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

During hemorrhoidectomy, a standard 16-gauge plastic catheter was sutured to the operative site so that analgesic doses of viscous lidocaine solution could be delivered to the site for the first 36 hours postoperatively. Although 14 patients had urinary retention that necessitated catheterization, no complication was attributed to the analgesic method. Of 227 patients, 92 per cent were treated with this method plus orally administered nonnarcotic analgesics. Viscous lidocaine injected into the anus is concluded to provide safe, convenient analgesia following hemorrhoidectomy. Toxic reactions to lidocaine were not a problem because the doses were small, and the drug was used only intermittently over a period of 36 hours.
Dis Colon Rectum
PMID:Viscous lidocaine as a posthemorrhoidectomy analgesic. 42 45

A prospective study of the necessity of sedation, or analgesia, or both in total colonoscopy was performed. The procedures were performed in the office on 212 consecutive, nonselected patients. Intravenous sedation was not started initially, and all procedures were begun without medication. If the patient developed significant discomfort or sharp pain, intravenous diazepam (Valium, Roche, Nutley, NJ) or midazolam (Versed, Roche, Nutley, NJ) was given. Total colonoscopy was successful in 201 (95 percent) patients. Of these procedures, 173 (82 percent) patients required no analgesia or sedation. In the remaining 39 (18 percent) patients, only small doses of Valium or Versed were necessary. There were 2 (1 percent) complications, but they were directly related to polypectomy (stalk bleeding, serosal burn) and not to the colonoscopy. Patient acceptance was high because most of the patients were able to leave the office immediately after the procedure and many (at least 82 percent) were able to return to work or resume normal activities that same day. Intravenous sedation is routinely used during total colonoscopy by most practitioners and is considered the standard of care in most communities. However, the need for sedation during total colonoscopy has never been proven and is probably not necessary in most cases. Furthermore, when sedation is necessary, most patients are probably over-anesthetized. This is significant, as it may make total colonoscopy more accessible, less expensive, and safer.
Dis Colon Rectum 1990 Jan
PMID:Avoidance of sedation during total colonoscopy. 235 Oct 8

The analgesic efficacy of locally injected bupivacaine was studied in 40 patients undergoing hemorrhoidectomy. After a standard Milligan-Morgan hemorrhoidectomy, 40 age- and sex-matched patients were randomized to receive either 0.5 percent bupivacaine (1.5 mg/kg) in adrenaline solution (1:200,000) injected into the perianal area, or equivalent volumes of adrenaline solution. Intramuscular opiate was available on demand during the postoperative period, and the amount and timing of analgesia given was recorded. All patients noted their pain on a daily basis using a linear analogue scale, and all patients answered a questionnaire assessing analgesic efficacy. Although the median time interval between surgery and first analgesic demand was nearly four times greater for patients receiving bupivacaine compared with adrenaline solution, there was no difference in the levels of pain recorded or in the overall opiate requirements. Local injection of bupivacaine after hemorrhoidectomy provides initial pain relief, but patients do not obtain an overall analgesic benefit.
Dis Colon Rectum 1990 Jun
PMID:Analgesic benefit of locally injected bupivacaine after hemorrhoidectomy. 235 Oct 1

Though patient-controlled analgesia (PCA) has been in use for over a decade, it has been popularized only recently. Conventional techniques of intermittent intramuscular (IM) administration of analgesia have fallen short of meeting the needs of patients following major abdominal surgery. This has prompted a search for methods to improve postoperative pain management. Though PCA has been accepted in many hospitals, few studies comparing conventional IM administration of morphine with PCA have been performed. A prospective randomized study comparing IM- and PCA-administered morphine in 62 patients undergoing colon surgery was performed. A comparison of the efficacy of analgesia and extent of sedation using these approaches shows that PCA allows for analgesia with less sedation and less drug requirement than that of IM administration. No differences were noted in postoperative duration of ileus, duration of hospitalization, and total hospital costs. This study confirms the safety and efficacy of PCA, and should be considered the current optimal method of controlling pain following major colonic surgery.
Dis Colon Rectum 1988 Feb
PMID:Patient-controlled analgesia vs. conventional intramuscular analgesia following colon surgery. 333 48

