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

Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. For minor surgery, regional anaesthesia associated to a light sedation is sufficient. However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.
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PMID:[Analgesia after surgery of the shoulder]. 874 51

A double-blind randomised clinical trial was undertaken in 40 patients undergoing major abdominal surgery. Postoperative pain relief was provided using epidural infusions of 0.06% bupivacaine with fentanyl 4 micrograms.ml-1 (n = 20) (group F) or with pethidine 1.5 mg.ml-1 (n = 20) (group P). Postoperative pain scores using a visual analogue scale (0-100 mm) were not significantly different between the two groups. Median pain scores were 0-19 mm at all times of assessment indicating that good analgesia was provided by both regimens. There was no significant difference between the epidural infusion rates in the two groups. The side effects and effect on pulmonary function were similar in each group. Nine patients were withdrawn from the study (four from group F, five from group P) due to failure of the epidural technique or other complications. Fourteen patients, equally distributed, required a total of 24 epidural 'top-ups' by an anaesthetist because of inadequate analgesia. We demonstrated no advantage with epidural pethidine over fentanyl when used by infusion in combination with bupivacaine in the management of postoperative pain.
Anaesthesia 1996 Jul
PMID:A comparison of epidural infusions of fentanyl or pethidine with bupivacaine in the management of postoperative pain. 875 69

Sympathetic nervous system stimulation, which releases noradrenaline, influences the nociceptor activity which develops after tissue injury. The alpha 2-adrenergic agonist, clonidine, produces analgesia through a central mechanism but also inhibits noradrenaline release at terminal nerve fibre endings. Clonidine may induce analgesia when administered at peripheral sites. This study assesses the potential analgesic effect of clonidine after intra-articular administration. Forty ASA I-III patients, scheduled for arthroscopic knee surgery under general anaesthesia were allocated randomly in 4 groups of 10 patients each, at the end of the surgical procedure. In the control group (group 1), the patients received 20 ml of intra-articular isotonic saline. In group 2, the patients received 150 micrograms of clonidine diluted in 20 ml of isotonic saline injected into the knee joint. In group 3, the patients were given 20 ml of intra-articular isotonic saline and clonidine 150 micrograms was injected subcutaneously. In group 4, morphine 1 mg, diluted in 20 ml of isotonic saline, was injected into the knee joint. Postoperative pain was assessed in a double-blind fashion using a visual analogue scale (VAS) at 1, 2, 3, 6 and 24 h after the end of surgery. VAS scores were significantly lower in groups 2 and 4, compared to groups 1 and 3, at 1 and 2 h after surgery. The delay between intra-articular injection and further postoperative analgesic administration was significantly longer (P < 0.05) in group 2 (533 +/- 488 min) compared to groups 1 and 3 (70 +/- 30 min and 132 +/- 90 min, respectively). The difference was not significant between group 4 (300 +/- 419 min) and the other groups. We conclude that a low dose of intra-articular clonidine produces analgesia unrelated to vascular uptake of the drug. This study further supports a peripheral analgesic effect of clonidine.
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PMID:Peripheral analgesic effect of intra-articular clonidine. 878 26

The effect of intravenous ketoprofen in reducing pain after laparoscopic sterilisation was studied in a placebo controlled, randomised setting in 100 patients undergoing outpatient laparoscopic sterilisation. The study group receive 100 mg ketoprofen i.v. 2 min prior to induction of anaesthesia and an additional 100 mg was infused in 60 min. The control group received saline. Postoperative pain was assessed by verbal ratings and Visual Analogue Scale (VAS) (0-100 mm) and pain medication was standardised. Achievement of toleration of oral fluids, walking and voiding were assessed as parameters of home readiness. Pain during the first three postoperative days was assessed by a postal follow-up questionnaire. After awakening the patients in the ketoprofen group had significantly (P < 0.05) less pain [median VAS 25 (range 8-80) mm compared to the control group 41 (0-87) mm]/ A 30% reduction of fentanyl requirement was seen in the study group [median 0.1 (range 0-0.3) mg] compared to the control group [0.15 (0.05-0.35) mg] in the postanaesthesia care unit (P < 0.05). Furthermore, significantly (P < 0.05) less paracetamol was needed in the study group in the Phase II recovery room. The results suggest that patients given ketoprofen have less pain upon awakening and need fewer analgesics for postoperative pain after laparoscopic sterilisation when compared to patients given saline. However, overall pain after awakening or time to home readiness did not differ between the groups.
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PMID:Effect of intravenous ketoprofen on pain after outpatient laparoscopic sterilisation. 884 2

