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

A prospective study has been performed of factors influencing postoperative pain in a cohort of children undergoing dental extractions under general anaesthesia. Postoperative pain was assessed immediately after recovery from anaesthesia and also by using a visual linear analogue scale which was completed by the parent hourly for the first 10 hours and then at 24 hours. Analgesic use was also recorded. The most significant factor influencing postoperative pain was the relationship of the accompanying adult to the child; children attending with their mothers were more likely to complain of postoperative pain (P < 0.05). The results also suggested that the age of the patient and the extraction of primary rather than permanent teeth were influencing factors, although they did not reach statistical significance. Pain was reported by 57.5% of the children immediately after treatment. It would seem that the greatest need for postoperative analgesia is immediately after the dental procedure, especially in young children undergoing multiple extractions.
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PMID:Pain reported by children after dental extractions under general anaesthesia: a pilot study. 832 33

Sixty five children aged from 1-10 years who underwent herniotomy, cystolithotomy or orchidopexy received either buprenorphine 4 micrograms kg-1 (n = 33) or morphine 50 micrograms kg-1 (n = 32) by the caudal epidural route; each thus received 0.5 ml kg-1 body weight. General anaesthesia was given for surgery. Post-operative pain and behaviour were assessed by an independent observer at 1, 4, 8, 16 and 24 h post-operatively. Caudal morphine and buprenorphine were equally effective for post-operative analgesia in children, but buprenorphine was better because of its longer duration of action and lower incidence of side effects.
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PMID:Comparison of caudal morphine and buprenorphine for post-operative analgesia in children. 833 Jun 2

Anterior cruciate ligament reconstruction by free patellar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecutive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B) a transpatellar tendon approach was used. Postoperative pain was managed by analgesics and, in patients who had epidural anesthesia, by administration of bupivacaine in indwelling catheters. Generally, the analgesics and bupivacaine were given immediately on request to establish comfort at rest and to permit range of motion exercises without severe pain. Compared with those in Group A, the patients of Group B had a significantly longer period from the first dose of analgesic or bupivacaine to the second, and the total number of doses of analgesic or bupivacaine was significantly lower. In the subgroup of patients with epidural anesthesia (21 in Group A and 32 in Group B), the Group B patients required significantly less analgesics, as doses equivalent to 10 mg of morphine, compared with that of Group A.
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PMID:Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach. 836 9

This report describes the anaesthetic management of a women with a term gestation, Von Hippel Lindau disease (VHLD), and a phaeochromocytoma, scheduled for a combined phaeochromocytoma resection and Caesarean section. Von Hippel Lindau disease is characterized by diffuse haemangioblastomas of the central nervous system (CNS) and viscera. It is also associated with phaeochromocytomas and renal cell carcinomas. Patients frequently have asymptomatic spinal cord and intracranial pathology. The patient and her fetus presented a challenge because of the anaesthetic restrictions imposed by VHLD, and her pregnancy. She was also at risk of developing malignant hypertension from the phaeochromocytoma. The patient was not a candidate for regional anaesthesia because of the possibility of spinal cord haemangioblastomas. She had received adrenergic blockade with phentolamine (total 30 mg a day) and propranolol (total 40 mg a day) since the 27th wk of gestation in order to control hypertension secondary to the phaeochromocytoma. General anaesthesia was administered with aggressive management of hypertension with adrenergic blockers (labetalol 1.0 mg.kg-1 and esmolol 0.75 mg.kg-1) and sodium nitroprusside 1.5 micrograms.kg-1 (total). Before delivery of the baby, opioids, which could have resulted in a fetus with CNS depression, were avoided. After delivery, opioids (sufentanil 0.4 microgram.kg-1 x hr-1) were used to limit the use of inhalational anaesthesia which may contribute to uterine atony. Postoperative pain was managed with an intravenous narcotic infusion. Both patients had uneventful postoperative courses.
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PMID:Caesarean section and phaeochromocytoma resection in a patient with Von Hippel Lindau disease. 840 82

