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

This randomised, double-blind study compared the analgesic properties of intra-articular injection of morphine and bupivacaine during therapeutic arthroscopic knee surgery. Forty male patients were randomly divided into 4 groups of 10 patients each. Group A received intra-articular injection of 1 mg morphine sulphate in 20 ml saline, Group B received 20 ml of 0.25% bupivacaine while Group C received 1 mg morphine sulphate in 20 ml of 0.25% bupivacaine injected intra-articularly. Group D did not receive intra-articular injection and acted as control. Post-operative pain was assessed by visual analogue score. The morphine group had significantly lower pain score compared to the control group from 4 hours onwards throughout the 24-hour study period (p < 0.05 at 4 hours and p < 0.001 at 24 hours). The bupivacaine group had lower pain score than the control group during the first 4 hours (p < 0.001 at 1 hour and p < 0.05 at 2 hours). At 4 hours, it showed similar analgesic efficacy as morphine. There was no significant analgesic effect at the end of the study period. The combination of the two drugs resulted in satisfactory analgesia throughout the entire study period (p < 0.001 at 1, 2 and 24 hours and p < 0.05 at 4 hours) and appeared to be a simple, safe and effective analgesic technique for patients who underwent therapeutic arthroscopic knee surgery.
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PMID:Intra-articular morphine and bupivacaine for pain relief after therapeutic arthroscopic knee surgery. 757 Jan 32

Intra-articular morphine has been shown to provide prolonged analgesia after arthroscopic knee surgery; the addition of local anaesthetic agents has been reported to improve this analgesic effect. Pethidine possesses local anaesthetic properties, and therefore this study was designed to evaluate its analgesic efficacy after arthroscopic meniscectomy. Sixty patients were allocated randomly to receive intra-articular injections of pethidine 50 mg, morphine 5 mg or saline after elective arthroscopic meniscectomy. Postoperative pain was assessed using an interval visual analogue scale and measuring analgesic requirements. Both treatment groups had significantly lower pain scores compared with the control group. Patients in the pethidine group had lower pain scores than those in the morphine group at 0.5, 1 and 2 h, but significantly higher scores at 12 and 24 h. These observations suggest that the local anaesthetic effect of pethidine may be responsible for the improved early analgesia, but its duration of action appears to be less than that of morphine.
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PMID:Intra-articular analgesia for arthroscopic meniscectomy. 757 79

Twenty-six hemiarthroplasties were performed for acute three- and four-part proximal humerus fractures between March 1986 and December 1991. Postoperative pain, active range of motion, and function were evaluated in 22 patients at a mean follow-up period of 30 months (range 12 to 66 months) with the American Shoulder and Elbow Surgeons evaluation form. Seventy-three percent of patients reported only slight or no pain. Active forward elevation averaged 107 degrees, external rotation averaged 31 degrees, and the average internal rotation was to the second lumbar vertebra. Strength and stability were rarely problematic. Seventy-three percent of patients reported difficulty with at least three of 15 functional tasks tested. Lifting, carrying a weight, and using the hand at or above shoulder level were the most common limitations. This study indicates that hemiarthroplasty for acute three- and four-part fractures generally can be expected to result in painfree shoulders. However, recovery of function and range of motion are much less predictable.
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PMID:Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. 760 Jan 69

In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intraabdominal surgery were randomly assigned to two groups: a control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. Postoperative pain relief was achieved with intravenous (IV) boluses of morphine using a patient-controlled analgesia device. We found smaller opioid requirements in the epidural group than in the control group for intraoperative fentanyl (465 +/- 179 micrograms vs 983 +/- 682 micrograms), for postoperative morphine at 12 h (3.1 +/- 3 mg vs 21.4 +/- 13.8 mg) and 24 h (9.1 +/- 6.4 mg vs 20.6 +/- 9.8 mg), and for the cumulated needs over the 3-day postoperative period (37 +/- 24 mg vs 86 +/- 42 mg). The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 +/- 2.4 vs 3 +/- 2), at 36 h (0.3 +/- 0.6 vs 3 +/- 2.7), and at 60 h (0.1 +/- 0.3 vs 1.8 +/- 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.
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PMID:Preoperative analgesia with epidural morphine. 763 68

One hundred patients (aged 22-86 years, mean 62.5), undergoing lower limb orthopaedic surgery, received continuous spinal anaesthesia using a 28 s.w.g. catheter inserted through a 22 s.w.g. Quincke needle. Post-operative pain relief was provided by bolus injections of 1-2.5 mL 4 h-1 of plain 0.25% bupivacaine. The mean dose of bupivacaine required for sufficient pain relief in 93% of patients was 1.6 +/- 0.2 (1.3-1.9) mL 4 h-1. The highest dose was needed between 4 and 8 h post-operatively. No dependence of dose on age or type of operation was found. Technical problems with the microcatheter occurred in 12%. The most frequent complaint was post-operative backache (12%). Only one patient suffered from post-dural puncture headache on the day after surgery. There was no microbiological contamination of the catheter tips after removal. In the post-operative interview, 89% of the patients were completely satisfied with CSA; 91% would prefer this technique to general anaesthesia.
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PMID:Microcatheter continuous spinal anaesthesia in the post-operative period: a prospective study of its effectiveness and complications. 764 17

Ambulatory laparoscopic cholecystectomy was attempted using a new anaesthetic regimen in 50 patients. 46 patients were discharged 3-5 hours after operation, four were admitted to and remained in hospital for 1-5 days, one for psychosocial reasons, one because of emesis and two because of extended surgery. 45 of 46 ambulatory patients were generally satisfied after having experienced ambulatory cholecystectomy. Postoperative pain and nausea were moderate. Only 24% needed parenteral opioids postoperatively, and only 30% needed anti-emetic treatment. One woman suffered unacceptable pain and discomfort during the first two days at home, and would not prefer to have ambulatory treatment (questionnaire). Four patients were readmitted. Two had a forgotten stone in the common bile duct and underwent ERCP to extract the stone, without further complications. The third had a clip occluding the common bile duct. She was reoperated on in order to remove the clip and insert a T-tube in the common bile duct. Finally one woman was readmitted because of abdominal pain and vomiting, of which we never found the cause. She recovered spontaneously. Even though serious complications associated with biliary surgery were unavoidable in this ambulatory series, we have documented that patients can be operated on safely in this way. Most patients were very content, and experienced much less postoperative discomfort than they had expected.
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PMID:[Laparoscopic cholecystectomy as ambulatory surgery. Safety requirements, benefit potential and patient satisfaction]. 765 19

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

In a double-blind, randomized study, 32 patients scheduled for elective inguinal herniotomy under general anaesthesia received subcutaneous infiltration with 40 ml ropivacaine 2.5 mg/ml or bupivacaine. Postoperative pain intensity was assessed repeatedly for 24 hours at rest, during cough and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine in the management of post-herniotomy pain.
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PMID:Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy. 772 86

This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. Analgesic requirements were calculated, and weightbearing status was recorded. We found that morphine alone injected intraarticularly at the completion of arthroscopic knee surgery had no significant effect on postoperative pain, need for supplemental analgesia, or weightbearing status. Patients receiving morphine in combination with bupivacaine did not demonstrate any statistically significant improvement over those receiving bupivacaine alone. Therefore, our results failed to show any beneficial effect of morphine used for postoperative analgesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated decreased pain scores, decreased analgesic use, and increased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most significant predictor of postoperative pain was preoperative level of discomfort.
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PMID:The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control. 772 52

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


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