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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 relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.
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PMID:[Peridural opiate analgesia. Clinical results of a 2-year study]. 661 18

In a double-blind study of post-cesarean analgesia, a single dose of 4 mg epidural morphine sulfate (EMS), with and without epinephrine, was compared with an equal dose of intramuscular morphine (IMS). Postoperative pain was assessed by visual analogue scores and the frequency of patient requests for subsequent meperidine injections. Plasma concentrations of morphine base after EMS and IMS were contrasted. Clinically apparent adverse effects were recorded. The stability of the preservative-free morphine preparation was substantiated. Pain indices after EMS were improved significantly over those after IMS. Pain scores and requests for intramuscular meperidine indicated that the onset of effective EMS analgesia was delayed. The duration of EMS analgesia was about 20 h. No significant difference between the effect of EMS with and without epinephrine was demonstrated. No circulatory or respiratory depression was attributed to the use of 4 mg EMS. The mean peak plasma morphine concentration after 4 mg EMS was significantly lower and later than the mean peak after 4 mg IMS. No correlation was observed between plasma morphine concentration and analgesic effect. These results support the view that epidural administration delivers more of a given dose of morphine directly (rather than via the bloodstream) to the spinal site of action than does intramuscular administration.
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PMID:Pain relief and plasma concentrations from epidural and intramuscular morphine in post-cesarean patients. 689 54

Postoperative pain relief obtained by the thoracic epidural injection of 5 or 10 mg morphine was assessed in two groups of elderly patients scheduled for abdominal surgery. In the first group of patients (n = 37, mean age 73.2 +/- 9.9 years), five epidural morphine provided a good and prolonged analgesia for an average duration of 24.5 hours. All patients showed a remarkable lucidity and remained fully cooperative when receiving chest physiotherapy. In the second group (n = 11, mean age 65.3 +/- 11.2 years), ten mg epidural morphine induced a more powerful analgesia lasting on average 38 hours. In this group however, fine patients developed a respiratory depression, often delayed in onset, associated with increased PaCO2 levels and/or bradypnea, requiring treatment with narcotic antagonists. Also an important degree of sedation was observed. These results emphasize the inherent dangers of ventilatory depression of high dose thoracic epidural morphine treatments in elderly patients.
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PMID:Epidural morphine for postoperative analgesia following abdominal surgery in elderly patients. 709 Jul 24

The effects of anaesthesia and surgery on the pharmacokinetics of ketobemidone were studied in 12 patients. Plasma ketobemidone concentrations were assayed with a mass-fragmentographic method. The peroperative Vd(area) was 5.9 +/- 2.6L/kg and the terminal half-life was 3.9 +/- 1.7 h. In the postoperative period Vd(area) decreased to 3.7 +/- 0.4L/kg and the terminal half-life to 2.1 +/- 0.4 h. Plasma clearance (Clp) did not change significantly, peroperative Clp being 18 +/- 4.3 ml/min/kg and postoperative Clp being 22 +/- 7.5 ml/min/kg. The pharmacokinetics of ketobemidone were not influenced by the addition of a spasmolytic agent in the commercial combination ketobemidone preparation 'Ketogin'. Postoperative pain was relieved in 15 patients by patient-controlled intravenous administration of ketobemidone by means of a programmable drug injector. The mean ketobemidone consumption was 2.3 +/- 0.8 mg/h, which produced a mean plasma concentration of 28 +/- 11 mg/ml. Pseudosteady-state plasma concentrations of ketobemidone were established with a mean minimum effective concentration (MEC) of 25 +/- 11 ng/ml. Ketobemidone 'plain' and 'Ketogin' did not differ significantly in these respects. Analgesia was considered by all patients to be satisfactory.
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PMID:Patient-controlled analgesic therapy, Part III: pharmacokinetics and analgesic plasma concentrations of ketobemidone. 709

The influence of anaesthesia and surgery on the pharmacokinetics of morphine was studied in 10 patients. Plasma concentrations of morphine were assayed by gas chromatography with electron capture detection. All patients were studied on the day of surgery and again 3 to 7 days later. Mean +/- SD for peroperative Vd(area) was 6.3 +/- 3.6 L/kg and for the terminal half-life was 3.8 +/- 2.3 h. In the postoperative period, Vd(area) decreased to 3.7 +/- 1.4L/kg and the terminal half-life to 2.2 +/- 1.1 h. Plasma clearance (Clp) remained constant, peroperative Clp being 20 +/- 7.0 ml/min/kg and postoperative Clp 21 +/- 6.0 ml/min/kg. Postoperative pain was relieved by patient-controlled administration of intravenous doses of morphine by means of a programmable drug injector. The mean morphine consumption was 2.6 +/- 1.2 mg/h, which produced a mean plasma concentration of 21 +/- 12 ng/ml with a calculated mean minimum effective concentration (MEC) of 16 +/- 9 ng/ml. In 1 patient, temporary hypercapnia was seen during a period of hypovolaemia. Analgesia was considered satisfactory by all patients.
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PMID:Patient-controlled analgesic therapy, Part IV: pharmacokinetics and analgesic plasma concentrations of morphine. 709 1

