Articles: analgesia.
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Patient-controlled analgesia is an effective method of controlling postoperative pain, providing its introduction is planned carefully and both staff and patients have been fully trained in the technique.
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Advances in the technology of infusion pumps and ports have opened a new spectrum of indications. The choice of the device is dependent on the specific indication. ⋯ As demonstrated in several studies, ports can be safely used for chronic pain treatment. However, as with the use of infusion pumps, the indications for use must be evaluated carefully and especially-trained staff is a prerequisite for success.
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Case Reports
Thoracotomy wound exploration in a single lung transplant recipient under extrapleural paravertebral nerve blockade.
Instillation of bupivacaine through a catheter accurately placed in the extrapleural space prior to closure of a thoracotomy incision provides effective, reliable post-operative analgesia. Its usefulness for further surgery in the post-operative period, in this case wound exploration in a lung transplant recipient, is described.
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Randomized Controlled Trial Clinical Trial
Effect of intravenous diclofenac on pain and recovery profile after day-case laparoscopy.
Diclofenac sodium, 100 mg, or saline was given intravenously after the induction of anaesthesia to 169 patients undergoing outpatient gynaecological diagnostic laparoscopy or laparoscopic sterilization by tubal ligation. Propofol was used as the main anaesthetic agent and fentanyl and paracetamol were given for post-operative pain relief. In the post-anaesthesia care unit the amount of analgesics given and the incidence of nausea and vomiting were recorded. ⋯ However, patients in the tubal ligation group needed significantly more post-operative analgesia than patients in the laparoscopy group. Diclofenac had no influence on the rapidity of recovery or home readiness in either group. It is concluded that diclofenac has no influence on home readiness, but prevents postoperative pain in patients undergoing diagnostic laparoscopies, whereas it was not a potent enough analgesic to prevent pain after laparoscopic tubal ligation.
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Randomized Controlled Trial Clinical Trial
Pediatric PCA: the role of concurrent opioid infusions and nurse-controlled analgesia.
We designed a clinical study to determine: a) the safety and efficacy of patient-controlled analgesia (PCA) therapy in children and adolescents undergoing major operations, b) if the use of a concurrent opioid infusion improved the efficacy of conventional PCA therapy, and c) if nurse control of the PCA device was a useful alternative in the intensive care unit (ICU) setting. ⋯ Both PCA and NCA were safe and efficient methods of analgesic administration in the pediatric ICU setting. However, use of a concurrent opioid infusion with PCA therapy did not provide any clinically significant advantages over intermittent bolus doses of the analgesic medication after scoliosis surgery. For patients unable to use a conventional PCA device, NCA is an acceptable alternative for the management of acute pain in the ICU setting.