Articles: postoperative-pain.
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Acta Anaesthesiol Scand · Feb 1982
Randomized Controlled Trial Clinical TrialInfluence of epidural morphine on postoperative pain, endocrine-metabolic, and renal responses to surgery. A controlled study.
In order to assess the analgesic properties of epidural low-dose morphine and its possible influence on the adrenocortical, hyperglycemic, renal, electrolyte and leukocyte responses to surgery and nitrogen excretion, a double-blind randomized study was undertaken in 14 otherwise healthy patients admitted for hysterectomy under halothane, N2O/o2 anesthesia. Before induction of anesthesia, an epidural catheter was introduced into the lumbar epidural space. After induction of anesthesia, either morphine 4 mg in 10 ml saline or 10 ml saline was injected into the epidural space, according to the allocation. ⋯ Plasma concentration of cortisol and glucose, plasma-and urine electrolytes, 24-h creatinine and free-water clearances, diuresis, fluid balance, leukocyte count and nitrogen excretion differed insignificantly between groups. In conclusion, epidural low-dose morphine is a superior alternative to conventional postoperative pain treatment because of greater and longer lasting pain relief, without apparent side-effects. The measured endocrine-metabolic and renal response did not differ between groups, indicating that low-dose epidural morphine does not inhibit afferent neurogenic stimuli from the site of surgical trauma.
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Anasth Intensivther Notfallmed · Feb 1982
[Epidural fentanyl analgesia for the relief of postoperative pain (author's transl)].
The results are reviewed which were obtained with epidural administration of fentanyl for the relief of pain in 134 patients who had undergone abdominal surgery or had sustained multiple fractures of the ribs. Single doses of 0.1 mg of fentanyl were given epidurally via an indwelling catheter inserted between L1/L2 or L2/L3 or, in the case of 7 patients with multiple rib fractures, between Th8/Th9. The results were satisfactory to excellent. ⋯ Epidural injections caused a steeper rise in concentration than did intramuscular administration. Although none of the patients developed respiratory depression the possibility of respiratory failure should be taken into account when employing epidural fentanyl analgesia. The method is very effective in intensive therapy for relieving postoperative or post-traumatic pain, but is unsuitable for the relief of chronic pain because the analgesic effect is comparatively short-lived.
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Randomized Controlled Trial Clinical Trial
Intercostal nerve block with thoracoabdominal and flank incisions.
A double-blind study was done in 90 patients undergoing a rib-resecting thoracoabdominal incision for testicular cancer or a flank incision for renal surgery to determine the effect of intraoperative intercostal nerve block with bupivacaine hydrochloride on postoperative pain and complications, day of ambulation, and day of oral fluid intake. In the patients treated with bupivacaine, we found a significant reduction in the amount of postoperative analgesia required, but no difference in the day of ambulation or fluid intake. Ten of 45 patients given a placebo nerve block experienced postoperative atelectasis, whereas only 4 of 45 patients in the treated group experienced this complication. We believe that intercostal nerve block is a valuable postoperative adjuvant in patients undergoing flank surgery to reduce the postoperative analgesic requirements and incidence of atelectasis.
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Langenbecks Arch Chir · Jan 1982
[Catheter epidural analgesia for treatment of postoperative and post-traumatic pain].
Postoperative epidural local anesthetics or opiates provide excellent analgesia but do not reduce the incidence of respiratory complications compared with systemic analgesics. Additional and sometimes lethal side effects reserve the routine use of epidural analgesia for highly selected patients. ⋯ TEA results in fewer pulmonary complications, shorter hospital stay, and lower mortality than artificial respiration. Late global pulmonary tests after TEA for treatment of SRF show normal results within comparable groups without rib fractures.