Articles: postoperative-pain.
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Comparative Study
Pain location, distribution, and intensity after cardiac surgery.
To study the location, distribution, and intensity of pain in a sample of adult cardiac surgery patients during their postoperative hospital stay. ⋯ In this patient population, the pain intensity diminished from POD 3 onward, although its distribution did not vary significantly during the first postoperative week. Moreover, pain location changed with time, with more osteoarticular type pain at the end of the first postoperative week. Among the patients' characteristics, only younger age had an impact on pain intensity, with a higher value on POD 2.
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Randomized Controlled Trial Clinical Trial
Effects of caudal block on cortisol and prolactin responses to postoperative pain in children.
We have performed a randomized controlled study in 60 children (ASA 1.8 month to 10 yrs) undergoing lower abdominal and genitourinary surgery, to assess the effects of caudal anaesthesia on plasma cortisol and prolactin concentrations during early postoperative period. After induction of anaesthesia by inhalation or intravenously, thirty children received a standardized general anaesthetic (control group) while the remaining children received caudal anaesthetics with 0.25% bupivacaine in addition to a similar general anaesthetic (caudal group). Blood samples for cortisol and prolactin were taken after induction and 1 hour after surgery. ⋯ These results were correlated with pain scores. No serious side effects were recorded. In conclusion, caudal anaesthesia attenuated the postoperative cortisol and prolactin responses to surgery and pain in children.
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Anesthesia and analgesia · Aug 2000
The efficacy and safety of epidural infusions of levobupivacaine with and without clonidine for postoperative pain relief in patients undergoing total hip replacement.
We assessed the efficacy and tolerability of epidural infusions of levobupivacaine, levobupivacaine plus clonidine, and clonidine for postoperative analgesia in 86 patients undergoing total hip replacement. For each group, an epidural cannula was inserted before surgery and 15 mL of 0.75% plain levobupivacaine was administered. Three hours later, an epidural infusion (6 mL/h) of levobupivacaine 0.125% (L), levobupivacaine 0.125% plus clonidine 8.3 microg/mL (LC) or clonidine alone (8.3 microg/mL) (C) was initiated. Morphine consumption was recorded for the following 24 h as were visual analog pain scores and the degree of sensory and motor blockade. The mean (median) morphine consumption was lowest in the combination group (LC),14 (7) mg; higher in the clonidine group (C), 23 (21) mg; and highest in the levobupivacaine group (L), 37 (36) mg (P = 0.022). The median times until the first request for analgesia which were 2. 9, 5.9, and 12.5 h for Groups L, C, and LC, respectively (P < or = 0. 01). There were no statistical differences among the groups regarding the maximum degree of postoperative motor blockade. On average, the systolic blood pressure in the two clonidine groups was slightly lower than in those from the levobupivacaine group. We conclude that the epidural administration of a combination of levobupivacaine plus clonidine is well tolerated and gives better analgesia than either drug used alone. ⋯ In patients undergoing total hip replacement, the addition of the alpha(2)-adrenergic agonist clonidine to epidural infusions of levobupivacaine significantly improved postoperative analgesia.
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Randomized Controlled Trial Clinical Trial
Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement.
Rapid development of acute opioid tolerance is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement. ⋯ Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia.