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

Midazolam, a water soluble bensodiasepine, has proven to induce a sleep pattern and amnesic effect that makes it preferable for use as a premedication for outpatient surgery. Used in addition to the regular anesthesia, Midazolam obviates the ineffectiveness of the analgesic drug. Since 1970, neuroleptic analgesia has been used as a method of outpatient anesthesia. Unfortunately, neuroleptic analgesia has provided inadequate coverage of pain relief causing pain and discomfort to patients. When a sedation and anxiolytic premedication are used, the patient acceptance increases. In a study in Ramathibodi hospital, Bangkok, Thailand effectiveness of midazolam as a premedication drug in laparoscopic interval sterilization, 150 women capable of reproduction and who were schelduled for the operation were studied. All of the women received 15mg midazolam orally either 60 or 90 minutes before the operation. The women were divided into 3 groups of 50 classified by the type of analgesic administered (tramadol or pethidine). Heart and respiratory rates and blood pressure were measured prior to, during, and after the operation. No difference in the rate of amnesia was found among the 3 groups, and a rate of 36% of amnesia was found in the study. Those results were lower than earlier reports, possibly due to circumstances at the hospital such as lack of coordination between administration of the medication and timing of the surgery.
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PMID:Amnesic effect of midazolam as premedication in interval laparoscopic sterilization. 318 58

We performed a double-blind study of the dose-response relationship of intrathecal morphine (0, 0.3, 1, and 2.5 mg) for postoperative pain relief in 33 subjects who underwent total knee or hip replacement surgery. Assessments commenced 1 hour after the opioid injection, which was given at the end of surgery, and continued for 24 hours. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine provided effective, long-lasting pain relief. All doses delayed the initial perception of discomfort (T-Pain) and also postponed the onset of severe pain requiring analgetic supplementation (T-Morphine) (1.25 hours control with placebo injections; greater than 20 hours with intrathecal morphine 0.3, 1, and 2.5 mg: P less than 0.05). Although 0.3 mg usually provided good analgesia it was unsatisfactory in three of 10 patients (30%), whereas 1 and 2.5 mg were absolutely reliable. Respiratory depression (increased PaCO2), common after the administration of 1 or 2.5 mg intrathecal morphine, was slow in onset and prolonged. The respiratory depression after 2.5 mg was more profound than after 1 mg, and produced apnea necessitating large-dose naloxone therapy. Pruritus was unique to intrathecal morphine administration, but nausea, vomiting, and urinary retention were common in all the groups. We conclude that no ideal dose of intrathecal morphine exists because, even with small quantities, minor adverse effects are evident. Doses between 0.3 and 1 mg, however, should provide good analgesia free from the major complication, respiratory depression.
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PMID:A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects. 318 98

Meperidine HCl was administered intramuscularly by hand-syringe to a number of individuals representing several species of cetaceans (n = 95) and pinnipeds (n = 36). Dosage administered was 0.11 mg/kg, 0.23 mg/kg or 0.45 mg/kg, with the majority of animals receiving the middle dosage. Meperidine HCl provided moderate restraint in cetaceans without obvious deleterious effects. Restraint was achieved rapidly, with maximum effect occurring 20 min after intramuscular injection and lasting for 2 to 3 hr. Analgesia appeared to last as long as 4 hr and was sometimes accompanied by a restoration of appetite in animals suffering from physical discomfort. Higher doses produced increased sedation and analgesia without noticeably depressing respiration. Meperidine HCl provided moderate restraint for phocids and walrus (Odobenus rosmarus) without apparent detriment. California sea lions (Zalophus californianus) showed little restraint, but demonstrated profound respiratory depression.
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PMID:The use of meperidine hydrochloride for chemical restraint in certain cetaceans and pinnipeds. 319 67

The care of burns to the head, face, and neck remains a challenge to the clinician. From 1978 to 1986, halo traction was used as an immobilizing device and as a protective frame for 31 patients with burns to the head (n = 8), face (n = 24), and neck (n = 28). The patients ranged in age from 8 months to 80 years (mean = 16 years) and had second- and third-degree burns covering a total body surface area of 8% to 75% (mean = 28%). The halo was used for an average of eight days (range one to 19 days) and served to immobilize and protect areas of fresh skin grafts, as well as to elevate and protect scalp donor sites (n = 10). Traction was initially used in patients who were confused and uncooperative, and in patients whose burns involved the neck to provide extension for prophylaxis against contractures. Treatment side effects included intermittent headache and backache, the latter occurring especially in the patients subjected to hyperextension. Eight patients (26%) complained of discomfort, which was reduced with adequate analgesia, sedation, and emotional support. The halo had to be removed from one patient after one day because of a loose pin, and in another patient after eight days because of the development of cellulitis at a pin site. Halo immobilization was used successfully to minimize graft loss in 30 of 31 patients.
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PMID:Halo immobilization in the treatment of burns to the head, face, and neck. 328 35

