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

Postoperative pain management (POPM) should be based on an organization exploiting existing expertise and documenting the outcome of the POPM in each individual patient. The aims of the present study were to evaluate the adequacy of database documentation of POPM of an anesthesia organized, nurse-based, anesthesiologist-supervised acute pain service (APS) on surgical wards and to assess to what extent the information obtained was continuously used to improve practice. From 2890 registered cases in the database (patient controlled analgesia, n = 1975; epidural analgesia [EDA], n = 915), a homogeneous two-year sample of documentation charts from use of EDA for POPM in connection with major, open, abdominal surgical procedures (n = 381) was chosen for detailed analysis. The data charts contained information on patient data, drug dosage, total amount of infused drug, duration of EDA treatment, occurrence of side effects, and patient's level of satisfaction. The database information was easily accessible making assessment of relevant aspects of the routines, including associations between analgesic technique, patient related factors, and satisfaction with the services, immediately available. Only 58% of the data charts were properly completed and fed into the database but the clinical safety of the missing nondatabase documented sample was not found jeopardized. Although the database documentation routines were considered to fulfill basic requirements of data collection and monitoring of the appropriateness of POPM, they were not found to function optimally. The reason seemed to be inadequate feedback of information between the parties involved in the POPM services. The present study stresses the importance of establishing routines for adequate, continuous feedback of recorded audit data from the APS team to the surgical wards for the maintenance of a high level of compliance with accepted guidelines.
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PMID:Postoperative pain management on surgical wards-impact of database documentation of anesthesia organized services. 1466 93

The author takes its stand in a dispute over epidural analgesia [EDA] widely used in practical obstetrics, a disagreement, which has divided obstetricians in the past few decades. The author believes that the psychosomatic preparation of mothers is more important and agrees that it is absolutely necessary to relief hard-to-stand labour pains lived by some as suffering, however he disagrees with the application of EDA as full analgesia in labour. He argues that one should not interfere in biological processes, developed by nature in the course of a very long evolution of human life, using particularly far-reaching and invasive methods. He points out that labour pains are important elements of a defence mechanism warning the body of imminent dangers and that the experience of pain at labour is most likely to initiate psychological reflexes that certainly contribute to the development of a healthy motherly pride and motherly identity and of a closer, long-term emotional attachment between mother and baby. Besides, EDA does not at all fit in the practice of natural labour recently reviving worldwide. At the same time, the author acknowledges that a controlled use of EDA can be justified in cases when the mother insists on having it, or, when it is recommended by her doctor, providing, however that the mother is correctly informed in either case. The author mentions the medical and legal difficulties involved in the application of EDA and underlines the necessity of correct information including its risks and negative effects also raised in his paper.
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PMID:[Thoughts about the efforts for the elimination of labour pain and the application of epidural analgesia in obstetrics]. 1686 60

Women undergo physiological and psychological changes during pregnancy, labor and lactation. The psychological adaptations can be affective, cognitive and behavioral and can be measured by dimensional personality instruments. This study aims to compare (1) the personality profile in mothers after birth with a normative group of non-lactating women and to examine (2) whether the personality profile differs 2 days, 2 months and 6 months after birth between mothers who have been exposed to epidural anesthesia, oxytocin administration or neither. Sixty-nine primiparae were assigned to four groups: mothers having received oxytocin infusion during labor (OT iv group, n = 9), mothers having received epidural analgesia with/without oxytocin infusion (EDA group, n = 23), mothers having received 10 iU oxytocin intramuscularly after birth (OT im group, n = 15) and mothers having received none of these treatments (unmedicated group, n = 22). At 2 days and 2 and 6 months postpartum mothers completed the Karolinska Scales of Personality (KSP). The unmedicated, the OT iv- and OT im groups scored significantly lower on anxiety and aggression related scales and higher on the socialization subscale during the entire observation period when compared with a normative group. These differences were not observed in the EDA group 2 days postpartum. At 2 and 6 months postpartum, the scores of the EDA group had changed significantly and were almost similar to the KSP scores of the other groups. ANCOVA analysis revealed that OT infusion, over and above the effects of EDA, was associated with decreased levels of several anxiety and aggression subscales. We conclude that women who received exogenous oxytocin during labor show similar positive personality traits during breastfeeding such as reduction in anxiety and aggression and increasing socialization, including maternal behavior, that have previously been ascribed to endogenous oxytocin. More importantly, these effects were not seen at 2 days postpartum in women who received epidural anesthesia during labor.
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PMID:Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: a comparative study. 1872 43

In this report, we describe a patient who developed severe headache following epidural analgesia for labor and delivery. Although the epidural puncture had been reported to be uneventful, headache was initially suspected to result from an accidental dural puncture. After the headache worsened, a sinus venous thrombosis was suspected and subsequently confirmed by magnetic resonance imaging. This case highlights the difficulty of differential diagnosis of headache in the postnatal period in patients after EDA and stresses the necessity of considering alternative pathologies.
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PMID:Sinus venous thrombosis: a differential diagnosis of postpartum headache. 2177 86

Due to intrathecal application, CSE combines rapid response with adequate analgesia with the possibility of providing unlimited neuraxial obstetrical pain relief via the indwelling epidural catheter. The superiority of CSE over EDA lies above all in its rapid action, excellent analgesia, lack of motor blockade after a single intrathecal opioid administration, lower rate of unilateral blockages and less need for subsequent epidural injections. The most common side effect is pruritus, which is harmless and usually does not require any therapeutic intervention. Even if no effect on rate of C-sections and APGAR values have been observed, the increased rate of fetal bradycardia after CSE must be kept in mind. A reduction of these fetal bradycardias and after intrathecal administration, prolongation of analgesia by means of appropriate drug combinations or additives should be the subject of future research.
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PMID:??? 2830 85