Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialAn evaluation of the safety and efficacy of administering rofecoxib for postoperative pain management.
The goal of our study was to evaluate the analgesic efficacy and safety of administering rofecoxib (1 mg/kg), a cyclo-oxygenase (COX)-2 selective nonsteroidal antiinflammatory drug, before pediatric tonsillectomy. Sixty-six patients, aged 3-11 yr, scheduled to undergo tonsillectomy received either placebo or rofecoxib (1 mg/kg). There were no significant differences between the two study groups with respect to demographics and blood loss. We found that the pain scores were significantly lower in the rofecoxib group compared with the control group at 2 h (P < 0.05) and 24 h (P < 0.006). The incidence of nausea (P < 0.03) and vomiting (P < 0.004) at home was more frequent in the control group than in the rofecoxib group. We conclude that a single preoperative dose of rofecoxib resulted in less vomiting and lower 24-h pain scores in pediatric patients undergoing an elective tonsillectomy. ⋯ In children undergoing tonsillectomy, a single preoperative dose of rofecoxib decreases 2- and 24-h pain and decreases nausea and vomiting at home.
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Anesthesia and analgesia · Jul 2003
Case ReportsBrugada-type electrocardiographic pattern induced by epidural bupivacaine.
In this case report, we describe the postoperative occurrence of electrocardiogram changes suggestive for the Brugada syndrome in a patient receiving a continuous epidural bupivacaine infusion. After withdrawal of bupivacaine, the electrocardiogram changes were reversible. The patient's history was unremarkable except for an incomplete right bundle branch block. We conclude that local anesthetics, particularly bupivacaine, have the potential to induce serious arrhythmias in patients with Brugada syndrome.
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Anesthesia and analgesia · Jul 2003
Comparative Study Clinical TrialA prospective one-year outcome study of interdisciplinary chronic pain management: compromising its efficacy by managed care policies.
Although interdisciplinary pain management programs are both therapeutically effective as well as cost-effective, they are currently being underutilized because of managed care policies. We used this prospective comparison trial, with 1-yr follow-up of chronic pain patients, to demonstrate the short- and long-term efficacy of an interdisciplinary pain management program, and evaluate the impact of managed care's physical therapy "carve out" practices on these treatment outcomes. Consecutive chronic pain patients (n = 201) were evaluated, some of whom had their physical therapy "carved out" from this integrated program. Results revealed that successful completion of interdisciplinary pain management was therapeutically effective. Most importantly, physical therapy "carved out" practices had a negative impact on both the short-term and 1-yr follow-up outcome measures. Thus, interdisciplinary pain management is effective in treating the major health problem of chronic pain. However, insurance carrier policies of contracting treatment "carve outs" significantly compromise the efficacy of this evidence-based, best standard of medical care treatment. This raises important medico-legal and ethical issues. ⋯ Interdisciplinary pain management is effective and cost-effective in treating the major health problem of chronic pain. The present study demonstrated its efficacy using a prospective, 1-yr posttreatment evaluation methodology. Moreover, physical therapy "carve out" practices by insurance carriers had a negative impact on the outcomes, raising important medico-legal and ethical issues.
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Anesthesia and analgesia · Jul 2003
Case ReportsSpinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation.
We report the successful management and outcome of spinal anesthesia for Cesarean delivery in a woman with a surgically corrected Arnold Chiari Type 1 malformation, a seizure disorder, and idiopathic thrombocytopenia of pregnancy.
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Anesthesia and analgesia · Jul 2003
Randomized Controlled Trial Clinical TrialSeverity of baseline pain and degree of analgesia in the third molar post-extraction dental pain model.
The purpose of this study was to determine whether different levels of pain would respond similarly to analgesia. We compared the analgesic response to ibuprofen in subjects with moderate versus severe baseline pain in clinical trials using the third molar post-extraction dental pain model. We performed a pooled raw data analysis of 517 subjects included in the ibuprofen treatment arm of 11 similar studies submitted to the Food and Drug Administration. The inclusion and exclusion criteria were similar in all studies. All studies used the same metrics and recorded pain at the same times. As expected, the well established analgesic effect of ibuprofen was confirmed. More intense baseline pain was initially associated with a larger decrease and greater fractional decreasing in pain intensity after medication. A larger percentage of those with milder baseline pain obtained relief compared with those with severe baseline pain. Reduction in pain intensity occurred mainly in the first 2 h. At later time points, the association of baseline conditions with a reduction in pain level diminished. We conclude that the intensity of initial pain is not correlated with the need for larger doses of analgesic. ⋯ A person taking an analgesic wants to know when and how well it will work. People with moderate pain are more likely to get relief, whereas those with severe pain who get relief will get relatively more relief. Most relief of acute pain occurs within less than 2 h. These data indicate that most people with intense initial pain do not require larger doses of analgesics.