Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The analgetic efficacy of intraoperative infiltration with bupivacaine 0.5% or saline of the skin incisions for the endoscopic trocars was examined in 30 female patients following operative endoscopic pelviscopy in a double-blind study. Infiltration of the peritoneum, abdominal wall, and subcutaneously was performed by endoscopic view before skin suture. There were no significant differences between the two groups in age, duration of surgery, operative technique, intensity of preoperative acute and chronic pain, or state of anxiety. Postoperative pain assessment was performed using a numeric rating scale (NRS) hourly within the first 8 h and after 24 h postoperatively. After 8 h patients were asked for the localisation and description of the worst pain. Cumulative tramadol doses were calculated for 3, 8 and 24 h using patient-controlled analgesia (PCA). Pain intensity within the first 8 h postoperatively did not differ between the bupivacaine and placebo groups (Fig. 1). The mean NRS after bupivacaine infiltration was 4.6 (+/- 2.4) in the 1st-3rd h and 3.4 (+/- 1.8) after 6-8 h (placebo: 4.8 (+/- 2) and 2.4 (+/- 1.7)). In both groups most patients reported lower (40%) or upper (12%) abdominal visceral pain as their worst pain. Pain due to skin incision was noted less, but in equal numbers in both groups. Of the patients in the bupivacaine group 77% and in the control group 80% started with PCA due to increasing pain scores within 60 to 120 min. The numbers of tramadol demands and given doses did not differ (Fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Wound infiltration with bupivacaine following pelviscopy does not reduce postoperative pain intensity. Results of a placebo-controlled, double-blind study]. 797 79

The study focused on the feasibility and validity of pain instruments and the optimal period of diary registration for measuring chronic pain intensity of 13 children. Highly positive associations were found between the registration of pain on a Visual Analogue Scale and on the Postoperative Pain Measure for Parents. For children under medical treatment for chronic limb pain a one-week dairy registration suffices.
 ...
PMID:Measuring chronic pain in children, an exploration. 922 32

Nociception is a protective system of the body which prevents it from injury and tissue damage. Human beings respond to noxious stimuli by moving away. They learn by pain to avoid these situations in future. Shortly after major injury, there is a limited analgesic period allowing the body to flee the area of danger, later on, emerging pain compels the body to rest and supports recuperation. While acute pain has a certain meaning, chronic pain does not. It induces a comprehensive suffering including loss of initiative, appetite and vigilance. It reduces life-quality, often accompanied by depressive moods. Acute pain causes changes in the central nervous system leading to an increased sensitivity of nociception (hyperalgesia). During healing, the central processing of noxious stimuli is normalised taking minutes to weeks. Sometimes, unknown factors initiate chronification of pain. Changes on a molecular level in peripheral tissue as well as in the central nervous system induce "cellular early genes", a synthesis of c-fos, c-jun and other proteins favouring the chronification of pain. All efforts have to be made to depress or interrupt such a development. One of the first steps to pain prophylaxis in a hospital is an optimal surgical technique: incision, extension, limited tissue damage and minimal invasive surgery should guarantee the smallest impairment of the nociceptive system possible. However, nociceptive input is intense and of long duration and leads to central sensibilisation. Postoperative pain has lost its function as surgery anticipates healing. Pain induces a reduction of ventilation, circulation, digestion and increases the risk of other disorders. There is need of aggressive pain treatment for humanitarian reasons and for reasons of late sequelae like permanent pain and increased reduction of function. This is of pivotal importance in patients with amputations or sympathetic reflex dystrophy (SRD). Antinociception is best provided by regional anaesthesia technique with a combination of local anaesthetics and opioids which results in better outcome. Hence, regional anaesthesia techniques are strongly indicated in those patients. Good antinociception may be even more important than it is assumed today. Anand demonstrated a lower morbidity and mortality in 45 newborns undergoing cardiothoracic surgery, when general anaesthesia was performed with high-dose sufentanil versus halothane supplementary doses of morphine. Anaesthesiologists have to reconsider the quality of general anaesthesia: the antinociception of their regimen.
 ...
PMID:[Neurophysiological aspects of pain and its consequences for the anesthetist]. 941 70

