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

Twenty-five consecutive patients underwent percutaneous laparoscopic cholecystectomy (PCC). The gallbladder was removed successfully in 18 patients. The mean postoperative hospital stay was 1.4 days and patients returned to normal activity at a mean 8 days after operation. Postoperative pain was minimal. Formal laparotomy was performed in 7 patients due to: bleeding (3 patients), stone spillage (3 patients) and exploration of the common bile duct (1 patient). Complications were reduced with experience and strict adherence to the described operative technique. With obvious advantages for the patient, hospitals and the community an increased demand for PCC is inevitable. However, its role in the management of cholelithiasis and overall safety have yet to be determined. There is a significant learning curve and proper training is necessary. The widespread introduction of PCC has immediate implications for surgical training.
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PMID:Laparoscopic cholecystectomy: initial experience. 182 30

Postoperative pain management continues to be a challenge to health care professionals. To address this, hospitals across the country are developing Acute Pain Services. It is fast becoming a specialty area and is being incorporated into the realm of practice of anesthesiologists. As postanesthesia nurses, we are in a unique position to enter this new field.
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PMID:Acute pain services: a new career direction for postanesthesia nurses. 183 30

The management of primary varicose veins is evolving. Recovery time, cost, recurrence rate, and cosmesis are critical determinants. Classic "high ligation" and ankle-to-groin stripping is expensive, results in a long convalescence, and may produce unacceptable scarring and possible permanent nerve injury. This report describes the technique of stab evulsion phlebectomy performed in an outpatient setting. Under loco-regional anesthesia, and after high ligation, existing tributary and trunk varicosities are evulsed with specially designed hooks. The multiple stab incisions, 1.5- to 3-mm long, are closed with adhesive strips. Fifty-six patients, with 69 involved limbs, have been operated on during the past 9 months. Postoperative pain and complications were minimal. Convalescence was eliminated and all patients immediately resumed normal daily activities. Cosmesis was excellent. This technique is based on hemodynamically accurate principles. It effectively removes all varicosities, eliminates the proximal source of reflux, and disconnects potentially outflowing perforators, yet leaves in situ undamaged trunk veins, which may be used as potential vein grafts.
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PMID:Ambulatory stab evulsion phlebectomy for truncal varicose veins. 186 40

Postoperative pain management in children is a topic that has been neglected in the past but is currently an active field of interest and effort. Clearly, the child's cognitive understanding of and emotional response to pain are different than an adult's, and these differences make pain assessment and control more difficult. Ongoing work to develop more accurate techniques of estimating pain intensity in children may have helpful results. The effects of untreated pain in children are similar to those in adults but may have more long-term consequences in children. In the past, postoperative pain treatment in children was often inadequate, but newer techniques, such as continuous infusion of opioids, patient-controlled analgesia, epidural administration of opioids, and regional analgesia, hold promise for improved care in the future.
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PMID:Postoperative pain management in children. 187 63

Carbon dioxide laser incisions are reported to be less painful, less bloody, and less prone to seroma formation and to heal better than scalpel or electrosurgical incisions. We compared all three modalities in a prospective randomized study of cholecystectomy incisions. Time required for the incision and incisional blood loss was less with electrosurgery than with the carbon dioxide laser or scalpel. Postoperative pain and wound healing, however, were the same for all three techniques. The carbon dioxide laser appears to offer no advantage over conventional means of making a standard incision.
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PMID:A prospective study of incisional time, blood loss, pain, and healing with carbon dioxide laser, scalpel, and electrosurgery. 155 Apr 88

