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

In January 1986 we initiated a prospective study in our center to evaluate the results of surgery in patients with anal fissure. Three groups were considered according to type of surgery: internal lateral sphincterotomy (ELI), lateral sphincterotomy and resection of cutaneous fibroma (ELI + FC), and sphincterotomy with hemorrhoidectomy (E + H). The basic objective was to evaluate postoperative pain, days of hospitalization and out-patient follow-up, complications and number of recurrences. Postoperative pain occurred in 12% of internal lateral sphincterotomies, in 42% of lateral sphincterotomies with resection of cutaneous fibroma in 50% of sphincterotomies with hemorrhoidectomy, as measured by the number of patients who requested analgesics. The hospital stay was similar in the first two groups (96 and 90% less than 24 hours) and longer in the third (50% greater than 24 hours). Out-patient follow-up was limited to one visit in 90% of internal lateral sphincterotomies, while 85% of internal lateral sphincterotomies + fibroma resection required more than two visits and 100% of sphincterotomies with hemorrhoidectomy needed three or more. Nine percent of those operated had mild complications like low fever, ecchymoses, fistula or wound infection. No patient presented incontinence or recurrence of the fissure. We conclude that internal lateral sphincterotomy is an ideal procedure for the treatment of anal fissure and, if possible, additional surgery should be avoided, however insignificant it may appear.
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PMID:[Internal lateral sphincterectomy. Results]. 276 41

A prospective comparative study was carried out between two anesthetic techniques for chemonucleolysis. Patients were divided into 2 groups of 50 patients each. Group A were submitted to general anesthesia and group B to epidural anesthesia with 0.5% bupivacaine, 2% mepivacaine and buprenorphine. Group B was divided into 2 subgroups: in B1, buprenorphine was administered with the local anesthetics, while in B2 buprenorphine was administered postoperatively when pain appeared. Postoperative pain and side effects like anaphylaxis were evaluated. No anaphylactic reactions occurred. Severe lumbar pain appeared in 22% of patients in group A in spite of systematic analgesics, while group B lumbalgia was not severe in any case. Patients in subgroup B1 did not have pain during the 24 first hours and 47.8% of patients in subgroup B2 needed in most of the cases only a dose of buprenorphine. We conclude that epidural anesthesia is a good technique in chemonucleolysis and that the association bupivacaine, mepivacaine and buprenorphine provides a good postoperative pain relief.
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PMID:[Chemonucleolysis. Peridural anesthesia versus general anesthesia]. 278 Oct 93

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

Secretion of pituitary immunoreactive beta-endorphin is hypothesized to modulate the perception of pain. The present study examined this question by evaluating the effects of intravenous placebo or dexamethasone (0.1, 0.32, or 1.0 mg) on suppression of immunoreactive beta-endorphin secretion and development of postoperative pain after the surgical removal of impacted third molars in 48 patients. Compared with placebo, all doses of dexamethasone suppressed the postoperative increase in circulating levels of immunoreactive beta-endorphin. Patients administered 0.1 mg dexamethasone reported greater levels of pain, compared with those given placebo, from 60 through 120 minutes after surgery. Postoperative pain for the 0.32 and 1.0 mg doses did not differ from that for the placebo group. The increased pain after suppression of beta-endorphin release by the low dose of dexamethasone suggests that pituitary secretion of immunoreactive beta-endorphin alleviates postoperative pain under these conditions.
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PMID:Dexamethasone alters plasma levels of beta-endorphin and postoperative pain. 296 1

In a double-blind, randomized study of 29 patients who underwent orthopedic procedures we studied the additional effect of intrathecal buprenorphine on isobaricpinal anesthesia and postoperative analgesia. The injections were 20 mg tetracaine (19 patients) or 20 mg tetracaine plus 0.15 mg buprenorphine (10 patients). In both groups the drugs were contained within a total volume of 4 ml cerebrospinal fluid. Progression and regression of the sensory blockade of spinal anesthesia were estimated with pinprick; the motor blockade was judged by the Bromage scheme. Postoperative pain was evaluated by the patients using an analogue scale after Scott and Huskisson. Arterial blood gases, respiratory rate, blood pressure, and heart rate were measured and other side-effects determined. Both groups were comparable in age, body weight, height and duration of operation (Table 1). The addition of buprenorphine elevated the sensory blockade by three segments both during spread and regression of anesthesia (Figs. 1, 2). Postoperative analgesia was better up to 8 h after injection (p less than 0.05), after 8 h pain levels were equal in test and control groups (Fig. 3). After buprenorphine patients became aware of pain sensation 13 h after injection; in the control group the pain-free interval lasted only 9 h (p greater than 0.05). There were no differences in the need for postoperative analgesics between both groups. The respiratory rate was lower during the whole period of observation (p less than 0.05). The mean values for PaCO2, pH and BE were similar in both groups (Fig. 4). PaO2 was elevated in the buprenorphine group. There was no essential alteration of blood pressure after buprenorphine. The pulse rate, however, was slightly diminished.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[O.15 mg Intrathecal buprenorphine applied for postoperative analgesia. A clinical double-blind study]. 311 38

