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Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a double-blind, placebo-controlled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml.kg-1), acetaminophen (10 mg.kg-1) or ketorolac (1 mg.kg-1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy.
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PMID:Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. 139 50

A study of the duration of analgesia and of the respiratory response to hypercapnia was carried out in 14 children who had had a caudal block with either bupivacaine alone (group B) or combined with fentanyl (Group B+F). Fourteen ASA I or II 5 to 10-year-old children undergoing genital and urinary surgery were included. They were not premedicated. At first, general anaesthesia was induced with halothane and nitrous oxide in oxygen. Thereafter, caudal anaesthesia was then carried out with 1 ml.kg-1 of 0.25% bupivacaine with adrenaline 1 in 200,000. Group B+F patients were also given 1 microgram.kg-1 of fentanyl in 1 ml of normal saline, and those in Group B 1 ml of normal saline. The level of sensory loss on leaving the operating theatre as well as the duration of motor paralysis were monitored. Postoperative pain was scored with Hannalah and Broadman's score (0 to 10) 2, 4, 8 and 24 h after the caudal block. Respiratory rate (fR), tidal volume (VT) and minute ventilation (VE) were assessed 10 min before induction of general anaesthesia, and 30, 60 and 120 min after the caudal anaesthesia. Petco2 was also measured before induction of general anaesthesia, and 60 and 120 min after caudal anaesthesia; at the same times, the ventilatory response to hypercapnia was assessed using Read's method with a Douglas bag containing 7% CO2 and 93% O2.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Caudal block in children: analgesia and respiratory effect of the combination bupivacaine-fentanyl]. 150 85

Laparoscopic cholecystectomy (LSC) is being performed increasingly often. The carbon dioxide cavity increases end-expiratory carbon dioxide (exCO2), which can be regulated by mechanical ventilation. Because about 20-40% carbon dioxide remains in the patient at the end of surgery, we were interested in its influence on spontaneous respiration. PATIENTS AND METHODS. Fifteen patients classed as ASA 1-2 and undergoing LSC were compared with 15 patients (also ASA 1-2) undergoing laparotomy for cholecystectomy (LAP). All patients had balanced anaesthesia with fentanyl, enflurane, nitrous oxide and vecuronium. After surgery they were extubated when spontaneous respiration and vigilance were adequate. In the next 3 h we continuously determined exCO2 in the expired air through an intranasal catheter, and oxygen saturation (SAT), respiratory rate (RR) and heart rate (HR) using Oscar (Datex) and Ohmeda (Braun) apparatus while the patients were breathing room air. The blood pressure (BP) was determined intermittently. Postoperative pain treatment was standardized. RESULTS. The groups were reduced comparable with respect of the anthropometric data, because the weight was significantly higher in the LAP group. Fentanyl consumption was also significantly higher in the LAP group, reflecting the more pronounced trauma than with LSC. Mean exCO2 was 46 mmHg after LSC and 36 mmHg after LAP (P less than or equal to 0.05), continuously decreasing in the LSC group and increasing in the LAP group to 40 mmHg after 3 h. Mean RR was 18-20.min-1 after LSC and 12-15.min-1 after LAP during this period (P less than or equal to 0.05). There were no differences in SAT (94-96%), HR (75.min-1) and BP (130/80 mmHg). DISCUSSION AND CONCLUSIONS. The remaining carbon dioxide after LSC has important implications for postoperative spontaneous respiration. Probably due to an activation of carbon dioxide receptors, RR is increased to eliminate residual carbon dioxide. This is confirmed by a significantly increased exCO2 compared with that in the LAP group. This effect lasts at least 3 h, exCO2 being comparable in both groups, but RR is still increased after LSC. This different respiratory pattern does not affect SAT, being normal without hypoxic episodes. Cardiovascular parameters were also normal without group differences. We conclude that the carbon dioxide peritoneal cavity has important consequences for postoperative ventilation. Using our anaesthetic technique and postoperative treatment exCO2 reaches normal values after about 3 h due to an increased RR. If other methods, e.g., stronger opioids, which decrease carbon dioxide response are used, this effect may even be prolonged and more pronounced. We are now performing an investigation to evaluate this effect.
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PMID:[The effects of the carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on postoperative spontaneous respiration]. 848 1

