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

The safety and efficacy of piezoelectric extracorporeal shockwave lithotripsy in the treatment of symptomatic gallbladder stones were evaluated in 53 consecutively treated patients. All treatments were performed as outpatients without anesthesia; over 95 per cent of 109 treatments were performed without analgesia or sedation. Ursodeoxycholic acid was administered post-treatment. Seventy per cent of patients had multiple sessions. Cumulative stone-free rates of 38 per cent at 6 months, 65 per cent at 12 months, and 75 per cent at 15 months were achieved. There was no difference in eventual stone clearance between patients with single stones less than 20 mm diameter, single stones greater than or equal to 20 mm diameter, or multiple (two or three) stones, although patients with single smaller stones required significantly fewer total shocks to become stone-free (P = .02). Stone clearance correlated with estimated stone volume. Biliary pain occurred in 62 per cent of patients after treatment but ceased in stone-free patients. Biliary complications of pancreatitis (7.5%) and choledocholithiasis (3.8%) were successfully treated by endoscopic papillotomy. Nonbiliary complications were virtually nonexistent. Three patients (5.7%) had elective cholecystectomy. Results indicate that piezoelectric lithotripsy is a safe, minimally painful treatment that, in conjunction with oral bile acids, can produce stone-free rates of 75 to 100 per cent in selected patients.
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PMID:Clinical results of piezoelectric gallstone lithotripsy. 158 83

We report the results of extracorporeal piezoelectric lithotripsy of gallbladder stones, using the EDAP LT 01 device, in 60 patients treated without anaesthesia or analgesia. Fragmentation was satisfactory (i.e. with fragments less than 5 mm wide) in 31 patients (52 per cent) after multiple sessions (mean: 1.6). The satisfactory fragmentation rate was higher in patients with stones smaller than 20 mm (63 vs 8 per cent; P less than 0.01) and not different in patients with solitary or multiple stones (53 vs 50 per cent). After bile acid dissolution treatment during 3, 6 and 12 months, the stone-free rates were 23, 41 and 64 per cent respectively, and significantly better at 3 and 6 months in patients with satisfactory fragmentation (42 vs 4 per cent; P less than 0.05, and 71 vs 9 per cent; P less than 0.01). Fourteen patients (23 per cent) reported biliary colic, but only one required cholecystectomy. No severe complication was observed. Piezoelectric lithotripsy is safe, requires short hospitalization and gives interesting results when the stones are less than 20 mm wide.
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PMID:[Treatment of gallbladder lithiasis by piezoelectric extracorporeal lithotripsy]. 213 61

From April to August 1990, 60 patients underwent laparoscopic cholecystectomy. Patients with biliary colic were included, but those who had florid acute cholecystitis, morbid obesity or scars in the upper portion of the abdomen were excluded. Three patients had acute cholecystitis, 56 had chronic cholecystitis and 1 had hydrops of the gallbladder. Nineteen patients had had previous lower abdominal surgery. Five patients did not require analgesia, but the remainder needed parenteral analgesia on an average of 1.7 occasions and enteral analgesia on an average of 1.8 occasions. There were no intraoperative complications, and no patient had the procedure completed by standard surgery. Postoperative hospital stay averaged 2.5 days. The mean follow-up was 39 days. Few postoperative complications were noted: two patients suffered from ileus; two patients had biliary colic postoperatively (one required endoscopic sphincterotomy with stone extraction, and in the other no common-duct stones were seen on retrograde cholangiography); one patient had an intra-abdominal abscess, which was drained percutaneously; and one patient complained of upper abdominal pain that was incisional in origin. Laparoscopic cholecystectomy should be considered the procedure of choice for elective treatment of uncomplicated symptomatic gallstone disease.
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PMID:Laparoscopic cholecystectomy: a report of 60 cases. 182 56

