Articles: postoperative-pain.
-
Regional-Anaesthesie · May 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Postoperative peridural analgesia via catheter following abdominal surgery. Peridural bupivacaine versus buprenorphine].
Seventy-five patients scheduled for major abdominal operations were randomly divided into four groups, each with a different postoperative analgesic regime. Group I: buprenorphine 4 micrograms/kg was injected i.v. every 4 h. Groups II-IV: all patients were preoperatively supplied with a thoracic epidural catheter that, however, was not used during the operation. ⋯ No patient in any of the other groups, however, was dropped (P less than 0.01). Later in the 1st postoperative day analgesia in groups II and IV lost its superiority at rest, but coughing continued to be less painful in comparison to groups I and III. We noticed that the duration of action of 0.25% bupivacaine, injected as a bolus, was considerably shorter than expected (less than 2 h) and that several patients experienced pain before the next top-up was given...
-
Comparative Study
Postoperative analgesia in children who have genito-urinary surgery. A comparison between caudal buprenorphine and bupivacaine.
A study conducted on 40 children, aged 1-11 years, who had genito-urinary surgery compared the quality and duration of analgesia after caudal blocks in two groups of patients. Group 1 (n = 20) received caudal bupivacaine 0.25% and group 2 (n = 20) caudal buprenorphine 4 micrograms/kg; each received 0.5 ml/kg body weight. Patients were operated on under general anaesthesia. ⋯ The results indicate that caudal buprenorphine provides excellent postoperative analgesia in children comparable to caudal bupivacaine in the early postoperative period. Buprenorphine proved better in the late postoperative period. Analgesia lasted from 20 hours to more than 24 hours after caudal buprenorphine with fewer side effects.
-
Mayo Clinic proceedings · Apr 1990
ReviewManagement of postoperative pain: review of current techniques and methods.
Pain is a common problem in the early postoperative period. Techniques that provide perioperative analgesia to alleviate pain may have a significant effect on postoperative events, such as earlier ambulation and earlier dismissal from the hospital with use of epidural analgesia than with systemic analgesia. Spinal opioids, which can be administered epidurally or intrathecally, provide analgesia that is superior to that achieved with systemically administered narcotics. ⋯ Intercostal nerve block, a valuable but underutilized procedure appropriate for unilateral upper abdominal or flank operations or for thoracotomy, has been shown to reduce postoperative narcotic requirements and pulmonary complications. A patient-controlled analgesia device, consisting of an electronically controlled infusion pump with a timing device that can be triggered by the patient for intravenous administration of a narcotic when pain is experienced, avoids the vast fluctuations in analgesia that accompany parenteral administration of drugs. In most patients, postoperative pain can be prevented or diminished, and clinicians should be aware of the available techniques for achieving this goal.
-
Thirty infants scheduled for a variety of gastrointestinal, genitourinary and thoracic surgical procedures were selected for insertion of lumbar or thoracic epidural catheters via the caudal approach using either an Intracath or a Burron continuous brachial plexus kit. The catheters were inserted with ease by residents in training and no catheter-related complications were encountered. Lidocaine 0.5 per cent with 1:200,000 epinephrine was then injected to assure proper placement of the catheter before narcotics were administered. ⋯ Urinary retention occurred in two infants and one infant became apnoeic three hours after epidural morphine administration but responded to naloxone and pulmonary ventilation with bag and mask. In conclusion, epidural catheters placed via the caudal approach are a safe and effective means of providing postoperative pain control in infants using preservative-free morphine. However, the use of epidural narcotics in infants less than two years of age is restricted to those who will receive intensive care unit monitoring postoperatively so that if apnoea occurs, rapid intervention can be taken by skilled nursing personnel.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between bupivacaine instillation versus ilioinguinal/iliohypogastric nerve block for postoperative analgesia following inguinal herniorrhaphy in children.
This study compared the postoperative pain relief provided by simple instillation of bupivacaine into a hernia wound with that provided by ilioinguinal/iliohypogastric (IG/IH) nerve block. Sixty children undergoing inguinal hernia repair under general anesthesia were randomized to receive 0.25 ml/kg of 0.25% bupivacaine for either IG/IH nerve block or up to 0.5 ml/kg of the same solution for instillation nerve blocks. In the postanesthesia care unit (PACU), a trained blinded observer evaluated the patient's level of postoperative pain using a standardized 10-point objective pain scale. ⋯ The two groups were not significantly different in age, duration of surgery, or anesthesia. There was no significant difference between patients who received the two treatment modalities in their pain scores, analgesic requirements in the PACU, recovery times, and discharge times. These results demonstrate that the simple instillation of local anesthetics into a wound provides postoperative pain relief following hernia repair, which is as effective as that provided by intraoperative IG/IH nerve block.