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)

The study was designed to compare five opioid analgesic regimens administered after cesarean delivery in a routine hospital setting with respect to patients' perceptions of their pain relief and the impact of analgesic technique on recovery and hospital costs. After cesarean delivery, 684 patients received one of the following: epidural morphine, alone (EM,n = 128), or with fentanyl (EM + F,n = 245); subarachnoid morphine (n = 48); intramuscular meperidine (n = 165), or patient-controlled analgesia using meperidine (PCA, n = 98). On the first three postoperative days (Days 1-3; day of operation is Day 1) patients were surveyed regarding their impressions of their analgesia, the incidence of side effects, times to resume normal activities and satisfaction with their technique. Information regarding drug interventions and costs was obtained from anesthetic records and nursing charts. Patients receiving intramuscular and PCA opioids reported significantly more severe pain during the first 16 hours than those receiving intraspinal opioids (p less than 0.05); differences were minimal for the remainder of Day 1. Among the intraspinal groups, analgesia was best overall with EM; specifically, fentanyl did not decrease early postoperative pain. Analgesia with PCA and intramuscular opioids was similar during the first 16 hours; however, PCA patients felt they had less pain thereafter. Side effects were common in all intraspinal groups and were least frequent with PCA (p less than 0.05 versus all intraspinal groups). Times to sit, walk and drink were similar in all patients except those receiving intramuscular opioids after general anesthesia, who experienced a several-hour delay. Other aspects of recovery did not differ among the groups. Satisfaction parallelled pain relief and was better with intraspinal than with systemic opioids. Costs were greatest with PCA, although differences were small (less than 1%) relative to total hospital charges.
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PMID:Analgesia after cesarean delivery: patient evaluations and costs of five opioid techniques. 188 71

In a randomized double-blind study of thirty grossly obese patients undergoing gastroplasty for weight reduction, the effects of intramuscular and epidural morphine were compared as regards analgesia, ambulation, gastrointestinal motility, early and late pulmonary function, duration of hospitalization, and occurrence of deep vein thrombosis in the postoperative period. The patients were operated on under thoracic epidural block combined with light endotracheal anesthesia. A six-grade scale was devised to quantify postoperative mobilization. A radioactive isotope method using 99mTc -plasmin was employed to detect postoperative deep vein thrombosis. For 14 hr after the first analgesic injection, respiratory frequency was noted every 15 min and arterial blood gases were measured hourly. Peak expiratory flow was recorded daily until the patient was discharged from hospital. Spirometry was performed the day before and the day after surgery. Plasma concentrations of morphine were measured after both intramuscular and epidural administration. Both intramuscular and epidural morphine gave effective analgesia, but the average dose of intramuscular morphine was up to seven times greater than that required by the epidural route. A larger number of patients receiving epidural morphine postoperatively were able to sit, stand, or walk unassisted within 6, 12, and 24 hr, respectively. Being alert and more mobile as a result of superior postoperative analgesia from epidural morphine, patients in this group benefited more from vigorous physiotherapy routine, which resulted in fewer pulmonary complications. Furthermore, earlier postoperative recovery of peak expiratory flow and bowel function presumably contributed to a significantly shorter hospitalization in patients receiving epidural morphine. There was no evidence of prolonged respiratory depression in this high-risk category of patients. The 99mTc -plasmin tests revealed no significant difference between the two groups.
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PMID:Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function. 623 17

Telemetry and conventional cardiotocography were compared by monitoring the labor of 60 patients with an uneventful pregnancy and delivery in the 38th-42nd week of pregnancy. 31 patients were monitored by telemetry and 29 by cardiotocography. The patients were matched for age (+/- 5 years), duration of pregnancy (+/- 7 days) and parity (I or II). The husband attended labor and delivery in 42% of the cases in the telemetry group and in 59% of the cases in the control group. Induction of labor by amniotomy was performed in 32% of the cases in the telemetry group and in 24% of the cases in the cardiotocography group. The patients monitored subjective pain every half hour during the opening phase. The telemetric patients were encouraged to sit or walk during the first stage. No maternal or fetal complications occurred. All infants were born in good condition with APGAR scores greater than or equal to 7 recorded at one and five minutes. There were 4 operative deliveries in the telemetry group and 5 in the control group. Indications for these were maternal or uterine exhaustion with the exception of two control patients where fetal asphyxia was suspected. The duration of the first stage of labor did not differ significantly between the telemetry and the cardiotocography groups. The telemetric patients received less analgesics than the controls but this difference was not significant. In spite of less analgesia in the telemetry group, the secondparas of the telemetry group experienced significantly less (p less than 0.01) labor pain than the controls. In addition, the secondparas of the telemetry group considered the present labor less painful than the previous one significantly more often than the controls. Among the primiparous patients there was no difference in the amount of pain experienced by the patients.
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PMID:The monitoring of labor by telemetry. 706 28

After gastrectomy, 103 patients were investigated concerning the effects of postoperative continuous epidural analgesia on the postoperative complications and early recovery. Sixty-seven patients who received epidural analgesia after the operation (group E) were able to sit on the bed, stand on the floor and walk themselves significantly earlier than 36 patients who were given analgesics intramuscularly or transrectally (group C). The incidence of postoperative complications was significantly less in the patients of group E than those of group C. These results show that postoperative continuous epidural analgesia decreases the incidence of postoperative complication and supports the early recovery from the operation.
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PMID:[The effects of postoperative continuous epidural analgesia on the early recovery from gastrectomy]. 816 17

