Articles: postoperative-pain.
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J. Thorac. Cardiovasc. Surg. · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain.
Increased interest in alternative approaches to thoracotomy has developed because of the considerable morbidity associated with the standard posterolateral technique. We conducted a prospective, randomized, blinded study of 50 consecutive patients to compare postoperative pain, pulmonary function, shoulder strength, and range of shoulder motion between the standard posterolateral and the muscle sparing thoracotomy techniques. Pulmonary function (forced expiratory volume in 1 second and forced vital capacity), shoulder strength, and range of motion were measured preoperatively and at 1 week and 1 month postoperatively. ⋯ Morbidity was identical in the two groups with the exception of postoperative seromas. The prevalence of seroma was 23% in the muscle-sparing group and 0% in the standard incision group (p = 0.0125). We have demonstrated that the muscle-sparing incision may be a reasonable alternative to the standard posterolateral approach.
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Case Reports
[A case report of long-term post-thoracotomy pain management with intrapleural bupivacaine].
A 50-year old woman with right post-thoracotomy pain was referred to us for assistance with pain control. She required pentazocine 60-150 mg per day before our treatment. First, we treated her with intercostal nerve block or oral morphine sulfate. ⋯ She felt so good from the intrapleural analgesia and could be discharged. There was no hypotension, respiratory depression, urinary retention except burning thoracic sensation. We think it is possible to use this intrapleural bupivacaine to treat a certain kind of unilateral chronic pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrapleural bupivacaine analgesia after thoraco-abdominal incision for oesophagectomy.
Intrapleural bupivacaine administration is said to produce good analgesia for the pain induced by a subcostal incision. However, reports of its efficacy after thoracotomy are conflicting. The goal of this study was to compare the analgesia produced by intrapleural administration of bupivacaine after oesophagectomy using a thoraco-abdominal incision with that obtained from intrapleural saline. ⋯ Plasma bupivacaine concentrations on Day 1 after the first intrapleural bupivacaine injection were less than 350 ng ml-1; on Day 4 after the last injection they were less than 1300 ng ml-1. In conclusion, intrapleural administration of bupivacaine produces effective analgesia after oesophagectomy performed with a thoracoabdominal incision. The technique is easy to perform and is safe.
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Rev Esp Anestesiol Reanim · Mar 1991
Comparative Study Clinical Trial Controlled Clinical Trial[Addition of fentanyl to mepivacaine in axillary brachial plexus block. Effects on the anesthetic and postoperative analgesic quality].
The possible potentiating effect of phentanyl on mepivacaine in brachial plexus blockade was evaluated, both for operative anesthesia and postoperative analgesia. Sixty ASA I patients, scheduled for upper limb surgery, were selected and distributed in 3 groups: 1) Mepivacaine 1% 40 ml (control group); 2) Mepivacaine 1% 40 ml + phentanyl 100 micrograms; 3) Mepivacaine 1% 40 ml + subcutaneous phentanyl 100 micrograms. The latency time and the quality of anesthesia were evaluated. ⋯ There were no significant differences between the 3 groups in the latency times of the development of blockade nor in the quality of surgical anesthesia. Also, there were no significant differences in the duration of postoperative analgesia (307, 316 and 326 minutes, respectively, in each group). It was concluded that the addition of phentanyl 100 micrograms to the local anesthetic in the axillary blockade of the brachial plexus does not change the anesthetic characteristics nor the time of postoperative analgesia.