Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five different patient-controlled analgesia (PCA) delivery systems were evaluated for the treatment of acute postoperative pain in 423 patients undergoing elective operations at a large tertiary care hospital. The PCA trial was conducted on four different postsurgical wards over a 5-mo period. All five devices were utilized on each ward for a 1-mo period. According to the nurses, the mean time (+/- SD) required to become comfortable using the Pharmacia Deltec CADD-PCA was significantly longer (50 +/- 37 min) than that using the Abbott Lifecare Plus (19 +/- 17 min), Bard PCA I (17 +/- 14 min), IVAC PCA (17 +/- 14 min), or Baxter PCA Infusor (7 +/- 8 min). With respect to ease of documentation by the nursing staff, the Baxter device was superior to the Pharmacia device. Similarly, mechanical problems were less frequent with the Baxter (6%) compared with the Pharmacia device (71%). The patients felt that the nurses were more comfortable using the Baxter device than the Pharmacia device. The patients also found the Baxter device easier to use, especially at night, and the least likely to interfere with ambulation. In conclusion, 80% of the nurses at this teaching center preferred the Baxter PCA Infusor over four widely used electronic PCA devices for the management of acute postoperative pain. The Pharmacia device was felt by the nurses to be less user friendly than the other programmable PCA devices used in this trial. Of the electronic devices we studied, the Bard and IVAC devices were the most cost-effective.
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PMID:Patient and nurse evaluation of patient-controlled analgesia delivery systems for postoperative pain management. 128 6

Intravenous patient-controlled analgesia (PCA) with pethidine (standard technique of self-administration of pethidine) for the treatment of postoperative pain in 10 patients who had undergone abdominal surgery was evaluated. Serum pethidine concentration also was measured in order to evaluate the suitability of dose of pethidine. After an operation, intravenous PCA pump (CADD-PCA, Model 5200 PXC, Pharma Deltec) was attached to intravenous line with a basal infusion rate of 50 mg.12 h-1 of pethidine, and set to administer pethidine 5 mg intravenously by rapid bolus no more frequently than once every 20 min until 72 hours postoperatively. Verbal descriptor score, doses of pethidine, serum level of pethidine and side effect were evaluated each 12 hour period until 72 postoperative hours. Pain scores within 36 postoperative hours were comparable and stable analgesia was obtained throughout 72 postoperative hours. In only two cases out of 9 pain score improved according to the elevation of serum pethidine concentration. We conclude PCA with pethidine is effective for postoperative pain in patients after upper abdominal surgery, but administered doses in this study is not enough to achieve complete relief of postoperative pain in view of the serum level of pethidine.
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PMID:[Intravenous patient-controlled analgesia with pethidine for the treatment of postoperative pain in patients undergoing upper abdominal surgery]. 154 8

Pain control using intramuscular analgesia is often unsatisfactory in sickle cell patients. In a pilot study, 15 patients with sickle cell anemia (SS) and one patient with SB thalassemia in vaso-occlusive crisis were treated with the Patient-Controlled Analgesia (PCA) technique using a Pharmacia Deltec Programmable pump (CADD PCA). Age range was 19-50 years (median = 27); there were nine females and seven males. The protocol consisted of 3 days of therapy using a background of continuous infusion meperidine. The starting dose was 20 mg/hr and was escalated to 30 mg/hr. The average amount given was 25.8 mg/hr. One to two boluses of 2.5-5.0 mg/dose (mode = 5.0) were also allowed each hour. In addition, patients number 8 through 16 were given hydroxyzine (Vistaril) 50 mg PO q6h. The number of days in pain prior to study entry (mean +/- SD) was 3.3 +/- 1.6. The number of pain sites per patient was 3.6 +/- 1.2. Using categorical and analog pain scales, patients' pain scores decreased only about 30%. However, most patients were fairly satisfied with the treatment and rated it overall as follows: 1 poor, 1 fair, 3 good, 6 very good, 4 excellent, 1 no comment. Patients number 8 through 16 gave higher ratings probably because a more idealized dosage regimen was being used by that time in the study. There were no adverse effects or major problems noted. It is our impression that PCA, when optimized, will be a safe and effective alternative method for providing patients with sickle cell vaso-occlusive crisis pain relief.
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PMID:Patient-controlled analgesia in patients with sickle cell vaso-occlusive crisis. 229 91

