Articles: pain.
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J Bone Joint Surg Br · Jan 1988
Randomized Controlled Trial Clinical TrialTranscutaneous electrical nerve stimulation after major amputation.
We studied the effect of transcutaneous electrical nerve stimulation (TENS) on stump healing and postoperative and late phantom pain after major amputations of the lower limb. A total of 51 patients were randomised to one of three postoperative treatment regimens: sham TENS and chlorpromazine medication, sham TENS only, and active low frequency TENS. ⋯ There were, however, no significant differences in the analgesic requirements or reported prevalence of phantom pain between the groups during the first four weeks. The prevalence of phantom pain after active TENS was significantly lower after four months but not after more than one year.
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Rev Med Univ Navarra · Jan 1988
Comparative Study[A bupivacaine-morphine combination by intrathecal route: correlation between pain relief and postoperative neuroendocrine response].
The purpose of the present study was to assess the repercussion of morphine injected in the intrathecal space on postoperative neuroendocrine response and the correlation with pain relief in the postop period. We studied 50 healthy patients (ASA I-II) submitted to orthopaedic surgery under general anaesthesia (N = 25) or spinal anaesthesia (N = 25). In the group under general anaesthesia we observed a hypersecretion of ADH, ACTH, cortisol and aldosterone during and after surgery. ⋯ Intraoperative and postoperative bleeding with spinal anaesthesia was significantly lower (p less than 0.01; p less than 0.05 respectively) than with general anaesthesia. Postoperative analgesia was excellent in group with spinal anaesthesia; the average duration of analgesia was 16.3 hours. We conclude that small intrathecal doses of morphine have beneficial effects and may be used usefulness in orthopaedic surgery.
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There is a sub-group of patients with non-malignant medical conditions who have severe, intractable pain and who require chronic opioid administration for adequate pain control. Reported here is a systematic clinical evaluation of 52 such patients who were referred after they had failed numerous, non-opioid pain treatments. Major causes of pain were irreversible degenerative and/or traumatic injuries to the musculoskeletal system. ⋯ Once pain relief was achieved, patients did not escalate their dosage, and they were able to maintain pain relief for long time periods. Although opioids produced dependence in all patients and complications of constipation and edema in about one third, high daily opioid dosage treatment appeared to be the only medical means to achieve adequate pain control in these subjects. We conclude that opioid maintenance should be utilized as a last resort treatment in patients who fail other pain treatments.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative analgesic efficacy and tolerability of ketorolac tromethamine and glafenine in patients with post-operative pain.
In a randomized, single-dose, double-blind, parallel comparative trial of analgesic efficacy, 96 adult patients received either 10 mg ketorolac tromethamine or 400 mg glafenine orally the morning after surgery if they requested pain relief medication. Each patient provided a baseline pain assessment and then received the assigned medication. Patients assessed pain intensity and pain relief and reported any adverse events in interviews held 30 minutes after drug administration and then hourly for 6 hours. ⋯ The differences in overall response were statistically significant (p = 0.017). Fourteen (30%) patients who received ketorolac tromethamine and 17 (35%) who received glafenine reported adverse experiences that began or seemed to worsen after administration of the study drugs. The most prominent were drowsiness and sleeping, both of which are common in post-surgical patients.
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Nephrol. Dial. Transplant. · Jan 1988
Randomized Controlled Trial Comparative Study Clinical TrialTopical anaesthesia for fistula cannulation in haemodialysis patients.
The use of a local anaesthetic cream (EMLA; Astra) for arteriovenous fistula cannulation was compared to placebo in a double-blind randomised manner in 26 patients undergoing chronic haemodialysis who were currently using injections of lignocaine. The EMLA cream was highly effective compared to placebo (P less than 0.001) on visual analogue and verbal rating scales as well as ease of venepuncture (P less than 0.01). It also gave more pain relief and improved the ease of venepuncture compared to lignocaine injections. Patients expressed a strong preference for the EMLA cream, which has advantages that outweigh the cost and convenience factors.