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

Fifteen millilitre of 0.5% lignocaine was injected into the radial artery to provide analgesia for hand surgery in an elderly arthritic female patient. She experienced only minimal discomfort during injection and analgesia was excellent. No untoward effects were observed. This technique is recommended when other methods of regional analgesia are unavailable.
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PMID:Intra-arterial regional analgesia of the hand. 176 55

The analgesic and adverse effects of intrathecal methadone 5 mg, 10 mg and 20 mg were assessed and compared with intrathecal morphine 0.5 mg. The study was conducted on 38 patients who underwent total knee or hip replacement surgery. The intrathecal opioid was administered at the end of surgery and assessments began 1 h thereafter and continued for 24 h. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine 0.5 mg provided effective and prolonged analgesia. Intrathecal methadone 5 mg, 10 mg, and 20 mg produced good analgesia of 4 h duration. Thereafter the median pain scores with intrathecal methadone were consistently higher (worse) than those with intrathecal morphine (P less than 0.05). The time to the onset of discomfort severe enough to require supplemental morphine was longer after intrathecal morphine than following methadone (15 h with morphine 0.5 mg; 6.25 h, 6.5 h and 6 h with methadone 5 mg, 10 mg, and 20 mg respectively: P less than 0.05). Central nervous system depression manifesting as respiratory depression, hypotension, and excessive drowsiness occurred in 3 of 8 patients injected with methadone 20 mg intrathecally. Generalized pruritus, nausea, vomiting, and urinary retention were common and equally distributed among the treatment groups. We conclude that both intrathecal morphine 0.5 mg and methadone 5, 10, and 20 mg provide excellent analgesia but that morphine has a more prolonged effect. Methadone 20 mg produced unacceptable side effects. Clinical evidence for rostral spread of methadone within the CSF, as indicated by facial itching and excessive drowsiness, was less apparent with 5 mg than with 10 and 20 mg. Various explanations for the observed differences between the drugs are discussed.
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PMID:Intrathecal methadone: a dose-response study and comparison with intrathecal morphine 0.5 mg. 208 26

The efficacy of long-acting local anesthetics for anesthesia during periodontal surgery and for analgesia during the immediate postoperative period was evaluated. The rationale for using long-acting local anesthetics such as etidocaine and bupivacaine is that they can provide surgical anesthesia and, because of their long duration, prevent discomfort that may occur for 4-6 hours postoperatively. Two clinical trials were performed. The first enrolled patients requiring bilateral periodontal surgery. Using a matched pair design and double-blind randomized study conditions, 2% lidocaine 1/100,000 epinephrine was compared with 1.5% etidocaine 1/200,000 epinephrine for periodontal surgery. The time until complete recovery and the time until pain onset were found to be longer for the etidocaine surgeries. Postoperative pain appeared more severe, and the need for oral analgesics was greater for the lidocaine surgeries. Surgeons' rating of surgical bleeding was significantly greater for the etidocaine procedures. When matched bilateral surgeries were not available, a second double-blind randomized parallel trial was performed that compared 1.5% etidocaine 1/200,000 epinephrine to 0.5% bupivacaine 1/200,000 epinephrine. No significant differences were seen in the quality of anesthesia, degree of bleeding, or postoperative pain between these two long-acting anesthetics.
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PMID:A clinical trial of long-acting local anesthetics for periodontal surgery. 209 42

This report summarizes [corrected] our experiences in 0.125% bupivacaine caudal analgesia in 70 pediatric patients with age ranging from 3 months to 7 years undergoing routine surgical procedures including herniorrhaphies, orchiopexies, and circumcision. The local anesthetic chosen was 0.125% bupivacaine with epinephrine (1:200,000) being added and the dosage administered [corrected] varied from 0.5-1.0 ml/kg depending upon the sites of the surgical procedures. In the recovery room, patients were observed and accessed using the modified Hannallah's pain/discomfort scoring system. Patients who achieved a score of four or more during a 30 min observation period were given codeine 1 mg/kg intramuscularly and the blocks were rated as uneffective. Our result was that 0.125% bupivacaine caudal analgesia was effective. The rate of success was 79%. The duration of analgesia was 4-8 hours. No delay or difficulty in urination was found. Most of the patients could move their lower extremities but could not bear their weight. Telephone follow-up failed to reveal any analgesia-related complication.
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PMID:Low concentration of caudal bupivacaine for postoperative analgesia in elective pediatric surgery. 213 4

