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

The analgesic efficacy, side effects, and satisfaction of patient-controlled analgesia (PCA) with intravenous and epidural morphine for postoperative pain were evaluated in this study. Twenty patients undergoing major joint replacement surgery were randomly allocated to intravenous PCA (IPCA) group or epidural PCA (EPCA) group. All patients had a standardized balanced anesthesia, and an epidural catheter was introduced after the operation in EPCA group. Postoperative pain relief was evaluated with verbal pain scale. The result showed that pain intensity and pain relief were similar in either group without significant difference (p greater than 0.05). Morphine consumption in IPCA group was 1.72 +/- 0.30 mg/h in the postoperative 0 - 12 h and 1.14 +/- 0.44 mg/h in 12 - 24 h. In EPCA group, relatively low doses of morphine were used, i.e., 0.20 +/- 0.07 mg/h in the postoperative 0 - 12 h and 0.17 +/- 0.07 mg/h in 12 - 24 h. Both groups showed an "incomplete" but satisfactory analgesia with relatively low doses of morphine. The "equianalgesic dose ratio" of IPCA to EPCA with morphine was approximately 8.5:1. Sedation was minimal in both groups. No respiratory depression developed in all patients. Nausea and vomiting were the most prominent side effects which might limit the usefulness of PCA. The incidence was 5 out of 10 patients in IPCA group and 4 out of 10 patients in EPCA group, despite under the treatment of droperidol (15 micrograms/kg, iv, prn) for most of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Patient-controlled intravenous versus epidural analgesia after major joint replacement]. 152 2

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

A prospective, randomized, double-blind trial was conducted to compare the analgesic actions and side effects of sufentanil continuously infused (5 micrograms/h) into the lumbar epidural space (L2-3) with those of an infusion of lumbar epidural morphine (0.5 mg/h). Forty patients admitted to an intensive care unit after elective major abdominal surgery participated over a varying period of 24-40 h. Post-operative pain was treated with an epidural bolus of either sufentanil (50 micrograms) or morphine (5 mg), followed by a continuous infusion of the same opiate. The quality of pain relief was similar in each group. The sufentanil group had a more rapid onset of analgesia. The incidence of nausea and vomiting, pruritus, and drowsiness was similar in the two groups. In spontaneously breathing patients there were no respiratory complications requiring treatment. Forced vital capacities were statistically significantly better during the first 1-4 h with sufentanil.
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PMID:Postoperative pain control with a continuous infusion of epidural sufentanil in the intensive care unit: a comparison with epidural morphine. 214 66

Postoperative pain relief and stress hormones were examined during the use of continuous epidural infusion of morphine at a rate of 0.1 mg/hr in 30 patients (Group B) after coronary artery bypass grafting. This was compared to our routine method of postoperative analgesia of intravenous morphine 2 mg/2 hr and as needed in another 30 patients (Group A). Continuous epidural morphine infusion required occasional supplementation with intravenous morphine and achieved effective analgesia in 80% of the patients. Pain relief was adequate in 50% of the patients in Group A. The mean dose of morphine used in Group B during the first 3 postoperative days was 5 mg per patient per day and was significantly lower than that used in Group A (mean 18 mg per patient per day). Serum morphine was undetectable (below 2.5 ng/ml) in Group B and was significantly lower than that in Group A (17 ng/ml). Epidural analgesia was associated with adequate postoperative pulmonary and cardiovascular functions; nausea and vomiting occurred in two patients. Levels of postoperative stress, serum cortisol, and beta-endorphin were significantly lower in Group B than in Group A. This study shows that continuous epidural infusion of morphine at a rate of 0.1 mg/hr provides selective and effective pain relief and reduces postoperative stress after cardiac operations. This method of analgesia was also associated with minimal side effects and provides an alternate approach for treatment of pain after cardiac operations.
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PMID:Continuous epidural infusion of morphine for pain relief after cardiac operations. 295 42

Pre-emptive treatment with an i.v. infusion of morphine 10 mg at induction reduces postoperative analgesic requirement and wound hypersensitivity compared with the same dose administered at the end of operation. Increasing the dose of preemptive morphine may potentially reduce postoperative pain further, while administering morphine at the end of operation, in addition to the beginning, may reduce pain generated by the sensory activity elicited from the wound in the immediate postoperative period. To examine this we have conducted a randomized, double-blind study in patients undergoing abdominal hysterectomy to compare the effect of morphine 20 mg administered before operation with 10 mg at induction and 10 mg on closure of the peritoneum. Postoperative pain was assessed by visual analogue score (VAS) at rest and on movement and by total morphine consumption administered by patient-controlled analgesia (PCA). Wound sensitivity was assessed by von Frey pain thresholds. Both groups had similar morphine consumption, VAS scores and touch and pain thresholds, and in both, secondary hyperalgesia was prevented. Nausea and vomiting scores were higher in the 20-mg group. There was no significant difference between the two groups and neither regimen appeared to offer obvious clinical advantages compared with a lower dose (10 mg) morphine analgesic strategy. Therefore, there may be a ceiling effect to the production of pre-emptive analgesia by morphine.
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PMID:Is there any clinical advantage of increasing the pre-emptive dose of morphine or combining pre-incisional with postoperative morphine administration? 773 57

