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

Oral presurgical medication with benzodiazepines carries several distinct advantages; it often reduces the patient's anxiety and allows for a "smoother" surgical procedure, provides analgesia, facilitates venipuncture, aids in the patient's tolerance of an ankle tourniquet, limits postoperative nausea and vomiting, and provides varying degrees of retrograde amnesia. Many podiatric surgeons prefer using oral anxiolytics/sedatives along with local anesthesia for their surgical patients because they are simple to use with in-office surgery. Patients may prefer this method because it allows them a sense of control and eliminates the fear of being "put to sleep." This method, however, is not without its potential drawbacks, as noted. The surgeon must be keenly aware of all the patient's medical problems and potential allergies, and how they may impact on the use of these agents. He or she also must be prepared to act in an emergency should an adverse reaction occur. The recovery time from local anesthesia with oral sedation can often be longer than from general anesthesia, and discharge may be delayed. The patient may have an unsteady gait for the period prior to complete drug elimination and may require assistance. If an oral agent is chosen, it must be administered early enough to provide the desired effect at the desired time. The clinician must be aware of the time to onset and the duration of action of the drug chosen. Dosage adjustments must be considered in the elderly, individuals with medical disorders, and patients taking multiple medications. If IV premedication is selected, the clinician must be even more aware of its potential effects and well trained in emergency procedures. IV administration allows the patient to present to the surgical suite without being sedated. The medication should be given shortly after venipuncture; the patient then becomes relaxed and ready for the local anesthesia. Intravenous sedation can be maintained throughout the procedure by carefully titrating small incremental doses; however, this requires close observation and monitoring of vital signs. This route often results in a faster drug elimination, patient recovery, and discharge. It has been said that the best preoperative anxiolytic is a complete, thorough, and reassuring preoperative explanation of the events that are to follow.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Antianxiety/sedative drugs. The benzodiazepines. 158 12

Sixty patients aged 50-65 years randomly received intrathecally either hyperbaric bupivacaine hydrochloride (one ml) in group A (30 cases) or bupivacaine hydrochloride (one ml) and buprenorphine 300 micrograms in combination in group B (30 cases). They were all scheduled for orthopaedic operations in the lower limbs. Prolonged postoperative analgesia, minimal disturbance of consciousness and respiration were observed in the group that received buprenorphine. The only side-effect found in the buprenorphine group was nausea and vomiting in 10 patients. This study shows that buprenorphine is an effective analgesic suitable for the management of postoperative pain in elderly patients.
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PMID:Intrathecal buprenorphine for postoperative analgesia in orthopaedic surgery. 159 45

In a double-blind, placebo-controlled study in 125 patients undergoing a cholecystectomy, a comparison was made of the quality of post-operative pain relief during 'patient-controlled' intake of sublingual buprenorphine in combination with either rectally administered naproxen 1000 mg/24 h, paracetamol 4000 mg/24 h or a placebo. Results obtained in 97 patients were analysed. Five of these patients needed a rescue medication with morphine hydrochloride intramuscularly because of insufficient pain relief or because of nausea and vomiting. The quality of pain relief, as measured on a four-point scale, was comparable in all three groups throughout the study period and no significant differences became apparent. Only on the day of surgery (day 0) was intake of buprenorphine significantly greater in the placebo group (2.3 tablets/24 h) than in the naproxen and paracetamol groups (1.8 and 1.5 tablets/24 h, respectively). It is concluded that after cholecystectomy 'patient-controlled' intake of sublingual buprenorphine as a sole agent provides acceptable pain relief in about 80% of patients. More elaborate methods, such as intravenous patient-controlled analgesia, might be necessary to achieve good pain relief in the remainder of these patients.
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PMID:Application of sublingual buprenorphine in combination with naproxen or paracetamol for post-operative pain relief in cholecystectomy patients in a double-blind study. 159 37