Plasma catecholamine levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in sixteen patients who underwent gastrectomy. Eight patients (epidural morphine group) obtained postoperative analgesia with continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia). A bolus of morphine was administered through an indwelling thoracic (Th8 X 9) epidural catheter 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042mg.hr-1 by the pump during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) received repeatedly intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma epinephrine levels increased significantly at the end of surgery in both groups, and were higher in the systemic analgesics group than those in the epidural morphine group. In the epidural morphine group, the catecholamine levels decreased to the previous day's levels on the first postoperative day and afterward, but remained high during three postoperative days in the systemic analgesics group. Plasma norepinephrine levels increased significantly at the end of surgery and afterward in both groups. However, they were significantly higher in the systemic analgesics group than in the epidural morphine group. Plasma dopamine levels were unchanged in the epidural morphine group during the surgical procedures, but they increased significantly on the first postoperative day and thereafter in the systemic analgesics group. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and exerts a suppressing effect on plasma catecholamine levels as compared with systemic analgesics regimen.
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PMID:[Plasma catecholamine levels following continuous epidural infusion of morphine for postoperative analgesia in surgical patients]. 238 91

Plasma levels of cortisol, ACTH and beta-endorphin like immunoreactivity (beta-ELI) were measured to evaluate postoperative pain relief with epidural morphine and systemic analgesics in conjunction with endocrine functions in 16 patients who underwent gastrectomy. Eight of these patients (epidural morphine group) obtained postoperative analgesia with continuous epidural infusion of morphine with a pump as in our previous report. A bolus of epidural morphine was administered through an indwelling thoracic (Th8,9) catheter at 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042 mg.hr-1 with a pump (CADD-PCA, Model 5200P, Pharmacia) during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) repeatedly received systemic pentazocine and buprenorphine when needed. Plasma cortisol levels increased significantly at the end of surgery and after in both groups. However plasma concentrations of cortisol in the epidural morphine group were significantly lower than those in the systemic analgesics group on the first and second postoperative days. Plasma levels of ACTH and beta-ELI increased significantly at the end of surgery but returned to levels of the previous day in both groups postoperatively. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and has suppressing effect on plasma cortisol levels as compared with systemic analgesics regimen.
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PMID:[Effect of continuous epidural infusion of morphine for postoperative analgesia on pituitary-adrenocortical function]. 277 49

We evaluated plasma levels of morphine during its continuous epidural infusion for postoperative analgesia in nine adult patients. A bolus injection of 3 mg of morphine was administered epidurally 3 hours prior to the proposed end of the surgery, and thereafter continuous epidural infusion of morphine was continued at a rate of 0.167-0.042 mg.hr-1 with a pump (CADD-PCA, 5200P, Pharmacia) during and after the surgery until the 3rd postoperative day. The dose of morphine was gradually decreased to 0.021-0.042 mg.hr-1 without reducing the quality of postoperative analgesia. Plasma morphine levels were measured by gas chromatography-mass spectrometry method. Plasma concentrations of morphine were 4.6 +/- 0.7 (Mean +/- SE) ng.ml-1 at the end of surgery and they decreased thereafter to 0.7 +/- 0.1 ng.ml-1, 0.3 +/- 0.1 ng.ml-1 and 0.1 +/- 0.1 ng.ml-1 on the 1st, 2nd and 3rd postoperative days, respectively. Plasma levels of morphine decreased gradually correlating with reduction of infused morphine. Adequate postoperative pain relief was obtained throughout the procedure without any severe complications such as respiratory depression. The analgesic effect of epidural morphine did not parallel with that of plasma concentration. Plasma concentrations of morphine administered by continuous epidural infusion with a pump were estimated to be lower than the minimum analgesic plasma concentration (10-40 ng.ml-1), and the toxic levels of morphine during continuous epidural infusion were not detected by our method.
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PMID:[Plasma morphine levels during its continuous epidural infusion]. 281 Jul 13

