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

A prospective study was conducted to investigate and compare the analgesic effect of morphine and bupivacaine injected intra-articularly following elective knee arthroscopy performed under general anesthesia without the use of a tourniquet. Cost-effectiveness of these agents was also evaluated. Patients in Group 1 (n = 41) received 30 cc of 0.25% bupivacaine with 1:200,000 epinephrine; while Group 2 (n = 40) received 2 mg morphine (1 mg/cc) in 28 cc normal saline (total volume 30 cc). Postoperative pain scores and the amount of supplemental analgesic agents used in a 24-hour period were recorded. Results showed that patients in Group 2 reported significantly less pain overall (P < .006) and significantly lower analgesic requirements (P < .0004) at a lower average patient cost than Group 1. We conclude that intra-articular morphine reduces postoperative pain and analgesic requirements more effectively and at a lower average patient cost than bupivacaine.
Orthop Rev 1994 Sep
PMID:Comparison of intra-articular morphine and bupivacaine following knee arthroscopy. 777 64

Postoperative pain is an important issue after major urological surgery. Efficient analgesia is mandatory. The administration of i.m. narcotics is considered routine. This technique, however, has some disadvantages due to the pharmacology and pharmacokinetics of the drugs used. In our institution, we recently introduced a new technique: the patient controlled epidural analgesia. A computerized pump administers a continuous infusion of a mixture local anaesthetic/narcotic through a peroperatively placed epidural catheter. This pump also allows patients to administer themselves additional boluses according to their needs. Sixty-two urological patients used this system to their own satisfaction and the satisfaction of the nursing and medical staff. This new approach of postoperative pain relief is discussed.
Acta Urol Belg 1993 Sep
PMID:[Patient-controlled epidural analgesia after major urologic surgery]. 790 19

A randomised double-blind study was carried out on 60 patients undergoing elective lumbar discectomy. Patients in the study group (n = 30) received an injection of 10 ml of 0.5% bupivacaine into the wound; the control group (n = 30) received none. Postoperative pain was measured by a visual analogue pain scale and by the amount of morphine administered by a patient-controlled analgesia system. Patients in the study group had lower pain scores, used less morphine, waited longer until their first demand for analgesia and reported their postoperative pain to be less severe.
J Bone Joint Surg Br 1993 Sep
PMID:Intraoperative bupivacaine diminishes pain after lumbar discectomy. A randomised double-blind study. 811 13

This report describes the anaesthetic management of a women with a term gestation, Von Hippel Lindau disease (VHLD), and a phaeochromocytoma, scheduled for a combined phaeochromocytoma resection and Caesarean section. Von Hippel Lindau disease is characterized by diffuse haemangioblastomas of the central nervous system (CNS) and viscera. It is also associated with phaeochromocytomas and renal cell carcinomas. Patients frequently have asymptomatic spinal cord and intracranial pathology. The patient and her fetus presented a challenge because of the anaesthetic restrictions imposed by VHLD, and her pregnancy. She was also at risk of developing malignant hypertension from the phaeochromocytoma. The patient was not a candidate for regional anaesthesia because of the possibility of spinal cord haemangioblastomas. She had received adrenergic blockade with phentolamine (total 30 mg a day) and propranolol (total 40 mg a day) since the 27th wk of gestation in order to control hypertension secondary to the phaeochromocytoma. General anaesthesia was administered with aggressive management of hypertension with adrenergic blockers (labetalol 1.0 mg.kg-1 and esmolol 0.75 mg.kg-1) and sodium nitroprusside 1.5 micrograms.kg-1 (total). Before delivery of the baby, opioids, which could have resulted in a fetus with CNS depression, were avoided. After delivery, opioids (sufentanil 0.4 microgram.kg-1 x hr-1) were used to limit the use of inhalational anaesthesia which may contribute to uterine atony. Postoperative pain was managed with an intravenous narcotic infusion. Both patients had uneventful postoperative courses.
Can J Anaesth 1993 Sep
PMID:Caesarean section and phaeochromocytoma resection in a patient with Von Hippel Lindau disease. 840 82

In a randomized, double-blind, placebo-controlled study designed to assess the post-operative analgesic efficacy and cost-effectiveness of ketorolac and diclofenac 60 ASA I and II patients undergoing laparoscopic cholecystectomy were studied. Prior to concluding the operative procedure, an injection (i.m.) of an equal volume of either saline 3 mL, ketorolac 60 mg, or diclofenac 75 mg was administered. All patients received intravenous morphine via a patient-controlled analgesia device (PCA). Post-operative pain intensity was assessed hourly for 4 h, by recording visual analogue score (VAS) for pain, PCA demands and actual morphine administered. PCA demands (mean +/- SD) were greater in the saline treatment group (115 +/- 90) when compared with both the ketorolac (42 +/- 44) and diclofenac groups (74 +/- 77). Furthermore, the saline treatment group received significantly (P < 0.05) more PCA morphine compared with both the ketorolac and diclofenac groups (12.2 mg +/- 5.0 vs. 8.6 mg +/- 5.2 vs. 8.9 mg +/- 4.8). Improved pain scores were demonstrated in both the ketorolac and diclofenac groups compared with the saline group. PCA demands and post-operative morphine requirements were similar in the ketorolac and diclofenac groups. Diclofenac has the added advantage, in our institution, of being 60% less expensive than ketorolac. We conclude that both ketorolac and diclofenac are effective post-operative analgesic drugs. However, economic considerations may favour diclofenac administration.
Eur J Anaesthesiol 1995 Sep
PMID:A comparative study of ketorolac and diclofenac on post-laparoscopic cholecystectomy pain. 854 59

Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects. Although opioids have played a prominent role in postoperative analgesia for centuries and are still often administered as a matter of routine, their frequent minor side effects and the increasing availability of suitable alternatives may limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing of analgesics and/or a reasonably large patient sample size. These data do not allow a proper meta-analysis to be performed because of the large variability in surgical procedures, dosing regimens, assessment criteria, among others.
J Clin Anesth 1996 Sep
PMID:Postoperative opioid analgesia: time for a reconsideration? 887 83

The utility of preoperative ketorolac administration to reduce the intensity and duration of postoperative pain was compared with placebo in a randomized double-blind design of 60 ASA 1-2 patients scheduled for minor orthopaedic surgery. No opioids nor local anaesthetic blocks were used during surgery. The patients received either 30 mg ketorolac IV before surgery followed by a placebo injection after surgery or the reverse. Postoperative pain intensity was assessed repeatedly for 6 h using a visual analogue scale. No differences in pain intensity were observed between the two groups except for the initial 15-min postoperative assessments in the ketorolac group. The time to first rescue morphine administration and the total morphine consumption during the 6-h observation period were similar. It is concluded that the preoperative administration of ketorolac did not provide a significant preemptive analgesic benefit with regard to postoperative pain relief and opioid dose-sparing effect.
Acta Anaesthesiol Scand 1996 Sep
PMID:Preoperative ketorolac administration has no preemptive analgesic effect for minor orthopaedic surgery. 890 33

Postoperative pain in 33 patients who underwent radical prostatectomy was managed by an intramuscular nonsteroidal antiinflammatory drug protocol rather than by administration of narcotics. Patients rated their perception of pain with a visual analog scale on the first postoperative day both before and after receiving ketorolac tromethamine. The medication was effective in relieving pain after this major operation. Costs were approximately one half that of the traditional narcotic protocol used before this study.
Urol Nurs 1996 Sep
PMID:Nurse evaluation of a pain medication protocol in a selective postoperative population. 929 98

Continuous cervical epidural anesthesia was used for 17 operations in 16 patients undergoing immediate reconstructive surgery after upper-extremity injuries or tumor resection and was continued for postoperative pain management. Routine hemodynamics, arterial blood gases, plasma bupivacaine levels, and skin temperatures were recorded before and after the block. The surgery time ranged from 3 to 18 hours. Postoperative pain management was maintained for up to 6 days. The blocks were adequate for surgery and postoperative pain treatment in all cases. There were no signs or symptoms indicating local anesthetic toxicity. Circulatory and respiratory integrity was well maintained. The patients were all ambulatory the day after surgery and could start physiotherapy immediately. This regional anesthesia technique may have significant advantages over branchial plexus block or general anesthesia for lengthy surgical procedures of the upper extremity.
J Hand Surg Am 1997 Sep
PMID:Continuous cervical epidural anesthesia in reconstructive hand surgery. 933 Jan 53

Ninety boys, aged 13-53 months, undergoing repair of hypospadias, were allocated randomly to receive 0.8 ml kg-1 of one of three solutions into the caudal extradural space: group B received bupivacaine 2 mg kg-1, group T received tramadol 2 mg kg-1 in 0.9% saline and group BT a mixture of both. Postoperative pain was assessed hourly for 12 h after injection using a modified TPPPS pain score and additional analgesia was administered to those children whose pain scores were > 3/10. Nine patients (30%) in group T required additional analgesia within 1 h of surgery compared with only two (6.7%) and three (10%) patients in groups B and BT, respectively (P = 0.04). Mean duration before additional analgesia was required in the remaining patients was 9.3 (SD 3.0) h in group B, 10.7 (2.2) h in group T and 10.5 (2.0) h in group BT (P > 0.20). There were no significant differences between the groups in mean ventilatory frequency, sedation scores, incidence of emesis, facial flushing or pruritus. We conclude that caudal tramadol had a slow onset of action and that the addition of tramadol to bupivacaine, when both drugs were administered caudally, did not significantly prolong the duration of action of bupivacaine.
Br J Anaesth 1997 Sep
PMID:Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery. 1109 7


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