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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effectiveness of patient-controlled analgesia (PCA) depends upon the patient's appropriate response to a strong aversive stimulus (i.e., pain) with subsequent reinforcement (i.e., opiate injection). Each patient may have psychological characteristics that modify this response to aversive stimuli. To test for such characteristics, 76 female patients undergoing abdominal gynecologic procedures were given psychological tests (i.e., the Chance External, Powerful Others External, and Internal subscales of the Multidimensional Health Locus of Control; the Activities of Daily Living scale; and the Hypochondriasis, Depression, and Hysteria scales of the Minnesota Multiphasic Personality Inventory). Patients utilized PCA for postoperative analgesia. At the completion of PCA, patients were given a questionnaire assessing both the level of pain and degree of satisfaction with pain relief. Correlational analysis compared the level of pain and degree of satisfaction with results of psychological testing. Results showed that female patients with an external locus of control had higher levels of pain and greater dissatisfaction with PCA. An internal locus of control was predictive of lower pain scores and increased satisfaction. PCA effectiveness, as measured by the level of pain and degree of patient satisfaction, correlated with results of psychological testing. The delineation of these and other possible modifiers of PCA efficacy may define populations that are optimally responsive to PCA.
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PMID:Modifiers of patient-controlled analgesia efficacy. I. Locus of control. 281 51

Fifty-eight gynecologic surgical patients using patient-controlled analgesia (PCA) were given several psychological questionnaires and their pain was monitored postoperatively. Pain scores were recorded hourly on postoperative day 1. In addition, patients were asked to score retrospectively their overall pain experience while using PCA (Patient Overall Evaluation). Patients having had a history of pain for at least 6 months were considered to have 'chronic pain,' while those who had no history of chronic pain were grouped as 'acute pain' patients. Chronic pain patients spent more time in 'moderate' pain than did acute pain patients. While patients with a history of chronic pain had higher scores on the hourly pain scale compared to acute pain patients, there were no differences between the two groups on the Patient Overall Evaluation. In addition, chronic pain patients reported the same pain levels after completion of PCA as they did during its use, in contrast to acute pain patients whose retrospective pain levels were higher than during PCA use. Compared to acute pain patients, chronic pain patients had higher scores on both the Hypochondriasis and the Hysteria scales of the MMPI. A history of chronic pain may affect the use of patient-controlled analgesia since chronic pain patients may accommodate to a 'moderate' pain level which approximates their preoperative perception of pain. By contrast, acute pain patients who have no 'chronic pain experience' may self-administer pain medication so as to attain a predominately 'mild' level of pain.
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PMID:Modifiers of patient-controlled analgesia efficacy. II. Chronic pain. 281 52

A 30-year-old female was scheduled for an expander insertion of the breast under local anesthesia. Thirty minutes after infiltration anesthesia with lidocaine and bupivacaine mixture, she suffered from dyspnea. She was intubated and transferred to our hospital. As her vital signs were stable and consciousness was clear, she was extubated in the emergency room. However, she was reintubated at night and ventilated mechanically for two days. Three months later, breast expander insertion was performed under general anesthesia. After extubation, dyspnea attack occurred and midazolam was injected. Seven months later, the reconstruction of TRAM flap was performed under general anesthesia and continuous subcutaneous injection of morphine was used for the postoperative analgesia. After extubation, she was sedated deeply and dyspnea attack did not occur. A month later, she was scheduled for the debridment and the resuture. Then, dyspnea attack occurred in the ward at night. The apnea monitor was attached to her in recovery room after extubation following the operation of debridment and resuture. Dyspnea attack appeared and was diminished with midazolam injection. We diagnosed her as hysteria with CMI and MMPI psychologic tests.
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PMID:[Dyspnea attack due to hysteria after general anesthesia]. 1084 92