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

The efficacy of long-acting local anesthetics for anesthesia during periodontal surgery and for analgesia during the immediate postoperative period was evaluated. The rationale for using long-acting local anesthetics such as etidocaine and bupivacaine is that they can provide surgical anesthesia and, because of their long duration, prevent discomfort that may occur for 4-6 hours postoperatively. Two clinical trials were performed. The first enrolled patients requiring bilateral periodontal surgery. Using a matched pair design and double-blind randomized study conditions, 2% lidocaine 1/100,000 epinephrine was compared with 1.5% etidocaine 1/200,000 epinephrine for periodontal surgery. The time until complete recovery and the time until pain onset were found to be longer for the etidocaine surgeries. Postoperative pain appeared more severe, and the need for oral analgesics was greater for the lidocaine surgeries. Surgeons' rating of surgical bleeding was significantly greater for the etidocaine procedures. When matched bilateral surgeries were not available, a second double-blind randomized parallel trial was performed that compared 1.5% etidocaine 1/200,000 epinephrine to 0.5% bupivacaine 1/200,000 epinephrine. No significant differences were seen in the quality of anesthesia, degree of bleeding, or postoperative pain between these two long-acting anesthetics.
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PMID:A clinical trial of long-acting local anesthetics for periodontal surgery. 209 42

Forty-five patients undergoing total abdominal hysterectomy were randomly divided into three groups. An epidural tube was inserted into one of the following three sites, Th11-12, L2-3, and caudal region. General anesthesia was then maintained with nitrous oxide-oxygen-enflurane, and pancuronium bromide. Morphine hydrochloride 2 mg in 8 ml of normal saline was administered into one of the designated epidural spaces one to two hours before the assumed end of surgery. Postoperative pain was assessed every four hours after the end of the operation until the next morning. Morphine exerted a relatively profound and prolonged analgesic effect in 40% of the Th11-12 group of patients, as well as in 6.7% of the L2-3 and caudal groups. But, supplementary analgesics were necessary in the other patients. No significant differences were found in the degree and extension of postoperative pain, as well as the doses of supplementary analgesics among the three groups. Adverse effects, such as nausea, vomiting and itching, occurred in 30 to 40% of each of the morphine administered groups. Though morphine was applied into different spinal levels, this clinical study did not show any difference in extension of analgesia. The epidurally applied morphine may be distributed widely in the spinal arachnoid space after some time, and may exert an effect on the brain as well as on the spinal nerves. When morphine is administered epidurally one to two hours before the end of a surgical operation, selection of an injection site according to the dermatome level of the skin incision may be unnecessary.
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PMID:[Degree and extension of analgesic effect of morphine applied at three different spinal levels of epidural space]. 227 45

Wide resection in 12 cases of malignant or potentially malignant lesions of the chest wall resulted in full-thickness loss of skeleton and frequently of overlying soft tissues (defect greater than or equal to 15 cm in its smallest diameter or at least 90% of the sternum resected). In reconstruction of the defect, steel bars were used to replace lost ribs and a double layer of Marlex mesh for intercostal spaces. Soft-tissue coverage and primary closure were accomplished with current plastic surgical procedures and good stability of the chest wall was achieved. Protracted respiratory support was required in only one case. Postoperative pain was managed with epidural anesthesia and routine analgesics. Functionally and cosmetically satisfactory long-term results were obtained, with no infection and no need for removal of prosthetic material. The overall 5-year and 10-year actuarial survival rates were 60% and 37.5%. If lesions are radically resectable, the extent of thoracic wall resection need not be restricted because of inability to close the defects.
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PMID:A method for reconstruction of large full-thickness defects of the bony thorax. 235 79

