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

A simple technique of wound perfusion with bupivacaine (Marcain) which provides sustained postoperative analgesia is described. No complications nor side effects related to toxicity, hypersensitivity, infection, or impaired wound healing were encountered. Postoperative pain was reduced and analgesic requirements were significantly lower in patients undergoing both intermittent (P less than 0.01) and continuous (P = 0.1) wound perfusion (Student t test). Perfusion with isotonic saline was also found to be effective. This may represent a true therapeutic effect attributable to the removal or dilution of pain mediating substances in the wound.
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PMID:The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain? 634 12

We evaluated postoperative pain relief and the incidence of side effects of three methods of thoracic epidural analgesia. Ninety patients, divided into three equal groups, received postoperative analgesia after thoracic surgery either as intermittent epidural injections of bupivacaine (25 mg/5 ml, 0.5% solution) as needed, or, intermittent epidural injections of morphine (5 mg/5 ml of normal saline, 0.1% solution) as needed, or continuous epidural infusion of morphine (0.1 mg, in 1 ml of normal saline) per hour supplemented with intravenous morphine (2 mg) upon request. Pain relief was evaluated by each patient on a pain scale visual analogue and by pain relief questionnaire for a period of 72 hr. Postoperative pain relief was achieved equally with these three methods of epidural analgesia in all patients with no significant difference between groups. Intermittent epidural injection of bupivacaine relieved pain for 4.9 +/- 1.9 (SD) hr/injection and was associated with urinary retention in all patients, with numbness and weakness of the hands in 12 patients, and with severe hypotension in 7 patients. Intermittent epidural injection of morphine relieved pain for 5.8 +/- 2.3 hr/injection and was associated with urinary retention in all patients, with pruritus in 12 patients, and with central narcosis and respiratory depression in 8 patients. Continuous epidural infusion of morphine with occasional intravenous morphine (2 mg) supplementation also effectively relieved postoperative pain and was associated with minimal systemic side effects. One patient complained of pruritus, and two patients developed urinary retention.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous epidural infusion of morphine for treatment of pain after thoracic surgery: a new technique. 646 62

The influence of transcutaneous electrical stimulation (TES) and psychological factors in determining the intensity of acute postoperative pain was examined in a prospective, double-blind controlled trial completed by 30 patients having elective surgery. Psychometric tests were administered prior to surgery. Postoperative pain was assessed by cumulative morphine requirement (M48) administered intramuscularly, and the mean score of a visual analogue scale of pain (VAS), in the first 48 h following surgery. M48 was significantly correlated with the VAS score (r = 0.62, P less than 0.001), and with the psychometric test scores for trait-anxiety (r = 0.70, P less than 0.001) and neuroticism (r = 0.67, P less than 0.001). Though patients treated with TES required 25% less morphine than those treated with placebo, the difference was not significant using monovariate analysis and applying unpaired two-tailed Student's t-test (P less than 0.2). When the contribution of neuroticism to the variance of M48 was adjusted using multiple regression analysis, the effect of TES became significant at the 0.05 level. Covariance analysis showed that TES contributed some 19% to the explained variance of M48 while neuroticism contributed about 80%, and there was no interaction between these two factors. These findings allow a degree of prediction of the individual patient's postoperative pain and narcotic requirement, and point to a strong correlation between postoperative pain perception and personality.
Pain 1983 Oct
PMID:Postoperative pain control: contribution of psychological factors and transcutaneous electrical stimulation. 660 53

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.
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PMID:[Peridural opiate analgesia. Clinical results of a 2-year study]. 661 18

In a double-blind study of post-cesarean analgesia, a single dose of 4 mg epidural morphine sulfate (EMS), with and without epinephrine, was compared with an equal dose of intramuscular morphine (IMS). Postoperative pain was assessed by visual analogue scores and the frequency of patient requests for subsequent meperidine injections. Plasma concentrations of morphine base after EMS and IMS were contrasted. Clinically apparent adverse effects were recorded. The stability of the preservative-free morphine preparation was substantiated. Pain indices after EMS were improved significantly over those after IMS. Pain scores and requests for intramuscular meperidine indicated that the onset of effective EMS analgesia was delayed. The duration of EMS analgesia was about 20 h. No significant difference between the effect of EMS with and without epinephrine was demonstrated. No circulatory or respiratory depression was attributed to the use of 4 mg EMS. The mean peak plasma morphine concentration after 4 mg EMS was significantly lower and later than the mean peak after 4 mg IMS. No correlation was observed between plasma morphine concentration and analgesic effect. These results support the view that epidural administration delivers more of a given dose of morphine directly (rather than via the bloodstream) to the spinal site of action than does intramuscular administration.
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PMID:Pain relief and plasma concentrations from epidural and intramuscular morphine in post-cesarean patients. 689 54

