Articles: postoperative-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Extradural clonidine infusions for analgesia after total hip replacement.
We have examined the effectiveness of extradural clonidine infusions for postoperative analgesia and the effect of clonidine on extradural morphine. In a double-blind, controlled study, patients, undergoing total hip replacement were allocated randomly to receive one of two doses of extradural clonidine (25 micrograms h-1 or 50 micrograms h-1), low dose extradural morphine or a combination of morphine and clonidine. ⋯ Arterial pressure was reduced in the clonidine groups, although the incidence of clinical hypotension was low. There were no significant differences between the groups in emetic symptoms or urinary retention.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of pre- vs postoperative inguinal field block on postoperative pain after herniorrhaphy.
The analgesic effects of an identical inguinal field block, performed before or immediately after inguinal herniorrhaphy, were evaluated in 32 healthy patients in a double-blind, randomized study. During surgery, all patients received a light general anaesthesia with thiopentone, alfentanil and nitrous oxide in oxygen. After induction of general anaesthesia, patients were allocated randomly to receive an inguinal field block with lignocaine, either 15 min before operation or immediately after operation, after closure of the surgical wound, but before the patients were awake. ⋯ No significant differences between the groups were observed in VAS scores or verbal pain scores during rest or ambulation at any time. There was no significant difference in time to first request for morphine or total morphine consumption. These results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.
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Anesthesia and analgesia · Apr 1992
Randomized Controlled Trial Comparative Study Clinical TrialA comparison between preincisional and postincisional lidocaine infiltration and postoperative pain.
We conducted a randomized, double-blind trial to compare the efficacy of preincisional and postincisional wound infiltration with 1% lidocaine (40 mL) on the postoperative pain of 37 patients scheduled for elective inguinal herniotomy. The demand for additional postoperative analgesics occurred earlier in those who received lidocaine infiltration after incision (165 min) than in those who received preincisional lidocaine (225 min, P less than 0.05). The preincisional lidocaine infiltration group also had fewer patients requiring supplemental analgesics (58%) than the postincisional group (94%) (P less than 0.05). We conclude that preincisional infiltration of the surgical wound with lidocaine is a more effective method of providing postoperative analgesia than is postincisional infiltration.
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Randomized Controlled Trial Comparative Study Clinical Trial
Tramadol: pain relief by an opioid without depression of respiration.
Two independent clinical trials were conducted simultaneously. In one, tramadol and pethidine were compared in 30 patients by patient-controlled analgesia during the first 24 h following abdominal surgery. The mean 24 h consumption of tramadol and pethidine was 642 mg and 606 mg respectively, giving a potency estimate of tramadol relative to pethidine of 0.94 (95% confidence interval 0.72-1.17). ⋯ At approximately 1.5 times the equipotent dose, as estimated from the first trial, tramadol transiently depressed the rate of respiration but had no effect on end-tidal carbon dioxide tension. Morphine caused apnoea or considerable depression of ventilation. The results suggest that mechanisms other than opioid receptor activity play a significant role in the analgesia produced by tramadol.
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Randomized Controlled Trial Clinical Trial
Intraoperative wound infiltration with bupivacaine in patients undergoing elective cholecystectomy.
In a double-blind randomized trial, 50 patients scheduled for elective cholecystectomy received 50 mL of either 0.25% bupivacaine hydrochloride or physiologic saline by wound perfusion at the end of the operation before wound closure. The duration of incisional infiltration, total amount of postoperative analgesics administered, and total hospital stay were recorded. Pulmonary function tests were performed the day before surgery and 1 day after surgery. ⋯ Both groups also had similar decrements in forced vital capacity and forced expiratory volume on the first postoperative day. We conclude that wound infiltration with 0.25% bupivacaine after elective cholecystectomy is not effective in reducing postoperative pain. Lung function disturbances cannot be prevented.