Clonidine is an effective preanesthetic medication in children, providing a preoperative sedative effect. The analgesic properties of the drug have been well documented in adults. The current study was designed to investigate the effect of oral clonidine given preoperatively on postoperative pain in children undergoing minor surgery. In a prospective, randomized, controlled clinical trial, 90 children aged 5-12 yr undergoing elective ophthalmic, urologic, and otologic surgery received placebo (control), clonidine 2 micrograms/kg, or clonidine 4 micrograms/kg. These drugs were administered 105 min before the estimated time of induction of anesthesia and followed by treatment with oral atropine 0.03 mg/kg 60 min before anesthesia. Anesthesia was induced and maintained with halothane and nitrous oxide in oxygen. Postoperative pain was assessed by a blinded observer using an objective pain scale (OPS). Clonidine 4 micrograms/kg provided lower OPS (highest) scores during 12 h after surgery and reduced requirement for postoperative supplementary analgesic (diclofenac suppository) compared with the other two regimens. These data suggest that oral clonidine premedication (4 micrograms/kg) is a possible approach to facilitating postoperative analgesia in children undergoing minor surgery.
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PMID:Oral clonidine premedication reduces postoperative pain in children. 1203 63

The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the propacetamol is injectable and its side effects are uncommon and mild, it is the drug commonly used in France for postoperative pain relief. The aim of this prospective study was to compare the analgesic efficacy of propacetamol after breast surgery or thyroidectomy when it was administered either systematically or on the patients demand. After informed consent, 119 patients having undergone breast surgery or thyroidectomy, having received the same general anaesthesia and scheduled for receiving propacetamol postoperatively, were included in the study. Two groups of patients were compared, those who received propacetamol on demand (D Group) and those who received propacetamol systematically (S Group). During the first 24 hours, analgesia was evaluated on a visual analogical scale graded from 0 to 100 mm, at rest and during mobilization; the efficacy was also evaluated by the amount of additional analgesic drug injected. Side effects were also compared between the 2 treatment groups. In the 2 groups, demographic data, type of anaesthesia and type of surgery were identical. Postoperative pain relief and supplemental injection of morphine were not statistically different between the 2 groups. Propacetamol doses were statistically higher in the S group than in the D group (7.8 +/- 0.7 g and 3.9 +/- 2.3 g respectively, p < 0.05). Pain during propacetamol infusion was more frequent in the D group than in the S group (30% and 13% respectively, p < 0.05). No other adverse effects were observed during the study. Propacetamol alone is sufficient for pain relief after peripheral surgery; more than 90% of patients need no supplemental analgesic, and adverse effects are rare.
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PMID:[Efficacy of propacetamol in postoperative pain based on two modes of intravenous administration]. 856 52

Since January 1993, 9 patients with bilateral ureteral obstruction due to advanced pelvic cancers underwent videoendosurgical cutaneous ureterostomy. Five patients had prostate cancer, 3 had uterine cancer and only 1 bladder cancer. In 5 cases a bilateral laparoscopic transperitoneal procedure was performed. In 4 cases a retroperitoneal laparoscopic technique was adopted and only in 1 out of these 4 cases the procedure was done bilaterally. All the procedures were done under general anesthesia. The procedure was accomplished in all the cases without any intraoperative complication; the operative time ranged between 35 and 130 min. Postoperative pain was rather insignificant and did not require additional medication. Postdiversion hospital stay ranged from 3 to 11 days according to the general condition of the patients. The mean follow-up is 10.8 months. In conclusion, retroperitoneal laparoscopic cutaneous ureterostomy seems to be a reasonable alternative to percutaneous nephrostomy in case of bilateral ureteral obstruction due to advanced prostate or uterine cancer, provided that the clinical condition of the patient allows general anesthesia.
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PMID:Videoendoscopic cutaneous ureterostomy for palliative urinary diversion in advanced pelvic cancer. 857 2