We report a prospective double-blind trial of the efficacy of a single epidural dose of buprenorphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain chart and by the additional requirement for analgesia. The patients receiving buprenorphine were significantly more comfortable (p less than 0.005) and required less analgesia in the first 12 hours after operation (p less than 0.05) than the control group. This simple procedure is recommended as an effective and safe method of reducing pain.
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PMID:Epidural buprenorphine for pain relief after spinal decompression. 328 57

Postoperative pain was assessed in patients undergoing inguinal hernia repair. Ten patients received lidocaine aerosol in the surgical wound before skin closure, ten patients received placebo aerosol devoid of lidocaine, and ten patients were untreated. The lidocaine-treated group had significantly lower pain scores and meperidine requirements during the first postoperative day compared to the control groups. During the second day after surgery, these variables did not differ between groups. Wound anesthesia, assessed by palpation of the wound 24 h after surgery by a blinded investigator, was significantly more pronounced in the group treated with lidocaine aerosol than in the control groups. Similarly, in patients undergoing bilateral herniorraphy, wound pain following palpation was significantly reduced on the lidocaine-treated side compared to the untreated side. Patients in the group receiving lidocaine aerosol indicated less pain in connection with mobilization than untreated patients, but not compared to patients treated with placebo aerosol. Plasma substance P (SP) and beta-endorphin (BE) measured in lidocaine-treated patients and in untreated patients before and after drug administration showed no significant differences regarding SP, while BE was significantly increased 1 h after surgery in the untreated group. Plasma lidocaine concentrations were well below toxic levels. Results show that lidocaine aerosol used as topical anesthetic in the surgical wound is simple to use, and results in a long-lasting reduction of pain after a single administration. Moreover, postoperative mobilization is facilitated, and the requirement for postoperative analgesics is reduced. Wound healing was normal, and no adverse reactions to lidocaine were reported.
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PMID:Topical anesthesia with lidocaine aerosol in the control of postoperative pain. 328 7

A prospective study of postoperative pulmonary complications (PPC) appearing during the hospital stay was carried out in 417 patients undergoing surgery through a subcostal or midline incision. Postoperative pain was relieved either by intercostal block and centrally-acting analgesics on demand or by centrally-acting analgesics alone. Pulmonary complications were diagnosed from combined physical and radiological signs. After biliary surgery through a subcostal incision, PPC were less frequent (P less than 0.05) in patients receiving intercostal blocks (6%) than in those given centrally-acting analgesics (11%). After surgery through a midline incision, the complication rate was higher, 15-57%, and was related to the type of surgery, the highest incidence being found after partial gastrectomy and operations for malignancy, and no significant reduction in the rate of PPC after intercostal blocks with this incision was found in any age group. Indeed, an increased rate of PPC was found in our patients over the age of 60 who had received bilateral intercostal blocks. Irrespective of the type of incision, surgery or method of postoperative pain relief, the patients with PPC more often had respiratory or other disorders preoperatively or a surgical complication intra- or postoperatively than those with normal postoperative recovery. Predisposing physical factors and high age were more common among the patients developing PPC in spite of treatment with intercostal blocks compared to those without such treatment.
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PMID:Pulmonary complications after upper abdominal surgery: their prevention with intercostal blocks. 334 2

One hundred and seventy procedures were performed on one hundred and forty patients with ingrowing toenails. Each patient was randomly allocated to one of three treatment groups. There were 55 wedge resections (WR), 53 segmental phenolizations (SP) and 62 wedge resection/segmental phenolization combination treatments (WR/SP). All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in the WR/SP group (9.4 +/- 13.5 h) than in the WR group (30.0 +/- 37.6 h, P less than 0.001). There were seven recurrences in the WR group, four in the SP group, and none in the WR/SP group. The results in the WR/SP group were statistically significant when compared with the WR group (P less than 0.01) and with the SP group (P less than 0.05). We conclude that the WR/SP combination procedure is a superior form of treatment for ingrowing toenails.
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PMID:Approach to ingrowing toenails: the wedge resection/segmental phenolization combination treatment. 334 12

In a double-blind prospective study, 20 patients undergoing major abdominal surgery were allocated randomly to receive a continuous 8-h i.p. infusion of either physiological saline or 0.25% bupivacaine 20 ml h-1 (in saline) following a loading dose of saline 1 ml kg-1 or 0.25% bupivacaine 1 ml kg-1 on entering the peritoneum. The following variables were measured before and at 2-h intervals during the infusion: serum glucose and cortisol concentrations, forced vital capacity, forced expiratory volume in the first second, peak expiratory flow rate and pain at rest, on mobilization and on coughing (visual analogue scale). Postoperative pain, impairment in pulmonary function and increase in serum cortisol and glucose concentrations were not influenced by the i.p. infusion of bupivacaine when compared with saline. This study shows that the i.p. instillation of therapeutically safe doses of bupivacaine was without effect in the management of pain, postoperative pulmonary dysfunction and the stress response in this group of patients.
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PMID:No effect of continuous i.p. infusion of bupivacaine on postoperative analgesia, pulmonary function and the stress response to surgery. 341 89


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