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

Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. All these drugs may be administered in combination between them, realising the so called "balanced spinal analgesia". The aim of this study is to analyse the available methods for the evaluation of pharmacological interactions, the types of interaction among different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of postoperative pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of postoperative pain, because these drug combinations are able to provide a satisfactory pain control at low doses with a reduction of the adverse effects. Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable.
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PMID:[Treatment of postoperative pain by balanced spinal analgesia]. 948 Jan 92

We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation. Tests of pulmonary function were performed and SpO2 was measured 4 h after surgery and on days 1, 2 and 3 after operation. Pain at rest was similar in the two groups, but in the laparoscopy group, requirements for postoperative opioid were 50% less (P < 0.05). Pain intensity during mobilization and on coughing was significantly less after laparoscopy (differences between mean pain scores in both groups ranged from 20 to 32 mm during mobilization and from 32 to 34 mm during coughing). Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were reduced significantly less after laparoscopic gastroplasty than after open gastroplasty (on day 1 forced vital capacity was reduced by 50% compared with 64%, forced expiratory volume in 1 s was reduced by 50% compared with 66% and peak expiratory flow rate by 45% compared with 60%). SpO2 values were significantly greater in the laparoscopy group (day 1: mean 95 (SD 2)% vs 91 (5)%; day 3: 97 (1)% vs 94 (3)%). This study suggests that the beneficial effects observed after laparoscopic gastroplasty in morbidly obese patients were similar to those reported after laparoscopic cholecystectomy in non-obese patients.
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PMID:Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients. 962 24

Pain is a subjective feeling; its assessment is therefore difficult, and no "gold standard" method exists for humans. Major improvements have, however, been made in the last decade by widespread acceptation of the concept of pain evaluation and widespread use on surgical wards. Evaluation by the patient himself is the rule (unless communication is impaired), as assessment of pain by nurses or doctors systematically leads to underestimation (which also occurs with observational scales). Theoretically, pain should be evaluated in its multiple dimensions such as intensity, location, emotional consequences and semiologic correlates. Scales which have been developed to evaluate these dimensions are, however, too complex for widespread and repetitive use in surgical patients. The Mac Gill Pain Questionnaire is therefore only used in the surgical setting for research purposes. Moreover, its scientific accuracy, although often accepted, is poor and in our opinion cannot be accepted as a reference method. Only methods assessing pain intensity can be used in the clinical setting because of their simplicity. The verbal rating scale (VRS), the numerical rating scale (NRS) and the visual analogue scale (VAS) are preferred by an increasing number of groups. Although scientific validation is difficult, VAS seems the most accurate and reproducible scale. Post-operative pain should be assessed several times a day in every patient, at rest and in dynamic conditions (cough, movement) and should focus on present pain rather than on pain in the previous hours. Assessment of pain is essential before quality-assurance programmes can be implemented.
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PMID:[Evaluation of postoperative pain]. 975 Jul 94

Studies of preemptive analgesia in humans have shown conflicting results. The study design, patient population and the duration of assessment of postoperative pain are important in the evaluation of preemptive analgesia. We carried out a prospective, randomized, double-blind controlled study in 80 patients of physical status ASA 1-3 undergoing upper abdominal and thoracic surgery. Patients received two epidural injections, one 20 minutes before induction and the other at the end of surgery. Study solution was either morphine (50 micrograms/kg), with or without 0.1% bupivacaine in 10 ml of normal saline, or normal saline alone. The study groups (Pre M, Pre MB) were given either morphine or morphine-bupivacaine before induction and saline at the end of surgery. The control groups (Post M, Post MB) were given saline before induction and morphine or morphine-bupivacaine at the end of surgery. Postoperative pain was assessed with a Visual Analogue Scale (VAS) during coughing and deep breathing at six-hourly intervals for five days. Epidural morphine was given if the VAS exceeded 4. Pre MB compared to Post MB had a significantly increased interval between the analgesic top-ups (P < 0.01) and decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.001). Pre M and Post M were comparable. Pre MB compared to Pre M had significantly decreased total postoperative morphine requirements (P < 0.0001) and number of top-ups (P < 0.0001). Epidural morphine plus bupivacaine is effective as a preemptive analgesic. Morphine plus bupivacaine has better efficacy than morphine given alone before the induction of anaesthesia.
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PMID:Pre-emptive analgesia with epidural morphine or morphine and bupivacaine. 1096 65

