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

The obstetric patient presents unique challenges to the anaesthesiologist. The physiologic changes in the mother during pregnancy and the anaesthetic implications of these changes, associated with the pathophysiologic conditions frequently superimposed on the pregnancy, distinguish the parturient from the other patients about to undergo anaesthesia and surgery. Furthermore, the obstetric patient may be in acute pain from labour and frequently needs urgent surgical intervention because of sudden changes in the condition of the mother or the fetus.
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PMID:Preanaesthetic management of the obstetric patient. 890 13

The author provides practitioners with a summary of recent trends in the management of acute pain in children. This review encompasses pharmacologic techniques as they pertain to two common acutely painful conditions in children: postoperative and procedural pain. In the area of postoperative analgesia, reviewed are the use of regional anesthesia, spinal opioids, alpha-agonists, preemptive analgesia, and patient-controlled analgesia. In the area of procedural pain, current standards for safety guidelines and several recently introduced sedative and analgesic medications are discussed. The author emphasizes that the proper and safe alleviation of acute pain in the pediatric population is not only feasible but is currently the standard of care in the United States.
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PMID:Recent trends in the management of acute pain in children. 893 46

The inadequacies of conventional intramuscular opioid analgesia have fueled an expansion in the use of patient-controlled analgesia and epidural analgesia after surgery. This is not always accompanied by increased education and specialist supervision of ward staff and patients. A survey in our hospital prior to the appointment of an Acute Pain Nurse showed an unacceptable incidence of side effects when epidural analgesia was employed on ordinary surgical wards. More surprisingly, efficacy of patient-controlled analgesia was found to be low. Frequent review of patients and regular education of ward staff by a specialist Pain Nurse have achieved a substantial reduction in side effects of epidural analgesia and improvement in efficacy of patient-controlled analgesia. We have shown that the advantages of patient-controlled analgesia can be largely negated by failure to address deficiencies in knowledge of pain management among ward staff and patients.
Anaesthesia 1996 Dec
PMID:Audit of postoperative pain control. Influence of a dedicated acute pain nurse. 913 3

A project is described in which a standard in the Post Anesthesia Care Unit (PACU) for managing patients with acute pain was implemented. The nurses' documentation and their perceptions concerning pain management were assessed. The data collected from the pre-questionnaires showed misconceptions about pain medication, lack of knowledge about measurement tools, and value systems that were inconsistent with recognizing a comfortable and safe "comfort level" of pain for patients. The pre-audit of PACU nursing documents showed that the assessment of pain was noted in terms of presence or absence but not quantified by the use of a measurement standard. After the implementation of a pain standard, results of the post-questionnaires showed changes in behaviors, attitudes, and knowledge that showed significant increases in the use of a numerical or visual pain tool, and an increase in documented evaluation of pain.
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PMID:Standardization of pain management in the postanesthesia care unit. 906 62

At the R. Adams Cowley Shock Trauma Center, participation of anesthesiologists in the care of thoracic trauma victims begins with the initial assessment of patients on arrival by helicopter or ambulance. It continues with management of the airway, stabilization of hemodynamics, intraoperative management, patient care in the PACU and critical care setting, and acute pain management. By using a team approach involving anesthesia, surgery, and critical care, the care of trauma victims with thoracic injury continues to be enhanced.
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PMID:Anesthetic considerations in chest trauma. 915 90

Effective treatment of acute pain secondary to surgery and trauma is often a complex and perplexing task. Concern about potential adverse effects of analgesic drugs on cardiovascular, respiratory, renal, and central nervous system functions often limits the use of analgesics in the very patients that could benefit from them the most. Combining drugs of different classes and with different mechanisms of action is an established anesthesia technique used to achieve a desired effect with a minimum of adverse side effects. Similarly, the use of a balanced or multimodal approach to the treatment of acute pain can greatly enhance the clinician's ability to safely provide effective analgesia. Systemic opioids, alpha-2 agonists, nonsteroidal antiinflammatory drugs, and local or regional analgesic techniques can be used in varying combinations to meet the needs of the painful animal and hasten recovery.
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PMID:Management of acute and surgical pain. 915 67

The first anaesthesia-based acute pain service in Singapore is described. The benefits, risks and resource implications of such a service during its first two years are reviewed. One thousand two hundred and sixty-eight (1,268) post-operative patients were treated with either patient-controlled analgesia (310 patients) or epidural opioid analgesia (958 patients). Retrospective analysis of the data revealed good patient satisfaction with a low incidence of potentially life threatening side-effects: more than 79% of patients reported satisfaction with pain control while only 0.2% of patients receiving epidural opioid analgesia experienced clinically significant respiratory depression. There were no reports of respiratory depression in the patient-controlled analgesia group. The authors conclude that the provision of an acute pain service in the local context was safe and resulted in excellent post-operative patient satisfaction.
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PMID:A two-year experience of an acute pain service in Singapore. 925 1

