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

The analgesic effects of an identical inguinal field block, performed before or immediately after inguinal herniorrhaphy, were evaluated in 32 healthy patients in a double-blind, randomized study. During surgery, all patients received a light general anaesthesia with thiopentone, alfentanil and nitrous oxide in oxygen. After induction of general anaesthesia, patients were allocated randomly to receive an inguinal field block with lignocaine, either 15 min before operation or immediately after operation, after closure of the surgical wound, but before the patients were awake. Pain score on a visual analogue scale and on a verbal scale at rest, during mobilization from supine into sitting position and during cough was assessed 1, 2, 4, 6, 8 and 24 h, and 7 days after operation. No significant differences between the groups were observed in VAS scores or verbal pain scores during rest or ambulation at any time. There was no significant difference in time to first request for morphine or total morphine consumption. These results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.
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PMID:Effect of pre- vs postoperative inguinal field block on postoperative pain after herniorrhaphy. 141 63

In 1987, Yeager et al. reported that intraoperative epidural anesthesia with local anesthetics and postoperative epidural analgesia with opiates diminished postoperative morbidity. In our first clinical trial on this topic, the better postoperative analgesia with epidural bupivacaine-fentanyl failed to improve the outcome after major abdominal operations over that obtained with parenteral piritramide. This randomized controlled investigation was designed to assess whether intraoperative epidural anesthesia with bupivacaine plus light general anesthesia and postoperative epidural analgesia with morphine would diminish the overall rate of postoperative complications after major abdominal operations compared with general anesthesia (without epidural) followed by patient controlled analgesia with morphine, and with intraoperative epidural anesthesia with bupivacaine and light general anesthesia followed by postoperative bupivacaine-morphine analgesia. METHODS. A total of 292 patients undergoing infrarenal aortic bypass operation, gastric resection, gastrectomy, duodenum-preserving pancreatic resection, Whipple's operation or cystectomy and neobladder formation were randomly divided into three groups: 1. PCA group (patient controlled analgesia, n = 107): patients were operated on under general anesthesia (midazolam, fentanyl, N2O/O2, if necessary with addition of halothane, enflurane or isoflurane; muscle relaxation with pancuronium bromide). Postoperative management consisted in patient-controlled analgesia with morphine (Prominject), bolus 2 mg, lock-out 5 min (recovery room, intensive care unit) or 15 min (surgical ward). 2. EBM group (epidural bupivacaine+morphine, n = 95): operation under light general anesthesia (midazolam, low-dose fentanyl, N2O/O2, pancuronium bromide). In addition, a mixture of bupivacaine (0.25%) and morphine (60 micrograms/ml) was infused (approximately 0.1 ml/kg.h) via an epidural catheter during and after the operation (approximately 72 h). 3. EM group (epidural morphine, n = 90): operation under the same kind of general-epidural anesthesia as in the EBM group. Postoperatively, epidural injection of morphine (0.05 mg/kg in 10 ml of saline) on request up to the 3rd postoperative day. Quality of analgesia (at rest and when patients coughed vigorously), strength of cough, and rate-pressure product were recorded at 8:00 h, 12:00 noon, 16:00 h and 20:00 h on the 1st, 2nd and 3rd postoperative days. Incidence and intensity of all postoperative complications (cardiovascular, pulmonary, renal and other organ failure, reoperations, major infection, sepsis, thromboembolism, metabolic and mental disturbances) were assessed from the day of operation until discharge or death (n = 10), respectively. RESULTS AND DISCUSSION. In the PCA and EM groups analgesia was equal but of slightly inferior quality compared with the EBM group. The ability to cough was best in the EBM group and significantly worse in the PCA and EM groups, with no difference between the last two. (ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Patient-controlled analgesia versus epidural analgesia using bupivacaine or morphine following major abdominal surgery. No difference in postoperative morbidity]. 175 32

The use of epidural morphine for postoperative analgesia outside of intensive care units remains controversial. In this report our anesthesiology-based acute pain service documents experience with 1,106 consecutive postoperative patients treated with epidural morphine on regular surgical wards. This experience involved 4,343 total patient days of care and 11,089 individual epidural morphine injections. On a 0-10 verbal analog scale, patient-reported median pain scores at rest and with coughing or ambulation were 1 (inter-quartile range 3) and 4 (interquartile range 4), respectively. The incidence of side effects requiring medication were as follows: pruritus 24%, nausea 29%, and respiratory depression 0.2%. There were no deaths, neurologic injuries, or infections associated with the technique. Migration of epidural catheters into the subarachnoid space and into epidural veins each occurred twice. Overall, 1,051 of the 1,106 patients (95%) experienced none of the following problems: catheter obstruction, premature dislodgement, painful injections, catheter migration, infection, or respiratory depression. We conclude that postoperative pain can be safely and effectively treated with epidural morphine on surgical wards.
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PMID:Postoperative epidural morphine is safe on surgical wards. 172 29

