Articles: surgery.
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Journal of anesthesia · Sep 1994
Assessment of postoperative pain: Contributing factors to the differences between patients and doctors.
This study was undertaken to compare the assessment of pain intensity by 50 patients and by their doctors according to a visual analog scale 5 h and 20 h after major abdominal surgery, and to examine the relationships between the differences in rating of patients and doctors and the factors inherent in the patients which include preoperative expectation of pain, level of anxiety, and the surgical history of the patient. The ratings given by the patients were significantly higher than those given by the doctors at both time periods. ⋯ The results of analysis using Hayashi's quantification theory Type II indicated a moderate association between the rating difference and the patient's age, surgical history, preoperative state of anxiety, and expectation of pain. It is concluded that postoperative pain management, whether in clinical practice or in research, necessitates more consideration of the several above-mentioned individual factors and a preoperative interview in which the patient's level of anxiety and the amount of information the patient has concerning the surgery and post-operative pain is clearly assessed.
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Local wound perfusion with bupivacaine after elective abdominal surgery seems to be a promising method of reducing postoperative pain. Applicability, effectiveness, side effects and risks were tested in a pilot study with 28 patients. During closure of the laparotomy incision two catheters were inserted, one between peritoneum and fascia and the other subcutaneously. ⋯ No severe side effects occurred, but the study was interrupted nonetheless in 3 patients, 2 of whom had a transit syndrome while the third had more severe hypotension than could be explained by the bupivacaine blood level. No infections and no problems with wound healing occurred during the study. This study proved that the method tested leads to significant pain reduction after elective abdominal surgery and has no severe side effects.
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Journal of anesthesia · Sep 1994
The effect of prostaglandin E1 on the increase of serum lactate and plasma granulocyte elastase activity during radical surgery for esophageal cancer.
Serum lactate concentrations and the lactate/pyruvate (L/P) ratio were measured in two groups of patients undergoing radical esophagectomy, as an indicator of tissue hypoxia, and β-glucuronidase and granulocyte elastase as indicators of tissue damage. One group received prostaglandin E1 (PGE1) and the other group received nothing. Serum lactate concentrations and the L/P ratio increased significantly 30 min after starting thoracotomy in the patients who were not treated with PGE1. ⋯ There was no change in serum β-glucuronidase activity in both groups. This study suggests that low doses of PGE1 maintain organ blood flow without affecting blood pressure. However, these low doses of PGE1 could not suppress granulocyte elastase release.
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The possible association of brain tumour with headache was investigated in 100 patients seen for brain surgery. Preoperatively, 43 patients suffered from headache. These patients were thoroughly questioned about the nature of their pain. Investigation included the McGill Pain Questionnaire. ⋯ Our investigations yielded new information concerning the epidemology of headache accompanying brain tumours. Headache is not an early cardinal symptom of brain tumours, as was generally believed earlier. With the help of the McGill Pain Questionnaire a fine quantitative and qualitative characterization of headache of different origins could be made. The connection between tumour localization and pain lateralization, as well as the possible mechanisms of intracranial pain projection was extensively analysed. The interpretations of the results are at best hypotheses and they do not help determine why more than half of the patients with brain tumour did not experience headache.