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

The intrapleural administration of local anesthetics via a catheter is a relatively new method for postoperative analgesia after thoracic and upper abdominal surgery. Many authors have described this technique as effective and with few side effects. METHODS. Intrapleural administration of bupivacaine (IPC group) was compared with intramuscular administration of buprenorphine in 26 patients who had undergone a cholecystectomy. During the 1st postoperative week the pulmonary function (vital capacity, forced expiratory volume in 1 s [FEV1]) and an arterial blood gas analysis were performed daily and the quality of analgesia was evaluated. RESULTS. The patients in the two groups were similar with regard to sex, age, weight, and height. The postoperative arterial oxygen partial pressure (pO2) did not differ significantly from the preoperative value in the IPC group, whereas in the opioid group the results were significantly lower than preoperatively (p less than 0.05 6 h after the operation and p less than 0.005 from the 1st to 7th postoperative days). There was a significantly higher pO2 in the opioid group preoperatively that, however, had no correlation with the differences between pre- and postoperative values. After the operation, the differences from the preoperative value were significantly smaller in the opioid group from the 1st to 7th postoperative days, reaching a significance of p less than 0.001 on the 2nd and 3rd, postoperative day. The pCO2 was slightly increased after the operation, but there were no significant differences between the groups. A significant decline in vital capacity and FEV1 occurred in both groups during the first days after the operation; there were no significant differences between the two groups during these days. The degree of pain was similar in the two groups before the analgesic was given. In both groups there was significant improvement of the degree of pain after administration of the analgesic. One hour after the injection, however, the degree of pain was significantly lower in the IPC group compared with the opioid group. Postoperatively, pathologic findings could be seen more often on chest X-rays in the opioid group, although there was no significant difference between the groups. There were no side effects caused by the intrapleural catheter or the local anesthetic except for a minor pneumothorax in 1 patient that did not need any treatment. CONCLUSION. The intrapleural administration of local anesthetic provided very good analgesia in our study. The pO2 was significantly higher and the analgesia was significantly better than after intramuscular opioid administration. Moreover, the technique is simple to perform and has few side effects. We therefore believe it should be employed for postoperative analgesia after thoracic and upper abdominal surgery as well as for other indications to a greater extent.
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PMID:[Intrapleural bupivacaine and parenteral opioid for postoperative analgesia. A comparative study]. 153 41

Problems facing a patient with severe dyspnea secondary to diaphragmatic herniation are hypoxia, hypercarbia and respiratory acidosis, and cardiovascular instability. It is easy to precipitate a crisis in these patients during anesthetic induction as a result of stress, bad positioning, induction of pneumothorax, or inappropriate anesthetic technique. These patients require a smooth, stress-free perianesthetic period with preoxygenation, positioning with the affected side down, rapid intravenous induction, endotracheal intubation, and mechanical ventilation. Maintenance with isoflurane is preferred, and nitrous oxide should be avoided. Close monitoring of the cardiovascular and pulmonary systems is essential. Recovery from anesthesia should include oxygen supplementation, pleural drainage, and local analgesia if required.
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PMID:Anesthesia for patients with diaphragmatic hernia and severe dyspnea. 158 3

Sixteen consecutive adult patients scheduled for permanent transvenous cardiac pacemaker insertion received as their total anesthetic the combination of a cervical plexus block and blocks of the second, third, and fourth intercostal nerves using a combination of 1% mepivacaine and 0.2% tetracaine with epinephrine, 1:200,000. This technique consistently provided complete surgical anesthesia of the third cervical (C3) through the fourth thoracic (T4) dermatomes, without anesthesia of the brachial plexus. Anesthesia was adequate for the surgical procedure without the need for supplemental analgesia or anesthesia in all cases. Because fluoroscopy was used routinely for the surgical procedure, it was possible to document that there were no instances of diaphragmatic paralysis or pneumothorax. In contrast to other reports, this technique provides surgical anesthesia that is adequate for all of the approaches used for transvenous pacemaker implantation, except for placement of a battery in an abdominal pouch. There were no serious complications and/or side effects in any of the patients studied.
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PMID:A complete regional anesthesia technique for cardiac pacemaker insertion. 186 85

