Articles: postoperative-pain.
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Randomized Controlled Trial Clinical Trial
Tenoxicam and paracetamol-codeine combination after oral surgery: a prospective, randomized, double-blind, placebo-controlled study.
We studied 90 adults undergoing surgical removal of at least both lower third molar teeth as day cases under standardized general anaesthesia. Patients were allocated randomly (with stratification for surgeon) to receive tenoxicam 40 mg, tenoxicam 20 mg or placebo i.v. at induction of anaesthesia and orally (effervescent tablets) with food on each of the subsequent 2 days. Panadeine (paracetamol 500 mg-codeine 8 mg) was given before operation and was available as needed for pain thereafter, to a limit of two tablets every 4 h. ⋯ Over the 6-day period, patients who received tenoxicam reported less pain on rest (area under the curve; P < 0.05) and less disturbance in sleep (P < 0.01) even though they used fewer Panadeine tablets (P < 0.05). Differences between tenoxicam 40 mg and 20 mg were not significant. There was no significant difference in nefopam requirements or side effects, and no adverse event attributable to the study medication.
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Obstetrics and gynecology · Dec 1998
Randomized Controlled Trial Clinical TrialA randomized, double-blinded trial of preemptive analgesia in laparoscopy.
We tested the hypothesis that local anesthetic administered before skin incision, an example of preemptive analgesia, reduces postoperative pain for women undergoing laparoscopy, as compared with postincisional local anesthetic or placebo. ⋯ The preemptive administration of bupivacaine before laparoscopy results in decreased postoperative pain and should allow a more rapid return to normal activities. The popular practice of infiltrating bupivacaine at time of incision closure does not offer any benefit in the control of pain after laparoscopy.
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J Laparoendosc Adv Surg Tech A · Dec 1998
Comparative StudyA comparative study of the analgesia requirements following laparoscopic and open fundoplication in children.
To introduce a new procedure, careful evaluation of its effects must be undertaken to assess its impact. Laparoscopic procedures in children are a relatively new phenomenon. A reduction in analgesia is a frequently quoted benefit of a laparoscopic procedure. ⋯ The total amount of morphine analgesia required was similar for both laparoscopic and open surgery (0.432+/-0.28, 0.427+/-0.28 mg/kg). The period for which analgesia was required was significantly less in the laparoscopic group (1.2+/-0.46, 2.7+/-0.67 days; p = 0.03), yet the requirement for morphine during the first 24 hours was greater in the laparoscopic group (0.399+/-0.19, 0.22+0.11 mg/kg, p = 0.02) despite similar NSAID requirements (18+/-17.28, 18+/-20.16 mg/kg, respectively). The benefit of a laparoscopic over an open fundoplication would appear to be in the decreased duration of pain, as indicated by the decreased duration of analgesia following surgery.
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Children are not "small adults," particularly when it comes to anesthesia and pain management. The psychological and physiologic uniqueness of children must not be forgotten. Cooperation and communication between the anesthesiologist, surgeon, and pediatrician are essential for successful anesthesia and pain management. Pediatric anesthesiologists involved in the perioperative management of infants and children are very much a part of the "continuity of care" concept.
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Parents are often the primary source of information regarding their children's pain in both research and clinical practice. However, parent-child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery. ⋯ Correlations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents' underestimation of their child's pain may contribute to inadequate pain control.