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

Acupuncture has been shown to be effective in experimental and clinical acute pain settings. This study aims to evaluate the effect of preoperative electroacupuncture (EA) on intraoperative and postoperative analgesic (alfentanil and morphine) requirement in patients scheduled for gynaecologic lower abdominal surgery. Ninety patients were randomly assigned to one of three groups: Group I (control group)--received placebo EA for 45 minutes before induction of general anaesthesia (GA); Group II--preoperative EA instituted 45 minutes before induction of GA; Group III--45 minutes of postoperative EA. The Bispectral Index monitor was used intraoperatively to monitor the hypnotic effect of anaesthetic drugs, and alfentanil was titrated to maintain the blood pressure and pulse rate within +/- 15% of basal values. Postoperative pain was managed by intravenous morphine via a patient-controlled analgesia (PCA) device. Patients in Group II (0.44 +/- .15microg/kg/min) received less alfentanil than those in Group III (0.58 +/- .22 microg/kg/min) (p = p.024), but not significantly less than those in Group I 10.51 +/- 0.21 microg/kg/min) (p = 0.472). Postoperative morphine consumption was numerically lower in Group II compared with the other groups; however, the difference was statistically significant only during the period of 6-12 hours between Group II [0.03 (0.05) mg/kg] and Group I [0.10 (0.11) mg/kg] (p = 0.015), and Group II and Group III [0.08 (0.10) mg/kg] (p = 0.010). The 24-hour cumulative morphine consumption for Group II (0.52 +/- .19mg/kg) was less than that for either Group I I0.68 +/- 38mg/kg) or Group III (0.58 +/- .27mg/kg), but the difference did not reach significance. In conclusion, preoperative EA leads to a reduced intraoperative alfentanil consumption, though this effect may not be specific, and has a morphine sparing effect during the early postoperative period.
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PMID:Effects of electroacupuncture on intraoperative and postoperative analgesic requirement. 1221 2

Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient's level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.
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PMID:Postoperative pain management on surgical wards-impact of database documentation of anesthesia organized services. 1466 93

Postoperative pain is one of the most common forms of acute pain. Optimal pain management decreases the stress response to surgery, reduces complications, improves recovery time, and results in improved economic and quality-of-life outcomes. A preoperative, multimodal approach to postoperative analgesia can be achieved through a combination of therapies that continue beyond the immediate perioperative time frame. This multimodal approach provides superior analgesia with opioid-sparing effects and reduced opioid-related adverse events. Although the use of nonspecific nonsteroidal antiinflammatory drugs in a surgical setting has been limited owing to concerns of renal and gastrointestinal complications as well as platelet dysfunction, cyclooxygenase (COX)-2-specific inhibitors appear to be safe and effective alone and in combination with opioids for a variety of surgical procedures. The COX-2-specific inhibitors may have an important role in extending the use of balanced, multimodal analgesia to a broad surgical population, thus ultimately improving patient outcomes after surgery.
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PMID:Making progress in the management of postoperative pain: a review of the cyclooxygenase 2-specific inhibitors. 1558 40

Postoperative pain is an important clinical problem that has received increasing attention in recent years. However, pain following craniotomy has been a comparatively neglected topic; this review seeks to redress this imbalance. A brief overview of the anatomy of the skull and its linings is given, with particular reference to innervation. The various approaches for craniotomies are classified, with their association with acute and long-term effects on analgesic requirements. A comprehensive search of the literature was undertaken to ascertain the incidence of acute pain post craniotomy and current thoughts on pharmacological management, touching briefly on pre-emptive treatment. Also discussed is the much neglected but nevertheless real incidence of chronic pain following craniotomy and its underlying pathogenesis, prevention and treatment.
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PMID:Acute and chronic pain following craniotomy: a review. 1596 Jul 21

