Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030201 (Postoperative pain)
 1,085 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a double-blind prospective study, 20 patients undergoing major abdominal surgery were allocated randomly to receive a continuous 8-h i.p. infusion of either physiological saline or 0.25% bupivacaine 20 ml h-1 (in saline) following a loading dose of saline 1 ml kg-1 or 0.25% bupivacaine 1 ml kg-1 on entering the peritoneum. The following variables were measured before and at 2-h intervals during the infusion: serum glucose and cortisol concentrations, forced vital capacity, forced expiratory volume in the first second, peak expiratory flow rate and pain at rest, on mobilization and on coughing (visual analogue scale). Postoperative pain, impairment in pulmonary function and increase in serum cortisol and glucose concentrations were not influenced by the i.p. infusion of bupivacaine when compared with saline. This study shows that the i.p. instillation of therapeutically safe doses of bupivacaine was without effect in the management of pain, postoperative pulmonary dysfunction and the stress response in this group of patients.
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PMID:No effect of continuous i.p. infusion of bupivacaine on postoperative analgesia, pulmonary function and the stress response to surgery. 341 89

Postoperative pain is a major cause of ineffective breathing after lung surgery, predisposing patients to hypoxemia. Because potent analgesics like opioids depress ventilation and other analgesic techniques are time-consuming, efficient postoperative pain therapy is difficult. Therefore, a less painful surgical approach could be beneficial. Forty-seven patients with diagnosis of a pulmonary nodule were prospectively studied. Patients were assigned to a video-assisted thoracic surgery (VATS) group (n=22) or a group undergoing axillary thoracotomy (n=25). Visual analogue scale (VAS) scores, plasma glucose levels, plasma epinephrine and plasma norepinephrine levels, as well as arterial oxygen (PaO2) and carbon dioxide (PaCO2) tension were determined the day before surgery, and 3, 15, 24, 48, and 72 h after surgery. Postoperative piritramide (a synthetic morphine compound) demand was recorded. VAS values were significantly lower (p<0.05) during the whole observation period in the VATS group. Significantly higher epinephrine levels were observed 3 and 15 h after surgery (267.4 +/- 28 vs 111.8 +/- 13 ng/L; p<0.01; and 176.6 +/- 46.5 vs 96 +/- 14.5 ng/L; p<0.05) in the thoracotomy group, whereas there was no significant difference in norepinephrine (correction of norephinephrine) levels. Piritramide demand was significantly (p<0.05) reduced in the VATS group throughout the whole observation period. There was no difference in PaCO2 values but PaO2 Values were higher in the VATS group over 72 h, with maximum differences occurring at 15 h after operation: 60.9 +/- 1.9 vs 49.2 +/- 2.4 mm Hg (p<0.01). In conclusion, the videoendoscopic approach is associated with less postoperative pain and better oxygenation than traditional surgical approaches.
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PMID:Early postoperative stress: video-assisted wedge resection/lobectomy vs conventional axillary thoracotomy. 876 23

Children aged 0-3 yr were stratified for age and randomized to receive either continuous morphine (CM, 10 microg x kg(-1) x h(-1)) with three-hourly placebo boluses or intermittent morphine (IM, 30 microg x kg(-1) every 3 h) with a placebo infusion for postoperative analgesia. Plasma concentrations of epinephrine, norepinephrine, insulin, glucose and lactate were measured before and at the end of surgery and 6, 12 and 24 h after surgery. Pain was assessed with validated pain scales [the COMFORT scale and a visual analogue scale (VAS)] with the availability of additional morphine doses. Minor differences occurred between the randomized treatment groups, the oldest IM group (aged 1-3 yr) having a higher blood glucose concentration (P=0.003), mean arterial pressure (P=0.02) and COMFORT score (P=0.02) than the CM group. In the neonates, preoperative plasma concentrations of norepinephrine (P=0.01) and lactate (P<0.001) were significantly higher, while the postoperative plasma concentrations of epinephrine were significantly lower (P<0.001) and plasma concentrations of insulin significantly higher (P<0.005) than in the older age groups. Postoperative pain scores (P<0.003) and morphine consumption (P<0.001) were significantly lower in the neonates than in the older age groups. Our results show that continuous infusion of morphine does not provide any major advantages over intermittent morphine boluses for postoperative analgesia in neonates and infants.
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PMID:Hormonal and metabolic stress responses after major surgery in children aged 0-3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine. 1151 22