Transdermal hyoscine (Scopoderm TTS CIBA) was compared with placebo in 67 patients receiving postoperative analgesia via a patient-controlled analgesia system. All patients underwent an abdominal hysterectomy and had a standard anaesthetic. They were followed up in recovery and daily for 3 days postoperatively. Fewer patients in the hyoscine group suffered emetic sequelae in recovery and on the third postoperative day (p less than 0.05). The hyoscine group received half the number of supplementary antiemetic doses compared to placebo. However, despite transdermal hyoscine there was still a high (78%) incidence of nausea and vomiting. The only significant (p less than 0.05) increase in side effects attributable to hyoscine was a higher reported incidence of visual disturbance on the second day.
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PMID:Transdermal hyoscine with patient-controlled analgesia. 846 Jul 81

A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.
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PMID:[Comparison of two methods for conscious sedation in maxillofacial surgery with local anesthesia]. 161 85

In 97 outpatients undergoing ambulatory arthroscopic procedures, we compared esmolol with alfentanil when used to supplement propofol-N2O-atracurium anesthesia according to a randomized, double-blind protocol. After an initial intravenous dose of 16 micrograms/kg alfentanil, or 2 mg/kg of esmolol, a variable-rate infusion of alfentanil or esmolol was administered to maintain a stable heart rate. After induction of anesthesia with 2.5 mg/kg of propofol, mean arterial pressure decreased to a larger extent in the alfentanil-treated patients. Although heart rate and mean arterial pressure increased in both groups after tracheal intubation, alfentanil more effectively blunted the hemodynamic response to this stimulus. Maintenance of anesthesia was adequate in both treatment groups. After discontinuation of anesthesia, patients in the esmolol group opened their eyes earlier (7.2 +/- 2.4 min vs 9.8 +/- 4.6 min) than those in the alfentanil group. Esmolol-treated patients also reported less sedation in the first 15 min of recovery than those receiving alfentanil. However, there were no differences in times to ambulation and discharge between the groups. Esmolol-treated patients reported more postoperative pain for the first 15 min of recovery and more esmolol-treated patients required postoperative opioid analgesia than those treated with alfentanil. There were no significant differences in the incidences of nausea and vomiting between the two groups. The authors conclude that esmolol may be used in place of alfentanil to supplement propofol-N2O-atracurium anesthesia in outpatients undergoing arthroscopic procedures. However, hemodynamic responses to tracheal intubation were larger with esmolol, and avoidance of alfentanil did not decrease the incidence of postoperative nausea and vomiting in this outpatient population.
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PMID:Efficacy of esmolol versus alfentanil as a supplement to propofol-nitrous oxide anesthesia. 134 15

Neurolept analgesia in ambulatory nasal endoscopies has been gaining widespread use recently. Scrupulous selection of patients and careful preoperative evaluation and premedication are essential. Excellent surgical block is a prerequisite to good neurolept analgesia. Versed (midazolam) is particularly suitable for outpatient surgery, since it provides superior operative condition to Valium (particularly less venoirritation) and rapid recovery in the postoperative period associated with a low incidence of nausea and vomiting. When used in combination with fentanyl (Sublimaze) or alfentanil, Versed is suitable for the provision of total neurolept analgesia. Careful intraoperative vigilance and monitoring, including pulse oximetry, cannot be overemphasized.
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PMID:Neurolept analgesia in ambulatory (nasal) endoscopies. 168 34

