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

Postoperative analgesia was achieved by peridural injection of small doses of piritramide (Dipidolor Gedeon Richter Budapest) to 24 gynaecological and surgical patients. Periods of action were longer than those obtainable from equivalent intramuscular or intravenous injections. Undesirable side effects of the opiates, such as disorders of respiration, vomiting, clouded consciousness, and suppression of cough reflex, were not observed. The method did not affect locomotor and sympathetic nerve fibres and, consequently, proved to be superior to postoperative analgesia by means of local anaesthesia. Repetitive injections can be made by nurses. Peridural opiate analgesia can be recommended for postoperative situations and for other patients with pain.
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PMID:[Postoperative analgesia by peridural piritramide application]. 712 73

The authors have performed 66 (cranial or spinal) operations with electro-anaesthesia supplemented by neuroleptics and pancuronium. In this technique, which respects the necessities of neurosurgical anaesthesia, analgesia is produced by means of Limoge's rectified high frequency currents. The protocol consists of: induction by a neuroleptic, application of the electrical current, intubation with benzodiazepin and succicurarium, controlled ventilation with a 50 p. cent oxygen/50 p. cent nitrous oxyd mixture and curare as required. The efficiency was estimated according to the necessity of a supplementary drug analgesia (fentanyl). The use of fentanyl, i.e. drug intoxication, was strongly reduced in 90 p. cent of the cases (average 0,46 micrograms/kg/hour). Absolute failures were encountered in 3 cases only. Patients waked up in very good conditions and extubation occurred on an average of 16 minutes. Reflexes of cough an deglutition are not depressed by electro-anaesthesia and we think this preservation of the respiratory function to be very profitable for such neurosurgical patients. Our opinion by now is that the best indications for electro-anaesthesia are high-risk patients, with a special mention for surgery of the posterior fossa.
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PMID:[Electro-anaesthesia during neuro-surgery (author's transl)]. 725 5

Fifty-three patients underwent 55 post-thoracotomy bupivacaine epidural analgesia experiences for pain control. Hospital records of all patients were analyzed for effectiveness of pain relief, changes in vital signs, and complications. In most instances, pain relief was adequate and patients were able to move, cough, and deep breathe unusually well in the postoperative period. Correlations were tested among changes in blood pressure, pulse, respiration, the actual value for low blood pressure, and subsequent elevation, age, sex, thoracotomy side, primary diagnoses, a secondary diagnoses, metastases, and complications. Systolic blood pressure reduction was greater in older patients who received epidural bupivacaine, with a correlation coefficient which attained significance (p less than 0.04). Patients who underwent thoracotomies for chronic pulmonary inflammation (p less than 0.04) or patients who had previous myocardial infarctions (p less than 0.05) also demonstrated significant reduction in systolic blood pressure. However, the number of patients in each group (six and four, respectively) makes their significance questionable. Although there were no serious complications or deaths attributable to this technique of pain control, possible morbidity is discussed. Removal of the epidural catheters was without incident. There was no evidence of irritation, pain, or infection at the catheter placement sites.
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PMID:Epidural analgesia for post-thoracotomy patients. 730 Apr 19

After thoracotomy some patients have discomfort, primarily in the rostral portion of their incisions. In this prospective, randomized study in 66 patients after lateral thoracotomy we evaluated whether, for equal fentanyl dosage in micrograms per kilogram, epidural infusion (lumbar catheter) of fentanyl 5 micrograms/mL provided better segmental analgesia (including the rostral portion of the incision) than a 10-micrograms/mL concentration infused at a rate half that used in the 5-micrograms/mL group. Ketorolac was used as an analgesic adjunct for nonincisional pain. Postoperative epidural fentanyl infusion included a 1-microgram/kg initial dose and an initial infusion rate of 1 microgram.kg-1.h-1 in both the 5-micrograms/mL and 10-micrograms/mL groups. Patients were evaluated for comfort level and pain relief while resting, taking a deep breath, coughing, and ambulating at eight times over 3 days using two visual analog scales for overall comfort and a verbal rating score (VRS) for segmental analgesia. There were no significant differences in demographics, surgical procedure, intraoperative fentanyl dose, side effects, rates of epidural fentanyl infusion, or total epidural fentanyl doses at 12, 24, 36, 48, and 60 h postbolus. Analgesia was effective in both groups. Although overall comfort levels were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group in 6 of 8 visual analog scores (VASs) for comfort level and 20 of 24 VRSs for comfort level scores, and mean VRSs for the rostral portion of the incision were lower (i.e., indicated greater comfort) in the 5-micrograms/mL group at 21 of 24 evaluation subsets (one statistically significant), statistical significance was achieved in only six evaluation subsets.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Analgesia after thoracotomy: effects of epidural fentanyl concentration/infusion rate. 748 87

