Articles: postoperative-pain.
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J. Perianesth. Nurs. · Jun 2004
ReviewAssessment and treatment of postoperative pain in older adults.
Hospitals are experiencing an increase in surgical procedures aimed at improving function and quality of life for elders. However, recent reports of pain management practices of elder patients show that pain is underassessed and undertreated. ⋯ The purpose of this article is to review strategies for assessing and treating postoperative pain in older adults. Attention is given to the challenges associated with mental and physical impairments experienced by elders and a review of assessment and pharmacologic and nonpharmacologic strategies are included.
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Anaesth Intensive Care · Jun 2004
Randomized Controlled Trial Clinical TrialPerioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial.
We hypothesized that perioperative ketamine administration would modify acute central sensitization following amputation and hence reduce the incidence and severity of persistent post-amputation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee amputation received ketamine 0.5 mg x kg(-1) or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.5 mg x kg(-1) x h(-1) or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. ⋯ The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period. Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post-amputation pain.
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Comparative Study
Quantification of pain and satisfaction following laparoscopic and open hernia repair.
Subjective experiences can be quantified by visual analog scale (VAS) scoring to improve comparison of surgical techniques. ⋯ Pain following hernia repair was age dependent. Following laparoscopic repair, patients had lower first-day pain scores in younger patients and earlier return to normal activities in all patients. Satisfaction was similar for both approaches. Subjective experiences can be quantified, compared to detect subtle differences in outcome for competing surgical techniques, and used to counsel patients before operation, with the goal of improving satisfaction.
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J Vet Med A Physiol Pathol Clin Med · Jun 2004
Randomized Controlled Trial Clinical TrialAnti-nociceptive and sedative effects of sufentanil long acting during and after sevoflurane anaesthesia in dogs.
The purpose of the present study was to determine the most effective time interval between the administration of sufentanil long acting (LA) and the induction of sevoflurane anaesthesia in dogs. The occurrence of sedation, analgesia and other marked side-effects were evaluated in addition to the possible dosage-reducing effect of sufentanil on sevoflurane in dogs. Forty clinically normal beagles aged 1-2 years and weighing between 8.4 and 13.6 kg were included. ⋯ Several dogs showed ataxia, lateral recumbency, arousal on auditory stimulation, defaecation, salivation and excitation at several time-points after sufentanil LA administration. Sufentanil LA in addition to sevoflurane anaesthesia offered beneficial dosage-reducing analgesic effects up to 69.8% for thiopental and 78.3% for sevoflurane; although several typical opioid side-effects occurred. To achieve this advantageous dosage-reducing effect 15 min should be respected between sufentanil LA administration and induction of sevoflurane anaesthesia.
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Prescrire international · Jun 2004
Comparative StudyParecoxib: new preparation. A NSAID for postoperative pain: no proven advantage.
(1) Parecoxib is the second nonsteroidal antiinflammatory drug, after ketoprofen, to be marketed in France for the treatment of postoperative pain. (2) Another injectable NSAID, ketorolac, was marketed briefly in the 1990s. It was shown to be no more effective than ketoprofen, but was withdrawn from the French market because it provoked bleeding. (3) The clinical evaluation dossier on parecoxib contains no data from comparative trials with ketoprofen. ⋯ There is no evidence that this reduction translates into a lower risk of adverse reactions to opiates. (5) Parecoxib is marketed as "Cox-2-specific inhibitor", but follow-up is too short to show whether this property avoids the severe adverse effects seen with other NSAIDs, such as renal failure, gastrointestinal haemorrhage, and delayed wound healing. Parecoxib, like its principal metabolite valdecoxib, can cause severe hypersensitivity reactions. (6) Parecoxib is 10 times more expensive than injectable ketoprofen in France. (7) In practice, ketoprofen is still the best choice for parenteral NSAID-based pain relief in the postoperative setting.