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

Aggressive pursuit of high-quality health care had guided the Health Service of the United States Army to establish a labor analgesia program within its hospitals. A dedicated Labor Epidural Service can be quite expensive, especially from the manpower standpoint. Therefore, the Anesthesia Service at Reynolds Army Community Hospital, Fort Sill, Oklahoma, implemented a program of intrathecal narcotic injection as an alternative to costly labor epidural analgesia. After reviewing a patient fact sheet, 150 laboring patients volunteered for labor intrathecal analgesia (LIA). Once active labor began, the patient received intrathecal morphine (0.25 mg) and fentanyl (25 micrograms). The pain level before and after the LIA was evaluated by the visual analog schedule method. At 2 weeks follow-up the intrathecal narcotic-assisted labor was subjectively reported by the patients. Ninety-four percent of the patients agreed that the LIA worked well and that they would do it again. LIA was found to be a well-accepted, cost-saving, very effective approach to labor analgesia.
Mil Med 1995 May
PMID:Comfortable labor with intrathecal narcotics. 765 7

Pain relief is an essential component of combat casualty care. For the injured soldier, analgesia is not only a matter of comfort. Alleviating pain may allow the soldier to remain quiet when noise discipline is at a premium. It may also allow that person to continue to move, thus avoiding detection and potentially permitting the mission to carry on. Regional anesthetics provide an alternative to systemic medications and thus may avoid a clouded sensorium, limit narcotic administration, and provide superior pain relief. Standard local anesthetics and newer agents with potential field applicability are discussed along with their side effect profiles. Simple nerve block techniques that can be used by Army Special Forces medics, Navy SEAL and Reconnaissance corpsmen, and Air Force pararescuemen in the far forward environment are described step by step. The advantages of these regional anesthetic methods should make their use a must for every special operations medical care provider.
Mil Med 2001 Mar
PMID:Pain management in the special operations environment: regional anesthetics. 1126 21

Surgical procedures to the distal humerus, elbow, and proximal forearm are ideally suited to regional anesthetic techniques. Selection of the preferred approach is determined by the innervation of the surgical site, the risks of regional anesthesia-related complications, and the preference and experience of the anesthesiologist. The axillary approach to the brachial plexus is the most commonly used because of its ease of performance, patient acceptance, safety, and reliability, particularly for hand and forearm surgery. Nerve location technique does not affect success rate with the supraclavicular and interscalene approaches but it does with axillary approaches. The purpose of this study was to evaluate three techniques of plexus identification in axillary blockade. Sixty-nine American Society of Anesthesiologists grade I to II patients who had undergone orthopedic or traumatological surgical procedures on the upper extremity during a period of 1 year were chosen. After premedication, patients were divided randomly into three groups according to the technique of plexus identification. Group A (n = 23) consisted of those treated with the Winnie technique; group B (n = 23) consisted of those treated with the transarterial technique; group C (n = 23) consisted of those treated with the combination technique. Axillary blockade performed using the combined technique had higher a success rate than blockade performed with the transarterial and Winnie techniques. Our results suggest that all three techniques are reliable for axillary blockade. But the onset, complete blockade time, and quality of analgesia were better with the combined technique than with the transarterial and Winnie techniques.
Mil Med 2002 Sep
PMID:Axillary brachial plexus blockade: an evaluation of three techniques. 1236 61

Total rectal prolapse is a disabling disease. The aim of this study was to evaluate pain management, hospital stays, constipation, and continence status among military personnel who underwent laparoscopic surgery. Forty patients (mostly men) underwent laparoscopic rectopexy (LR) or laparoscopic resection rectopexy (LRR). Colonic transit time, postoperative pain scores, preoperative and postoperative anal function, and changes in constipation were assessed. The median operation times for LR and LRR were 126 and 223 minutes, respectively. The median postoperative hospital stays were 3 and approximately 6 days for LR and LRR, respectively. Patients needed fewer analgesics in a short postoperative period. However, there was no difference between the two groups in analgesic requirements. Continence improved for approximately 71% of patients, but constipation was treated for 50% of affected patients. No recurrences were noted in the follow-up periods, which were 13 and 22 months for the LRR and LR groups, respectively. The quality of life for the patients who underwent LR was not as good as that for the patients who underwent LRR, at the end of 1 year. We eliminated total rectal prolapse and almost cured incontinence by using laparoscopy, although the disadvantageous aspects were long operation times and suboptimal healing with respect to constipation and related symptoms. LRR is the more feasible procedure, with the emphasis on elimination of incontinence and constipation, producing a better quality of life for patients, in addition to short hospitalizations, necessity for analgesia for a short time, and return to hard training field activities in a short time among military personnel.
Mil Med 2005 Sep
PMID:The impact of laparoscopic resection rectopexy in patients with total rectal prolapse. 1626 77