The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. Patients were randomly divided into two groups to receive a postoperative epidural infusion of fentanyl 5 micrograms/ml in bupivacaine 0.2%, with or without adrenaline 5 micrograms/ml, at a rate of 2 ml/h for more than 48 hours. Postoperative pain relief was assessed using visual analog scales (VAS), both at rest and during coughing, at 2, 24, and 48 hours after surgery. The number of rescue analgesics and side-effects such as nausea, vomiting, pruritus, respiratory depression, headache, muscle weakness, and hypotension were recorded. Patients who received adrenaline (n = 40) reported significantly lower mean VAS scores than those who received no adrenaline (n = 37), both at rest at 24 hours postoperatively and during coughing at 24 and 48 hours. The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.
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PMID:Does adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery? 1151 59

In this double-blind randomized study we compared a group of 15 patients undergoing thoracotomy who received a spinal injection of sufentanil 20 microg combined with morphine (200 microg) after induction of general anaesthesia with a control group of the same size. Post-operative pain was rated on a visual analogue scale (VAS) and a verbal rating scale at rest and with a VAS on coughing. In the recovery room, patients received titrated i.v. morphine until the VAS score was <30, and were followed by patient-controlled analgesia (PCA) for 72 h. The intrathecal sufentanil and morphine group had a lower intra-operative requirement for i.v. sufentanil and needed less i.v. morphine for titration in the recovery room. I.v. PCA morphine consumption and pain scores were lower in the active group than in the control group during the first 24 h. There were no differences after this time. Spirometric data (peak expiratory flow, forced vital capacity and forced expiratory volume in 1 s) were similar in the two groups. We conclude that the combination of intrathecal sufentanil and morphine produces analgesia of rapid onset and with a duration of 24 h.
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PMID:Intrathecal sufentanil and morphine for post-thoracotomy pain relief. 1217 17

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.
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PMID:Inguinal hernia repair: anaesthesia, pain and convalescence. 1367 40

In this study, effects and side effects of application of rectal naproxen, combined with patient controlled intravenous morphine analgesia, were investigated in the elective coronary bypass operations for postoperative pain control, sedation and opioid use. Following the ethical committee approval and individual patient self consent, 40 patients, who underwent coronary artery bypass surgery were included in the study. A double blind study was performed by administering rectal naproxen to group N (n = 20) and placebo to group P (n = 20), at the end of the operation. Doses were repeated at the 12th hour postoperatively. Patient controlled intravenous morphine analgesia was performed to all patients for postoperative 24 hours. Postoperative pain and sedation levels were assessed, the side effects were noted. There was no difference between two groups with respect to their demographic features duration of surgery, extubation time and side effects (p > 0.05). With respect to group P, decrease in opioid use, better sedation and decrease in pain scores during both resting and coughing was seen in group N (p < 0.05). In conclusion, analgesia applied by addition of rectal naproxen to opioids achieved better pain management in selected patients after cardiac surgery.
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PMID:[The effects of application of rectal naproxen on postoperative analgesia, sedation and morphine use in heart surgery operations]. 1515 35

