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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study compares retrospectively the postoperative analgesia provided via intravenous opioids with continuous regional techniques (interpleural and epidural infusions) administered as a clinical routine by an anaesthesia-based Acute Pain Service. In 2630 patients no severe complications resulting in morbidity or mortality occurred; the rate of potentially serious complications was in the 0.5% range and comparable between the techniques. A detailed analysis of a randomised subsample of 340 patients revealed better analgesia at rest and better compliance with physiotherapy under continuous regional analgesia. Techniques of continuous regional analgesia also resulted in fewer incidents of desaturation and fewer side effects. Patient satisfaction with these techniques was higher than with intravenous opioid administration. In conclusion, continuous regional analgesia in a routine clinical setting is comparable to intravenous opioid administration with regard to safety, but results in significantly better analgesia with fewer side effects.
Anaesthesia 1994 Jun
PMID:Continuous regional analgesia in comparison with intravenous opioid administration for routine postoperative pain control. 801

Postoperative pain is commonly treated with significant doses of narcotics, occasionally resulting in side effects including nausea, pruritus, and respiratory depression. One potential advantage of regional anesthesia is profound postoperative analgesia that reduces exposure to potent narcotics. To evaluate the efficacy of two long-acting local anesthetics, bupivacaine and etidocaine, in providing pain relief after major shoulder surgery, we randomized 20 patients to receive either bupivacaine or etidocaine for brachial plexus block as the primary anesthetic for shoulder surgery. Surgeons, patients, and the acute pain service were blinded as to drug selection. After the patient was sedated, an interscalene block was placed with the use of a nerve stimulator to facilitate proper needle placement. Forty milliliters of either 0.5% bupivacaine or 0.75% etidocaine containing 5 micrograms/mL epinephrine was injected into the brachial plexus sheath. An additional 8 mL of local anesthetic was administered for superficial cervical plexus blockade. Intraoperative sedation was accomplished with an intravenous infusion of methohexital as needed. After surgery, patients received a standard patient-controlled analgesia protocol providing incremental doses of morphine. The degree of postoperative analgesia resulting from residual local anesthetic effect was expressed as the time until first morphine requirement and the total dose of morphine required during the first 24 hours postoperatively. We found no statistically significant intergroup differences either in time of initial use of morphine or in the total dose of morphine required in the first 24 hours. Both etidocaine and bupivacaine provide prolonged analgesia after major shoulder surgery when injected into the brachial plexus. Bupivacaine, however, possesses significant cardiotoxicity and has a relatively delayed onset in peripheral neural blockade. Etidocaine is less cardiotoxic and also has a more rapid onset of effect. Thus etidocaine may be a preferable agent for interscalene block for major shoulder surgery.
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PMID:Postoperative analgesia after major shoulder surgery with interscalene brachial plexus blockade: etidocaine versus bupivacaine. 815 80

The behavioural responses of groups of seven lambs were compared with control groups after castration and tail docking by rubber rings, application of a Burdizzo clamp in addition to a rubber ring and after surgical castration at five, 21 and 42 days. All methods at all ages produced changes in behaviour which were interpreted as indicative of considerable pain. The rubber ring groups showed most changes in behaviour at all ages. The rubber ring with Burdizzo groups showed least changes and some lambs in these groups showed much less response than others. The surgical groups showed some behavioural responses which were different, both qualitatively and quantitatively to those in other groups. It is concluded that indices used for recognition and assessment of acute pain received conditional support, that modification of the rubber ring with Burdizzo may provide the least painful method without local anaesthesia and that age had little effect on the responses.
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PMID:Behavioural responses of lambs of three ages in the first three hours after three methods of castration and tail docking. 823 93

In this study we analyzed costs and income recorded in 1992 for an anesthesia department at a university hospital in Catalonia. We have broken down overall expenses into subcategories for each service provided by the department: anesthesia, intensive care, and pain (acute and chronic) therapy. We have also analyzed the department's income for these services, with particular attention to the acute pain clinic.
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PMID:[Economic analysis of an anesthesiology, resuscitation, and pain therapy service]. 837 60

Oral transmucosal fentanyl citrate (OTFC) has been used in a variety of clinical situations. This study was designed to determine if OTFC could provide analgesia to patients with acute pain after major surgery. Following written informed consent, 38 ASA Physical Status I-III patients undergoing either a total hip replacement or total knee arthroplasty were studied prospectively. The patients were randomly allocated to receive either OTFC (7-10 micrograms/kg) or a placebo identical in appearance to an OTFC unit. General anesthesia was administered for surgery, and patient-controlled analgesia (PCA) with morphine was initiated in all patients. The PCA interval dose was adjusted to provide adequate analgesia as determined by the patient and physician; the PCA lock-out time was not changed. On the morning after surgery, the most recent 12 h of PCA data (milligrams per hour of morphine and PCA attempts per hour) were recorded. OTFC or placebo units were administered at times 0, 4, and 8 h during a 12-h study, resulting in three identical units being completely consumed. PCA data, as well as incidence and severity of any adverse side effects, were recorded during the study and for the next 12 h. Treatment groups were compared for similarity, and study variables were analyzed. Twenty-eight patients completed the study, 13 in the control group and 15 in the OTFC group. There were no significant differences between the study groups as to patients' age, gender, ASA classification, or surgical procedure. In addition, there were no differences between the groups in the number of PCA attempts or delivered dose of morphine during the prestudy or poststudy periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oral transmucosal fentanyl citrate (OTFC) for the treatment of postoperative pain. 842 19

Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. Although anaesthesia based, this service requires close co-operation of surgeons, nurses and other paramedical personnel to achieve the expected results. Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development. The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetists.
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PMID:Development and organizational structure of an acute pain service in a major teaching hospital. 846 70

