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

Interpleural analgesia, a recently devised method for postoperative analgesia, consists of the injection of a local anaesthetic into the pleural space. The technique of the catheter insertion is simple and derived from the threadening of an epidural catheter, using the same equipment. An unilateral analgesia is obtained with a rapid onset but not efficient enough for a surgical procedure. The area covered by analgesia includes the thorax and the upper part of the abdomen. No haemodynamic adverse effects occur and ventilatory function is rather improved. The main mechanism of analgesia is probably a retrograde intercostal nerve blockade. Although the exact dose and volume of local anaesthetic is still controversial, 20 to 30 mL of 0.5% bupivacaine is very likely the most convenient. Lidocaine may also be administered at the dose of 2 mg.kg-1 of a 2% solution. Main indications of interpleural analgesia are cholecystectomies and thorax trauma patients. Adverse effects and hazards are uncommon and include mainly pneumothorax and toxic effects of a local anaesthetic overdose.
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PMID:[Intrapleural analgesia]. 781 8

Trauma is the leading cause of mortality in children between the ages of 1 and 14 years. It represents a major health problem in all industrialized countries. A well coordinated organization of the whole chain of cares is essential, from the initial management at the scene of the accident until the long term neurological rehabilitation of the child. During the initial examination, the presence of anoxia, hypovolemia or neurological distress was systematically evaluated. Emergency therapeutic measures should be ensured. At the term of this initial management: if the haemodynamic state is unstable, an emergency operative procedure may be required; if the haemodynamic state remains stable, one can realize a complete clinical and radiological assessment. The clinical and biological supervision must continue during this evaluation while sedation and analgesia are essential to limit an increase in intracranial pressure (ICP). At the term of this complete assessment, if one or several surgical lesions are identified, an operative program with a precise hierarchy is scheduled; if an intensive medical support is required, the child is then transferred to the pediatric intensive care unit. Most often, children with a serious head trauma do not have neurosurgical lesions but a "brain-swelling" or cerebral edema. Elevated ICP is one of the main risk for cerebral ischemia. Therefore, continuous assessment of ICP is essential. Thoracic trauma is most often a closed trauma in the child: pneumothorax and pulmonary contusion are the problems most frequently met. An emergency laparotomy is required if the abdomen volume increases rapidly associated to the persistence of a unstable haemodynamic status despite an important fluid expansion. However, the presence of intraperitoneal blood is no longer a formal indication to surgery. Frequent examination of liver and splenic lesions with abdominal tomodensitometry allows to avoid surgery in more than 90% of cases at the price of a very rigorous haemodynamic supervision. Intestinal perforations are rare and difficult to diagnose: peritoneal dialysis, if it reveals the presence of a leucocytosis greater than 500/mm3 or bacteria justifies the surgery.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Polytraumatised children]. 784 20

Few studies define differences between video-assisted thoracic surgery (VATS) over conventional posterolateral thoracotomy (PLT) for limited procedures. We propose that length of hospital stay (LOS), the days of requirement for narcotic analgesia (DNA) by epidural, intravenous, intramuscular, or oral administration, operating time (OT), return to pre-operative functional status (RT), and the achievement of a therapeutic objective are not dependent on the approach taken (VATS or PLT) for selected diagnostic and therapeutic procedures for pleural, pulmonary, or mediastinal disease. A total of 102 consecutive patients (52 males, 50 females, age 48 +/- 16 years) were eligible to undergo (VATS) for diagnosis and/or treatment of lung lesions, pleural disease, persistent pneumothorax or mediastinal lesions. Seventy-two underwent VATS only and 21, conventional posterolateral thoracotomy (PLT). Nine VATS patients were converted to PLT, for completion of lobectomies after VATS staging of resectable malignancy (6), extensive decortication (2), and giant bullectomy (1). VATS and PLT were compared according to OT, LOS, DNA, RT, achievement of diagnostic and/or therapeutic objective, and morbidity and mortality. After VATS only and PLT only, LOS was 4.8 +/- 2.7 and 7.8 +/- 4.6 days, respectively (P < .03). DNA was 3.4 +/- 2.1 and 6.1 +/- 3.6 days after surgery, respectively (P < .01). RT was 12.0 +/- 11.2 and 21.4 +/- 9.5 days, respectively (P < .01). OT was 80 +/- 34 and 95 +/- 32 minutes, respectively (P = ns). Among 9 conversions from VATS to PLT LOS was 11.4 +/- 5.5, DNA 6.9 +/- 4.4 and RT 20.1 +/- 6.0 days.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intrathoracic biopsies, pulmonary wedge excision, and management of pleural disease: is video-assisted closed chest surgery the approach of choice? 797 82