Military health care providers located in field environments frequently face situations in which procedural sedation and analgesia are necessary, without the advantage of sophisticated monitoring equipment. Ketamine is a unique agent that can be administered either intravenously or intramuscularly to produce predictable and profound analgesia, with an exceptional safety profile. We review the issues unique to ketamine and provide a practical guide for the use of ketamine for adult and pediatric patients in a field environment.
Mil Med 2006 Jun
PMID:Ketamine for procedural sedation and analgesia by nonanesthesiologists in the field: a review for military health care providers. 1680 25

We present a 20-year-old previously healthy male who suffered a gunshot wound to the abdomen and underwent multiple surgeries because of abdominal abscess and fistula formation. Pain control was difficult to achieve despite high-dose opioid therapy. Post-traumatic stress disorder was a confounding factor in treating this patient's pain. Ten months after the original injury, the patient returned to the operating room for an exploratory laparotomy with restoration of bowel continuity and abdominal wall closure. The patient presented to the intensive care unit after a 12-hour operation with an open abdomen and the requirement of mechanical ventilation, sedation, and analgesia. Sedation and analgesia were difficult to achieve and maintain with combinations of extremely high doses of midazolam, lorazepam, propofol, and fentanyl (motor assessment activity scale [MAAS] scores of 5), but profoundly achievable with dexmedetomidine. Dexmedetomidine also improved the patient's mental stability, which resulted in improved patient care through compliance with physicians, nurses, and physical therapists.
Mil Med 2009 Nov
PMID:Profound reduction in sedation and analgesic requirements using extended dexmedetomidine infusions in a patient with an open abdomen. 1996 Aug 34

Spontaneous pneumomediastinum (SPM) with associated subcutaneous emphysema is an uncommon and generally benign condition. We describe an occurrence of SPM that occurred from yelling in a U.S. Marine Corps Drill Instructor. The patient describes yelling at Marine recruits the day prior when he felt a pop "behind his nose." Upon arrival to the Emergency Department, the patient was normotensive, afebrile, and maintaining an oxygen saturation of 100% on room air. Chest films demonstrated pneumomediastinum and subcutaneous emphysema. A computed tomography scan of the head, neck, and chest showed pneumomediastinum and air tracking along the trachea, great vessels, and esophagus with subcutaneous emphysema and without pneumothorax or esophageal injury. The patient was admitted to internal medicine and discharged after 24 hours of observation with improved pain and decreased subcutaneous air. Pneumomediastinum is commonly associated with blunt and penetrating trauma, infection, and esophageal rupture. Life-threatening complications include tension pneumomediastinum/pneumothorax and rupture of intrathoracic viscus. Treatment includes rest, oxygen therapy, and analgesia. SPM has never been described as a result of a yelling, and persistent yelling is common for a drill instructor. SPM can present in primary care and operational settings, and recognition and prompt treatment is crucial for these patients.
Mil Med 2012 Nov
PMID:Ooh-rah! An unusual cause of spontaneous pneumomediastinum. 2319 20

The use of explosive armaments during Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn has resulted in a significant number of injured U.S. service members. These weapons often generate substantial extremity trauma requiring multiple surgical procedures to preserve life, limb, and restore function. For those individuals who require multiple surgeries, the use of patient-controlled analgesia (PCA) devices can be an effective way to achieve adequate pain management and promote successful rehabilitation and recovery during inpatient treatment. A subpopulation of patients are unable to independently control a PCA device because of severe multiple limb dysfunction and/or loss. In response to the needs of these patients, our team designed and developed a custom adaptor to assist service members who would otherwise not be able to use a PCA. Patient feedback of the device indicated a positive response, improved independence, and overall satisfaction during inpatient hospitalization.
Mil Med 2016 08
PMID:A Patient-Controlled Analgesia Adaptor to Mitigate Postsurgical Pain for Combat Casualties With Multiple Limb Amputation: A Case Series. 2748 40

Prehospital analgesia is vital to good clinical care and inhaled methoxyflurane (Penthrox) would be a valuable addition to the armed forces medical armoury. Penthrox would provide strong, fast-acting, self-administered and safe analgesia to patients with moderate to severe injuries. In addition, it would provide an option for strong analgesia which would not be subject to the regulations that govern controlled or accountable drugs which gives it a unique position as the military moves its focus from large enduring operations to small short-term training teams supported by lone combat medics in remote locations across the globe.
BMJ Mil Health 2020 Aug
PMID:Penthrox: a breath of PHEC air for the military? 3072 71

Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy-percutaneous peripheral nerve stimulation (PNS) - and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.
Mil Med 2019 03 01
PMID:Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma. 3090 95


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