Thirty-six patients undergoing elective thoracotomy with pulmonary resection with the use of combined epidural and general anesthesia were randomized into a double-blind study to receive a single intravenous preoperative dose of methylprednisolone 25 mg/kg body weight or a placebo (saline solution). Postoperative pain relief consisted of epidural morphine 4 mg and paracetamol 1 gm three times a day for 4 days. Postoperative pulmonary function (peak expiratory flow rate, forced expiratory volume in first second, forced vital capacity) was evaluated on days 1, 2, 3, 4, and 7 and after 1 month. The value obtained after 1 month served as the control value. Pain score at rest and during cough was evaluated after 4 and 8 hours and on days 1, 2, 3, and 4. Pulmonary function was reduced after operation to the same degree in the steroid and placebo group: 42% versus 41% for forced expiratory volume in first second and 38% versus 39% for forced vital capacity, compared with control values after 1 month. Pain score was reduced in the steroid group after 4 hours and on day 1 during rest and after 4 and 8 hours and on day 2 during cough, compared with results in the placebo group (p < 0.05). In the steroid group three patients underwent reoperation because of leakage through the chest wall incision. In conclusion, administration of a single preoperative dose of methylprednisolone did not affect the postoperative reduction in pulmonary function after thoracotomy despite attenuated pain response, and the results do not warrant steroid administration before lung operation.
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PMID:The effect of preoperative methylprednisolone on pulmonary function and pain after lung operations. 869 60

Both intravenous ondansetron (OND) and droperidol (DROP) have been observed to reduce vomiting after tonsillectomy in children. This randomized, double-blind investigation compared the effect of OND and DROP on vomiting after outpatient tonsillectomy in 276 healthy children age 2-12 yr. All subjects received a standardized anaesthetic, which consisted of induction with either propofol or halothane/N2O, vecuronium 0.1 mg x kg(-1) on an as needed basis, maintenance with halothane/N2O, midazolam and codeine, and reversal of neuromuscular blockade with neostigmine and atropine on an as needed basis. Subjects were given either OND 150 micrograms x kg(-1) or DROP 50 micrograms x kg(-1)iv after induction of anaesthesia. Rescue antiemetics in the hospital were administered to patients who vomited X 2 and X 4, respectively. Postoperative pain was treated with morphine, codeine and/or acetaminophen. For 24 hr following surgery, emesis was recorded by nursing staff while subjects were in the hospital, and by parents following discharge from hospital. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. The frequency of in-hospital emesis was 16% in the OND-patients and 30% in the DROP-group, P <0.05. The OND-subjects required fewer rescue antiemetics, 5% vs 13%, P <0.05. The overall incidence of emesis was 45% in the OND-group and 57% in the DROP-group, P <0.05. In conclusion, ondansetron was a superior prophylactic antiemetic for tonsillectomy in children when compared to droperidol.
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PMID:Ondansetron is a better prophylactic antiemetic than droperidol for tonsillectomy in children. 870 91

Postoperative nausea, vomiting and pain were compared between laparoscopic cholecystectomy group and minilaparotomy-cholecystectomy group. All patients were women, and ranged in age from 20 to 60 years. The body mass index of the patients was less than 30, and duration of operation was within 120 minutes in both groups. All patients received general anesthesia combined with epidural analgesia. Morphine hydrochloride 4 mg was administered into epidural space before incision. No significant differences were found in the incident of nausea and vomiting among the two groups. Postoperative analgesic requirement of laparoscopic cholecystectomy group was significantly less than that of minilaparotomy-cholecystectomy group. No significant differences were found in the incidence of nausea and vomiting between the group which required postoperative analgesic drugs and the group which required no postoperative analgesic drugs. These results suggest that laparoscopic operation and postoperative pain do not influence the incidence of nausea and vomiting. Postoperative pain after laparoscopic cholecystectomy is less than that after minilaparotomy-cholecystectomy.
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PMID:[Postoperative nausea, vomiting and pain in laparoscopic cholecystectomy: a comparison with minilaparotomy-cholecystectomy]. 872 5


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