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

Seventeen cynomolgus monkeys under N2O analgesia and sedation were subjected to severe volume-controlled hemorrhagic shock (shed blood volume of 21 or 27 ml/kg). In 12 monkeys, resuscitation was started after increasing periods of hemorrhagic shock from 30 min to 5 h. In five additional monkeys, volume-controlled hemorrhage was modified at hemorrhagic shock 30 min to control MAP at 30 mmHg: resuscitation was started at hemorrhagic shock of 2 h. A clinically relevant resuscitation protocol consisted of a field phase from 0 to 6 h (lactated Ringer's solution, spontaneous breathing), and a hospital intensive care phase from 6 h to 48 h (blood, lactated Ringer's solution to mean arterial pressure (MAP) greater than or equal to 70 mmHg, controlled ventilation, advanced life support). Fifteen of the 17 monkeys survived. After outcome evaluation at 4 or 7 days, the eight monkeys with "moderate insult" had only transient functional impairment. Of the nine with "severe insult," three showed signs of moderate transient non-oliguric renal failure. Eight of the 12 monkeys studied morphologically showed scattered liver cell damage. None of the monkeys developed pulmonary dysfunction or functional or morphologic evidence of cerebral damage. This study establishes a new hemorrhagic shock-resuscitation model simulating field-to-hospital life support. Severe hemorrhagic shock with MAP 30-40 mmHg for 90-120 min (without trauma or sepsis) can lead to complete functional recovery after transient malfunction of liver and kidneys.
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PMID:Monkey model of severe volume-controlled hemorrhagic shock with resuscitation to outcome. 165 92

The analgesic effect of morphine in the tail immersion test was studied in rats three and ten days after intracerebroventricular 5,7-dihydroxytryptamine (5,7-DHT) given to selectively destroy serotonergic neurons. Morphine analgesia was reduced three but not ten days after the neurotoxin. Ten days after 5,7-DHT, the inhibiting effect of metergoline, a serotonin antagonist, on morphine analgesia was still present, suggesting that functional recovery of the serotonergic system may partly explain the different results.
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PMID:The effect of intracerebroventricular 5,7-dihydroxytryptamine on morphine analgesia is time-dependent. 395 13

Results of 52 consecutive below-knee amputations for lower extremity ischemia were evaluated to determine whether use of immediate fit prostheses (IPOP) instead of soft stump dressings had any bearing postoperative hospitalization time, functional recovery, postoperative pain, morbidity, and mortality in amputees. Of 34 patients receiving IPOP, 21 per cent developed stump necrosis, 21 per cent had wound infection, 26 per cent required major reamputation, and 12 per cent died within 30 days of operation. Of 18 patients treated with soft stump dressings, 17 per cent developed necrosis, 33 per cent infection, 44 per cent required reamputation, and 11 per cent died postoperatively. None of these differences was statistically significant. Mean hospitalization time and average narcotic requirements for analgesia were also similar in both groups. Fifty-six per cent of patients with IPOP and 22 per cent of those with soft dressings ultimately ambulated with prostheses (P less than 0.05). Whether or not IPOP was used had little if any effect on the early evolution of vascular amputees in this series.
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PMID:The rigid versus soft postoperative dressing controversy: a controlled study in vascular below-knee amputees. 738 90

The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patient-controlled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy. The PCA group received a continuous infusion of 1.5 mg h-1 piritramide, a mu-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval = 15 min). The i.m. group received 0.3 mg kg-1 piritramide i.m. when requested by the patient with a minimum interval of 5 h. Pain intensity, sedation and the functional recovery of the patients were followed for 72 h post-operatively. The sum of pain intensity differences (SPID) was used as a measure of analgesic efficiency. Equipment and drug costs, and the demand on nursing time were recorded over 3 days post-operatively. The costs of PCA and i.m. therapies per patient were used to calculate the cost-benefit (cost of treatment vs. nursing time) and cost-effectiveness (cost of treatment vs. SPID) analyses. Both treatments initially provided comparable analgesia, but PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA = 61 +/- 4 min, i.m. = 88 +/- 5 min; P < 0.001). Functional recovery was not different for either treatment. Cost analysis indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA = 1.9 Belgian Francs (BEF) unit-1 SPID; i.m. = 1.7 BEF unit-1 SPID).
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PMID:Pharmaco-economic evaluation of a disposable patient-controlled analgesia device and intramuscular analgesia in surgical patients. 964 88

There is a direct relation between hospital costs and hospital length of stay after the operation. In the other hand, reduced stay increases the productivity of the public hospitals with high service demanding. The objective of this study was to identify factors determining the decrease in hospital stay after major thoracic surgery. A two-phase retrospective study was conducted on analysis of medical records. In the first phase, data on length of hospital stay and related factors were collected from a consecutive series of 169 patients divided into group I (n=81)--patients operated on between June 1990 and 1995, and group II (n=88)--1996 through May 2000. In the second phase, data were collected from a consecutive series of 20 patients (group III) starting backwards from March 2002, for analysis and comparison with a internet survey sent to 21 thoracic surgeons. Intensive care unit was avoided for most patients in the immediate post operative period. The mean hospital stay decreased from 7.6 days (median 7) in group I to 5.1 days (median 4) in group II (p<0.001). The more frequent utilization of epidural analgesia and less traumatic thoracotomy in group II reached statistic significance (p<0.001). In group III, the mean hospital stay was 4.2 days (median 4), and there was a more effective use of epidural analgesia (75%) and muscle-sparing thoracotomy (90%). Eight thoracic surgeons answered the survey: the mean hospital stay varied from 5 to 9 days and all patients were sent to intensive care or similar units. Only two surgeons utilize muscle-sparing thoracotomy. This study confirms that pain control and less traumatic surgical approach are important for faster functional recovery of the patients. It suggests that the IC units may be used only for selected patients.
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PMID:[Early discharge following major thoracic surgery: identification of related factors]. 1468 31

