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

The metatarsal osteotomy, a relatively simple procedure, provides a great amount of correction and relief with a limited amount of bone resection. Postoperative pain and edema are minimal, and disability and loss of time from employment are eliminated as patients are able to walk immediately in a surgical shoe. If biomechanical management is not adequate in relieving discomfort, then a 10-year study of more than 1000 cases indicates that the osteotomy is the procedure of choice.
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PMID:The metatarsal osteotomy: a 10-year follow-up on the second, third and fourth metatarsal osteotomies and a new approach to the fifth metatarsal osteotomy. 59 60

Postoperative discomfort following cholecystectomy has diminished considerably since laparoscopic surgery was introduced. This study assessed the degree of postoperative pain and nausea when, during the operation, the trocar sites had been infiltrated with bupivacaine and antiemetics (ondansetron) had been administered. Postoperative pain intensity was moderate as 20% of the patients were managed without any opiates postoperatively and 88% did not require any opiates after discharge from the recovery room. Postoperative nausea and vomiting is known to be a problem that occasionally has been reported to delay discharge from the hospital. A single dose of ondansetron at the end of the operation seems to reduce postoperative nausea effectively. Two-thirds of the patients had no complaints of nausea, and the majority of the remainder experienced only mild and transitory nausea. We recommend that stab-wound sites be infiltrated with local anesthetics and that antiemetics be administered at the end of the operation.
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PMID:Postoperative pain and nausea after laparoscopic cholecystectomy. 134 50

Postoperative pain after surgery in the cerebellopontine angle (CPA) is acknowledged to occur, but is rarely taken into account as a factor in the analysis of morbidity of such surgery. It is widely acknowledged that some patients, having undergone such surgery, particularly by means of the suboccipital approach, report significant post-operative pain and headache. This study was undertaken to determine the incidence and severity of pain after excision of acoustic neuromas and to establish whether this differed between the suboccipital and translabyrinthine routes. Ninety-one percent of all patients (n = 58), who had the suboccipital approach used for removal of their tumor, were surveyed. A smaller group (n = 40), matched for tumor size, age, and sex, but in whom the translabyrinthine approach was used, was similarly studied. A standard questionnaire, designed to detect and quantify postoperative pain, was administered to each patient. Of patients who underwent tumor excision by means of the suboccipital approach, 63.7% experienced significant local discomfort and headache, whereas this was notably absent in all those who had undergone translabyrinthine excision. In view of the significant morbidity noted to follow the suboccipital approach, several modifications of the surgical technique used were devised.
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PMID:Pain after surgery for acoustic neuroma. 140 29

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 for major abdominal or thoracoabdominal procedures requires bilateral multisegmental intercostal nerve blocks or epidural analgesia. This study was undertaken to examine the possible role of bilateral intrapleural regional analgesia (BIRA) and to select the proper dose for this new technique. Bilateral intrapleural catheters were inserted after surgery, using a Mancao dual-cannula system. Bupivacaine with epinephrine 1/200,000 (BE) was administered in each side as 20 mL of 0.5% in three patients. When this dose was found to be ineffective, 30 mL of 0.75% BE was administered in five patients; however, two patients complained of tinnitus and visual disturbances. Subsequently, 20 mL of 0.75% BE was used in five patients and was found to be satisfactory. Thirteen additional patients received the latter dose. Arterial blood levels of bupivacaine were determined at 15, 30, 60, and 120 minutes. The group of 18 patients (group I) who received 20 mL of 0.75% BE bilaterally were compared with a second group (group II) of 16 patients undergoing similar surgery who received only parenteral narcotics for pain management. BIRA was considered effective when patients denied pain or discomfort and when narcotics were not required in the postanesthesia recovery unit. Patients in groups I and II received narcotic medication whenever they felt pain or discomfort. The duration of BIRA was considered to be from the injection of the drug until the time a narcotic was administered to the patient. Demographic variables, changes in BP and heart rate after surgery, frequency of narcotic administration during the first four postoperative days, and postoperative hospital stay were compared in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bilateral intrapleural regional analgesia for postoperative pain control: a dose-finding study. 252 Sep 36