Somatostatin 1-14, a natural occurring neuropeptide (Somiaton), has been reported to have analgesic effects in humans in different painful conditions. The aim of the present study was to investigate if epidural somatostatin produced clinical analgesia to postoperative pain after upper abdominal surgery. In a randomized double-blind controlled study, 40 patients received either 125 micrograms of epidural somatostatin infusions every hour (using a continuous infusion pump: CADD-PCA model 5200 PCX, Pharmacia) or placebo: mannitol (somatostatin inactif ingredient) 2.5 mg during the first 3 postoperative days (plus additional pulses of either substance, 250 micrograms or 5 mg, respectively, according to the level of analgesia needed by the patient). Additional subcutaneous analgesic treatment with 1 mg/kg pethidine chlorhydrate was administered at the patient's request. The degree of pain was quantified with visual analogue scale at baseline, 1 h after the operation and at every 4 h for the next 3 days. Arterial blood gases and spirometry values were determined at different intervals throughout the study period. Somatostatin was significantly better than placebo for pain relief (P < 0.01) and respiratory function preservation (P < 0.05). The total consumption (and ranges) of somatostatin at 24, 48 and 72 h were: 5.2 +/- 1.4 mg (4.0-6.25 mg), 4.2 +/- 0.8 mg (2.2-5.0 mg) and 3.7 +/- 0.4 mg (2.2-4.7 mg) respectively. During the whole study the need for complementary analgesia (pethidine chlorhydrate) was significantly higher in the placebo group: 5.4 +/- 3.5 vs. 2.7 +/- 1.9 (mean +/- SD) P < 0.01, dose/72 h. Side effects were irrelevant and scarce in both groups. The sustained pain relief combined with the respiratory function preservation in the somatostatin group suggests an important role of this drug in postoperative analgesia.
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PMID:Epidural somatostatin as an analgesic in upper abdominal surgery: a double-blind study. 865 41

In order to introduce intravenous patient-controlled analgesia (PCA) in children in the Department of Anaesthesiology and Intensive Care, Odense University Hospital, we evaluated the technique in 13 children following major orthopaedic or abdominal surgery. The pump (Pharmacia-Deltec, CADD-PCA) was loaded with 1 mg/ml morphine in a 50 milliliters cassette. A bolus dose of 25 micrograms/kg and a lock-out interval of eight minutes were the initial settings. The morphine dose used, pain scores and side effects were currently recorded. Ages ranged from 4-15 years (mean 10.5 years) and the method was used for a mean of 89 hours (range 57-144 hours) postoperatively. Morphine requirements averaged 9.5 microgram/kg/hour (range 5.4-15.6 microgram/kg/hour). Pain control was good and side effects were few and of minor nature. PCA is an effective and safe means of providing good quality analgesia in children.
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PMID:[Patient-controlled analgesia in children]. 844 16

We report the performance and our impression of five patient-controlled analgesia (PCA) drug delivery devices commercially available; Atom PCA Pump 500, AP-II, Deltec CADD-PCA 5800, Sabratek 6060 and Verifuse. Each of these devices has unique features for PCA. However, these devices still leave some room for improvement. Especially, we hope that future devices will be lighter to carry and use dry batteries more economically. In order to use these devices effectively for the management of pain, it is important to understand their characteristics.
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PMID:[Comparison of five patient-controlled analgesia drug delivery devices]. 1040 30