Postoperative pain is the most important factor od so called "tumor-promotive effect of surgery" i.e. of endocrine-metabolic changes having the consequence drop in immune, antiinfective and antitumor defense. Due to presence of organic involutive changes, old people (= 65 years), often have serious side effects during application of usual analgetics. Since hypertonic glucose (33%) given i.v. or per os, works analgesically in small children there is assumption that it can be used in treatment of postoperative pain in old oncology patients. We tested the hypothesis that postoperative pain in old oncology patients can be treated with i.v. application of 50% of glucose solution. 37 oncology patients over 65 years, 26 females and 11 males, operated for breast cancer and soft tissue cancer, were investigated. Average age of the patients was 72 +/- 4 years. 50% Glucose solution was given in two boluses of 20 ml each: the first bolus was given to all patients at the end of anesthesia, and the other bolus was given individually after appearance of post-operative pain. Pain intensity (in coefficients of the visual analogue scale VAK = 1-100) and its characteristics were tested by oral testing of operated patients; after weakening from anesthesia, after the first appearance of the pain and 15 minutes after giving of the second glucose bolus. None patient had pain weakening from anesthesia. All tested patients experienced pain during the first 70 minutes and it could be categorized as very strong pain (= 82 VAK). The pain was decreased with another glucose bolus by approximately (= 56% VAK) so it was classifies in category of bearable pains (= 36 VAK). In 9 patients (24.3%) the pain had neuropathic component (filing of "burning") which could not be eliminated by hypertonic glucose, but only with application of tramadol. Activation of the central cholinergic transmission is the most significant mechanism of analgesic glucose effect, but, probably there is another one: facilitation of entrance of formerly given analgesics in the brain cells. As energetic substrate, entering all organism cells, glucose could make easier intracell breakthrough of any other analgesic drug, of the peripheral or central action, and final antipain effect could be potential or additional one. It was concluded that 40 ml of 50% glucose solution given in two identical boluses, has good analgesic effect in treatment of postoperative pain in old oncology patient: the pain was not completely eliminated, but it was significantly decreased and became tolerable. Hypertonic glucose neither eliminates, nor decreases neuropathic component of the pain, so, when the pain appears the therapy should be supplemented with other drugs, which may completely eliminate all pain components.
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PMID:[Treatment of postoperative pain in elderly oncology patients with intravenous administration of a 50% glucose solution]. 1460 64

Intrathecal opioids provide postoperative analgesia and hemodynamic stability by depressing the neuroendocrine response during the perioperative period. The effects of preoperative intrathecal morphine on perioperative hemodynamics, stress response, and postoperative analgesia were evaluated in patients undergoing abdominal hysterectomy with general anesthesia. A total of 24 patients were randomly assigned to the morphine group (n=12) or the control group (n=12). Patients in the morphine group were given intrathecal 5 microg/kg(-1) morphine before surgery. In all patients, general anesthesia was induced with 1 g/kg(-1) remifentanil, 2 mg/kg(-1) propofol, and 0.1 mg/kg(-1) vecuronium and was maintained with 1% to 2% sevoflurane-35% oxygen in N2O and remifentanil infusion. All patients received intravenous morphine patient-controlled analgesia after surgery. Postoperative pain was evaluated by means of a visual analogue scale. Blood samples were taken at 4 time points before and up to 4 hours after the start of surgery for assessment of plasma epinephrine, norepinephrine, and glucose. Mean arterial pressure (MAP), heart rate (HR), and adverse effects were recorded. Intraoperative hemodynamics was similar in both groups, but postoperative HR and MAP values at 4 h, 8 h, 12 h, and 20 h were significantly lower in the morphine group (P<.05). Postoperative VAS scores, total morphine consumption, and plasma epinephrine, norepinephrine, and glucose levels were significantly lower in the morphine group than in the control group (P<.05). Preoperative intrathecal morphine enhanced the quality of postoperative analgesia, decreased morphine consumption, and depressed the systemic stress response in patients undergoing total abdominal hysterectomy with general anesthesia.
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PMID:Intrathecal morphine: effects on perioperative hemodynamics, postoperative analgesia, and stress response for total abdominal hysterectomy. 1675 Nov 62

Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. All patients received preperitoneal abdominal wall infiltration with 0.25 per cent bupivacaine to control parietal (somatic) abdominal pain. The visual analogue and verbal rating pain scores at 0, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded in a prospective double-blind fashion at four points during the first 24 postoperative hours. Analgesia requirements, vital signs, blood glucose, and incidence of nausea and vomiting were also recorded. Patients in each group demonstrated a significant difference in visual analogue and verbal rating pain scores and analgesic consumption when compared with controls. Lignocaine controlled pain significantly better than saline or bupivacaine. Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.
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PMID:Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control--a randomized prospective double-blinded placebo-controlled trial. 1837 82

This study investigated the use of sprayed intraperitoneal bupivacaine to relieve postoperative pain behavior and biochemical stress response after laparoscopic ovariohysterectomy (LOVH) in dogs. Sixteen sexually intact female dogs were randomly assigned to two groups. The sprayed intraperitoneal bupivacaine (SIB) group received 4.4 mg/kg of sprayed intraperitoneal bupivacaine diluted to 0.25% with an equivalent volume of saline after pneumoperitoneum. The control group received 1.76 mL/kg of saline in a similar fashion. Both groups received preoperative periportal 5% bupivacaine (1 mL) before incision. Postoperative pain was measured using the short form of the Glasgow composite measures pain scale (CMPS-SF, 0-24). Serum cortisol and glucose concentrations were measured preoperatively and 0.5, 1, 2, 4, 6, 12, and 24h postoperatively. The SIB group had significantly lower CMPS-SF compared to the control group 1, 2, 4, 6, and 12h after the operation. Cortisol concentrations were significantly increased from preoperative concentrations in the control group at 0.5, 1, 2, and 4h post operation and at 0.5 and 1h post operation in the SIB group. No significant differences were seen in serum glucose within each group. This report suggests that the use of sprayed intraperitoneal bupivacaine can be used as part of a multimodal approach for pain management after LOVH in dogs.
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PMID:Sprayed intraperitoneal bupivacaine reduces early postoperative pain behavior and biochemical stress response after laparoscopic ovariohysterectomy in dogs. 2139 35