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

Anterior cruciate ligament (ACL) reconstruction is associated with significant postoperative pain, usually requiring parenteral narcotics. A prospective study of arthroscopically assisted autograft patellar tendon ACLR was initiated using Winnie's "three-in-one" femoral nerve block (FNB) as the primary means of postoperative pain control. Patient satisfaction and absence of parenteral narcotic use indicated clinical success. Of 24 patients studied, 92% had no parenteral narcotics administered following FNB. Ninety-five percent of patients believed FNB was beneficial and would request another. The average duration of pain control was 29 hours and the majority of patients (79%) believed discharge was possible within 23 hours. There were two patients who failed to respond to FNBs (8%) and no major complications. FNB is a safe, reliable, and effective form of analgesia following ACLR, eliminating the need for parenteral narcotics.
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PMID:Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. 757 71

Anterior shoulder dislocation is a common skiing injury. Several methods are available for reduction of shoulder dislocations. We evaluated a method for reduction of anterior shoulder dislocation that has not previously appeared in the literature. This method is performed with the patient seated in a chair with the chair used as countertraction. The physician applies traction to the affected shoulder using downward pressure on a loop of stockinette wrapped around the patient's forearm. Our method was successful in 97% of 118 anterior dislocations with no complications. Ninety-three percent were performed without the use of narcotic analgesia.
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PMID:Anterior shoulder dislocation. A simple and rapid method for reduction. 766 Dec 70

Anterior cruciate ligament (ACL) reconstruction is often a painful operation. Fifty-eight patients who underwent ACL reconstruction using patellar tendon autograft received either a lumbar plexus block (LPB) or patient-controlled analgesia (PCA) for pain relief during the first 24 h after surgery. The average total dose of narcotic used was dramatically less for the LPB group (10.1 mg) than for the PCA group (91.9 mg). The common narcotic analgesic side effects of nausea, pruritus, sedation, and urinary retention were significantly less in the LPB group. The LPB is a safe and effective alternative analgesia after ACL reconstruction.
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PMID:A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament reconstruction. 844 37

Anterior cruciate ligament reconstruction is performed routinely as an outpatient surgical procedure despite few studies of patient acceptance or postoperative patient analgesia. This study reports the first series of postoperative femoral nerve blocks as analgesia for outpatient anterior cruciate ligament reconstruction. The authors retrospectively reviewed 161 patients undergoing two incision arthroscopically assisted autograft middle 1/3 patellar tendon anterior cruciate ligament reconstruction on an out-patient basis at the authors' institution during a period of 30 months. Hospital and anesthesia records were reviewed, and 83% of patients were contacted retrospectively to survey their perceptions of the procedure and its outcome. Ninety-eight percent of the patients were discharged from the ambulatory surgery center, with 51% discharged the same day as the surgery and 47% discharged by 7:00 AM the next day. As the study progressed, the number of patients staying overnight was reduced by 50%. Ninety-eight percent of patients surveyed found femoral nerve block to be beneficial, and the same percentage thought the discharge time was appropriate. However, 69% of patients staying overnight cited reasons other than pain as factors in their stay. No significant complications were reported. Based on these results, the administration of a femoral nerve block is recommended for patients undergoing outpatient anterior cruciate ligament reconstruction because it is a highly effective form of analgesia with an excellent degree of patient satisfaction.
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PMID:Analgesia with femoral nerve block for anterior cruciate ligament reconstruction. 1061 84

Anterior cruciate ligament (ACL) procedures are associated with significant postoperative pain and have traditionally been done on a short-stay hospitalization basis because of concerns for adequate postoperative analgesia. A retrospective chart review was performed to determine postoperative intravenous patient-controlled analgesia (PCA) morphine requirements for 80 patients who had undergone arthroscopically assisted ACL reconstruction under general anesthesia by means of a patellar tendon autograft by 1 of 2 surgeons. The mean +/- SD PCA morphine used after surgery was 20.4+/-20.0 mg. There was a wide interpatient difference in postoperative opioid consumption: the amount of PCA morphine used ranged from 0 mg to 124 mg. A comparison between the surgeons revealed that 1 surgeon had significantly longer intraoperative surgical, tourniquet, and anesthesia times; however, there was no difference in the length of recovery room stay, amount of postoperative PCA morphine used, or time to hospital discharge. Predicting which patients may benefit from short-stay hospitalization after arthroscopic ACL reconstruction may be difficult because of considerable interpatient differences in postoperative analgesic requirements.
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PMID:Postoperative analgesic requirements in patients undergoing arthroscopic anterior cruciate ligament reconstruction. 1114 Mar 53

Anterior shoulder dislocations are the most common major joint dislocation seen in emergency departments. Intra-articular lidocaine is a useful method of analgesia for facilitating the reduction of anterior shoulder dislocations. Posterior shoulder dislocations represent a small minority of shoulder dislocations. We present the case of a posterior shoulder reduction in an elderly female whose reduction was performed following the intra-articular injection of lidocaine. Intra-articular lidocaine represents a useful alternative to facilitate the reduction of shoulder dislocations, particularly in patients at higher risk for complications from sedation.
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PMID:Intra-articular lidocaine for the reduction of posterior shoulder dislocation. 1735 12

Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. This case report describes a safe, effective technique for placing a thoracic EP catheter in a young patient undergoing anterior spine fusion surgery by thoracotomy. The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter. The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion.
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PMID:Combined ultrasound and nerve stimulation-guided thoracic epidural catheter placement for analgesia following anterior spine fusion in scoliosis. 1929 62

Anterior shoulder dislocation (ASD) is a common presentation in emergency departments, yet there is no national guidance on the use of sedation or analgesia. This article gives an overview of the aetiology and treatment of ASD, and reports the results of a literature review on best practice for timely and appropriate treatment of patients with ASD, and the effect of sedation on patient transit times
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PMID:Pain relief in the treatment of shoulder injury. 2156 Aug 93

Anterior dislocations of the shoulder are common among young males following trauma. Dislocations may be associated with fractures, rotator cuff tears as well as nerve and vascular injuries. However, recurrent instability is the major complication following primary dislocation of the shoulder. After physical examination and radiologic evaluation the humeral head may be reduced using a variety of methods. The methods differ in sedation, analgesia, body and arm position, type of manipulation, number of staff required for manipulation and finally, rates of success and complications. Following successful reduction, the arm should be fixed in an arm sling for at least three weeks. Young and active patients may be advised to undergo primary arthroscopic repair due to high risk of recurrent dislocation and cumulative damage to the shoulder.
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PMID:[Primary anterior shoulder dislocation]. 2216 38

Anterior shoulder dislocation is the most common joint dislocation seen in the emergency department. Although emergency medicine providers use several techniques for reduction, each method is associated with potential discomfort for the patient. In addition, pain from the dislocated shoulder causes muscle spasm that impedes reduction. Therefore, both analgesia and procedural sedation are often used to reduce pain and enable reduction. Intra-articular injection of lidocaine has demonstrated efficacy in reduction of pain and facilitation of shoulder reduction compared with analgesia and sedation. Intra-articular lidocaine may also reduce time to successful reduction of shoulder dislocations.
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PMID:Intra-articular lidocaine for reduction of shoulder dislocation. 2518 19


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