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

Recently, it has become obvious that disabling postoperative headache is a major problem with acoustic neuroma surgery. A questionnaire was used to retrospectively evaluate the incidence, clinical features, prognosis and possible therapeutic measures of this particular form of headache. Forty-two percent (42%) of patients had some headache prior to surgery but this was not a major complaint. After surgery, 75% of patients experienced headache. Only 24% had complete relief of headache. A very gradual improvement of the pain occurred in 32%. Pathogenesis remains unclear, but clinical characteristics of the headache suggest a combination of tension-type, neuralgic and vascular components. Postoperative pain occurs mostly around the surgical site suggesting that this type of headache is the result of surgical trauma. A prospective long-term study is needed to delineate this condition further. Some therapeutic suggestions are offered.
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PMID:Postoperative headache in acoustic neuroma. 855 Mar 67

Postoperative pain relief with codeine was evaluated in 11 women undergoing hysterectomy. Patient-controlled analgesia (PCA) was used to administer codeine. After the study the patients were phenotyped with respect to the O-demethylation of dextromethorphan (cytochrome P4502D6 polymorphism). Ten were extensive metabolisers and one a poor metaboliser. There was a nine-fold variation in the minimum plasma concentration of codeine consistent with pain relief (40-350 ng ml-1). Two patients did not experience any effect of codeine, one of whom was a poor metaboliser of dextromethorphan, confirmed by genotyping. In the other nine patients the effective dose of codeine varied from 4.8-25.3 mg h-1.
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PMID:Patient-controlled analgesia (PCA) with codeine for postoperative pain relief in ten extensive metabolisers and one poor metaboliser of dextromethorphan. 774 59

The purpose of this study was to compare the effect of local anaesthesia (LA) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, single-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with N2O/O2 and halothane or propofol and maintained with N2O/O2/halothane. Local anaesthesia included ilioinguinal and iliohypogastric nerve block plus subcutaneous injection by the surgeon of up to 0.3 ml.kg-1 bupivacaine 0.25% with 5 micrograms.kg-1 adrenaline. The dose for caudal anaesthesia was 1 ml.kg-1 up to 20 ml bupivacaine 0.2% with 5 micrograms.kg-1 adrenaline. Postoperative pain was assessed with mCHEOPS in the anaesthesia recovery room, with postoperative usage of opioid and acetaminophen in the hospital, and with parental assessment of pain with a VAS. Vomiting, time to first ambulation and first urination were recorded. The postoperative pain scores and opioid usage were similar; however, the LA-group required more acetaminophen in the Day Care Surgical Unit. The incidence of vomiting and the times to first ambulation and first urination were similar. The LA-patients had a shorter recovery room stay (40 +/- 9 vs 45 +/- 15 min, P < 0.02). The postoperative stay was prolonged in the CA group (176 +/- 32 vs 165 +/- 26 min, P = 0.02). We conclude that LA and CA have similar effects on postoperative care with only slight differences.
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PMID:Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia. 774 68

The purpose of this study was to assess and describe the multidimensional postoperative pain experience of patients (N = 194) undergoing coronary artery bypass graft surgery (CABG) using the McGill Pain Questionnaire. Postoperative pain significantly decreased from postoperative day 2 to postoperative day 3 for all components of the McGill Pain Questionnaire. Sensory words chosen from the McGill Pain Questionnaire on postoperative day 2 included sharp, sore, aching, and tender. Affective words chosen included exhausting on postoperative day 2 and tiring on postoperative days 2 and 3. The evaluative word annoying was chosen for both postoperative days 2 and 3. The present pain intensity (PPI) rating completed on a scale from no pain = 0 to excruciating pain = 5, showed a mean intensity rating of 1.08 for postoperative day 2 and 0.67 for postoperative day 3. These findings describing the typical pattern of postoperative pain are clinically significant in the differentiation of "normal" postoperative pain from pain experienced with postoperative complications from CABG surgery.
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PMID:Pain in the postoperative coronary artery bypass graft patient. 775 27

Postoperative pain relief and sedation with epidural ketamine were studied. Twenty-four patients for elective upper abdominal surgery were divided into 4 groups. Epidural catheter was inserted into thoracic epidural space before induction of general anesthesia. In each group, either 0.25% bupivacaine 5 ml only, ketamine 0.1 mg.kg-1 + bupivacaine 5 ml, or ketamine 0.3 mg.kg-1 + bupivacaine 5 ml, or ketamine 0.5 mg.kg-1 + bupivacaine 5 ml was injected into epidural catheter for complaint of pain in recovery room. In ketamine injected groups, blood pressure and heart were unchanged, but respiration rate increased significantly. Patients in ketamine 0.3 or 0.5 mg.kg-1 injected groups, pain relief and sedation score were significantly intensified, but patients in ketamine 0.5 mg.kg-1 injected group, incidence of pain in the back during injection and headache was high. We conclude that epidural ketamine is useful for postoperative pain relief, and the superior dose of epidural ketamine is 0.3 mg.kg-1.
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PMID:[Use of ketamine combined with local anesthetics in epidural anesthesia]. 777 28

Postoperative pain in adults has become a subject that has seen increasing research. The result of that research has been an increase in the type and quality of interventions available for pain relief. Although infants, children, and adolescents also experience postoperative pain, the research and interventions have been slower in arriving. Perhaps this is caused, in part, by the inability of this population to express the pain experience. It may also be because of the reluctance of health care providers to objectively assess and intervene in the pain experience of infants, children, and adolescents. The purpose of this article is to explore the pain experience of infants, children, and adolescents so the perioperative nurse will be better equipped to handle this experience with the patient and the family.
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PMID:The pain experience in infants, children, and adolescents. 778 Apr 16

A prospective study was conducted to investigate and compare the analgesic effect of morphine and bupivacaine injected intra-articularly following elective knee arthroscopy performed under general anesthesia without the use of a tourniquet. Cost-effectiveness of these agents was also evaluated. Patients in Group 1 (n = 41) received 30 cc of 0.25% bupivacaine with 1:200,000 epinephrine; while Group 2 (n = 40) received 2 mg morphine (1 mg/cc) in 28 cc normal saline (total volume 30 cc). Postoperative pain scores and the amount of supplemental analgesic agents used in a 24-hour period were recorded. Results showed that patients in Group 2 reported significantly less pain overall (P < .006) and significantly lower analgesic requirements (P < .0004) at a lower average patient cost than Group 1. We conclude that intra-articular morphine reduces postoperative pain and analgesic requirements more effectively and at a lower average patient cost than bupivacaine.
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PMID:Comparison of intra-articular morphine and bupivacaine following knee arthroscopy. 777 64

The development of ambulatory electrocardiographic recorders and analysers and the application of transesophageal echocardiography in the mid-1980's enabled investigators to quantify and describe the occurrence of silent as well as symptomatic ischemia in the perioperative period. Several technical advances which have recently occurred in ECG monitoring include the use of miniaturized digital computing equipment to store and analyze data. In addition, real time ST-segment analysis has become widely available on multicomponent monitors in both the operating room and intensive care units. The incidence of perioperative myocardial ischemia depends on the patient population, the surgical procedure, and the monitoring technique used. Several studies in the early 1990's have shown that cardiac morbidity in patients undergoing major, noncardiac surgery is best predicted by postoperative myocardial ischemia, rather than tradition preoperative clinical predictors. Long duration postoperative ischemia may be the factor most significantly associated with adverse cardiac outcome. Postoperative pain, physiological and emotional stress may all combine to cause tachycardia, hypertension, increase in cardiac output, and fluid shifts which, in high risk patients, might result in subendocardial ischemia and eventual myocardial infarction. If postoperative myocardial ischemia is the cause of late postoperative myocardial infarction in patients undergoing non-cardiac surgery, then treatment of postoperative myocardial ischemia should reduce morbidity. In addition, reducing pain and stress and avoiding postoperative hypoxemia might prevent postoperative myocardial ischemia and minimize the need for extensive preoperative cardiac evaluation.
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PMID:Myocardial ischemia--association with perioperative cardiac morbidity. 782 38

After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. Studies exist on the course of end-expiratory CO2 (Pe-CO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing. The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism. METHODS. After giving informed consent to the study, which was approved by the local ethics committee, 20 patients underwent laparoscopic cholecystectomy. All patients received general endotracheal anaesthesia. After induction, total IV anaesthesia was maintained using fentanyl, propofol, and atracurium. Patients were ventilated with oxygen in air (FiO2 0.4). The intra-abdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum (KP), CO2 elimination (VCO2), oxygen uptake (VO2), and respiratory quotient (RQ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy. Assuming an unchanged metabolism, the CO2 resorption (delta VCO2) at any given time (t) can be calculated from delta VCO2 (t) = VCO2 (t)-RQ(preop) VO2 (t). It was thus necessary to define the patient's metabolism on the day of operation. The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period. Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery. Patient's tracheas were extubated and metabolic monitoring started 30 min after release of the KP for 60 min. Simultaneously, a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency (RF) were obtained by the Capnomac Ultima (Datex) and registered every minute as well. Values were averaged over four periods of 15 min each. An arterial blood gas sample was drawn at the end of every 15-min period. Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being. All data were analysed by the Friedman or Wilcoxon test; P < 0.05 was considered significant. RESULTS. The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy (Tables 2 and 3, Fig. 1). Arterial CO2 as well as PeCO2 were elevated postoperatively (45 mm Hg vs. 36 mm Hg intraoperatively), while VCO2 and VO2 were unchanged when compared to the preoperative measuring period. The postoperative RF was comparable to preoperative values. Calculated delta CO2 was lower than 10 ml/min and within accuracy of measurements. The post-operative pain index ranged between 3 and 4, and 3.75-15 mg piritramid was administered. All patients felt tired immediately after the operation, but scores improved slightly at the end of the 60-min period of metabolic monitoring. CONCLUSIONS. There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.
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PMID:[Effect of capnoperitoneum on postoperative carbon dioxide homeostasis]. 784 Mar 99

Postoperative pain and convalescence following ambulatory inguinal herniotomy in local infiltration anesthesia was evaluated in this descriptive study. Sixty consecutive patients (median age 63 yr) were included. Per- and postoperative pain treatment were pre- and postoperative oral tenoxicam and methadone plus infiltration of the surgical field with up to 60 ml of 0.25% bupivacaine. Intraoperative pain intensity was slight and was treated with supplemental bupivacaine. Patients were totally relieved of pain at rest and during mobilisation in the first hours after surgery, but more than half of the patients had moderate pain from the first to the third postoperative day and still had light pain seven days after surgery. Normal daily activity was re-established five days postoperatively (median). Fifty-two patients were satisfied with the anesthesia and eight patients not satisfied due to fear of intraoperative pain. This study shows that inguinal herniotomy can be performed routinely as an outpatient procedure under local infiltration anesthesia. However, late postoperative pain was significant and should be improved with multi-modal analgesia.
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PMID:[Pain and convalescence after ambulatory inguinal herniotomy during local anesthesia]. 784 85


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