A sick premature baby who requires intensive care will undergo many uncomfortable procedures. It is now accepted that such babies perceive pain and need adequate analgesia, but little is known about the effects of sedation in these patients. We investigated the use of morphine to provide analgesia and sedation for ventilated preterm babies in a randomised, double-blind, placebo-controlled trial. 41 mechanically ventilated babies who had been treated with surfactant (Curosurf) for hyaline membrane disease were randomly assigned morphine in 5% dextrose (100 micrograms/kg per h for 2 h followed by 25 micrograms/kg per h continuous infusion) or 5% dextrose (placebo). Plasma catecholamine concentrations were measured 1 h after the first dose of surfactant and 24 h later. Blood pressure was measured at study entry and after 6 h. The morphine and placebo groups showed no differences in method of delivery, Apgar scores, birthweight, gestation, or catecholamine concentrations at baseline. Morphine-treated babies showed a significant reduction in adrenaline concentrations during the first 24 h (median change -0.4 [95% CI -1.1 to -0.3] nmol/L p < 0.001), which was not seen in the placebo group (median change 0.2 [-0.6 to 0.6] nmol/L, p = 0.79). There was a non-significant reduction in noradrenaline concentration in the morphine group. Blood pressure showed a slight but non-significant fall (median -4 mm Hg) in morphine-treated babies. The incidence of intraventricular haemorrhage, patent ductus arteriosus, and pneumothorax, the number of ventilator days, and the numbers of deaths did not differ significantly between the groups. Morphine, in the dose regimen we used, is safe and effective in reducing adrenaline concentrations in preterm ventilated babies.
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PMID:Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated pre-term babies. 810 52

The immediate effects and long-term results are reported of thoracoscopic pleurodesis in 225 patients (158 men, 67 women) treated for persistent or recurrent spontaneous pneumothorax. The procedure was performed by combined local and neurolept analgesia with direct visual exploration of the pleural space through a rigid thoracoscope. The technique included electrocoagulation of small pleural blebs, followed by regional application of fibrin and insufflation of talc powder. The main indications were a first event which persisted more than 7 days despite chest-tube suction drainage in 27% (n = 61) or a recurrent event in 73% (n = 164). The procedure provided primary success in 96.4% of the patients. Only 8 patients (3.6%) required surgical intervention including parietal pleurectomy. Perioperative complications were pharmacologically induced respiratory failure (n = 5), generalized subcutaneous emphysema (n = 8), bleeding by cutting adhesions (n = 5) and Horner's syndrome (n = 2). However, no fatal complications occurred which could be ascribed to the procedure and all patients were discharged from the hospital after an average of 12.3 days except one who died of pulmonary embolism 5 days after thoracoscopy. Long-term follow-up over a mean period of 4.1 years revealed an ipsilateral recurrence rate of 10.2% (n = 24), 16% of the patients complained of sporadic pains at the site of insertion, 51% still had diffuse thoracic pains and 2.4% reported occasional attacks of dyspnea. Spirometric lung function tests showed normal values in 89%. The immediate and longterm results show thoracoscopic pleurodesis with fibrin and talcum to be a safe and effective method for treatment of patients with persistent or recurrent pneumothorax.
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PMID:[Thoracoscopic pleurodesis in spontaneous pneumothorax]. 811 43

A 44-year-old patient, without remarkable medical history, was admitted with a head trauma with initial loss of consciousness and a thoracic trauma. The initial treatment included the insertion of a chest drain for evacuation of a pneumothorax and intrapleural analgesia with bupivacaine. The day after admission, the patient experienced a generalized epileptic crisis, without prodomes. Later, a left proportional hemiplegia with aphasia was recognized. The CT scan obtained immediately after the crisis, as well as the carotid Doppler ultrasonography and echocardiography were normal. The bilateral carotid angiography showed an image of fibromuscular dysplasia of the extracranial segment of the right internal carotid artery. The migration of a carotid thrombus initiated by the trauma was hypothetized. A treatment with a platelet aggregation inhibiting drug was started and associated 20 days later with low molecular weight heparin. The patient recovered a normal motility within 10 days; only the aphasia remained. Trauma of the carotid artery is not a frequent cause of cerebrovascular accident. The occurrence of the latter is favoured by a pre-existing lesion of this artery. This case demonstrates that in a trauma patient not all central nervous system manifestations are initiated by a head trauma.
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PMID:[Post-traumatic hemiplegia in a patient with fibromuscular dysplasia of the carotid artery]. 831 57

