The Clinical journal of pain
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Randomized Controlled Trial Comparative Study Clinical Trial
Does the anesthetic technique influence the postoperative analgesic requirement?
In order to determine the effect of two standard general anesthetic techniques on the postoperative analgesic requirement, 53 adults undergoing elective intra-abdominal surgery were randomly assigned to one of two anesthetic treatment groups according to an open parallel protocol design. One of the groups received an opioid-based anesthetic; the other group was administered an inhaled anesthetic. The postoperative analgesic requirement was quantified using a Baxter PCA device. ⋯ During the first 8 hours after discharge from the recovery room there was a trend toward higher PCA morphine usage in the inhaled anesthetic group (25.6 +/- 15 mg vs. 18.6 +/- 13 mg); however, this difference was not statistically significant (p = 0.08). From 8 to 40 hours after surgery, the morphine usage was nonsignificantly higher in the opioid group (64 +/- 30 mg vs. 56 +/- 38 mg, p = 0.43). In conclusion, the general anesthetic technique used during an elective operation appeared to have little if any effect on the postoperative analgesic requirement after discharge from the recovery room.
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Randomized Controlled Trial Clinical Trial
Modulation of heat pain perception by high frequency transcutaneous electrical nerve stimulation (TENS).
Although many studies have indicated that high frequency nonpainful transcutaneous electrical nerve stimulation (TENS) reduces clinical pain, controlled studies of the modulation of experimental pain by TENS have produced conflicting results. This study evaluated the effect of high frequency nonpainful TENS on heat pain perception using a model that we have previously shown to be sensitive to other nonpharmacological analgesic treatments. We found that TENS significantly reduced subjects' ratings of painful and near painful heat stimuli (43-51 degrees C) (p = 0.01) and increased the pain threshold from 46.7 to 47.9 degrees C (p = 0.002). ⋯ Furthermore, TENS did not alter subjects' ratings of visual stimuli, indicating that the analgesic effect was not due to a nonspecific distraction. These data suggest that TENS alters the perception of experimentally produced natural pain stimuli. The TENS related modulation also appears to be comparable to that produced by other nonpharmacological analgesic manipulations such as counterirritation and changes in attention.
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The technique of long-term, open catheterization of the spinal subarachnoid space for infusion of analgesics in patients with refractory cancer pain is sparsely reported in the literature. We report on a technique using 18G Portex nylon catheters and 16G-17G Tuohy needles, and its problems and complications. One hundred fifty-seven catheters were inserted in 142 patients, in most of them (79%) under deep sedation and local anesthesia. ⋯ Absorbent and impermeable dressings were applied over the tunnel exit, catheter Luer connection and bacterial filter. Antibiotics were given on the day of insertion and 2 days thereafter. During the insertion procedure, the following problems and complications were encountered; two or more attempts before successful spinal-dural puncture (32%), accidental puncture of an extradural vessel (10%), difficult dural puncture (18%), absence of free dripping of cerebrospinal fluid (CSF) in spite of successful dural puncture (4%), blood-stained CSF (9%), radicular pain and paresthesiae (4%), difficult advancement of the catheter (6%), difficult tunneling (11%), and bleeding in the tunnel (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)
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A study was conducted to determine symptom report patterns in a heterogenous population of orofacial pain patients and to evaluate how symptom patterns relate to various dimensions of the human pain experience. Results indicated that symptoms frequently associated with chronic orofacial pain disorders can be described by four indices related to the temporomandibular joint (TMJ) and its movement; discomfort of and parafunctional activities related to the masticatory muscles; interference of pain with activities of daily living; and presence of orofacial pain unrelated to myogeneous or arthrogenous TMJ disorders. Of these four symptom indices, only the pain interference (symptom) index was related to clinical pain and illness behavior. ⋯ Two of the indices were influenced by diagnosis. Biomechanical symptoms and parafunctional activities appear to be insignificantly related to perceived pain intensity, pain responsiveness, illness behavior, or personality, but are related to diagnosis. The results indicated that relatively simple symptom checklists have potential utility in screening orofacial pain patients and in evaluation of treatment outcome.