Articles: postoperative-pain.
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Comparative Study Clinical Trial
Efficacy and adverse effects of patient-controlled epidural or intravenous analgesia after major surgery.
The purpose of this retrospective study was to determine whether epidural fentanyl-bupivacaine patient-controlled analgesia (PCA) was more efficacious and had fewer adverse effects than epidural or intravenous morphine PCA. ⋯ Patients receiving epidural fentanyl-bupivacaine PCA experienced better overall pain relief, while morphine PCA, either epidurally or intravenously, caused more side effects. It is considered safe to use continuous epidural PCA with fentanyl-bupivacaine in patients receiving major elective surgery.
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Heart, lung & circulation · Dec 2004
Hand-assisted Thoracoscopic Surgery causes less postoperative pain than limited thoracotomy after cessation of epidural analgesia.
Hand-assisted Thoracoscopic Surgery (HATS) is a novel minimally invasive technique for performing procedures conventionally performed by posterolateral thoracotomy. HATS overcomes a major drawback of thoracoscopic surgery in allowing full manual palpation of the lungs via a subcostal (mini-Kocher's) incision under videoscopic guidance, avoiding a thoracotomy, when the indication is pulmonary metastasectomy with curative intent or resection of undiagnosed lung nodules. It is postulated HATS may produce improved postoperative quality of life outcomes compared to thoracotomy. ⋯ HATS results in lower postoperative pain after cessation of epidural analgesia. This form of analgesia may therefore not be required, reducing the management complexity, complications and hospital stay associated with its use. SHORT ABSTRACT: Hand-assisted Thoracoscopic Surgery (HATS) is a novel technique allowing full manual lung palpation as an adjunct to Video-assisted Thoracoscopic Surgery (VATS). Fifty-two patients were prospectively randomised to receive limited thoracotomy or HATS. Pain scores were significantly lower after HATS compared to thoracotomy, indicating epidural analgesia may not be required.
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Anaesth Intensive Care · Dec 2004
Comparative StudyDexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy.
We investigated the haemodynamic effects and the efficacy of a continuous infusion of dexmedetomidine without a loading dose in 50 patients having had cardiac surgery (n = 33), complex major surgery (n = 9) and multiple trauma (n = 8). The mean age was 60 (+/- 16) years, and the mean APACHE II score was 13 (+/- 5). Dexmedetomidine was commenced at an initial rate of 0.2 to 0.4 microg/kg/h (depending on whether anaesthetic or sedative agents had already been used) and rescue analgesia and sedation was administered with morphine and midazolam respectively. ⋯ The systolic blood pressure fell from 125 (+/- 22) mmHg to a low of 112 (+/- 20) mmHg at 1.5 hours with minimal change afterwards. Dexmedetomidine was an effective sedative and analgesic in this group of complex surgical and trauma patients with pronounced benefit in the cardiac surgery group. Omitting the loading dose avoided undesirable haemodynamic effects without compromising sedation and analgesia.
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Paediatric anaesthesia · Dec 2004
Clinical signs of infection during continuous postoperative epidural analgesia in children: the value of catheter tip culture.
Infection arising from the use of epidural catheters for postoperative analgesia is a major source of anxiety. ⋯ Minor local signs of inflammation and infection are common in pediatric patients during continuous epidural infusion. Epidural catheter tips are also frequently culture positive in patients with and without local signs and who may not go on to develop further signs or symptoms of infection. Routine culture of catheter tips is unnecessary as it is not a good predictor of epidural space infection.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Intraoperative autonomic nervous activities and postoperative analgesia when general anesthesia was applied using an opioid combination].