Articles: postoperative-pain.
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Anesthesia and analgesia · Jun 2004
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of the neuroprotective effects of S(+)-ketamine during open-heart surgery.
We compared the effect of S(+)-ketamine to remifentanil, both in combination with propofol, on the neurocognitive outcome after open-heart surgery in 106 patients. A battery of neurocognitive tests was administered before surgery and 1 and 10 wk after surgery. Fourteen patients (25%) in the control group and 10 patients (20%) in the S(+)-ketamine group had 2 or more tests with a cognitive deficit (decline by at least one preoperative SD of that test in all patients) 10 wk after surgery (P = 0.54). Z-scores were calculated for all tests. No significantly better performance could be detected in the S(+)-ketamine group, except for the Trailmaking B test 10 wk after surgery. We conclude that S(+)-ketamine offers no greater neuroprotection compared with remifentanil during open-heart surgery. ⋯ N-methyl-D-aspartic acid receptors play an important role during ischemic brain injury. We could not demonstrate that S(+)-ketamine resulted in greater neuroprotective effects compared with remifentanil during cardiopulmonary bypass procedures when both were combined with propofol.
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Randomized Controlled Trial Clinical Trial
Treatment of pain after spinal surgery in the recovery room by single dose lornoxicam: a randomized, double blind, placebo-controlled trial.
Lornoxicam has been used in microsurgical lumbar discectomy. However, there is no data about controlling pain after open discectomy or laminectomy. ⋯ Lornoxicam 16 mg given intravenously before wound closure provides inadequate pain relief immediately after disectomy or laminectomy in the PACU. However, adequate pain relief was demonstrated at 2 hr after surgery, which was similar to the placebo.
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Comparative Study
Quantification of pain and satisfaction following laparoscopic and open hernia repair.
Subjective experiences can be quantified by visual analog scale (VAS) scoring to improve comparison of surgical techniques. ⋯ Pain following hernia repair was age dependent. Following laparoscopic repair, patients had lower first-day pain scores in younger patients and earlier return to normal activities in all patients. Satisfaction was similar for both approaches. Subjective experiences can be quantified, compared to detect subtle differences in outcome for competing surgical techniques, and used to counsel patients before operation, with the goal of improving satisfaction.
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J. Perianesth. Nurs. · Jun 2004
ReviewTreating children for acute agitation in the PACU: differentiating pain and emergence delirium.
Differentiating postoperative pain from emergence delirium in children is challenging for even the most experienced PACU nurse. This article presents a review of the literature and clinical practice experiences that will help guide the PACU nurse in recognizing and differentiating these two conditions that are common in children recovering from anesthesia. ⋯ Treatment with opioids is recommended as the primary strategy for safely recovering the child experiencing acute postanesthesia agitation, whether from pain or emergence delirium. Tools commonly used to assess both pain and postanesthesia agitation in children are reviewed, and an algorithm to facilitate the decision-making process is provided.
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Prescrire international · Jun 2004
Comparative StudyParecoxib: new preparation. A NSAID for postoperative pain: no proven advantage.
(1) Parecoxib is the second nonsteroidal antiinflammatory drug, after ketoprofen, to be marketed in France for the treatment of postoperative pain. (2) Another injectable NSAID, ketorolac, was marketed briefly in the 1990s. It was shown to be no more effective than ketoprofen, but was withdrawn from the French market because it provoked bleeding. (3) The clinical evaluation dossier on parecoxib contains no data from comparative trials with ketoprofen. ⋯ There is no evidence that this reduction translates into a lower risk of adverse reactions to opiates. (5) Parecoxib is marketed as "Cox-2-specific inhibitor", but follow-up is too short to show whether this property avoids the severe adverse effects seen with other NSAIDs, such as renal failure, gastrointestinal haemorrhage, and delayed wound healing. Parecoxib, like its principal metabolite valdecoxib, can cause severe hypersensitivity reactions. (6) Parecoxib is 10 times more expensive than injectable ketoprofen in France. (7) In practice, ketoprofen is still the best choice for parenteral NSAID-based pain relief in the postoperative setting.