This study was conducted to evaluate the effects of continuous epidural analgesia (CEA) on the incidence of postoperative complications and the early recovery after lower abdominal surgery. A total of 109 patients who had received elective lower abdominal surgery were investigated retrospectively by separating them into two groups. Compared to 35 patients who had received standard analgesic techniques without epidural analgesia, 74 patients who had been administered CEA with buprenorphine, mepivacaine and droperidol for 24 hrs after surgery could sit on the bed significantly earlier. But the patients with CEA could not stand on the floor and could not walk significantly earlier than the patients without CEA. The overall postoperative complication rate was not significantly different between the patients with and without CEA. These results show that postoperative CEA exerts a beneficial effects on the early recovery after the lower abdominal surgery, but the effect is not so strong as in upper abdominal surgery group. The results also suggest that CEA does not decrease the incidence of postoperative complications.
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PMID:[The effects of postoperative continuous epidural analgesia on the early recovery from lower abdominal surgery]. 818 21

Patients who undergo percutaneous transluminal coronary angioplasty (PTCA) by the femoral approach are usually required to lie flat in bed for 6 to 24 hours, which may result in significant discomfort. This study was performed to evaluate the safety and benefit of a flexible sheath that enables patients to sit at a 60-degree angle while the sheath is in place in the femoral artery. Sixty patients were randomly assigned to receive either flexible or nonflexible sheaths before PTCA. Patients with flexible sheaths were allowed to sit at an angle of 60 degrees after the procedure. Heparin management was the same in both groups. Frequency of calls to nurses for back pain was recorded for both groups. For analgesia, nalbuphine was administered in 2-mg increments. All sheaths were removed the day after the procedure. Femoral ultrasound was used to detect groin complications (hematoma, pseudoaneurysm, or arteriovenous fistula) and was performed in all patients. Baseline characteristics were similar in both groups. There were no differences in ease of sheath insertion or guide catheter movement through the sheaths. The arterial pressure waveform was not dampened in any of the flexible sheath patients while in the sitting position. Patients with flexible sheaths had fewer calls for back pain and required less nalbuphine than patients with nonflexible sheaths. Groin complications were similar in both groups. In conclusion, by allowing patients to sit up to an angle of 60 degrees, flexible sheaths have a beneficial effect in reducing back pain and the need for analgesics after PTCA.
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PMID:Randomized comparison of flexible versus nonflexible femoral sheaths on patient comfort after angioplasty. 864 84

We evaluated the use of Kocher's original method (without humeral traction) for reduction of acute anterior glenohumeral dislocation in 28 alpine skiers and snowboarders at a single ski area during the 1995-1996 ski season. In all cases, reduction was begun within 1 hour of the acute injury. The Kocher method alone was successful in 23 (82%) patients. Of the patients having a successful reduction by means of the original Kocher technique, the mean reduction time was less than 5 minutes, and 9 (39%) of the reductions were achieved in less than 1 minute. Only 1 patient experienced discomfort significant enough to require analgesia, and no patients required sedation. The complication rate was minimal, with 1 patient developing hyperesthesia in the axillary nerve distribution; no fractures of the humerus or glenoid resulted from the reduction technique.
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PMID:Reduction of skiing-related anterior shoulder dislocation using Kocher's method without traction. 1104 67

We report anesthetic management for a child undergoing Nuss operation, a minimally invasive operation which requires neither cartilage incision nor its resection for correction of pectus excavatum. The patient was a 7-year-old boy with the funnel index 5 and the mediastinal shift to the left. General anesthesia with endotracheal intubation was induced and maintained with nitrous oxide, sevoflurane and fentanyl. Thoracic epidural anesthesia was used with 0.125% bupivacaine to supplement analgesia. When the curved bar was passed under the sternum with the aid of an endoscope, sinus tachycardia occurred and continued for 5 minutes but subsided without medication. Otherwise operative course was uneventful with negligible blood loss. After surgery, the patient was kept at bed rest for 2 days, receiving epidural patient-controlled analgesia combined with sedation with midazolam with good results. He was allowed to sit 3 days, to walk 5 days and discharged 10 days postoperatively.
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PMID:[Anesthetic management for the correction of pectus excavatum using pectus bar under video-assistance]. 1124 73

Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4-24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4-24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.
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PMID:Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. 1538 71

Epidural analgesia in labour is commonly associated with some degree of lower limb weakness often severe enough to be described as paralysis by the mother. We aimed to produce rapid reliable analgesia with no motor block throughout labour. We report a pilot survey of 300 consecutive women requesting regional analgesia in labour who received a combined spinal epidural blockade (CSE). The initial dose was given into the subarachnoid space and analgesia maintained via an epidural catheter. A subarachnoid injection of 2.5 mg bupivacaine and 25 mug fentanyl was successfully given in 268 women (89.3%). Completely pain-free contractions within 3 min of this injection occurred in 195 women (65%) and in all 300 within 20 min and there was no associated motor block in 291 (97%). 141 women chose to stand, walk or sit in a rocking chair at some time during labour. Only 38 women (12.6%) were immobile during the first stage of labour. Analgesia was maintained via the epidural catheter with bolus doses of 10-15 ml of 0.1% bupivacaine and 0.0002% fentanyl. The mean bupivacaine requirement was 9.5 mg/h throughout the entire duration of analgesia. The incidence of post lumbar puncture headache was 2.3%. Transient hypotension occurred in 24 women (8%) and was treated with 6 mg intravenous boluses of ephedrine. Complete satisfaction with analgesia and mobility was reported 12-24 h post partum by 95% of mothers. The use of this analgesic technique caused no alteration in obstetric management or post partum care of the women.
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PMID:Combined spinal epidural (CSE) analgesia: technique, management, and outcome of 300 mothers. 1563 80


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