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

Ileus may occur in horses of all ages secondarily to drug administration, colic, exhaustion, peritonitis, or metabolic disorders. Ileus most commonly occurs following abdominal surgery for colic and is a significant cause of postoperative mortality in these horses. The most common clinical signs of ileus are decreased or absent intestinal sounds and gastric reflux. Ileus is treated by eliminating the initiating causes, correcting metabolic imbalances, decompressing distended bowel, providing analgesia, stimulating motility with drugs, and regulating exercise and feed and water intake.
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PMID:Recognition and management of ileus. 328 99

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.
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PMID:Patient-controlled analgesia vs. conventional intramuscular analgesia following colon surgery. 333 48

The most important complications following gastrointestinal surgery are related to disruption of anastomoses. The fate of a gastrointestinal anastomosis is influenced by many factors. Among these, care in the anaesthetic management and postoperative treatment may reduce the incidence of complications. There are two major directions in which such care may be aimed. The prevention of high intra-luminal pressures and excessive longitudinal traction across anastomoses may be aided by care in the administration of neostigmine, and possibly by the avoidance of morphine for provision of intra-operative and postoperative analgesia. Maintenance of, or improvements in, oxygen supply to an anastomosis may be achieved by avoiding hypoxia, hypocapnia and hypovolaemia, and by the use of regional anaesthetic techniques during surgery and/or in the post-operative period. In addition, sedative and analgesic therapy may influence the incidence of postoperative ileus, and may thus contribute to morbidity.
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PMID:Anaesthesia for bowel surgery. 614 22

The author presents various electrostimulation techniques that have been applied with good results for triggering and stimulation of parturition, preventing secondary adynamia of pharmacologic analgesia at birth, for analgesia and sedation during childbirth, for the treatment of hypertensive dysgravida, for postoperative analgesia, and the prophylaxis of dynamic ileus, for the treatment of postoperative dynamic ileus and for the therapy of chronic pain. The electrostimulation technique is applied with several devices that deliver pulse currents of various form with a frequency between 1 and 250 Hz and intensities between 1 and 40 mA, through 2, 3 or 4 transcutaneous electrodes. The electrostimulation techniques can be applied as current therapeutical methods, or can be used as reserve therapy in various specialties. They are economical, easy to perform, and protect the patient against toxic, allergic, and genetic side effects of pharmacologic therapy.
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PMID:[Treatment with electric stimulation]. 645 Sep 75

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate Is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.
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PMID:Indwelling epidural morphine for control of post-lumbar spinal surgery pain. 663 31

We describe a patient with membranoproliferative glomerulonephritis, renal failure, hypoalbuminemia and massive proteinuria. Attempts to reduce the protein loss with corticosteroids, indomethacin and mercurial diuretics were unsuccessful. Renal artery occlusion via Gianturco stainless steel coils was accomplished with the sole major complication of an ileus, probably caused by narcotics given for analgesia. The coils provide a convenient means of terminating renal function without resort to nephrectomy.
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PMID:Renal ablation with the Gianturco stainless steel coil for control of massive proteinuria. 732 Nov 31

Laparoscopic surgery is becoming widely accepted as an alternative to conventional procedures. It is becoming more and more evident that laparoscopic techniques can be applied successfully to pediatric patients. Advantages of these techniques include less postoperative pain, decreased ileus, fewer pulmonary complications, and shorter hospital stays. Elective splenectomy for hematologic disease or for staging of Hodgkin's lymphoma also appears to be amenable to laparoscopic techniques. This report details 12 consecutive splenectomies successfully performed laparoscopically since July 1993. No case required conversion to laparotomy. Each case was reviewed with respect to operative time, estimated blood loss, identification of accessory spleens, time until full oral intake, analgesia requirements, and length of stay. Factors contributing to morbidity such as ileus, pulmonary complications, and would infections were evaluated. Documentation was also reviewed for late sequelae such as intestinal obstruction and incisional hernias. These patients were compared with 20 consecutively treated patients who underwent open splenectomy in the period immediately preceding the use of laparoscopic splenectomy. Laparoscopic splenectomy, in the authors' experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families.
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PMID:Pediatric laparoscopic splenectomy. 747 83

Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.
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PMID:Nonopioid analgesics shorten the duration of postoperative ileus. 748 51

Traditionally patients have received a physician-dictated regimen of gradual expansion of their diets following cesarean section. This has been based upon concern about the possibility of ileus from expanding the diet too rapidly. Given the economic necessity of earlier postoperative discharge following abdominal delivery, many patients have solid food reintroduced in their diets around the time they leave the hospital. This prospective, randomized, controlled study compared a traditional, gradual dietary expansion scheme with patient-determined reintroduction of solid food, which was offered within eight hours of surgery. The hypotheses were that women would eat more rapidly after cesarean section when given the opportunity and that early solid food consumption would reduce the need for analgesia. The results indicated that both hypotheses were correct. Given the opportunity, women will eat solid food very soon after cesarean section (mean +/- SD 10.2 +/- 5.2 hours from surgery to onset of solid food consumption) as compared to women on a traditional dietary expansion regimen (mean +/- SD 41.5 +/- 16.0 hours, P < .001). Women offered food within hours of cesarean section required less patient-requested injectable narcotic postoperatively than did women on gradual dietary expansion (median, 75 mg versus 225 mg meperidine, P < .05). There was no evidence of compromise of safety or comfort from introducing solid food early and allowing the patient to decide when to eat postoperatively. The conclusion from these data is that early postoperative feeding after cesarean section is a safe and effective alternative for most women, who now face early hospital discharge.
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PMID:Safety and efficacy of early postoperative solid food consumption after cesarean section. 765 Jun 62

Recently published information is changing the approach of anaesthetists to pulmonary aspiration prophylaxis, drug dosing, hypertension during general anaesthesia, hypotension during spinal and epidural anaesthesia, intraoperative hypothermia, and postoperative ileus in elderly patients. Routine aspiration prophylaxis is no longer recommended. Lower drug doses are required to achieve the same endpoints in the elderly as in younger patients. Greater use of antihypertensive drugs rather than additional doses of anaesthetic agents is recommended during general anaesthesia to avoid myocardial depression or prolonged emergence. Routine preoperative volume loading prior to spinal and epidural anaesthesia is being questioned. Tolerance of mean arterial pressures of 65 mmHg during spinal and epidural anaesthesia is encouraged even in patients with hypertension. The adverse effects of inadvertent intraoperative hypothermia are discussed, including the conversion of vecuronium from an intermediate to a long-acting neuromuscular blocking agent. Spinal or epidural local anaesthetics with or without spinal or epidural opioids and ketorolac are associated with less postoperative ileus than postoperative analgesia based on opioids administered intravenously or intramuscularly. Finally, improving postoperative care will reduce perioperatively mortality to a greater extent than reducing intraoperative anaesthesia-related complications.
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PMID:Clinical pearls in the anaesthetic management of elderly patients. 771 Feb 32


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