The intraoperative use of opioid analgesics decreases the volatile anesthetic requirement and provides for pain relief in the early postoperative period. In a randomized double-blind, placebo-controlled study involving 95 ASA physical status 1 or 2 children (ages 5-15 yr) undergoing general anesthesia for elective operations, we compared postoperative analgesia following the intraoperative intravenous (iv) administration of ketorolac, a nonsteroidal antiinflammatory drug or morphine, an opioid analgesic. After induction of general anesthesia and before the start of the surgical procedure, children received equal volumes of saline, morphine (0.1 mg.kg-1, iv) or ketorolac (0.9 mg.kg-1, iv). Postoperative pain was evaluated by the child using a 10-cm linear visual analog scale (VAS) and by a blinded observer using both a VAS and an objective pain scale (OPS) in the postanesthesia care unit (PACU). There were no statistically significant differences in the VAS and OPS scores in the PACU or in the postoperative analgesic requirements in children receiving morphine or ketorolac. The placebo group had a significantly higher VAS and OPS score and required earlier and more frequent analgesic therapy in the PACU compared to the two analgesic groups. Patients receiving ketorolac had less postoperative emesis than those receiving morphine. We conclude that ketorolac (0.9 mg.kg-1) is an effective alternative to morphine (0.1 mg.kg-1) as an iv adjuvant during general anesthesia, and in the dose used in this study, is associated with less postoperative nausea and vomiting in children.
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PMID:Comparison of ketorolac and morphine as adjuvants during pediatric surgery. 151 1

It has been suggested in various studies that the opiate agonist/antagonist nalbuphine (Nubain) provides for effective reversal of the respiratory depression after fentanyl while maintaining postoperative analgesia. We tested this hypothesis in a relatively large number of patients. The study consisted of two parts: one randomized open, the other randomized double-blind, each with 150 ASA I or II patients aged 18 to 65 years. After premedication with atropine 0.5 mg and flunitrazepam 0.5 mg, anaesthesia was induced with flunitrazepam 0.5 mg, fentanyl 0.1 mg, and etomidate 10 mg and maintained with N2O/O2, 2/1, and additional increments of 0.1 mg fentanyl as required. Relaxation for intubation and surgery was obtained with vecuronium, atracurium, or pancuronium depending on the expected duration of anesthesia. After the operation the patients were extubated and the residual effects of fentanyl antagonized with naloxone 0.05 mg or nalbuphine 10 mg or 20 mg i.v. (randomized open or double-blind). The patient data and fentanyl dosages are given in Table 1. Postoperative pain was assessed by the time interval between administration of the opiate antagonist and the requirement for the first analgesic medication. Figures 1a and b and Table 2 indicate that after nalbuphine 20 mg the first analgesic was required significantly later than after naloxone 0.05 mg (median 115 or 123 min after nalbuphine 20 mg vs 56 or 52 min after naloxone 0.05 mg; P less than 0.02). There was no significant difference between nalbuphine 10 mg and naloxone 0.05 mg. The open and double-blind studies gave virtually identical results. Sixty minutes after administration of 20 mg nalbuphine, vigilance was significantly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nalbuphine following fentanyl. Postoperative analgesia]. 330 Apr 8