A prospective randomly controlled study was conducted on 200 women undergoing sterilization by application of clips to the fallopian tubes. Laparotomy or laparoscopy was used, and the patients' response to the procedure was evaluated. There were few surgical complications. Postoperative pain and discomfort were experienced for a mean of 2.7 and 2.4 days in the those undergoing minilaparotomy and laparoscopy, respectively. The patients' response indicates a marginal benefit from the laparoscopic approach to application of clips to the fallopian tubes.
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PMID:Laparoscopy or minilaparotomy for sterilization of women. 644 52

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

Ambulatory laparoscopic cholecystectomy was attempted using a new anaesthetic regimen in 50 patients. 46 patients were discharged 3-5 hours after operation, four were admitted to and remained in hospital for 1-5 days, one for psychosocial reasons, one because of emesis and two because of extended surgery. 45 of 46 ambulatory patients were generally satisfied after having experienced ambulatory cholecystectomy. Postoperative pain and nausea were moderate. Only 24% needed parenteral opioids postoperatively, and only 30% needed anti-emetic treatment. One woman suffered unacceptable pain and discomfort during the first two days at home, and would not prefer to have ambulatory treatment (questionnaire). Four patients were readmitted. Two had a forgotten stone in the common bile duct and underwent ERCP to extract the stone, without further complications. The third had a clip occluding the common bile duct. She was reoperated on in order to remove the clip and insert a T-tube in the common bile duct. Finally one woman was readmitted because of abdominal pain and vomiting, of which we never found the cause. She recovered spontaneously. Even though serious complications associated with biliary surgery were unavoidable in this ambulatory series, we have documented that patients can be operated on safely in this way. Most patients were very content, and experienced much less postoperative discomfort than they had expected.
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PMID:[Laparoscopic cholecystectomy as ambulatory surgery. Safety requirements, benefit potential and patient satisfaction]. 765 19

This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. Analgesic requirements were calculated, and weightbearing status was recorded. We found that morphine alone injected intraarticularly at the completion of arthroscopic knee surgery had no significant effect on postoperative pain, need for supplemental analgesia, or weightbearing status. Patients receiving morphine in combination with bupivacaine did not demonstrate any statistically significant improvement over those receiving bupivacaine alone. Therefore, our results failed to show any beneficial effect of morphine used for postoperative analgesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated decreased pain scores, decreased analgesic use, and increased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most significant predictor of postoperative pain was preoperative level of discomfort.
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PMID:The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control. 772 52

A prospective study was undertaken to compare the analgesic effect of intra-articular bupivacaine, morphine, or saline in the 24-hour period following cranial cruciate ligament repair in dogs. Thirty-six clinical patients with ruptured cranial cruciate ligaments were randomly assigned to one of three groups. After surgical stabilization, and before skin closure, an intra-articular injection was given; group one (n = 12) received 0.5% bupivacaine HCl at 0.5 mL/kg, group two (n = 12) received morphine at 0.1 mg/kg diluted with saline to a volume of 0.5 mL/kg, and group three (n = 12) received saline at 0.5 mL/kg. Heart rate, respiratory rate, mean arterial blood pressure, cumulative pain score, visual analog pain score, and pain threshold test on both stifles were recorded preoperatively and at 0 to 6 and 24 hours postoperatively. Surgeons and pain scoring investigators were unaware of the intra-articular medication given. Supplemental analgesia, if needed, was provided in the postoperative period according to subjective assessment of patient discomfort. Postoperative pain scores were lowest in the bupivacaine group and highest in the saline group. Pain threshold, measured by applying calibrated loads to the knee, was higher postoperatively in the bupivacaine group than in the saline group. Dogs in the morphine and bupivacaine groups required less supplemental analgesia than dogs in the saline group. The local provision of analgesia reduces the need for systemic drugs with potential side effects. Both intra-articular morphine and intra-articular bupivacaine provided better postoperative analgesia than intra-articular saline, with intra-articular bupivacaine showing the greatest effect.
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PMID:Postoperative analgesia for stifle surgery: a comparison of intra-articular bupivacaine, morphine, or saline. 871 87


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