Articles: postoperative-pain.
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J Pain Symptom Manage · Dec 1999
Clinical TrialA descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients.
Visual analogue scales (VAS) and verbal rating scales (VRS) are widely used to assess pain. This paper presents a secondary analysis of a subsection of data collected as part of an evaluation of an intervention to improve nighttime pain. The aims were to describe the relationship between the VAS and VRS; to compare characteristics of the noncompliant groups in terms of age, gender, type of surgery, and analgesics; to explore the reasons for noncompletion of the VAS or VRS; and to determine the noncompliance rates with each assessment scale. ⋯ In contrast, two patients did not complete the VRS (0.5%). The scores generated from the VAS and VRS correlated well, although the range of VAS scores corresponding to each VRS category was wide. We conclude that the VRS was more suitable for use in this clinical setting.
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Rev Esp Anestesiol Reanim · Dec 1999
Randomized Controlled Trial Clinical Trial[Efficacy of 0.1 mg of subarachnoid morphine combined with bupivacaine on postoperative analgesia in total hip arthroplasty].
To analyze the analgesic efficacy, safety and side effects of subarachnoid morphine (0.1 mg) with bupivacaine in patients undergoing total hip arthroplasty. ⋯ Combining 0.1 mg morphine and bupivacaine for total spinal anesthesia during hip arthroplasty significantly decreased the consumption of intravenous morphine during the first 48 hours after surgery. No respiratory depression occurred and the only side effects were urinary retention and mild pruritus and drowsiness.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Dec 1999
Multicenter Study[Respiratory and circulatory parameters as indicators of the postoperative analgesic demand in newborns and infants].
Due to immature cognitive functions, infants are unable to communicate their pain perception verbally. To assess postoperative analgesic demand, the anaesthetist has to rely on observational techniques. Generally, pain expression is considered to be a multidimensional phenomenon consisting of physiological, motor-reflex and behavioural patterns. The majority of observational approaches to pain assessment in infants use the behavioural dimension only, regardless of the fact that pain perception might contribute substantially to the stress response. The aim of this study is to evaluate, whether sensitivity and specificity of a behavioural pain scale (CHIPPS [1]) can be improved by adding physiological measures, especially those representing the stress response. ⋯ Despite the multidimensional approach and the corresponding multivariate analyses, a unidimensional scale consisting of behavioural items was found to be a valid indicator of an postoperative analgesic demand. Due to the lack of diagnostic properties and difficulties to obtain sound values even under research conditions, physiological measurements like blood pressure, respiratory rate and heart rate are not suitable for the assessment of a postoperative analgesic demand in infants, neither for clinical nor for research purposes.
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Anesthesia and analgesia · Dec 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA comparison of the analgesic efficacy of 0.25% levobupivacaine combined with 0.005% morphine, 0.25% levobupivacaine alone, or 0.005% morphine alone for the management of postoperative pain in patients undergoing major abdominal surgery.
We compared the relative efficacy of the combination of the single-isomer local anesthetic levobupivacaine and the opioid analgesic morphine versus both drugs alone for postoperative epidural analgesia after major abdominal surgical procedures. Thoracic epidural anesthesia was produced and maintained with levobupivacaine 0.75% in combination with general inhaled anesthesia without opioids. Patients were randomized to one of three postoperative treatment groups: 1) a combination of levobupivacaine 0.25% and morphine 0.005%; 2) levobupivacaine 0.25%; or 3) morphine 0.005%. Postoperatively, all epidural infusions were commenced at a rate of 4 mL/h. Patients could receive a 4 mL-bolus dose and an increase in the epidural infusion rate by 2 mL/h on request for supplemental analgesia. Patients were also allowed ketorolac as a supplemental analgesic at any time after the first analgesic request. Patients in the combination group had longer times to request for supplemental analgesia as compared with the levobupivacaine only group (P < 0.05) and a trend toward longer time to request as compared with the morphine only group (P = 0.066). Patients in the combination group had lower visual analog scale pain scores at rest and activity at 4 and 8 h and fewer requests for supplemental ketorolac (P < 0.05). In conclusion, this study demonstrates a significant improvement in postoperative analgesic efficacy with the combination of levobupivacaine and morphine for continuous epidural analgesia after major abdominal surgical procedures. ⋯ A significant improvement in postoperative analgesic efficacy is demonstrated with the thoracic epidural administration of the combination of the single-isomer local anesthetic levobupivacaine 0.25% and morphine 0.005% in patients after major abdominal surgical procedures as compared with either drug used alone.
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Critical care medicine · Dec 1999
Randomized Controlled Trial Comparative Study Clinical TrialA randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children.
To evaluate the efficacy of a single dose of ketorolac compared with morphine for the relief of pain in children, and to determine the safety of ketorolac. ⋯ Ketorolac is comparable to morphine in relief of postoperative pain in children. A single dose of ketorolac does not result in abnormal postoperative bleeding or alter renal function. However, ketorolac may cause nausea and vomiting in some patients.