Pain
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Randomized Controlled Trial Clinical Trial
Determinants of success and failure of EMLA.
Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. ⋯ Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of the effects of noxious and innocuous counterstimuli on experimentally induced itch and pain.
We have studied experimentally induced itch (using histamine iontophoresis) and pain (using topical mustard oil) in healthy human volunteers, measured using visual analogue scale (VAS) ratings. The effects of the following counterstimuli were evaluated: innocuous vibration; innocuous transcutaneous electrical nerve stimulation (TENS); innocuous warming of skin; noxious heating of skin; noxious chemical skin stimulation (using mustard oil); mildly noxious constant current transdermal electrical stimulation. Innocuous stimuli applied 2 min after histamine or mustard oil challenge produced a modest reduction of itch and pain ratings (20-30%), which did not persist for more than 20 sec when the counterstimuli were removed. ⋯ The differential effects of noxious counterstimuli on itch and pain do not support the suggestion that itch is a subliminal form of pain. Noxious counterstimuli are likely to act via a central rather than peripheral mechanism. The novel finding that a persistent anti-pruritic state can be induced by transdermal constant current may be useful in conditions of clinical itch.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of morphine, pethidine and fentanyl in the postsurgical patient-controlled analgesia environment.
This study was designed to evaluate whether there is any scientific basis for clinicians' preferences for selecting opioids for use in patient-controlled analgesia (PCA) and to determine whether there are any patients' preferences for being treated with any of these opioids. Results were obtained for 55 postoperative patients recruited to investigate putatively equivalent doses of 3 commonly used opioids--morphine, pethidine and fentanyl--when self-administered postoperatively. No significant differences in the incidence of side effects between groups were found with the exception of more pruritus reported in the group given morphine. ⋯ The majority of patients reported being very satisfied with their postoperative pain management and with PCA, with no differences in satisfaction between the 3 opioid-treated groups. A senior consultant anaesthetist, when asked to make a judgement, was not able to identify which agent each patient was receiving with a better than chance accuracy. These findings suggest that while there may be subtle differences in patient response to these 3 commonly used opioids, none was obviously superior when used for postoperative PCA.
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The aim of the investigation was to evaluate the prevalence, severity, and parents' management of children's pain following short-stay and day surgery. The subjects were 189 parents of children (2-12 years of age) who had undergone short-stay or day surgery. Parents completed a 3-day diary of their child's pain and the methods used to alleviate it. ⋯ On day 3, 17% gave no medication and 45% gave 1-3 doses. Some types of 'minor' surgery result in significant pain postoperatively. Even when parents recognise that their children are in pain, most give inadequate doses of medication to control the pain.
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This study was conducted to determine the contribution of peripheral inputs from injured and intact afferent fibers to behavioral signs of neuropathic pain, using a previously developed neuropathic rat model. Neuropathic injury was produced by tightly ligating the left L5 and L6 spinal nerves; this procedure induced rats to display neuropathic pain behaviors in the ipsilateral hindlimb. The behaviors included signs of mechanical and cold allodynia, as well as ongoing pain. ⋯ Blocking afferent inputs by application of bupivacaine mimicked the results of dorsal rhizotomy, in a reversible manner. These results suggest that afferent signals from injured and intact fibers play distinctively different roles in neuropathic pain: inputs from injured afferents maintain all components of neuropathic pain, while those from intact afferents mediate evoked pain such as mechanical and cold allodynia. An hypothesis is proposed to explain the results of the present as well as other published studies.