Ropivacaine exhibits less cardiotoxicity and causes less motor block than bupivacaine when used in equianalgesic doses. This makes ropivacaine potentially well suited for epidural infusion for postoperative analgesia. The aim of this study was to determine which of three concentrations of epidurally administered ropivacaine infused for postoperative analgesia would attenuate intravenous opioid analgesia requirements while also minimizing motor block. Forty ASA I-III patients, having major lower abdominal surgery, completed the study. They were randomly assigned to one of four treatment groups: Group S, control, epidural saline (n = 10); Group 1, epidural 0.1% ropivacaine (n = 10); Group 2, epidural 0.2% ropivacaine (n = 10); and Group 3, epidural 0.3% ropivacaine (n = 10). The study was double-blind. Initial epidural analgesia was established with 0.5% ropivacaine, and then general anesthesia induced for surgery. Once in the recovery room, epidural infusions were commenced at 10 mL/h and maintained at that rate for 21 h. Intravenous patient controlled analgesia (PCA) morphine was used as required by the patients for supplemental analgesia. Total PCA morphine use was more over the 21-h period in Group S than all the ropivacaine groups, being significantly so for Group 2 (median values: Group S, 43.3 mg; Group 1, 18.7 mg; Group 2, 7.5 mg; Group 3, 19 mg; for Group 2, P = 0.03). Visual analog scale (VAS) scores on coughing were significantly lower (i.e., less pain) than control for all ropivacaine groups after 4 h of infusion and also for Groups 2 and 3 after 8 h of infusion. (Median VAS (mm) on coughing at 8 h: Group S = 70, Group 1 = 56, Group 2 = 32, Group 3 = 0; for Groups 2 and 3, P < 0.05 compared to Group S). There was a dose-related increase in the amount of motor block, with Group 3 having significantly more motor block than all other groups at 4 and 8 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery--a dose finding study. 748 88

Using a multidisciplinary critical pathway for chest surgery, the staff of Saint Joseph Medical Center (Burbank, California) and its physicians developed a strategy leading to improved patient outcomes with reduced overall costs. On referral from the surgeon's office, the multidisciplinary team, consisting of a clinical nurse specialist, physical therapist, and respiratory therapist, meet with the patient. The education that follows includes discussion of the surgical procedure, intubation, incentive spirometry, coughing, deep breathing, early ambulation, use of patient-controlled analgesia, chest physiotherapy, transfusion options, and evaluation of health status. A few days later, the patient undergoes the thoracoscopy-assisted thoracotomy. The success of the outcome-driven critical pathway can be related to several factors: (1) close coordination between the surgeon's office and hospital; (2) intensive preoperative education that decreases patient's anxiety and increases his or her ability to participate in recovery; (3) patient-controlled analgesia, nerve blocks, non-narcotic analgesia, and preemptive rehabilitation, which limit the risk for complication; and (4) thoracoscopy, which limits the surgical morbidity commonly affiliated with thoracotomy. The pathway, used for 160 patients during the past 2 years, has shown dramatic results related to reducing morbidity, practice variation, delay, and total overall cost.
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PMID:Thoracotomy, critical pathway, and clinical outcomes. 766 47

This double-blind, placebo-controlled study investigated the efficacy of intermittent doses of intrathecal fentanyl in 30 patients undergoing thoracotomy. They were allocated randomly to three groups, two of which had microspinal catheters inserted into the lumbar subarachnoid space at the end of surgery; the third group acted as a control. Intrathecal fentanyl or 0.9% saline was administered through the catheters and all patients received morphine using a patient-controlled analgesia (PCA) system. Pain scores, morphine consumption and peak expiratory flow rates (PEFR) were recorded on an hourly basis. Intrathecal fentanyl resulted in a faster onset of analgesia (mean visual analogue scale (VAS) score at 1 h = 0.9 compared with 6.3 (95% confidence intervals for the difference -6.8, -4.0) for the other groups; P < 0.001) and significantly lower pain scores at rest, on cough and on movement. PEFR values were consistently higher in the intrathecal fentanyl group. There were no cases of early or delayed respiratory depression.
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PMID:Intrathecal fentanyl for post-thoracotomy pain. 766 61