Postoperative pain relief was studied in 280 patients undergoing various kinds of surgery, e.g., thoracic, upper and lower abdominal, perineal, obstetric, and orthopedic. Morphine, 2 or 4 mg, was given after surgery through an indwelling epidural catheter. Excellent analgesia was noted in 87% of patients; only 3.5% of patients were dissatisfied. A single injection gave complete pain relief for the entire postoperative period in 30% of cases; in the remaining patients the mean duration of analgesia was 10.7 hours (SD +/- 4.3). Plasma morphine concentrations recorded after 2-mg doses suggest a regional spinal action as the basis for the long duration of analgesia, although the initial effect after 4-mg doses might well include systemic responses due to rapid vascular uptake of morphine from the epidural space. Peak expiratory flow (PEF) measurements and arterial blood gas analyses showed no significant early postoperative respiratory depression. Absence of sedation, orthostatic hypotension, respiratory depression, and motor paralysis facilitated early ambulation with less risk for postoperative respiratory complications. It is concluded that 2-mg doses of epidural morphine give good analgesia of long duration despite low plasma levels. After upper abdominal and thoracic surgery higher doses (4 mg) may be necessary in healthy patients. Elderly and frail patients appear to be sensitive to epidural morphine and doses in excess of 2 mg should be avoided regardless of the type of surgery. With this dose schedule we have not encountered delayed respiratory depression.
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PMID:Postoperative pain relief by epidural morphine. 719 76

Postoperative pain relief is only apparently an easy task. A brief survey of literature investigating the discomfort experienced in the postoperative phase is all but encouraging. One can identify four basic problems in obtaining adequate results by delivery of analgesic drugs: a) the biological variability among individual patients, b) the unpredictable uptake of the drug administered intramuscularly, c) the time lag involved between request by the patient and the subsequent administration of a single dose and d) the lack of knowledge about the nature of the discomfort and its remedies. An alternative strategy introducing "On-Demand" analgesia administering prescribed doses at the right moment is presented and analysed a) as an operant conditioning process implementing a particular reinforcement schedule (behavioural sciences), as well as b) a negative feedback control loop that entrust the central judgement to the patient (system theory). Both approaches give insight into the results: the technique copes with biological variability; anticipating pain induced by fear disappears; the feedback strategy works well and patients adapt to a wide range in prescriptions; intermittent administration makes more efficient use of the analgesic; an optimal result is demonstrated in studies comparing on-demand analgesia with the normal IM-regime and epidural analgesia; continuity in pain relief can be obtained in routine clinical practice.
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PMID:Postoperative pain relief by demand analgesia. 745 63

Postoperative pain relief is often inadequate. Ignorance and misconceptions about opioids by ward staff contribute to this poor management. The introduction of acute pain teams has done much to improve pain relief for patients. It may also have contributed to changes in attitudes and knowledge of medical and nursing staff. We questioned 48 doctors and nurses on their knowledge and beliefs about postoperative pain relief. Staff members were questioned on two units, one with access to an acute pain team and one without. Over half those on the unit using traditional postoperative care thought patients did not receive adequate pain relief (58%). In comparison, only one respondent from the unit with the pain team thought this was the case (P < 0.001). More staff members that had experience of patient-controlled analgesia (PCA) were optimistic about its benefits than those in the unit with no experience; they were also less concerned about possible side effects. Only one respondent on the unit using PCA thought it carried a risk of drug dependence, compared to over half (55%) of those on the unit with no experience in this technique (P < 0.001). Over two-thirds of staff familiar with PCA thought nursing workload had decreased. Acute pain teams have an important role in educating ward staff. The impact of establishing such teams on staff knowledge and attitudes needs further study to ensure that they can carry out this role most effectively.
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PMID:Shaping attitudes to postoperative pain relief: the role of the acute pain team. 753 28

This randomised, double-blind study compared the analgesic properties of intra-articular injection of morphine and bupivacaine during therapeutic arthroscopic knee surgery. Forty male patients were randomly divided into 4 groups of 10 patients each. Group A received intra-articular injection of 1 mg morphine sulphate in 20 ml saline, Group B received 20 ml of 0.25% bupivacaine while Group C received 1 mg morphine sulphate in 20 ml of 0.25% bupivacaine injected intra-articularly. Group D did not receive intra-articular injection and acted as control. Post-operative pain was assessed by visual analogue score. The morphine group had significantly lower pain score compared to the control group from 4 hours onwards throughout the 24-hour study period (p < 0.05 at 4 hours and p < 0.001 at 24 hours). The bupivacaine group had lower pain score than the control group during the first 4 hours (p < 0.001 at 1 hour and p < 0.05 at 2 hours). At 4 hours, it showed similar analgesic efficacy as morphine. There was no significant analgesic effect at the end of the study period. The combination of the two drugs resulted in satisfactory analgesia throughout the entire study period (p < 0.001 at 1, 2 and 24 hours and p < 0.05 at 4 hours) and appeared to be a simple, safe and effective analgesic technique for patients who underwent therapeutic arthroscopic knee surgery.
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PMID:Intra-articular morphine and bupivacaine for pain relief after therapeutic arthroscopic knee surgery. 757 Jan 32

Intra-articular morphine has been shown to provide prolonged analgesia after arthroscopic knee surgery; the addition of local anaesthetic agents has been reported to improve this analgesic effect. Pethidine possesses local anaesthetic properties, and therefore this study was designed to evaluate its analgesic efficacy after arthroscopic meniscectomy. Sixty patients were allocated randomly to receive intra-articular injections of pethidine 50 mg, morphine 5 mg or saline after elective arthroscopic meniscectomy. Postoperative pain was assessed using an interval visual analogue scale and measuring analgesic requirements. Both treatment groups had significantly lower pain scores compared with the control group. Patients in the pethidine group had lower pain scores than those in the morphine group at 0.5, 1 and 2 h, but significantly higher scores at 12 and 24 h. These observations suggest that the local anaesthetic effect of pethidine may be responsible for the improved early analgesia, but its duration of action appears to be less than that of morphine.
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PMID:Intra-articular analgesia for arthroscopic meniscectomy. 757 79


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