Sickle cell diseases comprise a group of inherited disorders that alter hemoglobin, ultimately causing hemolytic anemia and reoccurring instances of vascular occlusion that produce acute and chronic pain. Many patients with sickle cell disease require surgery for conditions associated with their disease. Painful vaso-occlusive episodes, which can be debilitating and require long hospital stays, are often precipitated by the stress of surgery. Poorly controlled postoperative pain also can worsen an impending painful crisis. Traditional therapy for patients with sickle cell disease undergoing surgery has included preoperative transfusion and postoperative opioid therapy. Recent studies have demonstrated that aggressive preoperative transfusion therapy is not beneficial over a more conservative approach. Postoperative pain control trends include nonsteroidal anti-inflammatory drugs such as ketorolac and opioid agonist-antagonist agents such as nalbuphine, as well as epidural analgesia to minimize respiratory depression. New preventive therapy for vaso-occlusive crisis includes hydroxyurea, a chemotherapeutic agent that stimulates the production of fetal hemoglobin. Inhaled nitric oxide is being used in clinical trials with success in slowing the sickling process and unsickling cells. Phase III clinical trials are in progress for 2 drugs that decrease sickling: poloxamer 188 and fructose 1-6 diphosphate. These new therapies should help improve the anesthetic course of the patient with sickle cell disease, reduce postoperative complications, and shorten hospital stays.
 ...
PMID:New advances in the treatment of sickle cell disease: focus on perioperative significance. 1175 66

The surgical requirement for thoracoscopy is a good view of the contents of the thorax. This is achieved by capitalizing on natural consequences and the skills of anaesthesiologists to produce a pneumothorax and collapse the ipsilateral lung--a process that is commonly enhanced by insufflating carbon dioxide. Insufflating CO2 to actively promote lung collapse creates the dynamics of a tension pneumothorax. Complications are clinically insignificant if CO2 is used judiciously. There is a body of experience using ordinary endotracheal tubes and two-lung ventilation. Techniques of one-lung ventilation are more widely reported. All the factors known to contribute to the significant increase in shunt fraction associated with one-lung ventilation apply. The manoeuvre of collapsing a lung is no longer regarded as benign. Chemical attempts to produce a reversible post-pneumonectomy pulmonary circulation have not been shown to be an improvement. Post-operative pain can be severe. The mechanism is not defined but it differs from that associated with thoracotomy. Epidural analgesia and opioids may be required. Chronic pain syndromes have been described as complications.
 ...
PMID:Anaesthesia for thoracoscopic surgery. 1249 43

Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative pain is best treated with a combination of local analgesia and peripherally acting agents (paracetamol, NSAID or their combination), while opioids should be avoided due to side effects, primarily nausea and sedation. Moderate or severe pain one year postoperatively is seen in 5-12% of patients. There seem to be no difference between different surgical or anaesthetic techniques, but the following factors have been related to a higher rate of chronic pain: previous or subsequent hernia surgery on the same side, young age, pain before surgery, high pain scores in the immediate postoperative period, and postoperative complications and prolonged convalescence. Patients should be informed about the risk of chronic pain, particularly if the hernia is asymptomatic. The duration of convalescence after hernia repair varies considerably, primarily due to variation in recommendations. No documentation is available to support that a prolonged convalescence reduces the risk of recurrence of the hernia, and most specialised institutions recommend immediate return to all usual activities. Pain seems to be the most important cause of prolonged convalescence. From all published consecutive materials with recommendations of short convalescence the mean or median duration is 6-8 days, in contrast to the two to four weeks often seen in randomised comparisons of different surgical techniques. Patients should be informed, that they can immediately resume all activity if pain permits, but also to expect that pain may limit function of activities of daily living during the first postoperative week. Hernia surgery, including treatment of recurrent hernias, can and ought to be performed as day case surgery, irrespective of the chosen anaesthetic technique, as there are no medical or surgical contraindications to this. Social causes may indicate, that overnight stay may be advisable or desirable, preferably in a patient hotel facility. Despite this, the fraction of patients operated in a day-case surgical set-up varies from 6% in France to 83% in US, and in Denmark 60% of patients have their hernia repair as a day-case procedure. A day-case hernia surgery service should be organised with standardised patient records, including descriptions of surgery performed as well as letters of discharge for the general practitioner. If clinical data are stored electronically, the basis is created for valuable clinical databases like the one behind the present thesis, and they can be used both for scientific purposes and for quality control and improvement.
 ...
PMID:Inguinal hernia repair: anaesthesia, pain and convalescence. 1367 40