Forty-nine patients with 66 GUEPAR offset knee hinge replacements followed for one to 5 1/2 years were evaluated using the American Rheumatism Association Medical Information System (ARAMIS). The series included 37 female and 12 male patients whose average age was 69 years. Postoperative pain in 92% of patients decreased by an average of three grades. Maximum walking ability improved in 43% and worsened in 14%. Fewer walking aids were used by 51% of patients, whereas 18% needed increased support. Stair-climbing ability improved in 42% and worsened in 10%. Thirty-six additional functions were evaluated. Standing, housework and shopping abilities improved significantly. Range of motion improved from 87 degrees to 103 degrees and flexion contractures decreased by 11%. Varus and valgus abnormalities were almost uniformly corrected. Complications included a 23% rate of patella dislocation or subluxation. Extensor lag occurred in 26% of patients postoperatively, averaging 11 degrees. Deep infection occurred in six knees (9.1%); five were successfully treated for infection and the sixth was successfully treated by arthrodesis. Silastic bumpers broke in all cases and were associated in some instances with significant pain and effusion. Probable loosening has occurred in only one component.
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PMID:Functional outcome of GUEPAR hinge knee arthroplasty evaluated with ARAMIS. 697 24

Median sternotomy, the preferred incision for most procedures on the heart and ascending aorta, has now gained acceptance in selected cases for the surgical treatment of pulmonary metastases and emphysematous blebs whether single or multiple, unilateral or bilateral. Contrasted to lateral thoracotomy, the median sternotomy combines adequate exposure for most pulmonary procedures with reduction in postoperative pain, pulmonary complications, and hospital stay. Patients with reduced pulmonary function, inoperable by standard incisions, become acceptable surgical risks when operated through the median sternotomy. Synchronous pulmonary, mediastinal, and cardiovascular procedures are readily performed, reducing the need for separate operations with their separate risks. This report is based on the eight cases approached by median sternotomy. Postoperative pain was acceptable. Postoperative narcotic requirement and hospitalization were reduced; there was no significant morbidity and no mortality.
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PMID:Extended indications for the median sternotomy incision. 714 75

Postoperative pain relief was studied in 280 patients undergoing various kinds of surgery, e.g., thoracic, upper and lower abdominal, perineal, obstetric, and orthopedic. Morphine, 2 or 4 mg, was given after surgery through an indwelling epidural catheter. Excellent analgesia was noted in 87% of patients; only 3.5% of patients were dissatisfied. A single injection gave complete pain relief for the entire postoperative period in 30% of cases; in the remaining patients the mean duration of analgesia was 10.7 hours (SD +/- 4.3). Plasma morphine concentrations recorded after 2-mg doses suggest a regional spinal action as the basis for the long duration of analgesia, although the initial effect after 4-mg doses might well include systemic responses due to rapid vascular uptake of morphine from the epidural space. Peak expiratory flow (PEF) measurements and arterial blood gas analyses showed no significant early postoperative respiratory depression. Absence of sedation, orthostatic hypotension, respiratory depression, and motor paralysis facilitated early ambulation with less risk for postoperative respiratory complications. It is concluded that 2-mg doses of epidural morphine give good analgesia of long duration despite low plasma levels. After upper abdominal and thoracic surgery higher doses (4 mg) may be necessary in healthy patients. Elderly and frail patients appear to be sensitive to epidural morphine and doses in excess of 2 mg should be avoided regardless of the type of surgery. With this dose schedule we have not encountered delayed respiratory depression.
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PMID:Postoperative pain relief by epidural morphine. 719 76

Postoperative pain relief is only apparently an easy task. A brief survey of literature investigating the discomfort experienced in the postoperative phase is all but encouraging. One can identify four basic problems in obtaining adequate results by delivery of analgesic drugs: a) the biological variability among individual patients, b) the unpredictable uptake of the drug administered intramuscularly, c) the time lag involved between request by the patient and the subsequent administration of a single dose and d) the lack of knowledge about the nature of the discomfort and its remedies. An alternative strategy introducing "On-Demand" analgesia administering prescribed doses at the right moment is presented and analysed a) as an operant conditioning process implementing a particular reinforcement schedule (behavioural sciences), as well as b) a negative feedback control loop that entrust the central judgement to the patient (system theory). Both approaches give insight into the results: the technique copes with biological variability; anticipating pain induced by fear disappears; the feedback strategy works well and patients adapt to a wide range in prescriptions; intermittent administration makes more efficient use of the analgesic; an optimal result is demonstrated in studies comparing on-demand analgesia with the normal IM-regime and epidural analgesia; continuity in pain relief can be obtained in routine clinical practice.
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PMID:Postoperative pain relief by demand analgesia. 745 63

Postoperative pain relief is often inadequate. Ignorance and misconceptions about opioids by ward staff contribute to this poor management. The introduction of acute pain teams has done much to improve pain relief for patients. It may also have contributed to changes in attitudes and knowledge of medical and nursing staff. We questioned 48 doctors and nurses on their knowledge and beliefs about postoperative pain relief. Staff members were questioned on two units, one with access to an acute pain team and one without. Over half those on the unit using traditional postoperative care thought patients did not receive adequate pain relief (58%). In comparison, only one respondent from the unit with the pain team thought this was the case (P < 0.001). More staff members that had experience of patient-controlled analgesia (PCA) were optimistic about its benefits than those in the unit with no experience; they were also less concerned about possible side effects. Only one respondent on the unit using PCA thought it carried a risk of drug dependence, compared to over half (55%) of those on the unit with no experience in this technique (P < 0.001). Over two-thirds of staff familiar with PCA thought nursing workload had decreased. Acute pain teams have an important role in educating ward staff. The impact of establishing such teams on staff knowledge and attitudes needs further study to ensure that they can carry out this role most effectively.
J Pain Symptom Manage 1995 Jan
PMID:Shaping attitudes to postoperative pain relief: the role of the acute pain team. 753 28


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