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

In a prospective open study we tested the Edmonton injector (EI), a device designed by our group for subcutaneous injection of narcotics. In 25 patients, the EI was used for patient-controlled analgesia (PCA); mean duration of treatment was 28 +/- 10 days. Mean equivalent daily dose of morphine was 160 +/- 85 mg. All patients found the EI safe and simple to operate. The main reason for discontinuation was death (10 cases) or return to oral narcotics (8 cases). In 20 patients who were admitted to the hospital and were too ill to learn PCA, the EI was used for regular s.c. administration by nurses. Narcotics were administered every 4 h and extra doses were administered on a 'PRN' basis. Waiting time for a 'PRN' dose in 8 patients before starting the EI was 18 +/- 7 min; after the EI was started, it was 3 +/- 4 min (P less than 0.01). We conclude that the EI is safe, effective and inexpensive, and that it will be particularly useful in smaller hospitals and developing countries.
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PMID:The Edmonton injector: a simple device for patient-controlled subcutaneous analgesia. 205 83

Management of postoperative pain has been shown to be inadequately controlled, and, in fact, can have significant deleterious effects on a patient's early postoperative recovery. Continuous epidural analgesia has recently been used to control postoperative pain. This mode of analgesia controls postoperative pain without the delays inherent in the PRN administration of systemic narcotics. This was a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 53 thoracic and 81 abdominal surgery patients. The focus of the study was to identify the benefits and problems of continuous epidural analgesia for postoperative pain management and the implications for the nursing care of the patients. Evaluation of the effectiveness of the analgesia was based on the following measures: (1) pain measured at regular intervals in the 72-hour period with a visual analog; (2) pain as measured after 72 hours with the word descriptor section of the McGill Pain Questionnaire; (3) amount of supplemental systemic narcotic analgesic needed; (4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; (5) occurrence of adverse effects; and (6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used (PRN) systemic administration of narcotics. With the exception of the report of back pain by patients receiving the normal saline epidural solution, complications did not occur in a significantly greater proportion when using the epidural route. Although some nursing care problems were identified, patients who received epidural analgesia were able to be cared for on general care units with no adverse effects reported.
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PMID:Efficacy of continuous epidural analgesia and the implications for patient care in the early postoperative phase. 228 19

A clinical study examining the efficacy of Patient Controlled Analgesia compared with Intramuscular Analgesia was conducted. Patient Controlled Analgesia (PCA) Therapy was used in a select group of patients after major abdominal surgery. Specific parameters monitored were: total amount of analgesia required, incidence of pulmonary complications, assessment of pain level and sedation, patient activity, nursing time required for administration, safety, cost-effectiveness of both modes of analgesia and length of hospital stay. A questionnaire survey of both patients and nursing staff was done to evaluate responses. Conventional pain management often is inadequate with PRN administration of analgesic drugs due to the unpredictable and uneven patient absorption rate and the individual pain intensity and tolerance. The patient experiences a repetitive cycle of pain and sedation. The patient on PCA therapy is able to titrate his analgesic medication very effectively and maintain a state of analgesia without sedation. He is more responsive and able to participate in the early postoperative rehabilitation phase. The transition to oral medication usually was accomplished at 48 hours postoperative.
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PMID:A study of pain management: patient controlled analgesia versus intramuscular analgesia. 292 58

Postoperative pain remains undertreated. Barriers to adequate postoperative analgesia include lack of knowledge regarding pain and its management, inadequate assessment, preconceived notions by nurses and physicians regarding pain and addiction, and the continued use of PRN administration of medications instead of active intervention on a scheduled basis. Knowledge regarding the physiology of pain provides nurses with information necessary to control pain. Pharmacologic management includes the use of nonopioids, opioids, and various adjuvant drugs. Principles regarding the use of these analgesics guide the nurse to use these drugs to their greatest effect. The special needs of the very young and the elderly must also be considered.
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PMID:Pharmacologic management of acute pain in the orthopaedic patient. 787 Apr 75

The report of the joint working party of the Royal College of Surgeons of England, Pain after Surgery, raised many questions in relation to the way pain is managed after surgery. This report questioned many of the existing practices of pain control and highlighted the need for the development of regular pain assessment. The report raised questions regarding PRN (pro-re nata, as needed) prescribing and reinforced the importance of the role of the nurse. This study reviews the way pain is managed in this hospital with regard to analgesia prescribing and analgesia administration trends as well as the documentation of pain. The study was conducted by retrospective review of randomly selected patient charts. The results of this study conclude that documentation of pain following surgery is poor, and needs improvement. Existing prescription trends, in particular PRN prescribing, may be hindering both good practice and the pre-emptive administration of analgesia.
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PMID:A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery. 929 69