As more extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee and shoulder reconstruction, hysterectomy) are being performed on an outpatient basis, the availability of sophisticated postoperative analgesic regimens are necessary to optimize the benefits of day-case surgery for both the patient and the health care provider. However, outcome studies are needed to evaluate the effects of these newer therapeutic approaches with respect to postoperative side effects, cost and important recovery variables. Recent studies suggest that factors other than pain per se must be controlled in order to reduce postoperative morbidity and facilitate the recovery process. Not surprisingly, the anaesthetic technique can influence the analgesic requirements and the likelihood of emesis in the early postoperative period. Although opioid analgesics will continue to play an important role, the adjunctive use of both local anaesthetic agents and NSAIDs will probably assume an even greater role in the future. Use of drug combinations (e.g., opioids with local anaesthetics, alpha2 agonists and/or NSAIDs) may provide for improved analgesia with fewer opioid-related side effects than narcotic analgesics alone. Finally, safer and simpler analgesic delivery systems are needed to improve our ability to provide cost-effective pain relief after day-case surgery in the future. In conclusion, as a result of our enhanced understanding of the mechanisms of acute pain and the physiological basis of nociception, the provision of "stress free" anaesthesia with minimal postoperative discomfort is now possible for most patients undergoing ambulatory surgical procedures. The aim of any analgesic technique should not only be to lower the pain scores but also to facilitate earlier mobilization and to reduce perioperative complications, in particular PONV. In future, clinicians should be able to effectively treat postoperative pain using a combination of "balanced," "preemptive," and "peripheral" analgesia techniques without producing emetic sequelae.
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PMID:Management of postoperative pain and emesis. 859 Apr 97

To evaluate a possible opioid-sparing effect of intravenous lidocaine we conducted a randomized, double-blind clinical trial. Patients undergoing intraabdominal surgery under general anesthesia were treated with patient-controlled analgesia (PCA) in three groups: Group 1 (n = 100; morphine 1 mg/mL), Group 2 (n = 44; morphine 1 mg/mL plus lidocaine 10 mg/mL), and Group 3 (n = 51; morphine 1 mg/mL plus lidocaine 20 mg/mL). Pain was evaluated using a 0-10 visual analog scale in the postanesthesia care unit (PACU) during deep inhalation at 15 and 30 min, and at 1, 2, and 4 h after arrival in the PACU, and continued after PACU discharge every 4 h for 36 h. Patients whose pain was more than 4/10 in the PACU received 2.5 mliters of the respective solutions every 7 min until pain was less than 4/10; then PCA was started. The number of bolus and cumulative drug doses during the study were recorded. Along with pain intensity, we assessed vital signs and side effects. Time to acceptance of oral liquids was also determined. Adding lidocaine 10 or 20 mg/mL to PCA morphine 1 mg/mL for acute pain treatment after abdominal surgery yielded no differences in opioid use, pain levels, or side effects.
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PMID:Equivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone. 865 17

In order to determine the degree to which the recommendations of the report of the joint working party on 'Pain after Surgery' by the Royal College of Surgeons of England and the College of Anaesthetists have been implemented, a postal survey was conducted of all hospitals in the United Kingdom where surgery is performed. The number of hospitals with a multidisciplinary acute pain service had significantly increased from 2.8% before September 1990 to 42.7% at the end of 1994. Over the same period there has been an increase in the number of hospitals with a named clinician responsible for acute pain management, from 20 before 1990 to 230 (65.2%) and the number of hospitals with an acute pain nurse has increased from 8 (2.3%) prior to 1990 to 139 (39.3%). Routine assessment of pain and sedation occurs in 82% of hospitals with established acute pain services and in less than 50% of hospitals without an acute pain service. The use of written protocols, the provision of out-of-hours cover and regular training for all staff have increased with time. Research and audit activity related to acute pain management has also improved since 1990.
Anaesthesia 1996 Mar
PMID:National provision of acute pain services. 871 21

Eight patients undergoing major maxillary surgery were given sustained-release morphine (100 mg MST Continus) rectally, immediately after induction of general anaesthesia. Blood samples for assay were taken just prior to morphine administration, together with a further 11 samples over the following 24 h. Assay of the plasma for morphine, morphine-3-glucuronide and morphine-6-glucuronide was carried out using a validated high-performance liquid chromatography technique. Morphine Tmax ranged from 3 h to 12 h (median 6 h), Cmax 8.0-40.0 ng/ml and AUC0-24 90.1-429.7 ng/h/ml in subjects offering blood samples over the 24-h period. Likewise, morphine-3-glucuronide Tmax ranged from 3 h to 24 h (median 9 h), Cmax 153-370 ng/ml and AUC0-24 2776-4390 ng/h/ml. Morphine-6-glucuronide Tmax ranged from 8 h to 12 h (median 10 h), Cmax 24-59 ng/ml and AUC0-24 137-803 ng/h/ml. Morphine and morphine metabolite AUC0-24 ratios were calculated, but they did not correlate with analgesic needs. The AUC0-24 ratios were similar to those following oral and rectal dosing in other studies involving cancer patients. The wide variation of individual morphine and metabolite plasma levels, and their AUC ratios indicates considerable interpatient variability in the absorption and metabolism of rectal sustained-release morphine. This large interpatient variation may indicate that it is not suitable for acute pain, because analgesic requirements change much more rapidly than in the chronic pain situation where individual patient titration can take place.
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PMID:Rectal controlled-release morphine: plasma levels of morphine and its metabolites following the rectal administration of MST Continus 100 mg. 880 41


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