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.
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PMID:Efficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care. 195 60

Mini-cholecystomectomy was performed in 24 unselected patients with symptomatic gallbladder stones with pain control by intra- and postoperative epidural analgesia. Twenty three patients were discharged on the second postoperative day, while one patient who required re-laparotomy for haemostasis had recovered completely on the third day postoperatively. Median pain score (VAS) was 0 at rest, during coughing and mobilisation. Pulmonary function was not influenced significantly and postoperative fatigue normalized after 48 hours. These preliminary, uncontrolled observations suggest that mini-cholecystectomy is advantageous compared to conventional cholecystectomy, and may represent an alternative to laparoscopic cholecystectomy.
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PMID:[Minicholecystectomy]. 195 71

Auditory evoked potentials have been used as an indicator of awareness. During combined local and general anesthesia clinical signs of adequate anesthesia are difficult to evaluate. In the present study we combined peridural analgesia with three techniques of general anesthesia. Intraoperative wakefulness was documented and correlated with cardiocirculatory parameters as well as with mid-latency auditory evoked potentials (MLAEP). METHODS. After institutional approval and informed consent 30 patients undergoing elective laparotomy were studied as follows: first, continuous peridural analgesia was instituted in all patients to block painful sensation of surgical stimuli and the anesthetic level was maintained at T5. Then general anesthesia was induced with propofol 2.5 mg/kg i.v. (group I, n = 10), thiopental 5 mg/kg i.v. (group II, n = 10), or etomidate 0.2 mg/kg i.v. (group III, n = 10) and maintained with propofol 3-5 mg/kg per hour i.v. (group I), isoflurane 0.4-0.8 vol.-% (group II), or flunitrazepam 0.005-0.01 mg/kg i.v. and fentanyl 0.0025-0.005 mg/kg i.v. bolus injections every 20-30 min (group III). Heart rate and arterial pressure were registered continuously. Purposeful movements of the limbs, eye-opening, or other movements as well as coughing were documented as signs of intraoperative wakefulness. AEP were recorded in the awake state, after induction, and during maintenance of general anesthesia. Latencies of the peaks V, Na, and Pa were measured. By fast-Fourier transformation corresponding power-spectra were calculated to analyze the energy content of the AEP frequency components. RESULTS. Intraoperative wakefulness occurred statistically significantly more often in the patients of group III than in those of groups I and II. There was no correlation between wakefulness and cardiocirculatory parameters. Latencies of peaks V, Na, and Pa in the awake patients were in the normal range; the corresponding power-spectra had their major energy content in the 30-40-Hz range. After induction of general anesthesia with propofol, thiopentone, and etomidate as well as during maintenance of general anesthesia with propofol and isoflurane peak latencies of Na and Pa increased, frequencies in the 30-40 Hz range became suppressed, and MLAEP energy maxima shifted to the low-frequency range. In contrast, during maintenance of general anesthesia with flunitrazepam/fentanyl peak latencies of Na and Pa returned to awake values and frequencies in the range of 30 Hz regained energy dominance in the corresponding power-spectra. CONCLUSIONS. The maintenance of MLAEP and the primary cortical complex Na/Pa correlates with the incidence of motor signs of wakefulness. During the combination of regional and general anesthesia, isoflurane and propofol seem to provide better suppression of intraoperative wakefulness than bolus injections of flunitrazepam/fentanyl.
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PMID:[Acoustic evoked potentials of medium latency and intraoperative wakefulness during anesthesia maintenance using propofol, isoflurane and flunitrazepam/fentanyl]. 205 23

Anesthesia of the tracheobronchial (TB) pathways during laser therapy (LT) faces a variety of problems including analgesia and sedation in patients with respiratory difficulties or who continue to breathe spontaneously while the airways are occupied by operating instruments. During the course of the study, two methods of anesthesia were compared in 36 patients undergoing LT of the TB pathways. The first method (Group A, n = 16) involved the use of Diazepam as an hypnotic starter and Fentanyl as an opioid analgesic in continuous infusion. Propofol was used both as an inducer and as the main drug in the second method (Group B, n = 20) in order to reduce the opioid dose required. The following variables were studied: heart rate, systolic and diastolic blood pressure, blood gas analytic parameters, side-effects such as cough and intraoperative movement, and disturbances of heart rhythm and conduction; in addition, the duration of operations and the time taken to regain consciousness were recorded, together with the total dose of Fentanyl used. An improved hematosis was observed in patients treated with Propofol during the operation and on regaining consciousness, and the time taken to regain consciousness was significantly reduced. No significant differences were observed between the two groups with regard to cardiocirculatory variables or undesirable effects.
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PMID:[Use of propofol during laser therapy of the tracheobronchial tract]. 208 86

