Articles: pain.
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Comparative Study
Ilioinguinal nerve block in children. A comparison with caudal block for intra and postoperative analgesia.
Fifty-two boys undergoing herniotomy, orchidopexy or ligation of patent processus vaginalis under general anaesthesia had supplementary analgesia; 26 had a caudal epidural block and 26 an ilioinguinal block. Analgesia was assessed both during and after surgery. Ilioinguinal block provides a useful alternative to caudal block.
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Because of the likely involvement of central convergence of afferent inputs in mechanisms underlying referred pain, the activity of single neurones was recorded in the cat's trigeminal (V) subnucleus caudalis (medullary dorsal horn) to test for the presence and extent of convergent inputs to the neurones. In chloralose-anaesthetized or decerebrate unanaesthetized cats, electrical stimuli were applied to afferents supplying facial skin, oral mucosa, canine and premolar tooth pulp, laryngeal mucosa, cervical skin and muscle, and jaw and tongue muscles, and tactile and noxious mechanical and thermal stimuli were applied to skin and mucosa. Considerable proportions of caudalis neurones which could be functionally classified on the basis of their cutaneous receptive field properties as low-threshold mechanoreceptive (LTM), wide-dynamic-range (WDR), or nociceptive-specific (NS) neurones, could be excited by electrical stimulation of several of these afferent inputs. ⋯ On the basis of antidromic activation, 15% of these WDR and NS neurones were shown to have a direct projection to the contralateral thalamus. The findings question the use of terminology and classifications of somatosensory neurones based only on the cutaneous receptive field properties of the neurones since distinctions between the different neuronal populations become less obvious when properties other than those related to cutaneous afferent inputs are taken into account. Moreover, the observations of extensive convergence of different types of afferents, which was especially apparent in cutaneous nociceptive neurones, also suggest a role for these neurones in mediating deep pain and in spread and referral of pain.
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Clinical Trial Controlled Clinical Trial
The effects of transcutaneous electrical nerve stimulation on post-cesarean pain.
The purpose of this study was to examine the effect of continuous transcutaneous electrical nerve stimulation (TENS) near the incision site on post-cesarean pain and on analgesic intake during the early postoperative period. This investigation utilised a 2-group (TENS-treated and placebo TENS-treated), single-blind experimental design. Eighteen multiparous women, each having undergone an elective cesarean delivery, participated in the study. ⋯ However, pain resulting from internal structures, i.e., deep pain, afterbirth pain (due to uterine contractions), and the somatic pain associated with decreased peristalsis (gas pains) were not amenable to TENS. No significant differences in analgesic intake were observed. The possible reasons for these findings are discussed.
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The assessment and development of pain in children is reviewed in the first part of a two-part series. Assessment of pain in children has relied on self-report measures that have included visual analogue procedures using concrete stimuli for ratings. Behavioral assessment procedures are more sophisticated, but research on behavioral assessment of pediatric pain has begun to emergy only recently. ⋯ There are preliminary indications that children's thoughts and attitudes about pain may change with age in a manner that contributes to more intense feelings of pain in adolescence than childhood. Children undergoing painful medical procedures show declining emotional outbursts with age and increasing signs of self-control and muscular rigidity. Possibilities for integrating the study of the developmental aspects of pain with social learning theory, cognitive developmental theory, and the psychology of physical symptom perception are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
A multiple-dose comparison of ketorolac tromethamine with diflunisal and placebo in postmeniscectomy pain.
The efficacy of oral ketorolac 5 mg and 10 mg taken qid was compared in a randomized double-blind study with that of oral diflunisal 500 mg bid (interleaved with placebo twice daily) and of placebo, in 120 patients suffering at least moderate pain following meniscectomy. The trial comprised two phases: (1) an acute phase (the first postoperative day) and (2) a chronic phase (days 2-5 postoperatively). Acutely, pain was assessed before drug administration, and then 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, 8.0, and 9.0 hours after the first dose. ⋯ Over the chronic phase, ketorolac 5 mg and placebo showed similar results, with diflunisal showing the least pain relief and ketorolac 10 mg the most. All the active treatments showed a low incidence of side effects and, in an overall evaluation, no one treatment was distinguishable. Ketorolac would seem to be an acceptable therapy for acute postoperative pain.