Three postoperative analgesic protocols were assigned randomly to 24 healthy dogs after thoracotomy at the left fourth intercostal space. Morphine was administered parenterally to eight dogs after tracheal extubation; selective intercostal nerve blocks with bupivacaine hydrochloride and epinephrine were administered to eight dogs before closure of the thorax; and bupivacaine hydrochloride and epinephrine were administered through an interpleural catheter to eight dogs after tracheal extubation. Heart rate, respiratory rate, rectal temperature, hematocrit, plasma protein, blood gas, and pain score evaluations were recorded before surgery and 30 minutes, 1 hour, 2 hours, and 3 hours after extubation. Morphine caused significant decreases in blood pH and blood oxygen tensions, and significant increases in carbon dioxide tensions. Dogs treated with intercostal nerve blocks had no significant changes in these parameters, and dogs treated with interpleural bupivacaine had significant decreases in blood oxygen tension. All dogs had significant decreases in rectal temperature, and hypothermia was prolonged after morphine. Analgesia was initially adequate in most dogs, but some dogs in each treatment group had recurrence of pain and were treated with interpleural bupivacaine. One dog developed pneumothorax. Interpleural administration of bupivacaine produced analgesia equal to that produced by systemic administration of morphine or selective intercostal nerve block with bupivacaine. Bupivacaine was easily readministered through an interpleural catheter. Respiratory compromise was less in dogs treated with bupivacaine than in dogs treated with morphine. After intercostal thoracotomy, interpleural bupivacaine provided prolonged analgesia with fewer blood gas alterations than morphine.
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PMID:Analgesia in dogs after intercostal thoracotomy. A comparison of morphine, selective intercostal nerve block, and interpleural regional analgesia with bupivacaine. 190 Nov 83

Patients with multiple rib fractures often suffer from severe pain that impairs their respiratory performance. The effect of interpleural administration of bupivacaine (20 ml 0.25% every 4 h) for pain management was evaluated in ten patients. The initial interpleural injection resulted in significant pain relief and improvement of arterial oxygen tension. Two patients needed additional i.v. injections of opioids (piritramide 15-22.5 mg/24 h). In one patient a small asymptomatic pneumothorax was observed following placement of the catheter, which resolved spontaneously. No other complications were reported. In an intraindividual comparison, bupivacaine alone and bupivacaine plus epinephrine 1:200,000 were compared with regard to pharmacokinetics of bupivacaine, analgesic effect, side effects, and respiratory performance. The addition of epinephrine yielded only minor advantages from a pharmacokinetic point of view (median peak concentration of bupivacaine 1.8 micrograms/ml vs 2.0 micrograms/ml for bupivacaine alone). The quality and duration of analgesia and the effects on respiration were not influenced by epinephrine. The heart rate was significantly higher and the blood pressure significantly lower when epinephrine was added to the solution. Nevertheless, these differences were too small to be of clinical importance. Even though maximum total plasma concentrations of bupivacaine above 2 micrograms/ml were found in some patients, there were no signs of CNS toxicity, most probably because of the increased protein binding of bupivacaine following trauma. Accordingly, the maximum free plasma concentrations in all patients were below the threshold level of 0.24 micron/ml. We therefore conclude tht interpleural administration of bupivacaine could be a valuable means of pain relief in patients with multiple rib fractures, providing no severe pulmonary contusions or concomitant injuries are present.
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PMID:[Intrapleural catheter analgesia in patients with multiple rib fractures]. 200 23

Fourty-three patients (28 males, 15 females, median age 50 years) with iatrogenic pneumothorax following invasive diagnostic procedures (percutaneous transthoracic fine needle aspiration biopsy 26, fiberoptic transbronchial biopsy 14, pleurocentesis 3), were treated with small calibre thoracic tube drainage. The tube consisted of a teflon catheter, 160 mm long, 2 mm in outer diameter which was inserted into the second intercostal space in the mid-clavicular line in local analgesia. Pneumothorax was evacuated by intermittent aspiration with a syringe in 16 patients. In the remaining 27 patients the catheter was connected to a one way flutter valve. Treatment was uncomplicated in all patients and successful in 41 (95%) patients, while two required a large calibre chest tube on account of persistent leakage. The median drainage time was 48 hours. Small calibre thoracic tube with a one way flutter valve is convenient for treatment of iatrogenic pneumothorax, being less traumatic and less expensive than conventional thoracic tube drainage.
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PMID:[Iatrogenic pneumothorax treated with a small calibre pleural tube]. 202 15