This paper reviews published data on welfare aspects of stag restraint and velvet antler removal, and prevention of antler growth. Several studies of physical restraint and handling demonstrate behavioural and physiological changes both during and after velvet antler removal. Interpretations vary as to whether the act of velvet antler removal imposes a welfare cost additional to that of handling and restraint alone. Chemical restraint presents immediate and delayed welfare risks to the animal. Surgical removal of velvet antler can be achieved without acute pain using a high dose rate of local anaesthetic applied as a ring block, rather than as regional nerve blocks, provided the wait time is adequate. However, there is evidence of less than optimum reproducibility. Lignocaine hydrochloride produces rapid analgesia of short duration, whilst bupivacaine has a delayed onset, but longer duration of analgesia. Mepivacaine has a rapid onset and intermediate duration of analgesia. Mixtures of long and short-acting local anaesthetics provide rapid onset and long duration of analgesia. Present methods for electronic analgesia are aversive and not sufficiently effective. The efficacy and possible aversiveness of compression techniques for inducing analgesia of antlers are currently under evaluation. Post-operative pain and the need for its control have been insufficiently researched. Post-operative sequelae are uncommon, but include clostridial infection. Antler growth in most stags can be prevented by rubber-band application to the growing pedicle, although behavioural changes after ring application suggest this practice may be painful. The procedures used for velvet antler removal, and whether practices are acceptable on the balance of welfare costs and benefits, should be reviewed on an ongoing basis as science, using an increasing range of techniques and measures, provides more data about the welfare implications of this practice.
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PMID:Welfare of farmed deer in New Zealand. 2. Velvet antler removal. 1603 77

The primary purpose of this study is to compare parental-global-impression of children's level of acute pain at home with parental assessment of children's pain using a structured instrument and with children's self-reports of pain. We recruited 32 parents of children aged 5 to 10 years who were diagnosed with a fractured limb and treated in a tertiary emergency department. After discharge, parents were asked to complete three home-based assessments relating to their child's acute pain: the parental-global-impression of pain, child's reported pain, and structured Parental Postoperative Pain Measure. Data analysis included odds ratios, sensitivity, specificity, positive and negative predictive values, and repeated-measures analysis of variance. When compared with child report of pain, the sensitivity of parental-global-impression was 76% on day 1 and 93% on day 2, whereas specificity was 91% on day 1 and 83% on day 2. When compared with child report of pain, the sensitivity of Parental Postoperative Pain Measure was 71% on day 1 and 66% on day 2, whereas specificity was 82% on day 1 and 83% on day 2. On the basis of acceptable statistical criteria, parental-global-impression has good sensitivity and specificity compared with the child self-report measure. We do not suggest, however, that parental-global-impression can or should replace child report, but rather suggest that it can be used as an adjunct assessment measure as needed.
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PMID:Accuracy of parental-global-impression of children's acute pain. 1754 26

Pain represents the most feared symptom of illness but for many years it has been underestimated in children. Only recently has analgesic treatment become an integral part in the assistance of ill children with acute pain, such as postoperative pain, and with chronic pain. Postoperative pain is a complication of surgery: postoperative pain prevention should replace the current theory and practice of postoperative treatment through the creation of ''pain services'' and adequate pain prevention planning. Pain prevention begins in the preoperative period, continues in the operating theaters and in the postoperative phase. A multimodal approach should employ techniques of loco-regional anesthesia using a variety of agents from opioids to nonsteroidal anti-inflammatory drugs or paracetamol. The techniques we currently use to control procedural pain are both medical and nonmedical. Nonmedical interventions such as distraction, muscular relaxation, and guided imagination for pain control are psychological techniques showing very good results in those children who must undergo various procedures. The medical treatment must guarantee both sedation and effective analgesia. Our medical approach includes local anaesthesia, conscious sedation, deep sedation, and general anaesthesia.
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PMID:Methodologies for the treatment of acute and chronic nononcologic pain in children. 1766 Jul 39

Post-operative pain in older people is a growing problem as the number of those undergoing surgical procedures for cancer continues to increase. Difficulties arise because of the complex nature of the pain itself and the variable manner in which older people can present and respond to treatment. Inadequately treated acute pain can result in significant consequences. Not all healthcare professionals have sufficient knowledge and training in this specific area. Management is also hindered by the limited kinds of pharmacological and non-pharmacological treatments actually available on a day-to-day basis. Nonetheless, much can still be done. Instead of being protocol driven, post-operative pain management should be tailored to the individual patient's requirements. This can be achieved through effective communication between healthcare team and patient, careful pre-operative planning and selective use of common analgesics based on knowledge of the different advantages and disadvantages of each.
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PMID:A review of the literature on post-operative pain in older cancer patients. 1786 93

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for inter-individual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychological and emotional distress, and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiological changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient-monitoring practices.
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PMID:Assessment, physiological monitoring, and consequences of inadequately treated acute pain. 1829 90

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for interindividual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychologic and emotional distress and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiologic changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient monitoring practices.
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PMID:Assessment, physiological monitoring, and consequences of inadequately treated acute pain. 1822 90


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