Postoperative pain relief was assessed by the effects of local anesthetic wound instillation on 100 patients who had undergone total abdominal hysterectomy with bilateral salpingo oophorectomy (TAH with BSO). Patients were divided into four groups of wound and non-wound instillation: Wound instillation Group A1 received diclofenac IM. Group A2 received diclofenac suppository. Non-wound instillation Group B1 received diclofenac IM. Group B2 received diclofenac suppository. A standard general anesthesia technique was administered. For would instillation, a multiholed (1 cm apart) 18G epidural catheter was placed above rectus sheath. This was connected to a pediatric regulated drip set with "Dial-a flo" to deliver 0.25% bupivacaine 10 ml/hour for 6 hours after a basal bolus of 10 ml. During first 6 hours after surgery rescue pentazocine 15 mg was administered to achieve VAS score < or = 30. Thereafter, rescue diclofenac was administered to patients. The requirement of rescue analgesic (pentazocine) was significantly less (P < 0.001) in wound instillation Groups A1 (13.80 mg +/- 13.64) and A2 (12.00 mg +/- 12.25) in comparison to non wound instillation Groups B1 (35.60 mg +/- 14.02) and B2 (31.80 mg +/- 15.80). Rescue diclofenac was not required in wound instillation groups as compared to 30 mg (B1) and 36 mg (B2) in non wound instillation groups. Nausea and vomiting was less in wound instillation groups. VAS score supine from 4th to 12th hours, VAS coughing during all time interval and VAS leg raising from 3rd to 12th hours was significantly lower (P < 0.001) in wound instillation group (A1, A2) in comparison to non wound instillation groups (B1, B2). We conclude that basal bolus infusion followed by continuous wound instillation of bupivacaine decreases analgesic requirement and pain scores in first 24 hours of postoperative period after TAH with BSO.
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PMID:Wound instillation with 0.25% bupivacaine as continuous infusion following hysterectomy. 1638 Dec 65

Postoperative pain continues to be inadequately managed. While opioids remain the mainstay for postoperative analgesia, their use can be associated with adverse effects, including ileus, which can prolong hospital stay. A number of studies have investigated the use of perioperative intravenous lidocaine infusion for improving postoperative analgesia and enhancing recovery of bowel function. This systematic review was performed to determine the overall efficacy of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery in patients undergoing various surgical procedures. We searched the databases of MEDLINE, CINAHL and the Cochrane Library from 1966 to December 2009. We searched for randomized controlled comparisons of lidocaine infusion with placebo in the surgical setting and reporting on postoperative analgesia and other aspects of patient recovery from surgery. The quality of all included studies was assessed using the Modified Oxford Scale. Information on postoperative pain intensity and analgesic requirements was extracted from the trials and compared qualitatively. Other relevant data such as return of bowel function, length of hospital stay, intraoperative anaesthetic requirement and adverse effects were also compared. Sixteen trials were included. A total of 395 patients received intravenous lidocaine with 369 controls. In open and laparoscopic abdominal surgery, as well as in ambulatory surgery patients, intravenous perioperative infusion of lidocaine resulted in significant reductions in postoperative pain intensity and opioid consumption. Pain scores were reduced at rest and with cough or movement for up to 48 hours postoperatively. Opioid consumption was reduced by up to 85% in lidocaine-treated patients when compared with controls. Infusion of lidocaine also resulted in earlier return of bowel function, allowing for earlier rehabilitation and shorter duration of hospital stay. First flatus occurred up to 23 hours earlier, while first bowel movement occurred up to 28 hours earlier in the lidocaine-treated patients. Duration of hospital stay was reduced by an average of 1.1 days in the lidocaine-treated patients. Administration of intravenous lidocaine infusion did not result in toxicity or clinically significant adverse events. Lidocaine had no impact on postoperative analgesia in patients undergoing tonsillectomy, total hip arthroplasty or coronary artery bypass surgery. In conclusion, intravenous lidocaine infusion in the perioperative period is safe and has clear advantages in patients undergoing abdominal surgery. Patients receiving lidocaine infusion had lower pain scores, reduced postoperative analgesic requirements and decreased intraoperative anaesthetic requirements, as well as faster return of bowel function and decreased length of hospital stay. Further studies are needed to assess whether lidocaine has a beneficial effect in patients undergoing other types of surgery and to determine the optimum dose, timing and duration of infusion of lidocaine in this setting.
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PMID:Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. 2051 81


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