Postoperative analgesia in infants and young children is a topic of growing interest in pediatric anesthesia. Two systems measuring postoperative pain in this group of patients have been offered recently: CHEOPS (Childrens Hospital of Eastern Ontario Pain Scale) by McGrath et al. and OPS (Objective Pain Scale) by Hannallah et al. and Broadman et al. [3, 7, 8]. Both systems are economical and not reactive, but their validity is not satisfying. The validity of CHEOPS is based on the statements of experienced nurses, using the method of convergent validation by an expert's assertion. Hannallah and Broadman et al. judged the validity of their objective pain scale for infants and young children by statements of juveniles between 13 and 18 years of age. McGrath et al. accepted the item of spontaneous verbal communication as useful in the CHEOPS, although no such verbal comment occurred in their study on interrater and inter-item correlations. The aim of the present study was to evaluate the statistical qualification of items for measurements of the intensity of postoperative pain in young children and to investigate some aspects of their validity. MATERIAL AND METHODS. The study was performed in 54 children of ASA groups I and II aged 29.2 +/- 10.7 months. They were included in the study if they were pain-free before the operation and had no signs and symptoms of neurologic disease. The following operations were accepted: herniorrhapy, orchidopexy, circumcision, and umbilical herniorrhaphy. Premedication and general anesthesia were standardized. The patients were premedicated with midazolam 0.5 mg/kg rectally and subsequent intramuscular injections of ketamine 2.0 mg/kg with atropine 0.01 mg/kg. Anesthesia was induced and maintained by inhalation of oxygen/nitrous oxide and halothane (FiO2 0.3). All children were intubated and ventilation was controlled during the operation. After the operation and under steady-state anesthesia with 0.5 vol.% halothane and spontaneous respiration, the children received either nalbuphine 0.1 mg/kg, piritramide 0.1 mg/kg, or placebo in a randomized and double-blind manner. Respiratory and circulatory parameters were recorded for 15 min before anesthesia was discontinued. Five minutes after halothane had been discontinued the first measurement of the childrens' behavior was started with four subsequent measurements at fixed time intervals of 15 min. The measuring system was based on the six items of CHEOPS complemented by five items related to the waking state because it was assumed that the waking state generally modulates the child's ability to demonstrate pain. The design of the study was accepted by the ethic committee with the provision that neither a sedative nor an analgesic drug should be withheld from any child if indicated. Therefore, all children who seemed to feel discomfort according to the subjective impression of the anesthetist received midazolam intraveneously to a maximal dose of 2 mg. All the behavioral data were included in a factor analysis (principal components)...
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PMID:[Critical aspects of an outside evaluation of postoperative pain in infants. A placebo-controlled double-blind study of the question of the reliability and validity of the measurement system]. 218 94

Stimulation of the endogenous opiate system produced relief of somatosensory induced pain states. Stimulation of the nonopiate system can control pain from somatosensory causes as well as damage to the nervous system. Neither of these systems in themselves are rewarding or produce self-stimulation in humans, who have free choice of whether to use stimulation or not, except to reduce discomfort. Lack of pain in general produces lack of use of the stimulation system. Apparently, the descending opiate system for somatosensory pain control involves descending norepinephrine and serotonin pathways at an intermediate step through the dorsolateral funiculus of the cord. Enhancement of the opiate system can be produced by administration of L-Tryptophan and L-Dopa due to precursor loading of serotonin and norepinephrine. The endogenous opiate system, when activated by electrical stimulation, usually produces excellent control of somatosensory induced pain, but often is not effective for centrally produced pain. Stimulation of areas that produce analgesia that are nonopiate-dependent are usually more effective in reducing pain from damage to the nervous system itself than the opiate-dependent system, but this is sometimes the converse. While cross tolerance to morphine from electrical stimulation of the endogenous opiate system exists in animals, it does not seem to be a problem clinically as the abstinence syndrome and tolerance have not been a problem in humans.
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PMID:Central stimulation-induced analgesia in humans--modulation by endogenous opioid peptides. 222 93