Postoperative pain relief and sedation with epidural midazolam were studied. Twenty-one patients for elective upper abdominal surgery were divided into 3 groups. Epidural catheter was inserted into thoracic epidural space before induction of general anesthesia. In each group, either 10 ml saline only, midazolam 0.05 mg.kg-1 + 10 ml saline, or midazolam 0.1 mg.kg-1 + 10 ml saline was injected into epidural catheter for complaint of pain in recovery room. For 120 minutes after epidural injection, blood pressure, heart rate, respiratory rate, serum concentration of midazolam, and sedation score were monitored. In midazolam injected groups, only slight changes were seen in blood pressure, heart rate, and respiratory rate. Sedation score was graded from 1 to 6:1 means complete sleep, and not responded to verbal command, 6 means agitated and many complaints. Midazolam 0.1 mg.kg-1 + 10 ml saline group had the lowest score, and saline 10 ml group had the highest score. Prolonged sedation and pain relief were obtained in midazolam injected group, especially 0.1 mg.kg-1 + 10 ml saline group. Serum midazolam concentrations were lower than 200 ng.ml-1. These values were considered as the lower limit for sedation by intravenous administration. In conclusion, epidural midazolam was useful for postoperative pain relief. The mechanism is considered to involve spinally mediated CNS action or direct spinal action.
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PMID:[Epidural midazolam for treatment of postoperative pain]. 194 8

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.
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PMID:Experience of an interdisciplinary pediatric pain service. 195 41

Postoperative pain continues to occur, despite both advances in analgesic techniques and recognition of the damaging effect of pain upon recovery. This study set out to describe the pain experiences of successive cholecystectomy patients in a large teaching hospital, using three different pain measures and self-reports of anxiety and pain-related attitudes and experiences. Nurses and doctors in surgical wards provided parallel information about their pain-related attitudes and practices. A substantial proportion of patients suffered significant postoperative pain, apparently related to their fear of addiction and reluctance to ask for extra analgesic help. Nurses were more convinced than patients that patients should have more control of their own pain relief. Barriers to effective pain relief are seen to include cognitive, attitudinal and systemic factors; some suggestions are offered for reform of relevant hospital practices.
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PMID:Postoperative pain experiences: relevant patient and staff attitudes. 197 5

Postoperative pain relief is necessary not only for patient comfort, but also to facilitate ventilation and ambulation. The use of opioid analgesia, either intravenously, intramuscularly, or intraspinally, may be ineffective and can cause respiratory depression. The administration of local anesthetics into the pleural space is a technique of providing analgesia of rapid onset and long duration. This analgesia is accomplished without causing the respiratory depression or sedation associated with the use of opioids. Because innovative analgesic methods are often selected for critically ill patients presenting after surgery in the intensive care setting, critical care nurses may encounter patients receiving local anesthetics administered via interpleural catheter.
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PMID:Interpleural analgesia. 198 90

Epidural butorphanol 1, 2 and 4 mg were compared with morphine, 5 mg, for postoperative analgesia in 92 consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anaesthesia in a randomized double-blind study. Postoperative pain was assessed using a visual analogue scale and recorded with heart rate, blood pressure and respiratory rate. The demographic characteristics, and the incidences of primary and repeat Caesarean sections, were not different among the four treatment groups. At 15, 30, 45 and 60 min after treatment the median pain scores following butorphanol were similar and lower than those following morphine (P less than 0.05). Calculated median percentage pain relief values for butorphanol were higher than morphine at each of these times (P less than 0.05). At 90 min and 2 hr the pain scores and pain relief values were similar. Beyond 45 min the number of patients requesting supplemental medication and dropping out of the study increased progressively in both the butorphanol and morphine treated patients. The attrition profiles for butorphanol were different from morphine (P less than 0.01). The median time in the study was greater than 24 hr for morphine, and 3, 2.5 and 4 hr for butorphanol, 1, 2 or 4 mg, respectively. No patient developed a clinically important change in heart rate or blood pressure, and none experienced a decrease in respiratory rate below 12 breaths.min-1. One of 69 patients (1.4 per cent) who received butorphanol developed pruritus compared with ten (43 per cent) of 23 patients who received morphine. The global assessments of the adequacy of analgesia were indistinguishable between morphine and butorphanol. Epidural butorphanol provides safe, effective postoperative analgesia, has a prompt onset, and a limited duration.
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PMID:Post-caesarean section analgesia: a comparison of epidural butorphanol and morphine. 198 36


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