Complications associated with interpleural block are often related to difficulty with needle and catheter placement. Thus there exists need for refinement of the puncture technique. We present our initial experience identifying the interpleural space with a new electronic detector (Episensor, Palex, Spain) that is sensitive to negative pressure. Twenty-five patients undergoing cholecystectomy (subcostal incision), nephrectomy or mastectomy were included in the study. All patients had an interpleural catheter placed after completion of surgery, but before extubation, using the Episensor. The technique was successful in all cases. The mean time from needle insertion to taping the catheter to the skin was 6.3 +/- 3.6 minutes. No patient developed a pneumothorax. Four patients (16%) complained of chest pain during the interpleural injection of radiopaque medium. Pain relief during the 48-hour observation period was good. Supplemental analgesia was required in nine nephrectomy patients. We believe the Episensor may be a valuable adjunct to the initiation of interpleural anesthesia.
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PMID:An electronic device (Episensor) for detection of the interpleural space. 204 24

Thoracic trauma is uncommon in children. It should not be managed any more as adult's trauma. We present our experience with 85 children form 1 to 16 years of age, presenting severe thoracic trauma treated in Lausanne, Switzerland, between 1976 and 1990. The specific features of diagnosis, treatment and outcome are presented. Most of them were involved in traffic accidents (62%), 55% had multisystemic injuries. The mortality rate was not a function of the Injury Seventy Score as in adults, but was only related to the Glasgow Score. Only 3 patients (3.5%) had hemodynamic instability on admission in relation with their thoracic injury. Patients with intrathoracic lesions showed dyspnoea (65%), cyanosis (25%), or clinical suspicion of a pleural effusion or a pneumothorax (47%). However 12 children had an asymptomatic severe thoracic injury. In 53 patients (62%) the auscultation was found abnormal either with absent or diminished breath sounds or other pathological findings. 10 out of 26 cases of pneumothorax could be suspected by percussion dullness. Chest X-rays showed a lesion in 76% of cases. Only 30% of the pneumothorax were associated with visible rib fractures. 10 children suffered from 4 to 12 fractures of the ribs (mean 6.6). None of these patients presented a flail chest as in adults, even when multiple rib fractures existed. 31 thoracic drainages were performed, during a mean period of 3.3 days. 30 patients were intubated and ventilated, 22 of these due to a neurosurgical condition. All patients had physiotherapy starting on day 2, under analgesia if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Characteristics of thoracic injuries in children]. 208 60

Interpleural analgesia has been successfully used for pain relief after cholecystectomy, renal surgery, breast surgery and thoracotomy. Little has been reported about side effects and complications. This article summarizes available information about adverse events collected from the literature. The survey comprises a total of 703 cases. Pneumothorax was the most frequently registered complication followed by signs of systemic toxicity and pleural effusion. Horner's syndrome, pleural infections and catheter rupture have also been reported.
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PMID:Side effects and complications related to interpleural analgesia: an update. 214 54

The authors present a pilot study in which 20 patients with simple rib fractures were randomized prospectively into two treatment groups. One group received ibuprofen and the other group ibuprofen plus a rib belt for analgesia. There were no statistically significant differences observed in pulmonary function testing between the groups at initial visit, 48 hours, or 5 days. Atelectasis developed in four patients, two in each treatment group; there were no cases of pneumonitis. Patients with displaced rib fractures experienced a higher rate of hemo- or pneumothorax than did those with nondisplaced fractures (5/10 v 1/10). Patients with displaced fractures who used rib belts experienced a higher rate of hemothorax than those using oral analgesia alone (4/6 v 1/4). Patients using rib belts uniformly reported a significant amount of additional pain relief. The clinician can use a rib belt to provide additional comfort to the patient with fractured ribs without apparent additional compromise to respiratory parameters. A further study stratifying displaced and nondisplaced fractures has been initiated to clarify the possible contributing roles of displaced rib fractures and the rib belt in patients with displaced fractures.
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PMID:A randomized clinical trial of rib belts for simple fractures. 219 66


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