Articles: postoperative-pain.
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J Pain Symptom Manage · May 2004
Randomized Controlled Trial Comparative Study Clinical TrialValdecoxib versus rofecoxib in acute postsurgical pain: results of a randomized controlled trial.
The analgesic efficacy of the cyclooxygenase-2 specific inhibitors, valdecoxib and rofecoxib, were evaluated in patients following oral surgery. In a randomized, double-blind, controlled trial, patients experiencing moderate or severe pain received single-dose valdecoxib 40 mg (n=99), rofecoxib 50 mg (n=101), or placebo (n=50) within 4 hours after multiple third molar extraction with bone removal. ⋯ However, valdecoxib was significantly superior to rofecoxib with respect to mean time-specific pain intensity difference and pain relief scores from 30 minutes to 1.5 hours post dose (P < 0.05). All treatments were well tolerated.
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Randomized Controlled Trial Clinical Trial
Evidence-based postoperative pain management in nursing: is a randomized-controlled trial the most appropriate design?
There is an increasing drive to make nursing care evidence-based. High quality evidence from systematic reviews relevant to postoperative pain relief exists, yet pain after surgery remains poorly controlled for many patients. This study aimed to assess whether implementing evidence-based pain management improved postoperative pain outcomes. ⋯ No effects were found on pain in the intervention wards. Pain ratings at rest since surgery, on movement since surgery and worst pain on movement were significantly reduced compared with baseline in the control wards. Although there are many pressures to utilize a randomized-controlled trial study design in the culture of evidence-based health care, there will be times, especially when implementing complex changes in practice that other types of design should be considered.
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Anesthesia and analgesia · May 2004
Randomized Controlled Trial Clinical TrialThe analgesic effects of gabapentin after total abdominal hysterectomy.
We investigated, in a randomized, placebo-controlled, double-blind study, the efficacy and safety of gabapentin on pain after abdominal hysterectomy and on tramadol consumption in patients. The 50 patients were randomized to receive either oral placebo or gabapentin 1200 mg 1 h before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50% N(2)O/O(2) with a fresh gas flow of 2 L/min (50% N(2)O in O(2)) and fentanyl (2 microg/kg). All patients received patient-controlled analgesia with tramadol with a 50 mg initial loading dose, 20 mg incremental dose, 10-min lockout interval, and 4-h limit of 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after 1 h. Patients were studied at 4, 8, 12, 16, 20, and 24 h for visual analog (VAS) pain scores, heart rate, peripheral oxygen saturation, mean arterial blood pressure, respiratory rate, sedation, and tramadol consumption. The VAS scores in the sitting and supine position at 1, 4, 8, 12, 16, and 20 h were significantly lower in the gabapentin group when compared with the placebo group up to 20 h after surgery. The tramadol consumption at 12, 16, 20, and 24 h and total tramadol consumption were significantly less in the gabapentin group when compared with placebo group. Sedation scores were similar at all the measured times. There were no differences between groups in adverse effects. Preoperative oral gabapentin decreased pain scores and postoperative tramadol consumption in patients after abdominal hysterectomy. ⋯ This randomized, controlled trial examined the effects of preoperative oral gabapentin 1200 mg on postoperative pain and tramadol consumptions. We conclude that preoperative oral gabapentin is effective in reducing postoperative pain scores and tramadol consumption in patients after abdominal hysterectomy.
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Minerva anestesiologica · May 2004
ReviewPostoperative analgesia in infants and children: new developments.
Nowadays, postoperative pain control in infants and children is a big challenge. The only effective solution is a multidisciplinary work with accurate guidelines, starting from the preoperative period throughout the surgery and arriving at the postoperative period. The approach must be scientific, based on the recent studies and research. ⋯ In these last two years also our group performed several continuous peripheral nerve blocks particularly axillary, femoral and sciatic for major orthopedic surgery and trauma. In our institution, we use a bolus dose of 0.5-1 ml/kg (depending on the nerve to be blocked) of ropivacaine 0.2% or levobupivacaine 0.25% with clonidine 2 microg/kg and then in infants older than 6 months and children we use a continuous infusion of 0.1-0.3 ml/kg/h of 0.2% ropivacaine or 0.25% levobupivacaine with clonidine 3 microg/kg/24h for 48-72 hours. For older children doses and concentrations are usually the same used in adults.
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Optimal treatment for acute pain is a function of an individual's willingness to make trade-offs between treatment side effects and pain control. The objective was to investigate the degree to which patients are willing to make these trade-offs. ⋯ We conclude that people have different relative preferences for different side effects and are willing to trade-off pain relief for less upsetting and/or less severe side effects but to different degrees. Thus, physicians should consider offering pain medications with fewer side effects than narcotics as a first choice. Our study indicates the need to balance analgesia and side effects in order for patients to achieve optimal pain control.