Patients undergoing major knee surgery may experience postoperative pain, which could be exacerbated by early postoperative continuous passive motion or active mobilization. This pain may result in poor functional recovery. Use of regional analgesia techniques to achieve more consistent pain relief and to facilitate rapid rehabilitation can play an important role in optimizing postoperative outcome after anterior cruciate ligament repair (ACLR). This case study concerns a 20-year-old male soldier, otherwise healthy, who underwent ACLR. We inserted a catheter in the fascia iliaca compartment and performed postoperative analgesia with low-concentration ropivacaine by using an elastomeric pump. The patient started early rehabilitation under fascia iliaca compartment analgesia. We discuss the case and the influence of regional analgesia techniques on postoperative and clinical outcomes.
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PMID:Early rehabilitation after anterior cruciate ligament reconstruction under regional analgesia: a case report. 1496 25

Two 37-year-old men, both drug addicts, and a 32-year-old homeless woman presented themselves with a painful arm. Except for the first patient, there was a delay in diagnosing the compartment syndrome of the arm. In the first patient emergency fasciotomy led to a good functional recovery, however kidney function was lost despite proper treatment, possibly due to combined heroine use and muscle breakdown. In the second patient prolonged immobility and altered consciousness by drug use should have increased clinical suspicion. Poor arm function remained even after fasciotomy. In the third patient inadequate clinical examination delayed surgery. Major early symptoms of compartment syndrome are progressive disproportional pain and sensory loss, not relieved by analgesia. If left untreated, the ischaemic tissue damage is potentially limb and even life threatening. The acute compartment syndrome is a clinical diagnosis and a low threshold for surgical exploration and fasciotomy is advocated.
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PMID:[The acute compartment syndrome of the arm]. 1571 40

Continuous peripheral nerve blocks offer the benefit of extended postoperative analgesia and accelerated functional recovery after major knee surgery. Conventional nerve localization is performed over a stimulating needle followed by blind insertion of the peripheral catheter. Correct catheter placement is confirmed by testing for satisfactory analgesia. Stimulating catheters offer the advantage of verifying correct placement close to the nerve during catheter placement. The aim of this randomized trial was to determine whether accurate catheter positioning under continuous stimulation accelerates the onset of sensory and motor block, improves the quality of postoperative analgesia, and enhances functional recovery. We compared femoral nerve catheters inserted under continuous stimulation with catheters that were placed using the conventional technique of blind advancement in 81 patients undergoing major knee surgery. Time of catheter placement was similar in both groups with 4 min (3/7.3; median, 25th/75th percentile) in the conventional group and 5 min (4/8.8) in the stimulating catheter group. In both groups, 42% of the catheters could be correctly placed (motor response of the patella with a current < or =0.5 mA) at first attempt. In 22 patients (58%) of the stimulating catheter group, the catheter had to be redirected 1-20 times, including 2 that could not be correctly placed within 20 min. The onset time of sensory and motor block was almost similar in both groups. There were no differences in the postoperative IV opioid consumption, and visual analog scale pain scores at rest and movement, or maximal bending and stretching of the knee joint during the 5 days after surgery. We conclude that with continuous femoral nerve blocks, blind catheter advancement is as effective as the stimulating catheter technique with respect to onset time of sensory and motor block as well as for postoperative pain reduction and functional outcome.
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PMID:Does femoral nerve catheter placement with stimulating catheters improve effective placement? A randomized, controlled, and observer-blinded trial. 1584 15

In fast-track surgical programmes, a variety ofperioperative elements are combined in an intensive multidisciplinary approach for the purpose of preserving the preoperative body composition and organ functions and actively stimulating functional recovery. Such programmes have already been introduced in several surgical procedures. The essence of fast-track colon surgery consists of extensive preoperative counselling, adequate preoperative nutrition with the avoidance of prolonged fasting, a minimum of invasive procedures and anaesthesia, no routine use of drains and nasogastric tubes, adequate perioperative analgesia encompassing high thoracic epidural anaesthesia, rapid mobilisation, rapid resumption of postoperative feeding, and medicinal support with prokinetics and laxatives. A systematic review shows that this programme accelerates recovery and hence shortens the primary and total hospital stay.
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PMID:[Elective colon surgery according to a 'fast-track' programme]. 1650 20

Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. Secondary outcomes included visual analog scale (VAS) pain scores, opioid consumption, and long-term functional recovery at 12 wk. Mean VAS resting scores were significantly lower among patients who received CFNB versus SFNB: first day (1.7 vs 3.3 [P = 0.002]) and second day (0.9 vs 3.2 [P < 0.0001]) after surgery. Mean maximal VAS scores during physical therapy were significantly lower among patients who received CFNB versus SFNB: first day (4.7 vs 6.3 [P = 0.01]) and second day (3.9 vs 6.1 [P = 0.0005]) after surgery. Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB: 15 mg versus 40 mg (P = or < 0.0001) on the first day after surgery; 20 mg versus 43 mg (P = 0.0004) on the second day after surgery. There was no difference in hospital LOS (3.8 vs 3.9 days) or long-term functional recovery (117 degrees versus 113 degrees knee flexion at 12 wk) between the two groups. The lack of effect provided by increased duration of analgesia (from CFNB) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States.
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PMID:The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. 1737 28


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