The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of patient-controlled analgesia and bolus PRN intravenous morphine in the intensive care environment.
We compared the use of patient-controlled analgesia (PCA) morphine and p.r.n. intravenous morphine in an intensive care unit setting. Thirty-eight patients scheduled for admission to the Surgical Intensive Care Unit (SICU) were prospectively randomized to either a PCA group or a p.r.n. intravenous morphine group. ⋯ PCA was found to be comparable in safety and efficacy to nurse-administered morphine in the intensive care environment. An unexpected finding was the higher initial morphine utilization seen in the patients utilizing PCA.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does the anesthetic technique influence the postoperative analgesic requirement?
In order to determine the effect of two standard general anesthetic techniques on the postoperative analgesic requirement, 53 adults undergoing elective intra-abdominal surgery were randomly assigned to one of two anesthetic treatment groups according to an open parallel protocol design. One of the groups received an opioid-based anesthetic; the other group was administered an inhaled anesthetic. The postoperative analgesic requirement was quantified using a Baxter PCA device. ⋯ During the first 8 hours after discharge from the recovery room there was a trend toward higher PCA morphine usage in the inhaled anesthetic group (25.6 +/- 15 mg vs. 18.6 +/- 13 mg); however, this difference was not statistically significant (p = 0.08). From 8 to 40 hours after surgery, the morphine usage was nonsignificantly higher in the opioid group (64 +/- 30 mg vs. 56 +/- 38 mg, p = 0.43). In conclusion, the general anesthetic technique used during an elective operation appeared to have little if any effect on the postoperative analgesic requirement after discharge from the recovery room.
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Randomized Controlled Trial Clinical Trial
Modulation of heat pain perception by high frequency transcutaneous electrical nerve stimulation (TENS).
Although many studies have indicated that high frequency nonpainful transcutaneous electrical nerve stimulation (TENS) reduces clinical pain, controlled studies of the modulation of experimental pain by TENS have produced conflicting results. This study evaluated the effect of high frequency nonpainful TENS on heat pain perception using a model that we have previously shown to be sensitive to other nonpharmacological analgesic treatments. We found that TENS significantly reduced subjects' ratings of painful and near painful heat stimuli (43-51 degrees C) (p = 0.01) and increased the pain threshold from 46.7 to 47.9 degrees C (p = 0.002). ⋯ Furthermore, TENS did not alter subjects' ratings of visual stimuli, indicating that the analgesic effect was not due to a nonspecific distraction. These data suggest that TENS alters the perception of experimentally produced natural pain stimuli. The TENS related modulation also appears to be comparable to that produced by other nonpharmacological analgesic manipulations such as counterirritation and changes in attention.
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Randomized Controlled Trial Comparative Study Clinical Trial
Subcutaneous-PCA: an alternative to IV-PCA for postoperative pain management.
Patients (n = 120) undergoing major orthopedic (e.g., total hip replacement), urologic (e.g., radical prostatectomy), or gynecologic (e.g., total abdominal hysterectomy) procedures were randomly assigned to receive either morphine or oxymorphone postoperatively using a patient-controlled analgesic (PCA) delivery system. The opioid analgesic was administered either intravenously (IV-PCA) or subcutaneously (SQ-PCA) during the 72-h study period. ⋯ Postoperative analgesia scores and patient satisfaction were similar in all four PCA treatment groups. Thus, SQ-PCA with either oxymorphone or morphine represents a clinically acceptable alternative to IV-PCA in the treatment of postoperative pain.
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Randomized Controlled Trial Clinical Trial
Effectiveness of alprazolam in the treatment of chronic pain: results of a preliminary study.
One hundred chronic pain patients were begun on alprazolam, 1.5 mg/day. No other medication changes or therapeutic interventions were made. ⋯ The average score of all patients had decreased from 3.6 to 2.2 on a verbal analog scale that rated pain severity from 0 to 5. There was no difference in response among the various diagnostic groups represented in the study population.