Despite the brief nature of the procedure with limited tissue trauma, some form of analgesia is required in most children after bilateral myringotomy and placement of pressure equalization (PE) tubes. Previous studies have demonstrated the relative inefficacy of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs), with 30%-55% of patients requiring supplemental postoperative analgesia. We undertook a prospective study evaluating the efficacy of the preoperative administration of oral acetaminophen (15 mg/kg) versus acetaminophen (10 mg/kg) and codeine (1 mg/kg). Fifty ASA grade I or II patients were randomized to receive oral midazolam premedication (0.7 mg/kg) mixed in either acetaminophen or acetaminophen with codeine elixir. Anesthesia was induced and maintained with halothane in nitrous oxide and oxygen. Postoperative pain was assessed at four times during the postoperative course using an objective pain scale. The two groups were similar with respect to age, weight, gender, duration of anesthesia, and duration of the surgical procedure. The patients who received acetaminophen with codeine had lower pain scores at all four points when compared with patients who received acetaminophen. None of the 25 patients who received acetaminophen with codeine required supplemental analgesics compared with 12 of 25 who received acetaminophen. No adverse effects were noted in either group. We conclude that the preoperative administration of acetaminophen with codeine provides superior analgesia after bilateral myringotomy and placement of PE tubes.
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PMID:Analgesia after bilateral myringotomy and placement of pressure equalization tubes in children: acetaminophen versus acetaminophen with codeine. 765 11

Fifty-four ASA I and II children 1 to 10 yr of age undergoing strabismus surgery were randomized to receive in a double-blind fashion intravenous ketorolac (0.9 mg/kg), fentanyl (1 microgram/kg), or saline placebo (2 mL) during a standardized general anesthetic. Patients received no analgesic or antiemetics intraoperatively except for the study drug. Patients receiving ketorolac or placebo compared to fentanyl had a significantly lower incidence of postoperative vomiting in the day surgery unit (DSU) (P = 0.03) and overall (DSU plus home) (P = 0.005). The severity (number of episodes) of post-operative vomiting was significantly lower in the DSU, at home (first 24 h after hospital discharge), and overall for patients receiving ketorolac or placebo compared to fentanyl (P < 0.01). Postoperative pain scores and frequency of acetaminophen administration did not differ among the study groups, suggesting that the intraoperative use of ketorolac or fentanyl during pediatric strabismus surgery is unnecessary. No patients required fentanyl postoperatively, indicating that rectal acetaminophen administered in the postanesthesia recovery room provides sufficient analgesia for pediatric strabismus surgery. In conclusion, neither ketorolac nor fentanyl was associated with less postoperative vomiting or analgesic requirements compared to saline placebo administered during pediatric strabismus surgery. Fentanyl should be avoided, as it was associated with a significantly greater incidence of postoperative vomiting compared to ketorolac or placebo.
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PMID:The effects of ketorolac and fentanyl on postoperative vomiting and analgesic requirements in children undergoing strabismus surgery. 861 27

Control of postoperative pain is an important element in preventing the modification of the excitability of the dorsal horn neurons. We studied the efficacy of bupivacaine 0.5% wound infiltration for postoperative pain management following thyroid surgery. Forty consecutive ASA I-II patients, scheduled for thyroidectomy, were assigned randomly to two groups. Group I (n = 20) consisted of patients receiving bupivacaine 0.5% (10 ml) wound infiltration at the end of surgery and group II (n = 20 included patients without infiltration. The patients did not know whether the wound had been anaesthetized or not. All patients received balanced inhalational anaesthesia, including fentanyl (a total dose of up to 4 micrograms.kg-1). Postoperative pain medication included morphine IV or IM, as needed. Twenty-four hours after surgery the worst pain was recorded using a visual analogue scoring system, from 0 to 10. Twenty-four hour postoperative morphine requirement was recorded. Groups did not differ in demographic data. Pain scores significantly different in the two groups. In group I, the mean pain score was 3.7 +/- 1.6 compared with 6.9 +/- 1.7 in group II (P < 0.05). Only six patients (30%) in group I received opioids and only one of these (5%) had a pain score above 5. In comparison, 18 patients (90%) in group II received morphine during the first postoperative day. The local injection of bupivacaine corresponds to a block of the superficial branches of the cervical plexus. This study demonstrated a simple, efficient and safe way to reduce pain perception following a thyroidectomy.
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PMID:Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand. 788 3