Ketorolac is one of the newer non-steroidal anti-inflammatory drugs (NSAIDs) that appears to have significant analgesic properties. The purpose of this study was to determine whether ketorolac would provide adequate postoperative analgesia following laparoscopic sterilization and whether it would impact the incidence of nausea and vomiting. Patients were assigned randomly, in double-blind fashion, to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of anaesthesia. All patients received fentanyl 100 mcg, a sleep-inducing dose of propofol, either atracurium or vecuronium, oxygen, nitrous oxide, isoflurane, atropine 1.2 mg, and neostigmine 2.5 mg. Surgery consisted of applying Hulka clips to the fallopian tubes. Postoperative pain was assessed using a visual analogue score (VAS) on 3 separate occasions in recovery. Patients received analgesia using a standard intravenous fentanyl, morphine or pethidine protocol if required. There was no significant difference between the 2 groups with respect to age, weight or procedure duration. Assessment of pain using the VAS slightly, but not significantly, favored the ketorolac group when patients were assessed prior to leaving the first stage recovery and prior to discharge. The worst pain scores recorded prior to discharge were similar in the 2 groups. On all occasions, there was an extremely wide range of scores in both groups. The mean opioid requirement in terms of pethidine equivalents was 23.5 mg in the ketorolac group and 35.5 mg in the saline group. This difference, however, is not statistically significant. Nausea occurred in 50% of ketorolac and 60% of saline groups, while vomiting ensued in 25% of ketorolac and 35% of saline patients. Anti-emetic use was similar in both groups (ketorolac 35%, saline 45%). A large study involving more than 186 patients would be necessary in order to demonstrate a statistically significant benefit of routinely administering ketorolac, with its potential side-effects, to all patients undergoing laparoscopic sterilization as out-patients.
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PMID:Intramuscular ketorolac for postoperative analgesia following laparoscopic sterilisation. 777 31

Pain is a marked feature of laparoscopic tubal ligation. Effective postoperative analgesia would make the procedure more acceptable for day-case anaesthesia. An analgesic suitable for day-case anaesthesia needs to provide analgesia without prolonging recovery or producing other adverse events such as nausea and vomiting. In the attempt to identify such an analgesic, the authors obtained informed oral consent from 80 patients to compare the effectiveness of diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization. Both drugs were administered preoperatively by intramuscular injection to the gluteal region, diclofenac sodium to 40 women and fentanyl to the remaining 40. Patients were subsequently sterilized by application of Falope rings to the Fallopian tubes. Postoperative pain was marked and both drugs provided only partial relief. Patients in the diclofenac group had pain scores which were initially higher than those in the fentanyl group and the difference between the groups was statistically significant. Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 minutes than comparable patients in the fentanyl group. Findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. This warrants the investigation into a combined analgesic technique employing morphine and a nonsteroidal anti-inflammatory drug.
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PMID:Diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization. 806 20

Efficacy and safety of a PCA protocol, without loading dose or background infusion, was investigated in 40 consenting patients after osteotomy of the foot. All patients had intrathecal lidocaine 5% 1.8 ml preoperatively. Postoperative pain relief was provided with morphine from a Baxter Travenol infusor with PC module. The morphine concentration was 2 mg/ml or 3 mg/ml. In order to reach the analgesic blood concentration as quickly as possible, the patients were instructed to start PCA from the very first moment pain occurred. The patients breathed room air. The nursing staff evaluated respiratory and cardiovascular parameters, pain and side effects. Although mean VAS scores were higher than 3 in the early postoperative phase, no supplementary analgesics were required. One patient had urine retention. One patient had a drop in blood pressure at the start of morphine, which was quickly restored with the administration of colloids. Oxygen saturations were lower (SpO2 < 95%) the first hours postoperatively, especially at the first assessment where no morphine was administered. Pain or relative hypovolaemia could be an explanation. Dry mouth and sleepiness were the most frequently reported side-effects, followed by dizziness, vomiting and nausea. Sweating and itching were less frequently reported. The occurrence of the side effects was the highest during the first postoperative day. We conclude that even when morphine is used in PCA without loading dose or background infusion after opiate-free locoregional analgesia, close monitoring is necessary for at least 5 hours.
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PMID:Evaluation of morphine for patient controlled analgesia with the Infusor system after opiate-free locoregional anesthesia for osteotomy of the foot. 866 16

Postoperative nausea, vomiting and pain were compared between laparoscopic cholecystectomy group and minilaparotomy-cholecystectomy group. All patients were women, and ranged in age from 20 to 60 years. The body mass index of the patients was less than 30, and duration of operation was within 120 minutes in both groups. All patients received general anesthesia combined with epidural analgesia. Morphine hydrochloride 4 mg was administered into epidural space before incision. No significant differences were found in the incident of nausea and vomiting among the two groups. Postoperative analgesic requirement of laparoscopic cholecystectomy group was significantly less than that of minilaparotomy-cholecystectomy group. No significant differences were found in the incidence of nausea and vomiting between the group which required postoperative analgesic drugs and the group which required no postoperative analgesic drugs. These results suggest that laparoscopic operation and postoperative pain do not influence the incidence of nausea and vomiting. Postoperative pain after laparoscopic cholecystectomy is less than that after minilaparotomy-cholecystectomy.
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PMID:[Postoperative nausea, vomiting and pain in laparoscopic cholecystectomy: a comparison with minilaparotomy-cholecystectomy]. 872 5

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission. Ninety patients were randomised to this double-blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. The balanced analgesia group received 5 ml of 2% lidocaine gel on the sterilization clips and perioperatively 200 mg of ketoprofen i.v. The lidocaine group received 5 ml of 2% lidocaine gel on the clips and placebo i.v. perioperatively. The placebo group received 5 ml of placebo gel on the clips and placebo i.v. perioperatively. Infusion of propofol and 67% nitrous oxide in oxygen were used for maintenance of anesthesia. Succinylcholine and vecuronium were used for muscle relaxation and 0.1 mg of fentanyl i.v. was given to all patients at induction of anesthesia. Postoperative pain and analgesic requirements, incidence of PONV and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70-90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day). It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.
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PMID:Balanced analgesia improves recovery and outcome after outpatient tubal ligation. 884 11


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