Articles: postoperative-pain.
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Randomized Controlled Trial Clinical Trial
Analgesic and pulmonary effects of continuous intercostal nerve block following thoracotomy.
This study examined the beneficial effects and potential systemic toxicity from continuous intercostal nerve block by repeated bolus injections of bupivacaine. In this double-blind, randomized study, 20 post-thoracotomy patients were assigned to receive four doses of either: 20 ml 0.5% bupivacaine with epinephrine 5 micrograms.ml-1 (bupivacaine group, n = 10), or 20 ml preservative-free saline (placebo group, n = 10) through two indwelling intercostal catheters every six hours. ⋯ Repeated intercostal bupivacaine administration did lead to systemic accumulation, but the peak bupivacaine level after 400 mg was low at 1.2 +/- 0.2 microgram.ml-1. Thus, the technique of continuous intercostal nerve block described in this study is an effective treatment for the control of post-thoracotomy pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Double-blind comparison of the morphine sparing effect of continuous and intermittent i.m. administration of ketorolac.
The morphine sparing effect of ketorolac 10 mg administered 4-hourly by intermittent i.m. injection was compared with a continuous i.m. infusion in a double-blind, placebo-controlled trial in patients undergoing upper abdominal surgery. During the 48-h postoperative period, each patient was provided with a patient-controlled analgesia (PCA) system which delivered bolus doses of morphine and administered the intermittent i.m. doses automatically via a computer controlled pump. ⋯ In the second 24 h and over the entire 48 h of the study, patients in the continuous group required significantly less morphine than those in the placebo group. The intermittent group used less than the placebo group, but this was not significant.
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Anesthesia and analgesia · Sep 1991
Randomized Controlled Trial Comparative Study Clinical TrialIbuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery.
The authors compared the analgesic efficacy of one dose of oral ibuprofen with that of intravenously administered fentanyl for relief of pain after outpatient laparoscopic surgery. Thirty healthy female patients received either 800 mg of oral ibuprofen preoperatively or 75 micrograms of intravenous fentanyl intraoperatively plus respective intravenous or oral placebos in a randomized, double-blind manner. Patients recorded their degree of pain and nausea in the recovery room, in the same-day surgery stepdown unit, during the ride home, and upon arrival at home. ⋯ Patients who received ibuprofen were more comfortable in the stepdown unit (P less than 0.05) and after arrival home (P less than 0.05) than those in the fentanyl group. Additionally, patients who received ibuprofen had lower nausea scores in the step-down unit (P less than 0.05); this may have been related to the lower total fentanyl dose in these patients. The authors conclude that ibuprofen may be a useful alternative to fentanyl for providing postoperative analgesia for outpatient surgery.
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Randomized Controlled Trial Clinical Trial
Effect of epidural clonidine on analgesia and pharmacokinetics of epidural fentanyl in postoperative patients.
Epidural clonidine produces postoperative analgesia in patients and potentiates opioid analgesia in animals. The aim of the current study was to assess the effect of epidural clonidine on the plasma concentrations and analgesic effect of fentanyl after epidural administration. Twenty ASA physical status 2 or 3 patients recovering from abdominal surgery were allocated randomly to receive either epidural fentanyl (100 micrograms in 10 ml isotonic saline; EF group) or epidural fentanyl (same dose) plus epidural clonidine (150 micrograms; EF + C group) in isotonic saline solution. ⋯ Peak plasma fentanyl concentrations (Fmax) and the time to reach Cmax (Tmax) were comparable in the two groups (0.29 +/- 0.15 ng.ml-1 at 16.2 +/- 14.8 min in the EF group and 0.27 +/- 0.11 ng.ml-1 at 8.3 +/- 5.5 min in the EF + C group), as were plasma concentrations at each definite time of measurement. Drowsiness and hypotension were noticed in the EF + C group. Thus, epidural clonidine appears to prolong epidural fentanyl analgesia without affecting its plasma concentration.
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The outcome of disk surgery in 40 consecutive patients was predicted by pre-treatment assessments of sociodemographic and psychological variables and findings in a standardised orthopaedic and neurological examination. The pre-surgery variables that proved to be associated with outcome criteria six months post surgery by means of a multiple stepwise regression procedure were selected for discriminant analyses, using three outcome criteria: functional status, patient evaluation of the outcome, and vocational rehabilitation. ⋯ No prediction was possible for postoperative pain behaviour and postoperative orthopaedic and neurological status. Significant predictors were time off work before surgery, active search for information about disease and surgery, presence of conditions that reinforce pain behaviour, and cognitive variables indicating helplessness.