This study examines the incidence and severity of postoperative pain after gingivectomy using one non-eugenol-containing periodontal dressing, Coe-pak (n = 76) and 2 eugenol-containing periodontal dressings, Wondrpak (n = 64) and Nobetec (n = 86). All patients were subjected to gingivectomy using 1 type of local anaesthesia (lidocaine + adrenalin) only and covering the surgical areas with either of the 3 different dressings in a randomized study. Postoperative pain was assessed on 100 mm visual analogue scales over 5 days starting immediately after surgery. No pain was reported by 22.0% of the patients after Coe-pak, 23.4% after Wondrpak and 30.2% after Nobetec. 13.2% of the patients took analgesics after Coe-pak treatment, 3.1% after Wondrpak and 1.2% after Nobetec. Mean pain score after Coe-pak was higher (P less than 0.05) than after Nobetec 2 h after operation until the morning on the 3rd postoperative day. Mean pain score after Coe-pak was higher (P less than 0.05) than after Wondrpak 3 h to 9 h after operation. No statistically significant difference was found between Wondrpak and Nobetec regarding mean pain score.
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PMID:Effect of non-eugenol- and eugenol-containing periodontal dressings on the incidence and severity of pain after periodontal soft tissue surgery. 239 30

We administered general anesthesia for an emergency abdominal surgery due to duodenal ulcer hemorrhage. The patient was in postoperative state after femoral supracondylar fracture, in pre-shock state, of old age (97 y-o), with severe anemia, and hypoproteinemia, and complicated with a giant abdominal aneurysm and mild aortic regurgitation. Before the operation, the patient was transferred to ICU and had intravascular volume replaced (infused with blood 600 ml, crystalloid fluid 2000 ml, colloid fluid 500 ml) and received stomach lavage. Under monitoring of direct arterial pressure, after fully pre-oxygenation, fentanyl 0.1mg was administered slowly, and crush induction was performed by a small dose of thiopental and SCC. After induction of anesthesia systolic blood pressure decreased to 60 mmHg temporarily and it was maintained between 80 and 120 mmHg during the surgery, but tachycardia continued (90-110.min-1). In order to treat oliguria owing to pre-shock state, we administered dopamine and urinastatin continuously. The patient was transferred to ICU postoperatively and close attention was paid. Postoperative pain controlled was well by epidural morphine and bupivacaine. The postoperative course was uneventful without any complications. Twenty three days later, abdominal aortic aneurysm resection was performed uneventfully. In this paper, problems of preanesthetic and anesthetic management of emergency abdominal surgery for an aged patient were discussed.
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PMID:[Anesthetic experience in emergency abdominal surgery in a 97-year-old patient complicated with a giant abdominal aneurysm]. 258 3

Pain in the muscles and the feeling of tension in the lower legs along the varicose veins brings many patients, especially women to an operation, usually after previous attempts of conservative treatment. The aim of the work was to present the choice of analgesia for the operation of the veins of the lower limbs with the control of the post-operative analgesia. The methods included two groups of patients. One group received halothane inhalation anaesthesia in combination with nitrous oxide and oxygen, and the other ketamine hydrochloride anaesthesia applied intravenously. Postoperative pain was graded as strong, medium, mild, and painfree state. The pain intensity was assessed for each patient by the hours, and by multiplying the obtained score by the number of patients, we got the total pain scores. The pain relief 1, 2, 3, and 4 hours after the administration of propoxiphen napsilate with paracetamol was calculated according to the formula: Br = Bo-B1 (2,3,4). As compared to the placebo, we got p.o.05 in favour of the active substance after ketamine hydrochloride anaesthesia. The results have shown that postoperative pain was much lower in the group of patients who had ketamine hydrochloride anaesthesia, what together with increased oxygen saturation during anaesthesia leads to the conclusion that this anaesthesia is appropriate for operations on the veins of the lower limbs because it ensures postoperative analgesia and oxygenation without oxygen inhalation. This is important because in the region attacked by varicosity the tissue metabolism is disturbed, oxygenation decreased and the values of pCO2 increased, frequently followed by skin atrophy, lower limb edema and lymphostasis.
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PMID:[Anesthesia in patients with varicose syndrome]. 261 18

Postoperative pulmonary complications are not uncommon, and the factors that contribute to lung dysfunction are well documented. Postoperative pain, spasm, and paralysis are all known to reduce lung function, although relief of pain does not completely restore function. Rather, diaphragmatic dysfunction has been found to persist even with adequate pain relief. Functional residual capacity is reduced both by the supine position and anesthesia. During anesthesia, the reduced FRC can contribute to airway closure during expiration and to a compression atelectasis that in turn precipitates hypoxemia and infection. Muscle paralysis can also create or contribute to atelectasis. Microthromboembolism impedes perfusion distribution, adding to the other causes of a ventilation-perfusion mismatch. Different anesthetic techniques and intraoperative management may help prevent or reduce the incidence of postoperative lung complications.
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PMID:Mechanisms of postoperative pulmonary dysfunction. 265 66