Outpatient surgery benefits patients only if postoperative sequelae are effectively treated. After laparoscopic tubal ligation (TL) intense pain and consequent postoperative nausea and vomiting (PONV) has been a problem delaying recovery and resulting in hospital admission. Ninety patients were randomised to this double-blind study, the aim being to evaluate the effect of balanced analgesia on postoperative pain and recovery after sterilization. The balanced analgesia group received 5 ml of 2% lidocaine gel on the sterilization clips and perioperatively 200 mg of ketoprofen i.v. The lidocaine group received 5 ml of 2% lidocaine gel on the clips and placebo i.v. perioperatively. The placebo group received 5 ml of placebo gel on the clips and placebo i.v. perioperatively. Infusion of propofol and 67% nitrous oxide in oxygen were used for maintenance of anesthesia. Succinylcholine and vecuronium were used for muscle relaxation and 0.1 mg of fentanyl i.v. was given to all patients at induction of anesthesia. Postoperative pain and analgesic requirements, incidence of PONV and need for antiemetic medication were all significantly lower in the balanced analgesia group. Home readiness was consistently achieved 70-90 min sooner in the balanced analgesia group compared to the other groups (P < 0.01 between the balanced analgesia and the placebo group), and the patients were able to return to normal activity sooner (cumulatively 93% of the patients in the balanced analgesia group vs. 60% in the other two groups (P < 0.01 between the balanced analgesia and the other groups) had returned to normal activity on the 2nd postoperative day). It is concluded that in patients undergoing laparoscopic TL the combination of analgesic regimens with different mechanisms of action offer a simple and efficient way of postoperative pain relief, as well as an improvement of quality (i.e. less PONV) and speed of recovery.
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PMID:Balanced analgesia improves recovery and outcome after outpatient tubal ligation. 884 11

This prospective, randomized double-blind study was conducted to examine the effect of intraoperative opioid (fentanyl) supplementation on postoperative analgesia, emesis, and recovery in ambulatory patients receiving propofol-nitrous oxide anesthesia. Eighty patients undergoing ambulatory gynecologic laparoscopy participated. Confounding variables that could influence the incidence of postoperative emesis were controlled. Patients received either fentanyl 100 micrograms (Group I) or ketorolac 60 mg (Group II) intravenously (IV) at the time of anesthetic induction. No further analgesic supplements were given intraoperatively. Anesthesia was induced with propofol and maintained with propofol-nitrous oxide. Atracurium was used for muscle relaxation and reversed with neostigmine and glycopyrrolate. Postoperative pain during early recovery was treated with IV fentanyl 25-50 micrograms (Group I) or IV ketorolac 15-30 mg (Group II). Subsequent breakthrough pain in both groups was treated with IV fentanyl 25 micrograms increments as needed (rescue analgesia). Eighty-four percent of patients in Group I required analgesics during early recovery versus 56% of patients in Group II (P < 0.05). Maintenance dose of propofol was significantly lower in Group I (129 +/- 35 micrograms.kg-1.min-1 than in Group II (170 +/- 63 micrograms.kg-1.min-1. Immediate recovery (emergence) in the two groups was comparable, despite different propofol requirements. Although the incidence of emetic sequelae in the postanesthesia care unit was not significantly different between the two treatment groups, a significantly larger number of patients in Group I (fentanyl group) had emetic sequelae that required therapeutic intervention (Group I 29% versus Group II 10%). Patients in Group I also took a significantly longer time to ambulate and meet criteria for home discharge. These results indicate that, in patients undergoing ambulatory gynecologic laparoscopy, the practice of administering a small dose of fentanyl at the time of anesthetic induction reduces maintenance propofol requirement, but fails to provide effective postoperative analgesia. Fentanyl administration at anesthetic induction increased the need for rescue antiemetics. The relative severity of emetic sequelae could have contributed to delay in ambulation and discharge.
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PMID:Recovery after propofol with and without intraoperative fentanyl in patients undergoing ambulatory gynecologic laparoscopy. 889 71