In many countries, the pyrazolone derivatives, which include dipyrone, antipyrine, aminopyrine and propyphenazone, are widely used analgesics. Dipyrone, the most widely used pyrazolone, has been the most studied. The pyrazolidine derivatives, phenylbutazone and oxyphenbutazone, which are not generally used for analgesia since they differ from the pyrazolones in terms of efficacy and tolerance, are not discussed in this article. Dipyrone is an inhibitor of cyclo-oxygenase but, unlike aspirin, its effect is rapidly reversible. The inhibition of prostaglandin biosynthesis contributes to the analgesic activity of the pyrazolone derivatives. Peak plasma concentrations of the pyrazolone derivatives generally occur 1 to 1.5 hours after oral administration. Half-lives vary from 1 to 2 hours with propyphenazone, to about 7 hours with dipyrone (2 hours for the active metabolite of dipyrone, 4-methylaminoantipyrine, MAA). Half-life of antipyrine varies considerably between individuals (5 to 35 hours). Unlike the NSAIDs generally, the pyrazolone derivatives antipyrine, aminopyrine and propyphenazone are minimally bound to plasma proteins. The pyrazolones undergo extensive biotransformation, aminopyrine and dipyrone being converted to active metabolites. Dipyrone is the only drug for which results of recent double-blind trials are available. Oral dipyrone has been shown to be more effective than an equal dose of aspirin or paracetamol in alleviating postoperative pain, and intravenous dipyrone 2.5g was similar in efficacy to pethidine 50 mg. In patients with acute ureteral or biliary colic, dipyrone 2.5g intravenously was similar in efficacy to indomethacin 50 mg or pethidine 50 mg. The most frequently reported side effects of the pyrazolone derivatives are skin rashes. Gastrointestinal side effects are rare. Blood dyscrasias, mostly associated with aminopyrine, have received wide attention in the medical literature, but their true incidence with dipyrone is considerably lower than the often quoted incidence for amidopyrine reported more than 30 years ago.
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PMID:Pyrazolone derivatives. 355 86

The analgesic effect of ceruletide in biliary and renal colic was evaluated by a randomized, double-blind study in 82 patients. Ceruletide was compared with pentazocine, a well-established analgetic agent. Rapid and effective analgesia was obtained by intramuscular injection of ceruletide 0.5 micrograms/kg in 56 patients with biliary colic. The analgesic effect of ceruletide compared well with pentazocine 0.5 mg/kg im, and was associated with remarkably fewer side effects. In 26 patients with renal colic, ceruletide was significantly inferior to pentazocine. These data support the recommendation of ceruletide as a first-choice analgetic agent for biliary colic.
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PMID:Analgesic effect of ceruletide compared with pentazocine in biliary and renal colic: a prospective, controlled, double-blind study. 389 Dec 84

Laparoscopic cholecystectomy for the treatment of gallstone disease has the advantages of a shorter postoperative stay, more rapid overall recovery time, and better cosmesis compared to open cholecystectomy. To assess the state of development of laparoscopic cholecystectomy in Brunei, a prospective review of all 220 such procedures performed at the RIPAS Hospital in Bandar Seri Begawan in 1992-96 was conducted. These cases represent the total number of procedures performed in Brunei to date. The standard four-portal technique was used with an open Hasson trocar placed at the umbilicus. 81 patients (37%) were male and 139 (63%) were female; the mean age of patients was 46 years. Indications for the procedure included biliary colic (130 cases), acute cholecystitis (47 cases), and obstructive jaundice caused by gallstones (26). The mean operating time was 109 minutes. 9 patients (4%) required conversion to open surgery. The overall morbidity rate was 5%, with one ductal injury (0.5%). Gallbladder perforation with leakage of bile and/or gallstones occurred in 17% of cases. There was 1 death in this series (0.5% mortality), involving an 87-year-old woman with postoperative bronchopneumonia. 57% of patients did not require any form of analgesia in the postoperative period. The mean hospital stay was 3 days.
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PMID:A prospective review of laparoscopic cholecystectomy in Brunei. 956 65

Gallbladder disease due to stones is well recognised as falling into two categories, presenting with either chronic symptoms or developing acute cholecystitis or other complications. We describe an intermediate group of 14 patients (11 women, three men, median age 31 years) presenting with 4-14 days of at least daily attacks of resolving biliary colic, who underwent early laparoscopic cholecystectomy within 24 hours of presentation. None had any evidence of acute inflammation, either at laparoscopy or on histology. Their surgery was straightforward with operating times ranging from 35-80 minutes and no complications. Patients with 'crescendo biliary colic' are often young women who can rarely afford invalidity. Rather than the current practice of analgesia for each attack and elective surgery weeks later, they are optimally managed by urgent laparoscopic cholecystectomy, preventing the development of complications and minimising the need for further medical involvement.
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PMID:The best management for 'crescendo biliary colic' is urgent laparoscopic cholecystectomy. 1019 18

