Articles: pain.
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Anesthesia and analgesia · Feb 1994
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPreoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy.
In a randomized, double-blind, placebo-controlled trial, we evaluated the use of preoperative local anesthesia with regard to postoperative pain. Before surgery in 66 patients scheduled for cholecystectomy, the abdominal wall along the proposed line of incision was infiltrated with 70 mL of 0.25% ropivacaine, 70 mL of 0.125% ropivacaine, or 70 mL of saline. Wound pain at rest, wound pain during mobilization, and pressure exerted to reach maximum pain tolerance were assessed after 6, 26, 50, and 74 h and after 7 days. ⋯ The median time to first request for postoperative analgesics was significantly shorter (P = 0.014) in the saline group than in the ropivacaine 0.25% group. These effects are suggested to be a residual anesthetic effect of ropivacaine. The study gives no support to the hypothesis that preoperative local anesthetics dampen the inflammatory response and ensuing hyperalgesia.
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Southern medical journal · Jan 1994
Multicenter StudyAre emergency physicians too stingy with analgesics?
Several recent reports suggest that emergency physicians do not use adequate analgesia for patients with acutely painful conditions in the emergency department (ED). To quantify the extent of this problem, we retrospectively studied 401 patients who were treated for acute fracture over a 17-day period in eight area-wide emergency departments. ⋯ Only 121 patients (30%) received analgesics while in the ED; neither fracture site, ED setting, or patient age significantly altered analgesic dispensing practices. We conclude that inadequate use of analgesics in patients who come to the ED for treatment of acute fractures is widespread and that efforts aimed at improving the appropriate use of analgesics in the ED are warranted.
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Refract Corneal Surg · Nov 1993
Case Reports Randomized Controlled Trial Multicenter Study Clinical TrialTopical diclofenac in the treatment of ocular pain after excimer photorefractive keratectomy.
Following excimer laser photorefractive keratectomy, patients experience significant ocular pain until corneal reepithelialization. Despite the use of cold compresses, bandage soft contact lenses, cycloplegics, narcotics, and topical corticosteroids, the pain has not been adequately controlled in many patients. ⋯ Diclofenac appears to significantly reduce the ocular pain following excimer photorefractive keratectomy.
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Arzneimittel Forsch · Nov 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialObserver-blind study with metamizole versus tramadol and butylscopolamine in acute biliary colic pain.
To investigate the combined analgesic and spasmolytic effect of metamizole (dipyrone, Novalgin, CAS 68-89-3) this drug was compared with an opioid analgesic (tramadol) and a pure spasmolytic drug (butylscopolamine). In a multicentre, observer-blind, parallel-group study conducted in five German centres 74 patients suffering from "severe" or "excruciating" colic pain caused by a calculus in the bile duct were randomized to receive intravenously 2.5 g metamizole (25 patients), 100 mg tramadol (25 patients), or 20 mg butylscopolamine (24 patients). The three treatment groups were homogeneous for age, sex, height, weight and baseline pain intensity. ⋯ Metamizole was also more effective for the secondary efficacy endpoint, pain intensity on a 5-point ordinal scale. In the patient's overall assessment of treatment efficacy at the end of the trial, metamizole was rated as the most effective drug (p < 0.005). Fewer patients in the metamizole (3) and the tramadol (1) groups than in the butylscopolamine group (8) needed a second injection of the "rescue" medication (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical therapeutics · Sep 1993
Multicenter Study Comparative StudyEconomic assessment of ketorolac versus narcotic analgesics in postoperative pain management.
The medical records for 174 patients who underwent cholecystectomy (n = 52) or hip/knee replacement (n = 122) at four community-based medical centers were retrospectively reviewed to determine if using a nonnarcotic alternative to morphine sulfate and/or meperidine as a primary postoperative analgesic could reduce resource costs per patient. Two cohorts were constructed: 87 patients received either morphine sulfate or meperidine as the primary postoperative analgesic, and 87 patients received ketorolac. ⋯ In contrast to substantial differences in the acquisition cost of ketorolac versus morphine sulfate/meperidine, the ketorolac cholecystectomy group was associated with lower overall resource costs per patient. In joint replacement procedures, however, the ketorolac group was associated with higher overall resource costs per patient, attributable primarily to a slightly higher postoperative length of stay.