Articles: analgesia.
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The appropriateness of any set of criteria generated to measure the quality of a particular intervention is dependent upon a thorough, up-to-date assessment of the current state-of-the-art. Few areas in nursing have received as much research attention as that of pain control, particularly post-operative pain control. ⋯ This particular format was selected in order to help in the development of structure, process and outcome criteria on the topic of post-operative pain management. The section on measurement is to inform practitioners about pain-assessment charts and provide ideas about auditing this area.
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Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. ⋯ The aim of an analgesic technique should be not only to lower the pain scores but also to facilitate earlier mobilization and reduce perioperative complications. If future clinical investigations clarify the issues that have been raised by laboratory studies, clinicians may be able to effectively treat postoperative pain using combinations of "balanced," "preemptive," and "peripheral" analgesia. More important, improved analgesic techniques will increase patient satisfaction and enhance their perception of ambulatory anesthesia and surgery.
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine and bupivacaine analgesia after arthroscopic knee surgery.
We assessed the effectiveness of intra-articular solutions of morphine, bupivacaine with adrenaline and a combination of both, compared with placebo in facilitating mobilisation and reducing postoperative pain and analgesic requirements for 24 h after operation. Forty patients undergoing arthroscopic knee surgery were studied in a double-blind, randomised, controlled trial. ⋯ Morphine alone provided the best analgesia and significantly decreased analgesic consumption for 24 h after surgery. We conclude that 1 mg of intra-articular morphine provides effective pain relief following arthroscopic knee surgery and that the addition of bupivacaine is of no benefit.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain relief in children. A comparison between caudal bupivacaine and intramuscular diclofenac sodium.
Two hundred and fifty children undergoing herniotomy or orchidopexy under general anaesthesia were randomly allocated to receive pre-operatively either diclofenac sodium 1 mg.kg-1 given intramuscularly or a caudal injection of bupivacaine 0.25% 1 ml.kg-1 with or without adrenaline or no analgesia. Plasma diclofenac and beta-endorphin concentrations were determined in eight and 21 patients respectively. Postoperative pain was assessed by ward nurses who were blinded to the group allocation. ⋯ Caudal analgesia abolished the stress-induced increase in plasma beta-endorphin level which was found in the children given diclofenac and in those who served as controls. Total plasma clearance of intramuscular diclofenac sodium appears to be higher in children than in adults. A single intramuscular dose of diclofenac significantly reduces the need for an opioid analgesic in children after inguinal herniotomy or orchidopexy, and owing to its long duration of action, it offers an alternative or complementary method of pain relief to caudal analgesia.
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Randomized Controlled Trial Clinical Trial
The EMLA patch--a new type of local anaesthetic application for dermal analgesia in children.
The skin application of EMLA cream under a Tegaderm dressing was compared in children with a new combined dressing/local anaesthetic patch--the EMLA patch. The analgesic effect during venepuncture was assessed using a visual analogue scale (patients) and a verbal rating scale (investigator). Skin adhesiveness and incidence of local skin reactions with the two types of application were also studied. ⋯ Only mild local skin reactions (with paleness in the anaesthetised skin area) were observed in both groups. It was concluded that both the EMLA patch and the Tegaderm/EMLA cream dressing provide effective dermal analgesia for venepuncture with a 0.8 mm (outer diameter) cannula. The two types of application were indistinguishable but the ease of application of the patch is a distinct advantage.