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

The intraoperative use of opioid analgesics decreases the volatile anesthetic requirement and provides for pain relief in the early postoperative period. In a randomized double-blind, placebo-controlled study involving 95 ASA physical status 1 or 2 children (ages 5-15 yr) undergoing general anesthesia for elective operations, we compared postoperative analgesia following the intraoperative intravenous (iv) administration of ketorolac, a nonsteroidal antiinflammatory drug or morphine, an opioid analgesic. After induction of general anesthesia and before the start of the surgical procedure, children received equal volumes of saline, morphine (0.1 mg.kg-1, iv) or ketorolac (0.9 mg.kg-1, iv). Postoperative pain was evaluated by the child using a 10-cm linear visual analog scale (VAS) and by a blinded observer using both a VAS and an objective pain scale (OPS) in the postanesthesia care unit (PACU). There were no statistically significant differences in the VAS and OPS scores in the PACU or in the postoperative analgesic requirements in children receiving morphine or ketorolac. The placebo group had a significantly higher VAS and OPS score and required earlier and more frequent analgesic therapy in the PACU compared to the two analgesic groups. Patients receiving ketorolac had less postoperative emesis than those receiving morphine. We conclude that ketorolac (0.9 mg.kg-1) is an effective alternative to morphine (0.1 mg.kg-1) as an iv adjuvant during general anesthesia, and in the dose used in this study, is associated with less postoperative nausea and vomiting in children.
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PMID:Comparison of ketorolac and morphine as adjuvants during pediatric surgery. 151 1

Postoperative pain relief immediately after major surgery cannot be achieved with opioids alone in all patients without respiratory depression or other significant side effects. This investigation was conducted to determine whether the need for opioids and the incidence of side effects can be reduced while maintaining the quality of pain relief using a nonsteroidal antiinflammatory drug as an adjuvant to an opioid. The analgesic efficacy and safety of patient-controlled analgesia using fentanyl with and without intravenous diclofenac were compared after total hip replacement. Forty patients were randomly assigned to receive either diclofenac 75 mg as an initial intravenous loading dose followed by an infusion of 5 mg per hour or saline in a double-blind fashion. The amount of fentanyl administered was recorded. The patients assessed their pain intensity verbally and on a visual analogue scale at intervals of 4 h. The diclofenac group showed a significant reduction in the amount of fentanyl administered during the first 16 h postoperatively as compared to the placebo group (0.65 mg +/- 0.2 vs. 1.08 mg +/- 0.4 respectively, P less than 0.01), and also reported less pain at 16 h (median score on visual analogue scale 0.75 vs. 2.4 respectively, P less than 0.05)). There were no differences in side effects, postoperative blood loss, plasma activated partial thromboplastin time, or Ivy bleeding time between the groups. In conclusion, the addition of diclofenac led to a reduction in fentanyl requirement but did not have any other significant advantages in the treatment of pain following major orthopedic surgery.
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PMID:Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement. 173 95

