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

A prospective study of the necessity of sedation, or analgesia, or both in total colonoscopy was performed. The procedures were performed in the office on 212 consecutive, nonselected patients. Intravenous sedation was not started initially, and all procedures were begun without medication. If the patient developed significant discomfort or sharp pain, intravenous diazepam (Valium, Roche, Nutley, NJ) or midazolam (Versed, Roche, Nutley, NJ) was given. Total colonoscopy was successful in 201 (95 percent) patients. Of these procedures, 173 (82 percent) patients required no analgesia or sedation. In the remaining 39 (18 percent) patients, only small doses of Valium or Versed were necessary. There were 2 (1 percent) complications, but they were directly related to polypectomy (stalk bleeding, serosal burn) and not to the colonoscopy. Patient acceptance was high because most of the patients were able to leave the office immediately after the procedure and many (at least 82 percent) were able to return to work or resume normal activities that same day. Intravenous sedation is routinely used during total colonoscopy by most practitioners and is considered the standard of care in most communities. However, the need for sedation during total colonoscopy has never been proven and is probably not necessary in most cases. Furthermore, when sedation is necessary, most patients are probably over-anesthetized. This is significant, as it may make total colonoscopy more accessible, less expensive, and safer.
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PMID:Avoidance of sedation during total colonoscopy. 235 Oct 8

Twenty women undergoing colposcopically directed laser evaporation of a cervical intraepithelial neoplastic (CIN) lesion were recruited. Using a linear analog scale they scored the pain associated with a normal period when not using contraception. Under standardized conditions and without any analgesia or local anesthesia their transformation zone was ablated to a depth of approximately 6 mm by an independent operator. Pain was assessed 10 min after the procedure by the same technique as that used for the measurement of dysmenorrhea. There is a direct correlation (r = 0.7) between the discomfort of dysmenorrhea and discomfort at colposcopy. This allows the operating colposcopist to predict which patients are most likely to experience discomfort during laser evaporation of a cervical lesion.
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PMID:The correlation between dysmenorrhea and the pain experienced during laser ablation of a cervical lesion. 229 11

Eight patients with established lower limb postamputation stump pain were given lumbar intrathecal fentanyl 25 micrograms and lidocaine 70 mg 2 weeks apart in an attempt to better understand the role of peripheral and central mechanisms in this condition. Baseline pain was recorded and then analgetic and side effects and their duration were assessed. Three self-administered questionnaires with appropriate psychometric proprieties were given to the patients. Intrathecal fentanyl always abolished the pain. Its onset was rapid being heralded within 1-2.5 min by a pleasant sensation of warmth involving the lower trunk and legs. Analgesia was complete by 5-10 min and had a median duration of 8 h. The patients had a sense of well being and were unable to elicit discomfort by pain aggravating maneuvers. Normal motor and sensory functions were retained. Pruritus was the only adverse effect unique to intrathecal fentanyl. Intrathecal lidocaine usually relieved the discomfort but was unable to abolish it in 3 of 8 patients despite adequate neural blockade. Its onset of action was slower and duration of effect shorter than fentanyl. Intrathecal fentanyl provided profound analgesia associated with normalization of stump sensations and euphoria, probably due to a segmental spinal action. The effects of lidocaine were inferior to fentanyl due to the associated motor and sensory paralyses as well as the absence of euphoria. This study suggests that, while peripheral mechanisms played a role, central mechanisms involving the spinal cord were more important in the modulation of established stump pain in the 8 subjects evaluated.
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PMID:A comparison of the effects of intrathecal fentanyl and lidocaine on established postamputation stump pain. 230 60

The purpose of this study was to determine if the timing of caudal block placement in relation to surgery affected either the duration of postoperative pain relief or the discharge time in children undergoing brief ambulatory surgical procedures. Forty ASA physical status I or II children ages 18 mo to 11 yr were randomly assigned to one of two groups. Group 1 patients received a caudal block with 0.5 ml.kg-1 of bupivacaine 0.25 per cent following the induction of anaesthesia but before the onset of surgery. Group 2 patients received a similar block at the completion of surgery but before emergence from general anaesthesia. An experienced observer, who was not aware of the timing of block placement, observed all patients from arrival to the post-anaesthetic recovery room until discharge from the ambulatory surgery unit. Pain was assessed at five-minute intervals using an Objective Pain Scale. No statistically significant differences were noted between Group 1 and Group 2 patients with regard to their postoperative pain/discomfort scores, the need for postoperative narcotic analgesia, or the time required for either group to meet standard discharge criteria. It is concluded that the duration of postoperative analgesia is not impaired by placing the caudal block prior to the start of a brief surgical procedure.
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PMID:Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patients. 234 Jun 12

The present study examined the effect of codeine, a centrally acting opiate, on the respiratory sensations elicited in normal subjects by breathing to exhaustion against externally applied inspiratory threshold loads. Subjects were tested on two separate days following the double-blind, randomized administration of either placebo or codeine (90 mg). The intensity of the sensations of effort and discomfort experienced during two loaded breathing trials (a "high" load that was 73% of the maximum inspiratory pressure (MIP) and a "low" load that was 63% of the MIP) was evaluated using category (Borg) scores on each day of study. To verify that the dosage of codeine administered was sufficient to produce analgesia, we also determined the effect of this dosage on the time that subjects could tolerate immersion of one hand in ice water. Codeine altered neither the perceived effort nor the sense of discomfort associated with breathing against external loads and had no appreciable effect on the time to exhaustion during loaded breathing trials. This dose of codeine did, however, increase the time that ice water immersion could be tolerated and reduced the rate at which the sense of discomfort increased over time during ice water trials. These results indicate that, provided the pressure-time index of respiratory muscle contraction remains constant, analgesic doses of codeine alter neither the sensations elicited by loaded breathing nor the total time that breathing against a fatiguing inspiratory load can be tolerated.
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PMID:Effect of codeine on the sensations elicited by loaded breathing. 235 94