Seventy-five patients scheduled for major abdominal operations were randomly divided into four groups, each with a different postoperative analgesic regime. Group I: buprenorphine 4 micrograms/kg was injected i.v. every 4 h. Groups II-IV: all patients were preoperatively supplied with a thoracic epidural catheter that, however, was not used during the operation. Group II: bupivacaine 0.15 ml/kg was injected epidurally every 2 h, the first dose being 0.5%, the top-ups 0.25%. Group III: buprenorphine 4 micrograms/kg in 10 ml saline was given via the catheter and repeated on request. Group IV: these patients received a combined regime. Bupivacaine was injected as in group II, and in addition buprenorphine was added epidurally in the doses and time intervals of group I. After extubation the patients categorized the intensity of postoperative pain twice, first while lying immobile and then after coughing vigorously, using a rating scale with pain scores from 0 to 10. Thereafter, the analgesic regime described above commenced. One hour later the patients' pain scores were again determined. In addition to pain scores, heart rate (HR), mean arterial pressure (MAP) and paCO2 were recorded at the same points in time. The investigation was then interrupted overnight. The analgesic regime continued as described for groups I and II. Patients in group III received 0.15 mg buprenorphine on request i.v., and in group IV bupivacaine was given as in group II with no further buprenorphine. The study recommenced the next morning at 7:00 a.m. After the initial values (pain scores, HR, MAP, paCO2) had been recorded the analgesic program, as scheduled for each patient, restarted. In group IV buprenorphine was again added to bupivacaine and repeated every 4 h, whereas bupivacaine was injected every 2 h. All values were registered hourly until 7:00 p.m., when the investigation was terminated. RESULTS. On the day of operation and during the first few hours on the morning thereafter, analgesia in groups II and IV was considerably better compared to groups I and III (P less than 0.001). We could not statistically demonstrate, however, that analgesia in group IV was superior to that in group II despite the fact that pain scores were lowest in this group, with a median at rest of 0 throughout the study time. In group III (n = 20), epidural buprenorphine failed to produce any acceptable analgesic effect in 6 patients despite correct catheter position. For this reason they were dropped from the study. No patient in any of the other groups, however, was dropped (P less than 0.01). Later in the 1st postoperative day analgesia in groups II and IV lost its superiority at rest, but coughing continued to be less painful in comparison to groups I and III. We noticed that the duration of action of 0.25% bupivacaine, injected as a bolus, was considerably shorter than expected (less than 2 h) and that several patients experienced pain before the next top-up was given...
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PMID:[Postoperative peridural analgesia via catheter following abdominal surgery. Peridural bupivacaine versus buprenorphine]. 219 6

Management of postoperative pain has been shown to be inadequately controlled, and, in fact, can have significant deleterious effects on a patient's early postoperative recovery. Continuous epidural analgesia has recently been used to control postoperative pain. This mode of analgesia controls postoperative pain without the delays inherent in the PRN administration of systemic narcotics. This was a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 53 thoracic and 81 abdominal surgery patients. The focus of the study was to identify the benefits and problems of continuous epidural analgesia for postoperative pain management and the implications for the nursing care of the patients. Evaluation of the effectiveness of the analgesia was based on the following measures: (1) pain measured at regular intervals in the 72-hour period with a visual analog; (2) pain as measured after 72 hours with the word descriptor section of the McGill Pain Questionnaire; (3) amount of supplemental systemic narcotic analgesic needed; (4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; (5) occurrence of adverse effects; and (6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used (PRN) systemic administration of narcotics. With the exception of the report of back pain by patients receiving the normal saline epidural solution, complications did not occur in a significantly greater proportion when using the epidural route. Although some nursing care problems were identified, patients who received epidural analgesia were able to be cared for on general care units with no adverse effects reported.
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PMID:Efficacy of continuous epidural analgesia and the implications for patient care in the early postoperative phase. 228 19

Ventilation and gas exchange lung functions were studied in 110 patients with severe closed chest trauma. In chest trauma that was not accompanied by intrapulmonary traumatic changes the main pathogenetic mechanism of gas exchange damage was marked pain syndrome. Such patients did not suffer from severe arterial hypoxemia and their intrapulmonary shunting did not exceed 15%. Analgesia and, if necessary, lung decompression improved considerably respiratory parameters and prevented the onset of severe pulmonary failure. Patients with intrapulmonary traumatic changes (lung contusion, intrapulmonary hematomas) were characterized by progressing arterial hypoxemia due to a considerable increase in intrapulmonary shunting. These patients are managed mainly by preventive therapy of pulmonary hyperhydration, thorough tracheobronchial cleansing, cough stimulation, prevention of pneumonia.
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PMID:[The effect of severe closed chest trauma on gas exchange]. 228 31


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