Surgery on the shoulder often causes severe pain and, therefore, requires high doses of opiates. As postoperative pain is frequently treated inadequately, it is desirable to seek alternatives for providing effective analgesia. In a prospective study we examined the efficacy of balanced anesthesia consisting of general anesthesia combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for operations on the shoulder. METHODS. Using the technique described by Winnie, interscalene block (ISB) was performed in 100 awake patients. After location of the brachial plexus by means of a peripheral nerve stimulator, we injected 40 ml bupivacaine 0.375%, after which general anesthesia (GA) was induced. At three predetermined points in time (recovery room, 8 h, and 24 h after the end of surgery), pain was evaluated by a visual analogue scale ranging from 0 to 10 and the extent of sensory blockade was tested by the pinprick method. The results of the pain scores and individual demands for analgesics were compared with a group of 22 patients who received only GA. Both groups were comparable in age, sex, and type of surgical procedure. RESULTS. We noted technical failure of the ISB in 8% of our patients. Side effects such as Horner's syndrome (18%), phrenic nerve paralysis (10%), and recurrent laryngeal nerve block (1%) were only temporarily observed during the action of the local anesthetics. During the surgical procedure, the group with ISB received a mean dose of 0.13 +/- 0.07 mg fentanyl versus 0.29 +/- 0.08 mg in the GA group (P less than 0.01) with equipotent doses of volatile anesthetics (1.0 to 1.5 MAC enflurane). Postoperative pain occurred for the first time in 39% of the patients given ISB later than 12 h after the end of surgery (average 8.7 +/- 5.9 h). In contrast, 95% of the patients with GA complained of pain in the recovery room. Pain measurement by the analogue scale clearly demonstrated the advantages of balanced anesthesia directly and 8 h after the operation (P less than 0.01). Even 24 h after the end of the surgical procedure the patients had better pain relief (P less than 0.05) in spite of the decreasing effect of the ISB. These significant differences led to the following results for postoperative treatment: 35% of the patients with ISB did not require additional analgesics during the first 24-h period after surgery, whereas 95% of those with GA requested analgesia. Only 32% of the ISB patients required opioids versus 86% with GA. The average duration of stay in the recovery room was reduced by 25% in the group with ISB (86 vs 134 min). In a final assessment, 84% of the patients were satisfied with the balanced anesthesia and only 5% were disappointed with the method. CONCLUSION. The combination of ISB and GA allows a reduction in intraoperative doses of opiates and facilitates postoperative pain management. Because of the low incidence of side effects, the lack of complications, and the high degree of patient acceptance, we recommend this type of balanced anesthesia for patients undergoing shoulder surgery.
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PMID:[The combination of general anesthesia and interscalene block in shoulder surgery]. 174 12

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

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

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

Postoperative pain management in the critically ill patient is a challenge for nurses. Knowing the basis of pain transmission and mechanisms of action of interventions can assist the critical care nurse in making clinical decisions regarding pain control for individual patients. There are a number of modalities available to treat postoperative pain including both pharmacologic and nonpharmacologic interventions. Techniques such as PCA not only can provide good analgesia, but allow the critically ill patient at least one aspect of control in the otherwise highly controlled environment of the critical care unit. Epidural or intrathecal analgesia, using either opioids or LAAs alone or in combination, provides excellent analgesic effect (with minimal side effects) and may improve patient outcomes. Nonpharmacologic techniques, unfortunately, are commonly overlooked as adjuncts to traditional analgesia routines because of the nature of the illness in the critically ill patient. Nonpharmacologic techniques of pain management have a place in the care of the critically ill when applied based on the assessment of an individual patient's needs and abilities to participate in his or her care. Ensuring optimal patient comfort can benefit critically ill patients and improve clinical outcomes.
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PMID:Pain management. 209 59

A prospective, randomized, double-blind trial was conducted to compare the analgesic actions and side effects of sufentanil continuously infused (5 micrograms/h) into the lumbar epidural space (L2-3) with those of an infusion of lumbar epidural morphine (0.5 mg/h). Forty patients admitted to an intensive care unit after elective major abdominal surgery participated over a varying period of 24-40 h. Post-operative pain was treated with an epidural bolus of either sufentanil (50 micrograms) or morphine (5 mg), followed by a continuous infusion of the same opiate. The quality of pain relief was similar in each group. The sufentanil group had a more rapid onset of analgesia. The incidence of nausea and vomiting, pruritus, and drowsiness was similar in the two groups. In spontaneously breathing patients there were no respiratory complications requiring treatment. Forced vital capacities were statistically significantly better during the first 1-4 h with sufentanil.
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PMID:Postoperative pain control with a continuous infusion of epidural sufentanil in the intensive care unit: a comparison with epidural morphine. 214 66

Sixteen otherwise healthy women undergoing cholecystectomy were randomized to receive postoperative analgesia either by continuous infusion of papaveretum (n = 8), or by continuous interpleural infusion of bupivacaine (n = 8). Postoperative pain was assessed by linear analogue and ventilatory capacity. Changes in body protein were measured by in vivo neutron activation analysis. Clinical course was also noted. Pain scores were significantly lower in the interpleural group over the first 48 h (P less than 0.02). Ventilatory capacity was also significantly better for the first 24 h (P less than 0.025). There was no evidence of shortened postoperative ileus; hospital stay and postoperative fatigue were similar for the two groups. Weight and protein losses over a 2 week period were similar in the two groups. It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively, with an advantage in ventilatory capacity over the first 24 h.
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PMID:Interpleural catheter for analgesia after cholecystectomy: the surgical perspective. 220 33


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