Hysterosalpingography provides important information in the evaluation of infertility but is generally considered an uncomfortable and painful procedure. We evaluated various analgesics for decreasing or eliminating the discomfort from this procedure. Two types of analgesia were required to give maximum pain relief during and after the examination in the 180 patients evaluated. The best results were achieved with a combination of naproxen sodium, 550 mg, given orally two hours before the examination, and 20% benzocaine, applied to the cervix.
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PMID:Pain relief in hysterosalpingography. A comparison of analgesics. 235 47

Postoperative pain management for major abdominal or thoracoabdominal procedures requires bilateral multisegmental intercostal nerve blocks or epidural analgesia. This study was undertaken to examine the possible role of bilateral intrapleural regional analgesia (BIRA) and to select the proper dose for this new technique. Bilateral intrapleural catheters were inserted after surgery, using a Mancao dual-cannula system. Bupivacaine with epinephrine 1/200,000 (BE) was administered in each side as 20 mL of 0.5% in three patients. When this dose was found to be ineffective, 30 mL of 0.75% BE was administered in five patients; however, two patients complained of tinnitus and visual disturbances. Subsequently, 20 mL of 0.75% BE was used in five patients and was found to be satisfactory. Thirteen additional patients received the latter dose. Arterial blood levels of bupivacaine were determined at 15, 30, 60, and 120 minutes. The group of 18 patients (group I) who received 20 mL of 0.75% BE bilaterally were compared with a second group (group II) of 16 patients undergoing similar surgery who received only parenteral narcotics for pain management. BIRA was considered effective when patients denied pain or discomfort and when narcotics were not required in the postanesthesia recovery unit. Patients in groups I and II received narcotic medication whenever they felt pain or discomfort. The duration of BIRA was considered to be from the injection of the drug until the time a narcotic was administered to the patient. Demographic variables, changes in BP and heart rate after surgery, frequency of narcotic administration during the first four postoperative days, and postoperative hospital stay were compared in groups I and II.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bilateral intrapleural regional analgesia for postoperative pain control: a dose-finding study. 252 Sep 36

A double-blind study of patients selected at random compared the analgesic and adverse effects of intrathecal methadone (1 mg) with those of intrathecal morphine (0.5 and 1 mg). The study was conducted on 30 patients who underwent major orthopedic or urologic surgery. The intrathecal opioid was administered at the end of surgery, and assessments began 1 h thereafter and continued for 20 h. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine (0.5 and 1 mg) provided effective and prolonged analgesia. Methadone, however, was unable to ensure the same degree of analgesia; consequently, the median pain scores were consistently higher following methadone than morphine (0.5 and 1 mg) (P less than 0.05). The time to the onset of discomfort severe enough to require supplemental morphine was longer after intrathecal morphine than that following methadone (24 and 29 h with morphine 0.5 and 1 mg; 6.5 h with methadone; P less than 0.05). Respiratory depression (increases PaCO2) was not associated with methadone and morphine 0.5 mg but was common following morphine 1 mg (P less than 0.05). Facial pruritus was unique to intrathecal morphine. Urinary retention requiring bladder catheterization was more frequent following morphine than methadone, although this was not statistically significant. Nausea and vomiting were common to all groups. Intrathecal morphine (0.5 and 1 mg) provides superior postoperative analgesia to 1 mg methadone. Various explanations for the observed differences between the drugs are discussed, including the possibility that the dose of methadone used in the subarachnoid space was inadequate and that a larger dose might have produced an effect equal to that of morphine.
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PMID:Intrathecal methadone and morphine for postoperative analgesia: a comparison of the efficacy, duration, and side effects. 235 28

Only recently has the use of anesthesia and analgesia become widely accepted in the newborn infant. This is largely a result of the overwhelming evidence that neonates have the neurologic substrate for the perception of pain and display characteristic behavioral, physiologic, metabolic, and hormonal responses to noxious stimuli. The management of postoperative pain in the surgical neonate begins in the operating room, where techniques can be chosen that will ease the transition into the postoperative period. For postoperative analgesia, the most widely used and effective agents are the narcotics morphine and fentanyl. They may be administered either intermittently or continuously, and with proper precautions may be given to both intubated and nonintubated newborns. Other medications for analgesia and sedation are not as well studied in the newborn, but chloral hydrate and the benzodiazepines are useful for sedation, and acetaminophen may be used for analgesia alone or for potentiating the effect of narcotics. In addition, a number of creative nonpharmacologic techniques are being developed and promise to further decrease the discomfort experienced by postoperative neonates.
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PMID:Management of pain in the postoperative neonate. 265 66

A randomised double-blind study compared the dose-response relationship of intrathecal diamorphine (0, 0.25, 0.75, 1.5, and 2.5 mg) for postoperative pain relief, in 35 subjects who underwent total knee replacement surgery. Assessments commenced 2 h after the opioid injection and continued for 20 h. Pain, analgesic effect, supplementary analgesic requirements and adverse effects were noted. Intrathecal diamorphine was unable to delay the initial perception of discomfort. It was, however, capable of postponing the onset of severe pain requiring analgesic supplementation (control 5.25 h vs approximately 8 h: P less than 0.05). There was no significant difference in the quality of analgesia between the groups. Pruritus was the only undesirable feature unique to intrathecal diamorphine administration. Intrathecal diamorphine was safe and was not associated with clinically apparent respiratory depression. Its effects were inconsistent and its use was associated with irritating side effects. Possible explanations for the erratic behaviour of the diamorphine are discussed.
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PMID:Intrathecal diamorphine: a dose-response study. 233 97


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