 0.05 mg.kg-1.h-1, and Group III received saline. After recovery from inhalation anaesthesia (without opiates or a local anaesthetic) pain relief and chemoreceptor carbon dioxide tolerance were assessed before and at various times after starting the analgesic infusion. A similar degree of pain relief was found after 10 min in Groups I and II, which lasted until the end of observation period (20 h). Heart rate and systolic and diastolic blood pressures were lower in Group II than in Groups I and III, and respiratory rate fell in Groups I and II. After 6 h arterial carbon dioxide tensions (PaCO2) became significantly higher in Group II than Group III. The maximum percentage fall in mean tidal volume (VT) and expired minute volume (VE) from the preinjection values was significant in Groups I and II. End-tidal carbon-dioxide (PETCO2) and PaCO2 were significantly higher after 20 h of infusion in Group II compared to Group I. The slope of VE/PETCO2 (mean value of S) was increased in Group I and it was significantly reduced in Group II. Analysis of derived variables, such as the CO2 intercept (CO2I) and minute ventilation at 7 kPa (VE7), indicated a shift to the right of the slopes in Groups I and II, initially more so in Group I.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Post-surgical pain relief with zero-order intravenous infusions of meptazinol and morphine: a double-blind placebo-controlled evaluation of their effects on ventilation. 211 12

From analyzing the epulis patient population of 40 years it could be established that from the 1019 lesions 12.8% relapsed, in 40% of surgical interventions, beside the extraction of the tooth involved. For the removal of epulis an own method has been elaborated by the authors. As a first step the tumour is excised by carbon dioxide laser, thereafter excochleation and bone decortication are performed, which is followed, as a third step, by evaporation. In each case attempt is made at preserving the teeth, when necessary radicular treatment and fixation are done. Postoperatively minimal edema and pain occurred, the majority of the patients was able to work on the first postoperative day. Following laser removal of 63 epulis recurrence was seen in 5 cases (7.9%), without intraoperative tooth extraction. The combined method was successfully applied also in a hemophilic patient. Beside the conventional laser surgical handpiece an endoscope of own construction was also used on surfaces untreatable from direct sight.
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PMID:[Removal of epulis using CO2 laser (clinicopathologic analysis and surgical experience)]. 212 10


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