The effects of prescribing guidelines for analgesia were assessed by auditing prescriptions for opioids before and after the introduction of hospital prescribing guidelines. Opioid prescriptions were collected by the pharmacy department over a 2-week period in November 1994 and repeated in November 1995. Following the initial audit, analgesic prescribing guidelines were introduced. A statistically significant increase was achieved in the number of prescriptions that were correct for both dose and frequency according to both the British National Formulary recommendations (40-61%; p < 0.001) and our Acute Pain Service guidelines (16-26%; p < 0.05). There was a statistically significant decrease in the number of prescriptions that were inadequate for both dose and frequency according to both the British National Formulary recommendations (18-3%; p < 0.001) and our Acute Pain Service guidelines (36-17%; p = 0.001). The use of accessible prescribing guidelines promotes demonstrable improvements in opioid prescribing.
Anaesthesia 1997 Aug
PMID:Audit of opioid prescribing: the effect of hospital guidelines. 961 81

Anaesthetists, using basic scientific concepts of peripheral opioid activity, try to improve regional anaesthesia and postoperative analgesia by injecting opioids, with or without local anaesthetic, close to nerve trunks or nerve endings. To test the evidence that peripherally applied opioids (all except intra-articular) have an analgesic effect outside the knee joint. Systematic search for published reports of randomised controlled trials in the period 1966-1996 (MEDLINE, EMBASE, Oxford Data Base, reference lists) which compared efficacy of peripheral opioids with placebo, local anaesthetic, or systemic opioids in acute pain. Reports of pethidine or intra-articular opioids were not included. Data on intraoperative efficacy (onset, quality, duration of sensory block), and postoperative efficacy (pain intensity, analgesic consumption) were extracted. Statistical significance as indicated in the original reports and clinical relevance of differences between opioids and controls were taken into account to estimate qualitatively overall efficacy. Twenty-six trials with data from 952 patients were analysed. Opioids used were morphine (16 trials), fentanyl (8), alfentanil (1), buprenorphine (1), and butorphanol (1). Of four experimental pain trials, two reported a statistically significant difference in favour of the opioid. In 22 clinical trials efficacy of opioid injections into the brachial plexus (10), Bier's block (4), perineural (3), or other sites (5) was tested. Five of 10 clinical trials measuring intraoperative efficacy reported statistically significant efficacy with opioids compared with control; none of them were judged to be clinically relevant. Five of 17 clinical trials measuring postoperative efficacy reported a significant difference in favour of the opioid; none was judged to be clinical relevant. Trials of lower quality were more likely to report increased efficacy with opioids. Adverse events related to the route of administration were not reported. These trials provide no evidence for a clinically relevant peripheral analgesic efficacy of opioids in acute pain.
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PMID:Analgesic efficacy of peripheral opioids (all except intra-articular): a qualitative systematic review of randomised controlled trials. 931 71

Patients suffering from vascular disease are often a challenge for the acute pain service. Ischaemia, impaired wound healing, stump and phantom limb pain often require a complex analgesic regimen. Invasive measures such as spinal or epidural catheters can be very helpful but carry the risk of infection, as shown by this case report. A 53-year-old woman with a ten-year history of diabetes developed arterial vascular disease. Her right lower leg had been amputated two years previously. She was now admitted with necroses of the left forefoot. A bypass operation was performed under general anaesthesia. Because of intractable ischaemic pain, she was provided with an epidural catheter by the acute pain service. The bypass occluded, however, and a few days later her left lower leg also had to be amputated, this operation being performed under epidural anaesthesia with bupivacaine. The catheter was subsequently used for postoperative pain control and as a means to prevent phantom limb pain. When signs of superficial catheter infection were noticed days later, the catheter was immediately removed. Intractable pain then developed in the left leg which could not be sufficiently controlled with opioids and NSAIDs, and so a second epidural catheter was inserted one segment rostrally. Several days later the infected vascular prosthesis had to be removed followed by amputation of the thigh, this operation also being performed in epidural anaesthesia. Eleven days after insertion of the first epidural catheter, the patient complained of low back pain and headache. Examination by a neurologist revealed no signs of intraspinal infection. The second epidural catheter dislocated at this point in time and it was decided to introduce a third one, this being the only means to treat the otherwise intractable stump pain. Ten days later meningism, Kernig's sign and leucocytosis developed. NMR tomography detected intraspinal fluid in the epidural space at the dorsal border of the spinal canal. A hemilaminectomy was performed. The spinal epidural space showed signs of inflammation of the adipose tissue, but no pus. A little necrotic material and residues of an old haematoma were removed and the epidural space was lavaged. Specimens taken from the epidural material revealed colonisation with staphylococcus epidermidis, which was sensitive to the broad spectrum antibiotics formerly given to the patient to treat the infection in the left stump. By the next day, all signs of epiduritis had disappeared and the patient recovered completely.
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PMID:[Epiduritis after long-term pain therapy with an epidural catheter--review of the literature with a current case report]. 932 67


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