This prospective study was conducted to examine pain after endoscopic sinus surgery (ESS). The hypothesis was that a long-acting anesthetic agent would result in patients experiencing less pain in the 24-hour postoperative period and therefore needing fewer oral analgesics. We randomized 100 patients undergoing ESS to receive either lidocaine (1% or 2%) with epinephrine or bupivacaine (0.25% or 0.5%) with epinephrine as an anesthetic and for a sphenopalatine block. Postoperative pain was assessed with a standard numeric pain assessment scale at baseline and at 2, 6, and 24 hours after surgery. The use of analgesics during this period was also documented. We compared the results between patients receiving bupivacaine and those receiving lidocaine, as well as between patients who required nasal packing and those who did not. We discovered that in general, pain after ESS was less severe than expected. We further found that the type of anesthetic used did not significantly affect postoperative pain; pain score changes and use of analgesics were similar between the two anesthesia groups. Postoperative pain was also similar between the "packing" and "no packing" groups. Although patients receiving packing had consistently lower increases in pain (and in fact many patients in this group had decreases in pain from baseline), none of the differences between group means was statistically significant.
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PMID:Bupivacaine for postoperative analgesia following endoscopic sinus surgery. 891 5

Ten paediatric patients (ASA status 1) who had bilateral club foot deformities and underwent bilateral posterior medio-lateral release within a two week interval (one foot operated each time) were assigned to one of two groups in a double-blind manner. Group one received caudal bupivicaine (0.25%) 2 mg.kg-1 before the surgical incision, followed by caudal normal saline infused at the same volume after the surgical incision. Group two received caudal saline before surgical incision followed by caudal bupivicaine (0.25%) infused 15 min after the surgical incision. No additional analgesic was used before or during the operation. Patients were selected in a manner that allowed each patient to be assigned to either group one or two during the first or second surgical episodes. Anaesthesia was induced with halothane and maintained with nitrous oxide and isoflurane. The anaesthesiologist following the patient for postoperative pain control and analgesic requirement was blinded to the regional technique. Postoperative pain was rated on a paediatric pain scale. Children received a morphine suppository at the appropriate dose related to the body weight for postoperative pain control. There was no significant difference in the cumulative postoperative analgesic requirements within the first 48 h, nor in the time to the first postoperative analgesic administration between the two groups.
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PMID:The effect of perioperative and postoperative caudal block on pain control in children. 893 46

The feasibility of day case laparoscopic cholecystectomy was assessed in unselected patients using a standard anaesthetic protocol. Postoperative pain and nausea were assessed at 6 and 24 h postoperatively (visual analogue scale, range 0-10). Thirty-two patients were studied (23 female, 9 male, mean age 49.6 years). The mean duration of surgery was 68 min. At 6 h after surgery, 10 patients (31%) had no pain at rest. For the group as a whole, the median pain score was 3 at rest (range 0-6), 4 on movement (0-9), and 5 on coughing (0-9) and eight patients (25%) were nauseated. At 24 h, 15 (46.9%) had no pain at rest. For the group as a whole, the median pain score was 1 at rest (0-7), 3 (0-6) on movement and 3 on coughing (0-9). The same eight patients were nauseated. Ten patients (31.3%) were judged fit for discharge at 6 h, and 28 (87.5%) by 24 h. There was no statistical difference in mean age or duration of surgery in those judged fit for early discharge compared to the study group as a whole. Nausea was an important factor in those unfit for discharge at 24 h. Selection criteria might improve these figures. From the results of our study, 24 h admission is a more realistic goal and will be suitable for most patients requiring laparoscopic cholecystectomy.
Anaesthesia 1996 Oct
PMID:Feasibility of day case laparoscopic cholecystectomy in unselected patients. 898 74

A 26-yr-old morbidly obese parturient with a body mass index of 62 kg.m-2 underwent elective cesarean section for preeclampsia under epidural anesthesia. The distance between the skin and the epidural space was about 9 cm at the L3-4 interspace via mid approach. Epidural catheter was inserted 5 cm cephalad in the sitting position and a bolus of 17 ml of mepivacaine 1.5% was given in the supine position. The T5 level of analgesia was obtained 10 min later. Forty minutes after the start of the surgery, a female newborn weighing 3,206 g was delivered with an Apgar score 8 at 1 min and 9 at 5 min. Throughout the surgery, sufficient analgesia was obtained and any complications such as severe hypotension and respiratory depression did not develop. Postoperative pain was relieved sufficiently with a continuous epidural infusion of 0.25% bupivacaine at a rate of 0.5 ml.h-1 for two days. Both maternal and neonatal postpartum courses were uneventful. In conclusion, elective cesarean section in a morbidly obese parturient was successfully managed with epidural anesthesia. This indicates that an elective cesarean section under epidural anesthesia reduce the risk of perioperative complications in a morbidly obese parturient.
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PMID:[Cesarean section in a morbidly obese parturient under epidural anesthesia]. 899 52


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