Painful experiences, such as circumcision without the benefit of anesthesia, during the neonatal period may induce lifelong behavior changes in infants and children. By inference, this is probably true for other painful experiences encountered during childhood. It is much easier to prevent the establishment of pain than it is to eradicate it once it has become firmly established. As "captain of the ship," there are three very basic things a pediatric surgeon can do to reduce postoperative discomfort in your young patients. First, whenever possible, allow caudal blocks or other forms of regional anesthesia, such as penile or ilioinguinal-iliohypogastric nerve blocks, to be performed on your patients. Second, always use timed analgesics and avoid PRN orders. Last, know how to use two analgesics well, one narcotic and one non-narcotic. Be completely familiar with their uptake, distribution, and elimination half-lives. This article presents a review of the efficacy and safety of caudal blocks, and the use of ilioinguinal/iliohypogastric, "splash," and penile blocks as alternative techniques for providing perineal analgesia. In addition, the most current and efficacious dosage regimen for the rectal administration of acetaminophen (40.0 mg/kg after induction of anesthesia, then 20.0 mg/kg every 6 hours for the first 24 postoperative hours) is presented. Additionally, the novel use of intravenous methadone (0.2 to 0.3 mg/kg) to provide intense and protracted narcotic analgesia is discussed.
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PMID:Blocks and other techniques pediatric surgeons can employ to reduce postoperative pain in pediatric patients. 1006 67

The purpose of this study was to analyze the efficacy of femoral nerve blocks (FNBs) in decreasing postoperative narcotic use in adolescents undergoing patellar realignment surgery (PRS). All patients who underwent PRS at 2 children's hospitals between 1998 and 2002 were included in the study. Patients were grouped according to postoperative analgesia: FNB (n = 14), as-needed intravenous morphine (PRN-IV; n = 16), or patient-controlled analgesia using morphine (PCA; n = 13). Total postoperative i.v. morphine use was statistically significantly different among the 3 groups: 9.0 mg for FNB, 26.43 mg for PRN-IV, and 64.7 mg for PCA. FNB use was effective in significantly decreasing postoperative i.v. narcotic use.
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PMID:Use of femoral nerve blocks in adolescents undergoing patellar realignment surgery. 1830 83

This report describes a noninterventional audit of current patient-controlled analgesia (PCA) use in an Indian cancer hospital over a 1-year period. Because there appeared to be an underutilization of PCA in the authors' hospital, they performed this audit. A major reason to start PCA was inadequate analgesia despite ongoing epidural or standard PRN analgesic regimes, especially in thoracic, major abdominal, and pelvic bone surgeries. PCA was used for an average 52.13 hours. The reason to stop the PCA in 72 patients was minimal usage due to decreased need after the second postoperative day. Multiple triggers at the same time were a common problem encountered in 21 patients. A blocked intravenous (IV) line was encountered in 12 patients. Thirty-one patients ranked their pain relief with PCA as excellent and 39 patients stated it as good. Their protocols shall be suitably amended to ensure that PCA shall be used in immediate postoperative period as a principal modality of pain relief, especially in the above-mentioned group in absence of epidural analgesia.
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PMID:Patient controlled analgesia: redefining its role in an Indian cancer hospital. 2071 41

Methylnaltrexone is a methylated form of the mu-opioid antagonist naltrexone that blocks peripheral effects of opioids without affecting centrally mediated analgesia. The authors conducted a 3-month open-label extension trial of methylnaltrexone in patients with advanced illness and opioid-induced constipation (OIC). Following completion of a 2-week double-blind (DB) trial, 82 patients with OIC who did not respond to laxatives received subcutaneous (SC) methylnaltrexone as needed for up to 3 months. Patients received 0.15 mg/kg as a first dose, adjusted to 0.3 mg/kg or 0.075 mg/kg as needed (maximum of one dose per 24 hours). Mean laxation response (rescue-free bowel movement within 4 hours) rates (DB phase, months 1, 2, 3 open-label phase) were 45.3%, 45.5%, 57.7%, and 57.3%, respectively, for patients treated with DB methylnaltrexone and 10.8%, 48.3%, 47.6%, and 52.1%, respectively, for patients treated with DB placebo. Median time to laxation among responders was 45 minutes (range 0-4 hours) for all doses. Approximately 50% of patients reported improvement in constipation distress. Patient and investigator global clinical impression of change scores also improved. There were minimal changes in pain scores and opioid withdrawal symptoms. Adverse events included abdominal pain and nausea, mostly mild or moderate in severity. SC methylnaltrexone administered PRN (as needed) for up to 3 months continued to rapidly induce laxation in advanced illness patients with OIC.
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PMID:Methylnaltrexone for opioid-induced constipation in patients with advanced illness: a 3-month open-label treatment extension study. 2165 61

As-needed (PRN) oral pain medication is an essential part of multimodal pain therapy. Medication delivery is often delayed because of multiple demands upon nursing time in a busy postoperative nursing unit. Postoperative pain control was compared using either the manual delivery of PRN oral pain medication or a bedside oral patient-controlled analgesia device. Thirty patients in each group completed a survey on the day of discharge, and additional data were collected by chart reviews. Device patients had significantly better pain scores than the usual care group on postoperative Day 2 and within the last 24 hours prior to discharge. The device group reported statistically less pain interference overall with general activity, mood, physical therapy, sleep, and appetite. Use of an oral patient-controlled analgesia device may improve pain management and patient function following total knee arthroplasty compared to the traditional delivery of oral PRN pain medication.
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PMID:The traditional method of oral as-needed pain medication delivery compared to an oral patient-controlled analgesia device following total knee arthroplasty. 2505 27


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