Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1995
Clinical Trial Controlled Clinical Trial[Efficacy of propacetamol in postoperative pain based on two modes of intravenous administration].
The analgesic and antipyretic efficacy of propacetamol is identical to paracetamol. Because the propacetamol is injectable and its side effects are uncommon and mild, it is the drug commonly used in France for postoperative pain relief. The aim of this prospective study was to compare the analgesic efficacy of propacetamol after breast surgery or thyroidectomy when it was administered either systematically or on the patients demand. ⋯ Pain during propacetamol infusion was more frequent in the D group than in the S group (30% and 13% respectively, p < 0.05). No other adverse effects were observed during the study. Propacetamol alone is sufficient for pain relief after peripheral surgery; more than 90% of patients need no supplemental analgesic, and adverse effects are rare.
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This review describes the mechanisms of analgesic effect, advantages and risks related to the perioperative use of non steroidal antiinflammatory drugs (NSAID's). The NSAID's should be used as the first analgesic, around the clock, with a rapid onset of the therapy. Their combination with other NSAID's (acetaminophen) or opioids can have an additive analgesic effect and may limit frequent secondary effects as nausea and vomiting. Their potential toxicity must be remembered and the contra indications, maximum doses and duration of treatment have to be respected.
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The use of a pneumatic tourniquet to provide a bloodless field in orthopedic surgery is often complicated by tourniquet pain. The mechanism of this pain remains incompletely understood, but it is probably multifactorial. Nerve compression is a common etiologic feature. ⋯ Superficial (skin) compression and deep components compression like blood vessels and muscles can both induce tourniquet pain. Central nervous system can also interfere. Release of tourniquet can increase the pain by post-ischaemic oedema due to ischaemia and reperfusion injury.
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Cahiers d'anesthésiologie · Jan 1995
Comparative Study[Postoperative analgesia after ligamentoplasty of the knee. Comparison of epidural morphine and intravenous nalbuphine].
Surgery of the anterior cruciate ligament causes severe postoperative pain. This study aimed to compare efficacy and side effects of two postoperative analgesia methods, during 24 hours. Twenty healthy patients were assigned to two groups (n = 10): the patients of the first group were given by an epidural catheter 3 mg of morphine hydrochloride, every twelve hours. ⋯ The incidence of respiratory depression, nausea, pruritus was not statistically different between the groups, but 7/10 patients in the first group suffered of urinary retention (the first micturition was obtained 10.5 hours after the end of surgery in the first group and 5.3 h in the second one). Two patients needed an uretral catheter. These results might tend to show a greater efficactly of epidural morphine, with a higher incidence of urinary side effects.