The causes of irritable bowel syndrome remain elusive and there are few effective treatments for pain in this syndrome. Electroacupunture (EA) is used extensively for treatment of various painful conditions including chronic visceral hyperalgesia (CVH). However, mechanism of its analgesic effect remains unknown. This study was designed to investigate effect of EA on colon specific dorsal root ganglion (DRG) neurons in rats with CVH. CVH was induced by intracolonic injection of acetic acid (AA) in 10-day-old rats. Electromyography and patch clamp recordings were performed at age of 8-10 weeks. Colon DRG neurons were labelled by injection of DiI into the colon wall. EA was given at ST36 in both hindlimbs. As adults, neonatal AA-injected rats displayed an increased sensitivity to colorectal distension (CRD) and an enhanced excitability of colon DRG neurons. EA treatment for 40 min significantly attenuated the nociceptive responses to CRD in these rats; this attenuation was reversed by pretreatment with naloxone. EA treatment for 40 min per day for 5 days produced a prolonged analgesic effect and normalized the enhanced excitability of colon DRG neurons. Furthermore, in vitro application of [D-Ala(2), N-MePhe(4), Gly(5)-Ol] enkephalin (DAMGO) suppressed the enhanced excitability of colon neurons from rats with CVH. These findings suggest that EA produced-visceral analgesia, which might be mediated in a large part by endogenous opioids pathways, is associated with reversal of the enhanced excitability of colon DRG neurons in rats with CVH.
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PMID:Electroacupuncture attenuates visceral hyperalgesia and inhibits the enhanced excitability of colon specific sensory neurons in a rat model of irritable bowel syndrome. 1955 27

Endoscopic procedures are common and sedation is frequently used to minimize anxiety and discomfort, reduce the potential for physical injury during the procedure, and improve overall patient tolerability and satisfaction. In this article, the authors review the variety of options for sedation and analgesia available to the gastroenterologist or surgical endoscopist.
Clin Colon Rectal Surg 2010 Feb
PMID:Sedation, analgesia, and monitoring. 2128 86

The obese patient presents many challenges to both anesthesiologist and surgeon. A good understanding of the pathophysiologic effects of obesity and its anesthetic implications in the surgical setting is critical. The anesthesiologist must recognize increased risks and comorbidities inherent to the obese patient and manage accordingly, optimizing multisystem function in the perioperative period that leads to successful outcomes. Addressed from an organ systems approach, the purpose of this review is to provide surgical specialists with an overview of the anesthetic considerations of obesity. Minimally invasive surgery for the obese patient affords improved analgesia, postoperative pulmonary function, and shorter recovery times at the expense of a more challenging intraoperative anesthetic course. The physiologic effects of laparoscopy are discussed in detail. Although laparoscopy's physiologic effects on various organ systems are well recognized, techniques provide means for compensation and reversing such effects, thereby preserving good patient outcomes.
Clin Colon Rectal Surg 2011 Dec
PMID:Anesthetic implications of obesity in the surgical patient. 2320 37

The transversus abdominis plane block has been used as a component of postoperative analgesia after hysterectomy and open abdominal surgery. This block involves the injection of anesthetic between the internal oblique and transversus abdominis muscles. We demonstrate an improved method by the use of laparoscopic guidance for transversus abdominis plane blocks.Transversus abdominis plane blocks are performed at the conclusion of an elective laparoscopic procedure by an experienced colorectal surgeon. With the use of direct visualization with a laparoscope, a Braun Stimuplex A insulated needle is passed through the skin at the level of the midaxillary line, midway between the iliac crest and the costal margin. The needle is inserted further until 2 distinct "pops" are felt, indicating the correct needle position between the internal oblique and transversus abdominis muscle. The laparoscope confirms a bulge, which signifies the injectate covered by the transversus abdominis muscle. The procedure is performed at a second injection site on the same side and bilaterally.The transversus abdominis plane block is useful as an adjunct to reduce postoperative analgesia in patients undergoing laparoscopic colorectal surgery. Our method for transversus abdominis plane blocks with the use of laparoscopy is easily performed at the conclusion of any laparoscopic procedure. Prospective randomized trials are necessary to assess the significance of these blocks in postoperative pain control, length of stay, and cost benefit.
Dis Colon Rectum 2013 Mar
PMID:Laparoscopic-guided transversus abdominis plane block for colorectal surgery. 2339 58

The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. "as needed") for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient.
Clin Colon Rectal Surg 2013 Sep
PMID:Postoperative pain control. 2443 74

Pain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.
Clin Colon Rectal Surg 2019 Mar
PMID:Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. 3083 61


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