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.4%). Ninety seven patients underwent pleural abrasion, and 10 underwent parietal pleurectomy. Prolonged continuous epidural analgesia was performed in 57 cases. Postoperative complications occurred in 15 patients (14%). Overall morbidity was significantly higher in patients with chronic lung disease (26.3%) than in patients without chronic lung disease (7.2%) (p < or = 0.01). As far as postoperative hospital stay was concerned, the same significant difference was observed (16.8 days versus 12.7 days) (p < or = 0.005). In patients with idiopathic pneumothorax, postoperative hospital stay was significantly shorter in those with epidural pain relief (11.7 days) than in the others (13.6 days) (p < or = 0.025). No recurrence was observed with a mean follow-up of 27 months. We conclude that: 1) surgery is the most efficient treatment of persistent or recurrent pneumothorax; 2) operative morbidity is related to the underlying lung disease and not to the procedure itself; 3) epidural analgesia is beneficial in this surgery.
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PMID:[Results of surgical treatment of persistent or recurrent pneumothorax]. 831 71

Data were collected from a retrospective audit in anaesthetists members of the French Association of Anaesthetists in Paediatrics (ADARPEF) and from the prospective study of the author's practice of appendectomy using open or laparoscopic surgery. Retrospective data obtained in 9 of the 16 answering centres show that contraindications include respiratory disability, cardiopathy and age lower than 5 years when surgical instruments of proper size are not available. Monitoring included electrocardioscope, non invasive arterial pressure, pulse oximetry and capnography. Three centres excluded halothane due to possible cardiovascular concern. In two institutions N2O was omitted to limit the size of potential gas embolism. Intraoperative events included high PETCO2 (37%), high arterial pressure (10%), low arterial pressure (3%), bradycardia (1%), hypoxia (0.5%) and one case of pneumothorax. In the appendectomy series, laparoscopy increased the duration of the procedure, and therefore intraoperative opioids requirements. Arterial pressure was higher in this group, irrespective to intraabdominal pressure and to PETCO2. No significant improvement in postoperative analgesia was found. It is therefore recommended to pay special attention to intraoperative anaesthetic and surgical management of children undergoing laparoscopic surgery, particularly in newborns and infants. The high incidence of minor intraoperative adverse events should be balanced by increased postoperative benefit to the patient which has not yet been demonstrated in children.
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PMID:[Laparoscopic surgery in pediatrics: the point of view of the anesthetist]. 837 18

The ability of interpleural analgesia to reduce the pain caused by an indwelling chest drain was evaluated in 22 patients treated for spontaneous pneumothorax. Intermittent 8-hourly bolus injections of 20 ml bupivacaine 0.5% with epinephrine were compared with placebo in a randomized double-blind fashion. Visual analogue pain scale (VAS) scores were registered after the 1st, 2nd, 4th, 7th and 10th injections. The scores were significantly lower in the bupivacaine group at 5, 15, 30 and 60 min after the first injection. No significant differences in pain scores were found after 4 or 8 h. Pain scores in the bupivacaine group were also reduced after the 2nd, 4th, 7th and 10th injections, but compared with placebo the differences were significant only after the 2nd and 7th injections. Parenteral morphine consumption was not significantly lower in the bupivacaine group. Arterial blood gases were unaffected by the treatment in both groups. It is concluded that interpleural analgesia using bupivacaine given as bolus injections at 8-h intervals significantly reduces the pain caused by a chest drain within 5 min of injection, but the duration of pain relief is less than 4 h.
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PMID:Interpleural bupivacaine for analgesia during chest drainage treatment for pneumothorax. A randomized double-blind study. 844 5

A 23-year-old woman experienced headache following a high thoracic epidural analgesia to control postoperative pain after thoracoscopic treatment of a recurrent pneumothorax. On fourth postoperative day, a blood patch has been sited with 17 mL of autologous blood, injected into the thoracic epidural space at T1-T2 level, which was immediately effective. Except a mild and transient cervical pain during the procedure, no other complication occurred. The technique of thoracic blood patch is similar to the lumbar one, except some minor modifications. According to this case of a thoracic epidural blood patch which is seemingly the first one reported in the literature and our expertise with two other unpublished cases, a volume of 10 mL of blood may be sufficient and free of adverse effects.
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PMID:[Blood-patch treatment of headache occurring after post-dural puncture at the thoracic level]. 873 53


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