Postoperative pain relief can be achieved by several methods, including the use of systemic opioids and regional anaesthesia with intrathecal or epidural opioids or local anaesthetics. On-demand analgesia using a PCA (patient-controlled analgesia) system is regarded as the ideal option for systemic opioid analgesia. While PCA devices are not yet commonly used in all recovery units, the use of repetitive boluses on demand is still the most frequent form of administration in postoperative pain therapy. The objective of the present study was to show if continuous infusion of the opioid tramadol could produce better analgesia than repetitive administration of boluses. METHOD. In a study under double-blind conditions 135 ASA I and II patients were assigned at random to group I (infusion group) or group B (bolus group) when they first requested pain treatment after abdominal surgery. The patients in group I received an initial intravenous loading dose of 100 mg tramadol, followed by an infusion of 12 mg/h tramadol for 24 h; if necessary, repeated boluses of 50 mg tramadol were given. In group B the patients received a placebo infusion instead of the tramadol infusion; otherwise, the procedure was the same. Pain relief was monitored by means of a VAS (visual analogue scale) up to 6 h after surgery. We investigated the retrograde assessment of analgesia by the patients after 6 h, how often repetitive boluses were required, and the amount of analgesics administered in 6 and 24 h. RESULTS. The pain relief was assessed as excellent or good by 76.5% of group I and 65.6% of group B; 19.1% of group I and 26.9% of group B assessed the analgesic effect as satisfactory; 4.4% of group I and 7.5% of group B complained of insufficient analgesia. In group I 69.2% requested only one or no repetitive bolus, compared with 40.3% in group B, while two or more boluses were demanded by 30.8% in group I und 59.7% in group B. The average analgesic consumption after 6 h was 223.5 +/- 53.7 mg tramadol in group I and 176.6 +/- 63.1 mg tramadol in group B, respectively. After 24 h it was 449.5 +/- 66.0 mg tramadol in group I and 201.6 +/- 83.9 mg tramadol in group B. While the consumption during the first 6 h was comparable, from then on the consumption in group I increased significantly. Side effects were reported by 25% in both groups. They were clinically irrelevant and did not necessitate termination of the clinical trial in any case. During the study period pulse and blood pressure remained within the normal range and did not show any significant changes. CONCLUSION. The fact that the patients in group I requested far fewer repetitive boluses than those in group B and the assessment by the patients led to the conclusion that treatment in the infusion group is better than that in the bolus group. Concerns that a significantly higher consumption of analgesics would cause unwanted side-effects have proven unfounded. Six hours after surgery, when analgesia was evaluated by the patients, there was no significant difference between the two groups. Not until the maintenance infusion had been administered for a further 18 h, was the tramadol consumption within the infusion group significantly higher. Thus, we should consider continuing unreduced administration of the maintenance infusion 6 h after operation.
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PMID:[Postoperative analgesia with tramadol. Continuous infusion versus repetitive bolus administration]. 804 60

In a randomized, double-blind, placebo-controlled study designed to assess the post-operative analgesic efficacy and cost-effectiveness of ketorolac and diclofenac 60 ASA I and II patients undergoing laparoscopic cholecystectomy were studied. Prior to concluding the operative procedure, an injection (i.m.) of an equal volume of either saline 3 mL, ketorolac 60 mg, or diclofenac 75 mg was administered. All patients received intravenous morphine via a patient-controlled analgesia device (PCA). Post-operative pain intensity was assessed hourly for 4 h, by recording visual analogue score (VAS) for pain, PCA demands and actual morphine administered. PCA demands (mean +/- SD) were greater in the saline treatment group (115 +/- 90) when compared with both the ketorolac (42 +/- 44) and diclofenac groups (74 +/- 77). Furthermore, the saline treatment group received significantly (P < 0.05) more PCA morphine compared with both the ketorolac and diclofenac groups (12.2 mg +/- 5.0 vs. 8.6 mg +/- 5.2 vs. 8.9 mg +/- 4.8). Improved pain scores were demonstrated in both the ketorolac and diclofenac groups compared with the saline group. PCA demands and post-operative morphine requirements were similar in the ketorolac and diclofenac groups. Diclofenac has the added advantage, in our institution, of being 60% less expensive than ketorolac. We conclude that both ketorolac and diclofenac are effective post-operative analgesic drugs. However, economic considerations may favour diclofenac administration.
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PMID:A comparative study of ketorolac and diclofenac on post-laparoscopic cholecystectomy pain. 854 59


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