This randomized, double-blind study of 40 patients was designed to determine if the predominant analgesic effect of extradural fentanyl is mediated by a direct spinal action or an indirect systemic one. After Caesarean section, postoperative analgesia was provided for 24 h by patient-controlled extradural analgesia (PCEA group) or by patient-controlled i.v. analgesia (PCIVA group). Both groups received a bolus dose of fentanyl 20 micrograms with a 10-min lockout interval. In the PCIVA group, nine patients stopped early (compared with none in the PCEA group) because of inadequate analgesia. Mean visual analogue pain scores (0-100 mm) at 8 and 12 h were lower for PCEA (23 (sd 13) mm at rest, 31 (23) mm on coughing) than for PCIVA (50 (25) mm at rest, 67 (24) mm on coughing) (P < 0.0005). The mean dose of fentanyl self-administered between 4 and 8 h was lower in the PCEA group (38 (sd 30) micrograms h-1) compared with the PCIVA group (59 (27) micrograms h-1) (P < 0.05). Our results support the hypothesis that the predominant analgesic effect of extradural administration of fentanyl is mediated by a direct spinal action rather than an indirect action from systemic absorption.
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PMID:Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action? 769 69

We studied whether continuous interpleural infusion of bupivacaine would be effective in alleviating pain after thoracotomy compared with effect of continuous epidural infusion of bupivacaine and buprenorphine. Twenty patients who had received thoracotomy and lobectomy were randomly divided into two groups to receive continuous interpleural infusion (IP group) of 0.5% bupivacaine at the rate of 5 ml.h-1 or continuous epidural infusion (E group) of 0.25% bupivacaine and 0.025 buprenorphine at the rate of 1 ml.h-1. The patients assessed their level of pain using a 100 mm visual analog scale (VAS) at rest and on coughing or changing the posture, verbal descriptor pain scale (VDPS), and times of supplemental analgesic. Assessment was performed at 7 points (mornings and evenings) for 3 postoperative days. In the evening of the day of surgery, VAS at rest in IP group was significantly higher than one in E group, but VASs at rest were similar in both groups from the first postoperative day to the third postoperative day. VAS on coughing or changing the posture in IP group was significantly higher than in E group in the evening of the day of surgery, and VASs on coughing or changing the posture in IP group were higher than in E group for 3 postoperative days. Supplemental analgesics were administered significantly more often than in E group in the evening of the first postoperative day. We conclude that continuous interpleural infusion does not give better analgesia than continuous epidural infusion after thoracotomy.
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PMID:[The effects of continuous interpleural vs. epidural infusion for postoperative pain relief following thoracotomy]. 781 97

The purpose of the present study was to investigate the efficacy of interpleural (IP) analgesia with bupivacaine or lidocaine after esophageal surgery and to measure the plasma concentrations of bupivacaine and lidocaine after intermittent IP administrations. Two IP catheters were inserted percutaneously in the seventh intercostal space during operation. Patients in the bupivacaine group (Gr B) received 1 mg/kg of 0.5% bupivacaine with epinephrine 1:200000 in 20 mL of saline 0.9%, patients in the lidocaine group (Gr L) received 3 mg/kg of 2% lidocaine with epinephrine in 20 mL of saline 0.9%, and patients in the placebo group (Gr P) received 20 mL of saline 0.9% every 4 h during 2 days. Pain was assessed by visual analog scale (VAS) every 4 h at rest (VASR), after a deep breath or cough (VASC), at the thoracotomy (VAST), and at the laparotomy (VASL). Morphine consumption using a patient-controlled analgesia (PCA) device was recorded. There was no significant difference in the mean VASR, VASC, and VASL scores among the three groups. VAST scores were significantly lower in Gr B at 12, 16, 28, and 32 h when compared with Gr P and Gr L (P < 0.05). There was no statistical difference in mean VAST between Gr L and Gr P. Total consumption of morphine was lower in Gr B than in Gr P and Gr L (41.2 +/- 13 mg vs 66.1 +/- 21 mg in Gr P (P < 0.02) and 75.5 +/- 27 mg in Gr L (P < 0.01)), but were similar in Gr L when compared with Gr P.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of interpleural administration of bupivacaine or lidocaine on pain and morphine requirement after esophagectomy with thoracotomy: a randomized, double-blind and controlled study. 789 24


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