Articles: postoperative-pain.
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Randomized Controlled Trial Clinical Trial
Effects of a nighttime opioid infusion with PCA therapy on patient comfort and analgesic requirements after abdominal hysterectomy.
Since pain during the early postoperative period can disrupt a patient's normal sleep pattern, we investigated the influence of a nighttime "basal" infusion of morphine on patient comfort, ability to sleep at night, restfulness, and analgesic requirements following elective abdominal hysterectomy. One hundred fifty-six adult women were randomly assigned to receive either patient-controlled analgesia (PCA) alone or PCA supplemented with a nighttime infusion of morphine 1.0 mg.h-1. The infusion was started in the postanesthesia care unit and continued until the morning after surgery. ⋯ In addition, the number of patient demands and supplemental bolus doses, opioid usage, and recovery parameters were similar in the two treatment groups. The use of a basal infusion resulted in six programming errors, and three patients required discontinuation of the infusion because of hemoglobin oxygen desaturation (i.e., SpO2 less than 85% for greater than 5 min). We concluded that the routine use of a continuous nighttime opioid infusion in combination with a standard PCA regimen failed to improve the management of postoperative pain, sleep patterns, or recovery profiles compared to PCA alone after abdominal hysterectomy.
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Randomized Controlled Trial Clinical Trial
Intrapleural bupivacaine in the control of postthoracotomy pain.
A randomized, double-blind trial was conducted to determine the effectiveness of intrapleural bupivacaine hydrochloride in the management of pain after thoracotomy. Thirty-three men and 7 women with a mean age of 62 years (range, 21 to 76 years) undergoing elective posterolateral thoracotomy were randomly allocated preoperatively to either a study group receiving 20 mL of 0.25% bupivacaine or a control group receiving 20 mL of 0.9% saline solution through a pleural catheter every 4 hours. Patients received supplementary doses of intramuscular papaveretum as required. ⋯ The forced vital capacity and forced expiratory volume in 1 second at 6 weeks postoperatively remained significantly lower than preoperatively (p less than 0.05). The fall in forced vital capacity from this postoperative level was significantly less in the bupivacaine group at 4, 24, and 48 hours, and the fall in forced expiratory volume in 1 second was significantly less at 4 and 48 hours in the treated group. When used in conjunction with doses of parenteral narcotic, intrapleural bupivacaine gives better pain control with less respiratory depression than intermittent doses of narcotic alone.
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Regional anesthesia · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative epidural morphine, but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy.
Gastric emptying is delayed during the first days after abdominal surgery. Studies with volunteers have shown that epidural morphine delays gastric emptying but epidural analgesia with bupivacaine does not. The aim of this study was to evaluate whether these differences in healthy volunteers are also found after cholecystectomy when epidural morphine or epidural bupivacaine is used for postoperative pain relief. ⋯ Postoperative gastric emptying was significantly delayed after epidural analgesia with morphine compared to thoracic epidural bupivacaine. Compared to the control situation, epidural bupivacaine did not influence gastric emptying.
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Ann R Coll Surg Engl · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of bupivacaine instillation and inguinal field block for control of pain after herniorrhaphy.
In a single-blind, randomised trial, 50 consecutive adult patients for inguinal herniorrhaphy under general anaesthesia received either an inguinal field block or bupivacaine instilled into the wound to provide postoperative analgesia. Bupivacaine instillation was found to be simple, safe and effective. The method is particularly appropriate for day-case surgery.
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Helvetica chirurgica acta · Mar 1992
Randomized Controlled Trial Clinical Trial[Effect of continuous postoperative analgesia with peridural bupivacaine on intestinal motility following colorectal resection].
In a prospective randomized trial the effects of continuous peridural analgesia on gastrointestinal motility and the postoperative course was studied in 48 consecutive patients with elective colorectal resections. 24 patients had peridural analgesia (PDA) with bupivacaine while 24 patients received intravenous analgesia (IVA) with pentazocine. With PDA the first passage of flatus and faeces was significantly accelerated. PDA was not associated with an increased rate of anastomotic breakdown and there were no respiratory complications in the PDA group.