Articles: postoperative-pain.
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Anesthesia and analgesia · Apr 1991
Randomized Controlled Trial Comparative Study Clinical TrialComparison of epidurally administered sufentanil, morphine, and sufentanil-morphine combination for postoperative analgesia.
Postoperative analgesia provided by epidurally administered sufentanil and/or morphine was evaluated in 45 patients recovering from major gynecologic surgery. At the first complaint of pain in the Postanesthesia Care Unit, patients received a single epidural bolus of 30 micrograms sufentanil (group A), 5 mg morphine (group B), or 30 micrograms sufentanil plus 3 mg morphine (group C) in a randomized blinded fashion. Analgesic efficacy was assessed throughout the 24-h study period with 10-cm visual analog scales. ⋯ Group B subjects experienced the longest duration of analgesia (B vs A and C, P less than 0.05) and required significantly less patient-controlled analgesia (morphine) than patients in group A (P less than 0.05). No patient developed clinically significant respiratory depression or excessive sedation, and there were no intergroup differences in incidence of pruritus or nausea (P value not significant). The data indicate that a mixture of sufentanil and morphine provides either a more rapid onset of epidural analgesia or reduced patient-controlled analgesia narcotic requirement than respective doses of each agent administered alone.
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Anesthesia and analgesia · Apr 1991
Randomized Controlled Trial Clinical TrialContinuous infusion of interpleural bupivacaine maintains effective analgesia after cholecystectomy.
Twenty-five patients who had undergone elective cholecystectomy were prospectively randomized to receive via an interpleural catheter either a continuous infusion of 0.25% bupivacaine at 0.125 mL.kg-1.h-1 (n = 13) or repeated bolus injections (n = 12) of 0.5% bupivacaine with epinephrine 1:200,000 at 0.4 mL/kg every sixth hour. Adequacy of pain relief was measured by the amount of patient-controlled analgesia morphine required postoperatively and by patient scores on a visual analog scale obtained every sixth hour. Two venous blood samples for measurements of serum bupivacaine levels were obtained from patients in the continuous group at hours 6 and 24; four blood samples were obtained from patients in the bolus group, both immediately before and 30 min after injections at hours 6 and 24. ⋯ The difference was not, however, statistically significant, but when activity during the 2-h time periods immediately before reinjection were examined, patients in the bolus group required and received significantly more morphine than did those in the continuous group (P less than 0.05). Patients in the continuous group had visual analog scale scores that averaged 2.9 +/- 0.6 over the 24-h study period. Patients within the bolus group had visual analog scale scores before and again 30 min after injection that averaged 5.8 +/- 0.8 and 1.8 +/- 0.5, respectively (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement.
A randomised controlled study was undertaken to assess the analgesic efficacy of continuous lumbar plexus block for the first 48 hours after total knee replacement surgery. Boluses of 0.5% bupivacaine with adrenaline 1 in 200,000 (0.3 ml/kg) were administered through a cannula inserted into the neurovascular sheath of the femoral nerve. Thirteen patients who received this block required significantly less morphine than a control group of 16 patients. Pain scores were similar and there were no complications related to this technique.
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Pediatric nurses practicing in a children's hospital participated in this exploratory study investigating nurses' attitudes regarding postoperative pain in infants, including recognition of pain cues and strategies for pain management. Three instruments developed by us were used to obtain data: the Pain Questionnaire, a demographic and attitudinal profile; a self-directed videotape; and the Videotape Questionnaire, an interactive tool to obtain participant responses to videotaped vignettes of infants recovering from surgery. ⋯ Nurses attending pediatric pain classes administered more narcotics. Noncritical care nurses rated the pain experienced by the infants in the vignettes to be more severe compared with ratings made by critical care nurses.
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Investigated postoperative PRN analgesic medication decisions regarding children in 113 hospital nurses, using analog stimuli. Nurses with greater narcotics knowledge and comfort indicated they would provide significantly more medication. Nurses provided more analgesics to children showing higher pain, and on the first than on the third postoperative day. ⋯ These findings were consistent across high and low pain conditions. Nurses' ratings of children's pain were also affected by seriousness and time since surgery. Findings are discussed with reference to problems of undermanagement of children's pain.