In a randomized, double-blind study, buprenorphine was compared with morphine in the treatment of pain after major abdominal operations by means of continuous-plus-on-demand epidural infusion for constant analgesia. The patients received bolus epidural injections of 0.15 mg buprenorphine or 2 mg morphine-HCl prior to an on-demand epidural infusion of 0.03% buprenorphine or 0.25% morphine HCl at a basal rate of 0.06 ml/h. Over 50 h, mean buprenorphine consumption was 0.85 +/- 0.08 mg, and mean morphine consumption was 6.4 +/- 0.5 mg. Under the treatment, no discomfort or side-effects necessitating treatment occurred. We conclude that buprenorphine is a useful substitute for morphine in the treatment of pain after major abdominal operations by continuous-plus-on-demand epidural infusion, and that the relative analgesic potency ratio of epidural buprenorphine is 8.
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PMID:Continuous-plus-on-demand epidural infusion of buprenorphine versus morphine in postoperative treatment of pain. Postoperative epidural infusion of buprenorphine. 329 75

The milieu of the critical care unit is stressful for both the patient and health care professionals. As such, it has the potential to increase pain perception in patients, and decrease the nurse's awareness of pain relief needs of the patient. Several physical and pharmacologic methods of pain relief were discussed in this article. Nontechnologic analgesia such as hypnosis and relaxation were introduced as adjuncts or alternatives to more familiar methods of pain relief. Although critically ill patients are not always able to express their discomfort, it is the responsibility of the nurse to recognize the potential for pain, and plan treatment accordingly. This article suggests several strategies for dealing with pain in critically ill patients.
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PMID:Pain: advances and issues in critical care. 330 58

Removal of genital warts by thermocautery was performed in 108 patients (57 men and 51 women) under topical anaesthesia with a local anaesthetic cream, lidocaine and prilocaine (EMLA). Most men had warts in the preputial cavity, most women had warts situated on the mucous membranes of the vulva, and warts at multiple sites were common. About 1 ml of cream per lesion was applied to the warts for 20 to 105 minutes before the operation. Plastic film (Glad, Union Carbide) was applied over the cream when natural occlusion, such as under the prepuce or on the introitus, was not present. Local pallor was seen in 30% of the patients, redness in 53%, and oedema in 15%, but did not cause any discomfort and were clinically insignificant. Analgesia was sufficient in 96% of the men and in 40% of the women. Additional local infiltration was given to 60% of the women, but was not as painful as injections generally are in the genital area. The analgesic efficacy on women may be further improved by optimising the application time on the genital mucosa.
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PMID:Topical anaesthesia with local anaesthetic (lidocaine and prilocaine, EMLA) cream for cautery of genital warts. 331 60

A prospective, randomized study was performed in 87 patients to compare the safety, efficacy and dose requirements of two sedation techniques for stereotactic headframe application. Sedation administration and headframe application averaged 30 min. Fifty patients weighing 76 +/- 13 kg (mean +/- SD) received mean doses of 154 micrograms fentanyl plus 5.5 mg droperidol i.v. (FD group). An additional 37 patients weighing 76 +/- 19 kg received mean doses of 127 micrograms fentanyl plus 6.7 mg Valium (diazepam; FV group). Both treatments provided excellent hemodynamic stability and a low incidence of adverse side effects while providing adequate analgesia and sedation. The incidence of anesthetist-assessed patient anxiety and discomfort was more favorable in the FD group.
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PMID:Sedation for stereotactic headframe application: a randomized comparison of two techniques. 332 51

In this study, the patient-controlled analgesia (PCA) technique was used to compare the suitability of butorphanol with that of morphine in relieving postoperative pain. Twelve patients, 19-77 years old, who had abdominal surgery, used the PCA device through the first 24-hour postoperative period. Results showed that all patients expressed satisfaction with the PCA technique. Analysis of the degree of discomfort according to the verbal description scale, recordings of respiratory rate, and assessment of sedation status showed no significant differences between patients who received butorphanol and those who received morphine. Patients were able to maintain acceptable analgesia with minimal sedation. There were no adverse side effects reported with butorphanol.
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PMID:Double-blind comparison of butorphanol and morphine in patient-controlled analgesia. 334 99

A group of 685 obstetric patients were randomly allocated to have their epidural block performed using either a 16-gauge or an 18-gauge Tuohy needle. Bleeding was noted from needle or catheter trauma in 18% of patients and it proved impossible to insert the catheter in 3%. The majority of mothers experienced little discomfort during the procedure but 2% found insertion to be very uncomfortable. There was no significant difference in the complication rate, ease of use, or patient discomfort between the 18- or 16-gauge needles. Epidural analgesia, although safe, is not without hazard. It may be difficult to perform and may, rarely, cause considerable discomfort.
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PMID:Cannulation of the epidural space. A comparison of 18- and 16-gauge needles. 335 12


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