Ketorolac is a nonsteroidal anti-inflammatory medication that is used widely for pain management. Its effects are mediated through the inhibition of prostaglandins, which makes it uniquely different from opioids in relieving pain. We conducted a randomized, prospective, double blind study of patients presenting to our Emergency Department (ED) with a diagnosis of acute biliary colic. Study patients were randomized into one of two treatment groups, meperidine 1.5 mg/kg with a maximum dose of 100 mg or ketorolac 60 mg given intramuscularly (i.m.). The patients rated their pain before and 30 min after medication on a scale of 1 to 10 using a Visual Analog Pain Scale. Overall pain relief was compared between the two groups using a two-sample t test. Thirty patients were enrolled in the study, 16 in the ketorolac group and 14 in the meperidine group. Patients ranged in age from 18 to 71 years and 6 (20%) were male. The average pain score at time 0 was 7.6 for the ketorolac group and 7.3 for the meperidine group. Pain relief at time 30 min was 3.8 in the ketorolac group and 3.9 in the meperidine group, which was not statistically different. The mean global pain score and need for an emergency cholecystectomy were similar in the two groups. Rescue medication for additional analgesia at 30 min was needed in 4 patients in the meperidine group and in 2 patients in the ketorolac group (28.6% versus 12.5%, respectively; NS). In this study of patients with acute biliary colic there was no significant difference in the pain relief achieved by using either ketorolac or meperidine.
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PMID:A prospective study comparing i.m. ketorolac with i.m. meperidine in the treatment of acute biliary colic. 1120 4

Fifty seven patients were selected from 620 cases with gallstones to be treated with an electromagnetic shock wave generator (Lithostar Plus). The machine has an overhead module with an electromagnetic generator able to produce 150-150 bar of pressure in the center of the focal zone (2 x 8 cms.) An in line ultrasound probe permits in vivo view of stone localization and fragmentations. The wide aperture of the device permits to treat patients with little pain in ambulatory basis. The mean age of the patients was 50 +/- 14 years, 57 were female and 20 were male. Stones were single in 35 cases and were multiple (2-4 gallstones) in the rest. The patients received a mean of 2620 +/- 371 shock waves. Intravenous analgesia (Fentanyl 87 +/- 40 ug p/session) was required in 26 cases. In 58.5% of the cases, fragmentation produced gallstone-rests of < 0.5 cm. Larger fragments (> 0.5 cm), were observed after an initial shock wave session in 33%. These patients underwent additional treatments sessions. Hence patients received 1.8 +/- 0.8 sessions. Minor fragmentation or no fragmentation after the first session was observed in the 14.5%. Mild biliary pain appeared in 17 patients and acute biliary colic in 2, one of these underwent emergency cholecystectomy. Overall gallstone disappearance after one year after lithotripsy, plus bile acid therapy (10-12 mg Kg day) was 72%. Patients with single gallstones were free of stones of fragments in 92% of the cases, after the same period of follow up.
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PMID:[Electromagnetic shock wave lithotripsy plus bile acids for the treatment of gallblader stones: results and perspectives from the first 57 patients]. 1925 39

The prevalence of gallstones is 10% to 15% in adults. Individuals with acute cholecystitis present with right upper quadrant pain, fever, and leukocytosis. Management includes supportive care and cholecystectomy. The prevalence of choledocholithiasis is 10% to 20%, and serious complications include cholangitis and gallstone pancreatitis. The goal of management in individuals with choledocholithiasis consists of clearing common bile duct stones. Acute ascending cholangitis is a life-threatening condition involving acute inflammation and infection of the common bile duct. Treatment includes intravenous fluids, analgesia, intravenous antibiotics, and biliary drainage and decompression. Biliary dyskinesia includes motility disorders resulting in biliary colic in the absence of gallstones.
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PMID:Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia. 2913 21


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