Articles: pain.
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Gynecologic oncology · Jul 1987
Comparative StudyPatient-controlled analgesia in gynecologic oncology.
Patient-controlled analgesia (PCA) is currently being evaluated as an alternative to prn intramuscular injections for the relief of postoperative pain in patients with gynecologic malignancies. From June 1985 to May 1986, twenty patients undergoing abdominal hysterectomy received PCA rather than traditional intramuscular injections for relief of postoperative pain. PCA was administered by a lightweight, wearable, disposable system, the Travenol Infuser with Patient Control Module. ⋯ No cases of respiratory or cardiac depression were observed, and patients were generally alert throughout the period of analgesia. These data suggest that PCA is a safe and effective mode of analgesia administration. In addition, the unique characteristics of this new compact device were well accepted.
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The formalin test in mice is a valid and reliable model of nociception and is sensitive for various classes of analgesic drugs. The noxious stimulus is an injection of dilute formalin (1% in saline) under the skin of the dorsal surface of the right hindpaw. The response is the amount of time the animals spend licking the injected paw. ⋯ It is suggested that the early phase is due to a direct effect on nociceptors and that prostaglandins do not play an important role during this phase. The late phase seems to be an inflammatory response with inflammatory pain that can be inhibited by anti-inflammatory drugs. ASA and paracetamol seem to have actions independent of their inhibition of prostaglandin synthesis and they also have effects on non-inflammatory pain.
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The effectiveness of pain control following surgery is notoriously difficult to assess, but objective assessment by nursing staff has been found to correlate reasonably well with subjective patient assessment. A study was designed to investigate the attitudes and knowledge of 86 qualified nursing staff in relation to postoperative pain management. ⋯ Additionally, almost three-quarters of staff felt that, in general, postoperative patients received adequate pain relief, while the great majority felt that prescription writing could be improved, mainly by improved legibility and clarity of actual instructions. The results suggest that the aim of postoperative pain management--that is, the provision of adequate analgesia--may need to be more strongly defined in nursing education.
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Patients who use on-demand analgesia prefer voice feedback rather than buzzer tones to indicate operation of the apparatus. Twenty-four patients had experience of a patient-controlled analgesia apparatus which incorporated a sophisticated feedback of buzzer tones and a speech synthesizer. Of those who expressed a preference, fifteen preferred the speech synthesizer and only one preferred the buzzer tones. The speech synthesizer is a reliable, inexpensive and simple method of supplying feedback to patients when such apparatus is used.