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

From October 1974 through March 1995, 453 patients with spontaneous pneumothorax admited to our institution and 416 patients underwent an operation. Among them, except bilateral pneumothorax, 204 patients under sixty years of age underwent an axillary incision (Group Ax) and 80 patients underwent a thoracoscopic surgery (Group Ts). In Group Ax, 178 male and 26 female, median age was 26.6 years old and in Group Ts, 68 male and 12 female, median age was 24.6 years old. The median operating time was significantly shorter for patients in Group Ts than for those in Group Ax (73.2 versus 111.3 minutes; p < 0.05). The median intraoperative blood loss was significantly less in Group Ts than in Group Ax (5.4 versus 65.6 g; p < 0.01). There was no significant difference in the duration of intercostal drain placement between the two groups (2.1 versus 2.7 days) but the median postoperative hospital stay was significantly shorter in Group Ts than in Group Ax (8.0 versus 12.5 days; p < 0.01). 58.9% of the patients needed postoperative analgesia in Group Ts, while 82.3% of the patients in Group Ax, and it was significantly less in Group Ts. The rate of recurrent pneumothorax was more in Group Ts (5.0% versus 2.9%), because of fail to notice the bulla under the thoracoscopy. Recently we observe the thoracic cavity using electric bronchoscope in order that we may not miss the bulla, and we take laser treatment for bullous emphysema with much effect.
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PMID:[Thoracoscopic surgery versus axillary thoracotomy for spontaneous pneumothorax]. 871 61

The anaesthetic management of a child undergoing video-assisted thoracoscopic resection of a large lung cyst is described. In particular, we discuss the prolonged postoperative stay, which resulted from persistent pneumothorax, and his need for substantial analgesia up to the twelfth postoperative day-which seemed no shorter than might have been expected following a thoracotomy. While other workers have claimed advantages with thoracoscopic operations, in terms of reduced pain and morbidity, compared to traditional thoracotomy, we feel that one should be aware of the potential for severe postoperative pain in these patients.
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PMID:Anaesthetic management of a child undergoing thoracoscopic removal of a lung cyst. 918 18

We describe a novel supraclavicular approach to the brachial plexus. Designated as the intersternocleidomastoid technique, this new approach was tested in unembalmed cadavers. It was then applied for evaluation to 150 ASA grade I or II patients scheduled for elective surgery or physiotherapy of the upper limb or for treatment of reflex sympathetic dystrophy associated with painful shoulder. The new approach was easy to master because of a very simple surface landmark, i.e., the triangle formed by the sternocleidomastoid heads, which were visible and palpable in most patients studied (90%). The procedure was effective intraoperatively, providing satisfactory anesthesia in 140 patients (93%), partially satisfactory blocks in 6 (4%), and unsatisfactory blocks in only 4 (3%). The catheter entry point is cephalad enough not to obscure the surgical field on the shoulder. Catheter insertion was successful in 63 of 70 patients. Postoperative analgesia was provided for 48 h or more in 45 patients and for 24 h in 18 patients. Only minor complications were observed: asymptomatic phrenic nerve block in 89 patients (60%), transient Horner's syndrome in 15 (10%), transient recurrent laryngeal nerve blockade in 2, and misplacement of the catheter into the subclavian vein in 1 patient. No pneumothorax was observed.
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PMID:A novel supraclavicular approach to brachial plexus block. 958 21

Life-threatening haemorrhage is common in major chest and abdominal trauma (Figure 1). Management consists of rapid fluid transfusion via large bore intravenous cannulae and early surgical intervention if indicated. Refractory hypoxaemia is frequently present in the chest injured patient (Figure 2). Pneumothorax and haemothorax must be carefully sought, and chest drains used in their management. Hypoxaemia secondary to simple chest injury should be managed with oxygen administration and the provision of analgesia initially. Resistant hypoxaemia may necessitate intubation and ventilation.
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PMID:Anaesthetic management of the severely injured patient: chest injury. 937 6

The outcome of video-assisted thoracoscopic treatment of spontaneous pneumothorax was analyzed. Eighty-three procedures were performed in 79 patients (58 men, 21 women: mean age 28.3 years, range 16 to 76 years). The reasons for intervention were recurring pneumothorax in 53 patients, contralateral pneumothorax in 10 (one of whom was treated on both sides), bilateral involvement in 3, and persistent air leakage in 13. Seven patients (8.4%) also required open thoracotomy. In 72 (88%) of the remaining 76 procedures, only video thoracoscopy was used. Three patients (3.6%) underwent video-assisted thoracotomy. Mean postoperative hospital stay was 5.1 days (2 to 24 days). No related deaths occurred but surgical complications were reported for 3 (3.9%). Significant postoperative complications developed in 9 cases (11.8%). One patient with prolonged air leakage underwent a second procedure, video-assisted thoracotomy, 12 days after the first intervention. Seventy-one of the 72 patients received follow-up examinations, with a mean follow-up period of 28.1 months (range 54 days to 54 months). Three recurrences (3.9%) were recorded but there were no cases of chronic pain requiring analgesia. We conclude that video thoracoscopy is an effective approach, with the advantage of being minimally invasive. We therefore believe it should be the procedure of choice, once improved morbidity and recurrence rates are observed, as these factors are influenced by the learning curve.
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PMID:[Short and long term follow-up of spontaneous pneumothorax treated using video-thoracoscopy]. 945 15

