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

We evaluated postoperative pain relief and the incidence of side effects of three methods of thoracic epidural analgesia. Ninety patients, divided into three equal groups, received postoperative analgesia after thoracic surgery either as intermittent epidural injections of bupivacaine (25 mg/5 ml, 0.5% solution) as needed, or, intermittent epidural injections of morphine (5 mg/5 ml of normal saline, 0.1% solution) as needed, or continuous epidural infusion of morphine (0.1 mg, in 1 ml of normal saline) per hour supplemented with intravenous morphine (2 mg) upon request. Pain relief was evaluated by each patient on a pain scale visual analogue and by pain relief questionnaire for a period of 72 hr. Postoperative pain relief was achieved equally with these three methods of epidural analgesia in all patients with no significant difference between groups. Intermittent epidural injection of bupivacaine relieved pain for 4.9 +/- 1.9 (SD) hr/injection and was associated with urinary retention in all patients, with numbness and weakness of the hands in 12 patients, and with severe hypotension in 7 patients. Intermittent epidural injection of morphine relieved pain for 5.8 +/- 2.3 hr/injection and was associated with urinary retention in all patients, with pruritus in 12 patients, and with central narcosis and respiratory depression in 8 patients. Continuous epidural infusion of morphine with occasional intravenous morphine (2 mg) supplementation also effectively relieved postoperative pain and was associated with minimal systemic side effects. One patient complained of pruritus, and two patients developed urinary retention.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous epidural infusion of morphine for treatment of pain after thoracic surgery: a new technique. 646 62

The alpha-adrenergic agonists have been demonstrated to have synergistic effects with opioids and local anesthetics in animal research. The present study was performed to determine whether the addition of adrenaline improves the analgesic effects of an epidural infusion of a combination of fentanyl and bupivacaine after abdominal surgery. We studied 90 ASA 1 or 2 patients scheduled for abdominal surgery under epidural anaesthesia, with or without general anaesthesia. Patients were randomly divided into two groups to receive a postoperative epidural infusion of fentanyl 5 micrograms/ml in bupivacaine 0.2%, with or without adrenaline 5 micrograms/ml, at a rate of 2 ml/h for more than 48 hours. Postoperative pain relief was assessed using visual analog scales (VAS), both at rest and during coughing, at 2, 24, and 48 hours after surgery. The number of rescue analgesics and side-effects such as nausea, vomiting, pruritus, respiratory depression, headache, muscle weakness, and hypotension were recorded. Patients who received adrenaline (n = 40) reported significantly lower mean VAS scores than those who received no adrenaline (n = 37), both at rest at 24 hours postoperatively and during coughing at 24 and 48 hours. The number of additional analgesics and incidence of side-effects did not differ between groups. In conclusion, the results of the present study demonstrate that the addition of adrenaline to a combination of fentanyl and bupivacaine improves the quality of epidural analgesia after abdominal surgery. Under the conditions of the study, we did not detect any disadvantage from the addition of adrenaline.
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PMID:Does adrenaline improve epidural bupivacaine and fentanyl analgesia after abdominal surgery? 1151 59

Permanent neurological complications related to neuraxial techniques are rare. We report a case in which performance of the regional block and the intervention were free of noteworthy incidents. Postoperative pain was controlled by use of multimodal analgesia. The epidural catheter was removed on the ward after 24 hours. However, 72 hours after the intervention, the patient developed lower limb weakness and associated paresthesia mainly on the right side. Examination disclosed flaccid paralysis from the second lumbar vertebra affecting mainly the right lower extremity with no involvement of the sphincters. Emergency magnetic resonance imaging was negative for masses occupying the spinal canal. After a battery of tests over the following days (electromyography, lumbar puncture, and magnetic resonance imaging), bilateral polyradiculitis related to epidural analgesia was diagnosed. The clinical course was satisfactory, though resolution was slow. Electromyography at 8 months confirmed clear improvement in lesions. After a year, the patient continued rehabilitation and occasionally still used a cane.
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PMID:[Bilateral polyradiculitis after an epidural block: a rare, serious complication]. 1729 33

Spinal progressive muscular atrophy (SPMA) is a rare lower motor neuron disease in which anesthetic management is often difficult as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents. A 43-year-old female patient with SPMA was scheduled to undergo laparotomy for ovarian teratoma. Her vital capacity was only 530 ml and % volume capacity was 22.2%, indicating a severe restrictive pulmonary disfunction. We selected general and epidural anesthesia for the surgery. Anesthesia was induced by propofol and the trachea was intubated with additional topical anesthesia. Spontaneous ventilation was kept during anesthesia without neuromuscular blocking agents, and systemic and epidural opioids were avoided to evade their respiratory depression. Because of severe spine scoliosis syndrome, we inserted an epidural catheter into the epidural space under radiographic monitoring for safety and precision. Postoperative pain control was stable using continuous epidural infusion of 0.2% ropivacaine without neurological adverse effects. One day after surgery, the trachea was extubated and respiratory function did not aggravate. Despite the controversy surrounding the use of neuraxial blocks in motor neuron diseases, in this case, epidural anesthesia was useful to keep the respiratory function stable.
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PMID:[Anesthetic management in a patient with spinal progressive muscle atrophy and compromised severe restrictive respiratory dysfunction]. 2299 4

Erector spinae plane block (ESPB) as postoperative analgesia method has been successfully carried out in several surgical interventions. Postoperative pain treatment for cesarean section is considered one of the important challenges for anesthesiologists due to the risk of chronic pain development and even pospartum depression. Regional anesthesia techniques were effectively used to prevent the pain together with multimodal analgesia regimes in cesarean section. Formerly, successful erector spinae plane block was documented as postoperative analgesia treatment for cesarean section; however, no motor weakness was recorded as a side effect. In this case report, we present an unexpected motor weakness as a side effect of the erector spinae plane block after cesarean delivery operation in a 29 year old patient. To our knowledge, this is the first report of motor weakness related to the ESPB.
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PMID:Ultrasound guided erector spinae plane block as a cause of unintended motor block. 3000 58