Articles: postoperative-pain.
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Ann R Coll Surg Engl · Jan 1989
Randomized Controlled Trial Comparative Study Clinical TrialSubcutaneous ketamine analgesia: postoperative analgesia using subcutaneous infusions of ketamine and morphine.
A series consisting of 32 women undergoing total abdominal hysterectomy received a standard narcotic-free anaesthetic. For the first 24 h postoperatively, eight were given the standard regimen of intramuscular morphine sulphate whilst the other three groups received continuous subcutaneous infusions of either morphine sulphate, ketamine hydrochloride or the two drugs combined. The amount of time they were pain free, the incidence of sleep and nausea, together with cardiovascular and respiratory changes were recorded. ⋯ No patient reported psychomimetic side effects, but ketamine on its own produced feelings of malaise in three patients on the second postoperative day. Subcutaneous infusions provide better postoperative analgesia than intermittent intramuscular morphine. Ketamine on its own cannot be advocated, but combined with morphine it allows a single infusion rate to be used for all patients, decreasing the need for nursing and medical involvement.
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Acta Chir Scand Suppl · Jan 1989
ReviewThe influence of anesthesia and postoperative analgesic management of lung function.
General anesthesia itself may influence postoperative lung function. It leads to a depression of the functional residual capacity, which, in combination with surgical trauma and postoperative pain, can provoke insufficient breathing, retention of bronchial secretions, and atelectasis. ⋯ After upper abdominal or thoracic surgery, postoperative epidural analgesia causes a significant increase of lung function as compared with systemic analgesia. The combination of regional anesthesia and general anesthesia intraoperatively appears to reduce lung function much less than general anesthesia alone.
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Anesthesia and analgesia · Jan 1989
Randomized Controlled Trial Clinical TrialFailure of proglumide, a cholecystokinin antagonist, to potentiate clinical morphine analgesia. A randomized double-blind postoperative study using patient-controlled analgesia (PCA).
The potential clinical utility of drug interactions between morphine and the cholecystokinin antagonist proglumide was examined in 80 postoperative patients suffering from moderate to severe pain. Four groups of ASA I-III patients (mean age 51 years, mean weight 72 kg) recovering from major abdominal or gynecological surgery (mean duration of surgery 141 minutes) performed under balanced anesthesia (midazolam, droperidol, fentanyl, N2O, enflurane) were randomly assigned to self-administer morphine-proglumide mixtures on the first postoperative day (ODAC; morphine demand dose 3 mg; infusion rate 0.36 mg/hr; lockout time 2 minutes; hourly maximum dose 15 mg/hr; proglumide doses per demand 0, 50 micrograms, 100 micrograms, or 50 mg). ⋯ There were no statistically significant differences between the groups either for drug consumption, pain scores, or side effects. It is therefore concluded that proglumide does not potentiate morphine analgesia in a clinical (postoperative) setting.
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Ann Fr Anesth Reanim · Jan 1989
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of nalbuphine and pentazocine in the treatment of postoperative pain by self-administration].
The side-effects of two opioid agonist-antagonists, nalbuphine and pentazocine, were assessed when used for patient-controlled postoperative analgesia. Forty ASA I or II patients scheduled for upper abdominal surgery were randomly allocated to two equal groups. The anaesthetic technique was the same for all the patients: premedication with atropine and diazepam, induction with thiopentone and suxamethonium and maintenance with fentanyl, pancuronium, nitrous oxide and halothane. ⋯ The only parameters significantly different between the two groups were Pasys and PRP, being higher in the pentazocine group. There were no significant differences in the side-effects (drowsiness, nausea, vomiting, headache, amnesia, logorrhoea and urine retention). All patients in both groups were satisfied with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)
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Optimal care of surgical patients includes effective control of incisional pain. Attention is beginning to be focused on new in-hospital services created to improve the management of postoperative pain. Additional information regarding the organization and operation of this type of service, especially in the framework of a university hospital, is presented. The specific roles of an academic anesthesiologist involved in acute pain management are: to provide leadership by the development of effective services, to clarify through research optimal treatments, to train future practitioners in the management of acute pain, and to serve as a consultant for improving pain control for the whole medical community.