Blunt chest trauma is the leading cause of thoracic injuries in Germany, penetrating chest injuries are rare. Hereby, single or multiple rib fractures, hemato-pneumothorax and pulmonary contusion represent the most common injuries. The early management of thoracic injuries consists of detection and sufficient therapy of acute life threatening situations like tension pneumothorax, acute respiratory insufficiency or severe intrathoracic bleeding. Most of the isolated thoracic injuries are adequately treated by conservative means, sufficient analgesia, drainage of intrapleural air or blood, physiotherapy and clearance of bronchial secretions provided; operative intervention is rarely indicated. In multiple injured patients however, severe blunt chest trauma and especially pulmonary contusion negatively affects outcome with a significant increase of morbidity and mortality. Hence, patients with this combination of pulmonary injuries, such as lung contusion and associated severe injuries, carry a particular high risk of respiratory failure, ARDS and MOF with a considerable mortality. Therefore, early exact diagnosis of all thoracic injuries is essential and can be achieved by thoracic computed tomography, which becomes more and more popular in this setting. Early intubation and PEEP-ventilation, alternate prone and supine positioning of multiple injured patients with lung contusion and differentiated concepts of volume- and catecholamine therapy represent the basic therapeutic principles. Additionally, the entire early trauma management of multiple injured patients must focus on the presence of pulmonary contusion. Every additional burden on their pulmonary microvascular system like microembolisation during femoral nailing, the trauma burden of extended surgery or mediator release in septic states may cause rapid decompensation and organ failure and therefore, has to be avoided.
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PMID:[Thoracic trauma]. 961 9

In a prospective study series of 167 patients with tube thoracostomy for spontaneous pneumothorax in 1993-1996, 32 patients (age range 16-79 years, mean age 45.5 years) were treated with autologous blood-patch pleurodesis for persistent air leak. In 27 (84%) of cases the air leak ceased within 72 h after the pleurodesis. The duration of air leak was significantly shorter (p < 0.01) than in simple drainage. Empyema developed in three cases, and two patients with failed pleurodesis required open thoracotomy. Minor complications, mainly fever and pleural effusion, occurred in nine patients. Neither analgesia nor sedation was required during or after pleurodesis. There was no recurrence of pneumothorax during 12-48 months of observation, whereas simple drainage was followed by recurrence in 22 patients. Blood-patch pleurodesis is a simple, effective and painless method in pneumothorax, but carries an increased risk of intrathoracic infection.
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PMID:Autologous blood patch pleurodesis in spontaneous pneumothorax with persistent air leak. 963 62

Regardless of its origin, the treatment of persisting or recurring spontaneous pneumothorax (SP) is classically surgical. To assess the contribution of thoracoscopy in the management of SP 100 consecutive patients with persistent or recurrent pneumothorax were treated at our unit by endoscopic procedure between 1992 and 1997 to obtain permanent pleurodesis and to treat the lung lesion responsible for the leak. There were 90 men and 10 women ranging in age from 16 to 60 years (mean age 28+/-12 years). The technique includes electrocoagulation of pleural blebs and thoracoscopic apical pleurectomy. All patients were subjected to physical examination and plain x-ray at 1 and 3 months and 1 year postoperatively. After completion of the procedure, air leaks disappeared in 90 cases, while 5 cases air leak ceased 5 to 7 days postoperatively. The remaining 5 cases were converted to an open procedure. The mean length of follow-up was 3 years. No patient required transfusion and there were no operative deaths. No recurrence of pneumothorax occurred and no major complications encountered. Video-assisted thoracoscopic pleurectomy for the treatment of pneumothorax is concluded to be that safe and efficacious. It shortens the hospital stay, requires less amount of postoperative narcotic analgesia.
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PMID:Thoracoscopic apical pleurectomy for persisting or recurring pneumothorax. 968 6

Medical thoracoscopy is an efficient technique to evaluate the gravity of a spontaneous pneumothorax in order to choose the most appropriate treatment. Classification of lesions into four types (from endoscopically normal lungs to large bullae) guides the choice from local talc pleurodesis to surgical bullectomy and pleurectomy. Most patients with the first three types can be treated with talc pleurodesis, with a good success rate (93%) and no functional sequelae (lung volumes within the normal range in primary pneumothorax and similar to previous values in secondary pneumothorax). Neuroleptanalgesia in association with patient-controlled analgesia appears to be superior to local anaesthesia in the prevention of immediate pain induced by talc poudrage. Talc pleurodesis is the treatment of choice for recurring spontaneous pneumothorax because of its high success rate and absence of complications.
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PMID:Medical thoracoscopy in the management of pneumothorax. 968 1

In a double-blinded study we examined the effect of supplementing patient-controlled morphine analgesia with intercostal nerve blockade to identify if this improved analgesia and reduced morphine requirements following renal transplantation. Fifty patients were randomized to receive unilateral intercostal nerve block with either 0.5% bupivacaine or saline to the lower five intercostal nerves. Each block was performed on the side of surgical incision following the completion of surgery. Patients receiving bupivacaine blockade reported reduced pain scores and used less morphine in the initial 4 h following renal transplantation, but did not demonstrate a significant reduction in overall pain scores, total 24 h morphine requirements, or sedation scores. Two patients developed a pneumothorax, neither of which were clinically apparent at the time of diagnosis, and only detected by chest radiography. A chest radiograph should therefore be considered mandatory after intercostal nerve blockade.
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PMID:An evaluation of intercostal nerve blockade for analgesia following renal transplantation. 969 4


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