Articles: postoperative.
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Pain and pain-related sympathoadrenergic reactions (hypertension, tachycardia) accompanied by nausea, vomiting and shivering are the most common side effects of recovery from anaesthesia. The alpha(2)agonist clonidine acts as a sedative, anxiolytic, antihypertensive, antiemetic, antisialogogue and decreases the incidence of shivering. Thus, we studied the effects of intraoperatively administered clonidine on the recovery period and the postoperative analgesic requirements in patients undergoing maxillofacial surgery. ⋯ Opiates are frequently used as analgesics after maxillofacial surgery, even though their most common side effect-respiratory depression, nausea and vomiting-are particularly dangerous in these patients because of the obstruction of the upper respiratory tract. Self-titration of the opiate dosage on demand can decrease the incidence of serious side effects. Clonidine administered intraoperatively caused a profound reduction in analgesic requirements in this study. Additional opiate administration in the postoperative period was unnecessary in nearly all clonidine-treated patients. The attenuating effect on sympathoadrenergic reactions leads to lowering of the rate-pressure product and may be of advantage for patients suffering from arterial hypertension, angina pectoris or bronchial asthma. The slower emergence from anaesthesia following clonidine administration is probably caused by double-blind study properties preventing full consideration of the decreased isoflurane requirements after clonidine.
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Interpleural analgesia is a method of postoperative analgesia that was developed by Kvalheim and Reiestad in 1984. The main indication is postoperative pain after unilateral thoracic and upper abdominal surgery. Many authors report good analgesic effects and better postoperative lung function following cholecystectomy. ⋯ The local anaesthetic of choice is bupivacaine (in concentrations of 0.25-0.75%, injection volumes of 10-40 ml, with or without epinephrine, applied as bolus or infusion), but others, such as lidocaine or morphine, are also being tested. Risks involved in this method are pneumothorax when the catheter is placed blind and the systemic toxicity of the local anaesthetic. This review provides information on the mechanism of action, the technique, the clinical use to date and possible risks.
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Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. ⋯ Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.
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The spectrum of perioperative pain treatment is discussed in the present review. The analgesic efficacy of various drugs and the dosage methods of administration and side effects reported for them in such reference works as the practical guide on the management of acute pain recently published by the International Association for the Study of Pain (IASP) are described. Effective postoperative analgesia can diminish stress reactions following surgery. ⋯ Investigations performed by the author of this review have shown that epidural infusion of highly diluted mixtures of bupivacaine/fentanyl is highly effective in the analgesic treatment of patients undergoing prostatectomy, providing excellent physical mobilization. The potential dangers of drug combinations and contraindications are also discussed. The concept of using balanced analgesia to induce additive or synergistic effects following the administration of analgesic drugs requires further clinical studies.
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In a double-blind, randomized, placebo-controlled study, 86 patients (44 verum, 42 placebo), scheduled for knee-joint arthrotomies or minor orthopaedic operations received either naproxen, a nonsteroidal antiinflammatory analgesic, or placebo orally in three doses: the first immediately before the operation and the others 6 h and 12 h after the first. The verum group received 1250 mg naproxen in total. Postoperative pain intensity was measured by the category splitting procedure. ⋯ The intensity of typical side effects of opioids and antipyretic anti-inflammatory analgesics (nausea, vomiting, stomachache, headache, vertigo) was low and they were easily controlled in all cases. Lowering of respiratory frequency was not observed. Perioperative administration of the nonsteroidal anti-inflammatory analgesic naproxen results in better pain relief and significantly lower opioid requirements (by about 46%) after minor orthopaedic surgery.