Three retrospective studies were conducted at St. Vincent's Hospital to compare the outcomes of colorectal anastomoses, with and without resections, with respect to anesthetic technique. Operations were performed upon patients anesthetized with either combined regional (epidural) and general anesthesia (CRAG) or general anesthesia alone (GA). Postoperative pain relief was achieved with either continuous epidural analgesia (CEA) in the CRAG group or with postoperative narcotics in the GA groups (GA/PN). In one group, a different regimen was introduced: combined epidural and general anesthesia with postoperative epidural morphine (CRAG/EDM). Overall, anastomotic leak rates and death rates were lower in the CRAG group, and the lowest incidence of anastomotic leak was reported in the patients receiving CEA. Thus the reduced leak rate was associated more with the postoperative analgesia regimen than with the anesthetic technique. An increased incidence of wound dehiscence occurred with postoperative epidural morphine analgesia.
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PMID:Combined epidural and general anesthesia versus general anesthesia in patients having colon and rectal anastomoses. 271 11

A prospective comparative study was carried out between two anesthetic techniques for chemonucleolysis. Patients were divided into 2 groups of 50 patients each. Group A were submitted to general anesthesia and group B to epidural anesthesia with 0.5% bupivacaine, 2% mepivacaine and buprenorphine. Group B was divided into 2 subgroups: in B1, buprenorphine was administered with the local anesthetics, while in B2 buprenorphine was administered postoperatively when pain appeared. Postoperative pain and side effects like anaphylaxis were evaluated. No anaphylactic reactions occurred. Severe lumbar pain appeared in 22% of patients in group A in spite of systematic analgesics, while group B lumbalgia was not severe in any case. Patients in subgroup B1 did not have pain during the 24 first hours and 47.8% of patients in subgroup B2 needed in most of the cases only a dose of buprenorphine. We conclude that epidural anesthesia is a good technique in chemonucleolysis and that the association bupivacaine, mepivacaine and buprenorphine provides a good postoperative pain relief.
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PMID:[Chemonucleolysis. Peridural anesthesia versus general anesthesia]. 278 Oct 93

In a double-blind, randomized study of 29 patients who underwent orthopedic procedures we studied the additional effect of intrathecal buprenorphine on isobaricpinal anesthesia and postoperative analgesia. The injections were 20 mg tetracaine (19 patients) or 20 mg tetracaine plus 0.15 mg buprenorphine (10 patients). In both groups the drugs were contained within a total volume of 4 ml cerebrospinal fluid. Progression and regression of the sensory blockade of spinal anesthesia were estimated with pinprick; the motor blockade was judged by the Bromage scheme. Postoperative pain was evaluated by the patients using an analogue scale after Scott and Huskisson. Arterial blood gases, respiratory rate, blood pressure, and heart rate were measured and other side-effects determined. Both groups were comparable in age, body weight, height and duration of operation (Table 1). The addition of buprenorphine elevated the sensory blockade by three segments both during spread and regression of anesthesia (Figs. 1, 2). Postoperative analgesia was better up to 8 h after injection (p less than 0.05), after 8 h pain levels were equal in test and control groups (Fig. 3). After buprenorphine patients became aware of pain sensation 13 h after injection; in the control group the pain-free interval lasted only 9 h (p greater than 0.05). There were no differences in the need for postoperative analgesics between both groups. The respiratory rate was lower during the whole period of observation (p less than 0.05). The mean values for PaCO2, pH and BE were similar in both groups (Fig. 4). PaO2 was elevated in the buprenorphine group. There was no essential alteration of blood pressure after buprenorphine. The pulse rate, however, was slightly diminished.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[O.15 mg Intrathecal buprenorphine applied for postoperative analgesia. A clinical double-blind study]. 311 38


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