The postoperative care of patients usually is characterized by the fact that the individual need of pain killers is not sufficiently recognized. An opioid given only when asked for, results in an underdosage as the patient does not receive the analgesic in time, so that he suffers pain. As there is insufficient knowledge with regard to the pharmacology of opioids which can be used for postoperative pain therapy, physicians and nurses usually tend to give a lower dose in order to avoid any possible side-effects. Considerations which lead to opioid underdosage include: the development of addiction and possible side-effects such as respiratory depression, heavy sedation, possible constipation and urinary retention. The aim in postoperative pain therapy is a time-contingent dosing after careful intravenous titration of the compound in the lower dose range during continuous supervision. Thus, the individual need in the recovery room can be estimated. Only such a procedure helps to keep the patient pain-free over a long period of time, reduces the workload of nurses during the night, results in the reduction of complications and finally may even reduce the hospital stay. Piritramide is a compound which has a number of potential advantages with regard to efficacy and side-effects in postoperative pain therapy. It has the highest analgesic potency among those compounds suitable for postoperative pain therapy; when compared with pethidine, pentazocine or nalbuphine it shows remarkable cardiovascular stability. In comparison to morphine, pethidine and pentazocine, piritramide has a lower incidence of nausea and vomiting. With a mean duration of action of up to six hours, piritramide has an advantage over pentazocine (3 hours), pethidine (2-3 hours) and morphine (5-6 hours). Compared to other mixed narcotic analgesics, piritramide does not induce dysphoric side-effects when given in the higher dose range and does not lead to addiction. It is derived from the same group of agents such as fentanyl or alfentanil which are used in neuroleptanaesthesia so that there is an increase in analgesia one to the interaction with the same receptor site. Piritramide has a fast onset of action, 2-5 minutes after intravenous injection and a peak action after 10 minutes. In comparison to pethidine it has no cardiovascular effects, in particular no myocardial depression or increased myocardial oxygen demand (MVO2). Last but not least, the cost-effectiveness is a financial factor of increasing importance to the institution that runs the hospital.
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PMID:[Postoperative pain treatment]. 168 69

The most frequently used postoperative analgesia techniques are intramuscular injection (IM) and patient controlled analgesia (PCA). Recently, the use of epidural catheter injection (EPI) has been done with success. This study was done to prospectively compare these three techniques for postoperative analgesia after extensive operations upon the colon and rectum. Patients were randomized to one of three analgesia groups--IM, intramuscular morphine sulfate; PCA, patient controlled morphine sulfate, and EPI, epidural morphine sulfate. Data collected included age, time to first bowel movement, amount of narcotic, number achieving 75 per cent of preoperative forced vital capacity, postoperative pruritus, headache, nausea and vomiting, respiratory depression, atelectasis or pneumonitis. A visual analog pain scale was used to evaluate postoperative pain severity (0, no; 1, partial; 2, marked, and 3, total relief). Sixty-eight patients were eligible for study (IM, 19; PCA, 22; EPI, 23, and excluded, four). The EPI group required significantly less daily narcotic compared with either the IM or PCA groups (17.0 +/- 6.12 milligrams; 67.8 +/- 26.8 milligrams; 40.5 +/- 20.6 milligrams, respectively, less than 0.05 ANOVA) and total narcotic (81.3 +/- 31.3 milligrams; 355.4 +/- 147.7 milligrams; 215.3 +/- 105.4 milligrams, respectively, p less than 0.05 ANOVA). EPI achieves excellent pain control in more patients with a significantly lower dose of narcotics and significantly fewer pulmonary complications. Therefore, epidural analgesia is the optimal method of postoperative analgesia after extensive abdominal operations.
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PMID:Epidural analgesia. 173 72

This retrospective study explores a number of variables encountered with the use of either epidural or non-epidural anesthesia and analgesia. Postoperative mobility, amount of narcotic used, incidence of blood transfusion, length of stay, and presence of urinary retention, pruritus, nausea and vomiting, or respiratory depression were compared in a group of 101 consecutive patients scheduled for total hip or knee arthroplasty. Fifty-two patients received epidural anesthesia and analgesia; the remaining 49 received non-epidural anesthesia, followed by standard IM/IV postoperative analgesia. Epidural patients required significantly less narcotic than the non-epidural group. There were significantly fewer blood transfusions in the epidural group; however, epidural patients had significantly increased incidence of urinary retention and pruritus. The use of epidural anesthesia and analgesia for total hip and knee arthroplasty patients has definite merit, but is most safely administered in a monitored, skilled nursing unit.
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PMID:A comparison of epidural and non-epidural anesthesia and analgesia in total hip or knee arthroplasty patients. 173 19


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