We present a prospective controlled trial, comparing methods of analgesia for the relief of discomfort on removing nasal packing, including a general discussion on the considerations for, and methods of, nasal tamponade. On the basis that nasal packing is likely to continue to be used frequently, nitrous oxide (as Entonox) is advocated as a safe and relatively cheap means of pain relief with a statistically significant advantage over papaveretum.
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PMID:Analgesia and removal of nasal packing. 222 3

Forty-five patients were evaluated during knee arthroscopy performed using local anesthesia produced by lidocaine with epinephrine to determine the dose-response relationship for operative analgesia. Serum lidocaine concentrations were also measured. Patients were randomized prospectively to receive 20 mL of 0.5%, 1.0%, or 1.5% lidocaine with epinephrine intraarticularly. Intraoperative discomfort was measured by verbal response on an 11-point linear pain scale. Pain scores were significantly higher in patients receiving 0.5% lidocaine during the first 45 min of surgery (P = 0.03). After 45 min, pain scores continued to be higher in the 0.5% lidocaine group than in the 1.0% or 1.5% groups, but the differences were not statistically significant. Ninety-four percent of patients in the 1.5% lidocaine group were willing to repeat this anesthetic technique for surgery compared with 83% of those in the 1.0% lidocaine group and 75% of those in the 0.5% lidocaine group (P greater than 0.05). The duration of postoperative analgesia was similar in all groups. Serum lidocaine concentrations before and 15, 30, 60, and 120 min after instillation of lidocaine were highest in the 1.5% lidocaine group with a peak concentration of 278 ng/mL. No patient had symptoms of lidocaine toxicity. We recommend that lidocaine concentrations of 1.0% or 1.5% be used when 20 mL is instilled intraarticularly for knee arthroscopy based on patient comfort and absence of lidocaine toxicity.
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PMID:Lidocaine local anesthesia for arthroscopic knee surgery. 224 Jun 41

Carpal tunnel release was performed under local anaesthesia in 108 wrists of 98 patients. The local anaesthetic (bupivacaine 0.5% and adrenaline) was injected into the subcutaneous tissue down to the flexor retinaculum in the line of the incision. The median nerve was not anaesthetised. No tourniquet was required and analgesia was complete in all but four patients, who complained of some minor discomfort on cutting the flexor retinaculum. Protracted postoperative analgesia was obtained.
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PMID:Outpatient carpal tunnel decompression without tourniquet: a simple local anaesthetic technique. 201 21

One-hundred patients undergoing Falope ring or clip laparoscopic tubal ligation were given either a placebo or a 100 mg indomethacin rectal suppository one hour pre-operatively. Treatment was randomised and double-blind. Post-operative analgesic requirements and side effects were monitored. Forty-seven patients receiving indomethacin and 48 patients receiving placebo were available for analysis. Thirty-five patients in the indomethacin group required Meperidine (pethidine) analgesia (mean dose 58 mg) compared to 41 patients (mean dose 65 mg) in the placebo group. These differences were not significant. There were no significant differences in the non-narcotic analgesia given to each group, the side effects or the number requiring to stay overnight in the hospital. Analysis of the analgesic requirements of the 53 patients having clip sterilization and the 42 patients sterilized with Falope rings showed no statistical differences. This trial suggests that the immediate post-operative discomfort rates between ring and clip tubal occlusion are not different and that there is no significant benefit from the use of an indomethacin suppository pre-operatively.
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PMID:Post-operative discomfort after ring or clip tubal ligation--is there any difference and do indomethacin suppositories help? 228 90


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