Pain has been recognized as a problem of global proportions, and postoperative pain is one of the most common types of pain. Postoperative pain is acute and, although it is preventable and/or treatable, it is often undertreated. Lack of appropriate analgesic management has significant impact on clinical and economic outcomes. Negative clinical outcomes of inadequately managed acute postoperative pain include extended hospitalization, compromised prognosis, higher morbidity and mortality, and the development of a chronic pain state as a result of neuronal plasticity. Although estimating the economic burden of postoperative pain is difficult, this burden is considerable and results from direct costs due to excess health-care resource use, as well as indirect costs due to reduced patient functionality and productivity. These latter factors also have a significant adverse impact on patients' quality of life and may be associated with the development of depression and anxiety. Thus, improved clinical outcomes are dependent not only on the availability of effective drugs but also on their appropriate utilization. A multimodal approach incorporating different drugs and techniques is effective in reducing postoperative pain but is limited by the currently available therapies. The efficacy of opioids is well established, but there are concerns about dependency, respiratory depression and side-effects, which patients often find intolerable. Non-steroidal anti-inflammatory drugs (NSAIDs) are effective as adjunctive medication in a multimodal regimen but are associated with side-effects, such as platelet dysfunction and renal and gastrointestinal toxicity, that have special clinical significance in patients undergoing surgical procedures. Cyclooxygenase-2-specific inhibitors such as celecoxib, rofecoxib and valdecoxib, were developed to provide the efficacy of non-specific NSAIDs while limiting associated toxicity. These agents have demonstrated analgesic efficacy and an opioid-sparing effect in a variety of surgical procedures, suggesting their value as an alternative to non-specific NSAIDs. Further studies are needed to determine the impact of these drugs on clinical and economic outcomes when used in a programme of postsurgical pain management.
 ...
PMID:The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors. 1458 17

Postoperative pain is an important clinical problem that has received increasing attention in recent years. However, pain following craniotomy has been a comparatively neglected topic; this review seeks to redress this imbalance. A brief overview of the anatomy of the skull and its linings is given, with particular reference to innervation. The various approaches for craniotomies are classified, with their association with acute and long-term effects on analgesic requirements. A comprehensive search of the literature was undertaken to ascertain the incidence of acute pain post craniotomy and current thoughts on pharmacological management, touching briefly on pre-emptive treatment. Also discussed is the much neglected but nevertheless real incidence of chronic pain following craniotomy and its underlying pathogenesis, prevention and treatment.
 ...
PMID:Acute and chronic pain following craniotomy: a review. 1596 Jul 21

Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.
 ...
PMID:[Post-operative pain therapy of a chronic pain patient]. 1715 86

Postoperative pain management aims not only to decrease pain intensity but also to increase patient comfort and to improve postoperative outcome. Better pain control is achieved through a multimodal combination of regional analgesic techniques and systemic administration of analgesic agents. To guarantee uneventful follow-up and unnecessary prolongation of hospital stay, it is important to avoid side-effects of analgesic agents, especially those of opioids which are dose-related, by decreasing opioid demand through combination with non-opioid agents. Epidural analgesia not only has the advantage of providing potent and effective analgesia but also of hastening recovery of bowel function and facilitating physiotherapy and rehabilitation. Unfortunately, a reduction in postoperative morbidity and mortality by epidural analgesia has not actually been demonstrated. Inclusion of postoperative pain treatment in a multimodal approach of patient rehabilitation may improve recovery and shorten hospital stay. Effective treatment of postoperative pain is also likely to prevent chronic pain syndrome after surgery, but further studies are needed to support this hypothesis.
 ...
PMID:Postoperative pain management and outcome after surgery. 1748 22


1 2 3 4 Next >>