Articles: postoperative-pain.
-
The three main nerves from the lumbar plexus may be blocked by injection of local anesthetic into the facial envelope of the femoral nerve ("three-in-one block"). The femoral nerve may be localized by obtaining paresthesia, by employing a nerve stimulator or by the loss of resistance technique. ⋯ The "three-in-one block" may be employed for immediately pain relief of pain and for treatment of postoperative pain from fractures in the hip, femur and knee. Introduction of a catheter into the femoral nerve sheath is recommended to provide continuous block of the lumbar plexus for relief of postoperative pain.
-
The surgical experience is often characterized by fear, stress, and pain. Whenever an individual has to confront a painful or stressful event such as surgery, the individual's opportunity to control some aspect of the situation may actually influence the degree of pain experienced. ⋯ Regression analyses controlling for age and type of opioid revealed that the psychological measures were important predictors of pain and PCA use. Patients with higher anxiety levels and less social support had higher postoperative pain and made more frequent PCA demands.
-
Randomized Controlled Trial Clinical Trial
Analgesic benefit of locally injected bupivacaine after hemorrhoidectomy.
The analgesic efficacy of locally injected bupivacaine was studied in 40 patients undergoing hemorrhoidectomy. After a standard Milligan-Morgan hemorrhoidectomy, 40 age- and sex-matched patients were randomized to receive either 0.5 percent bupivacaine (1.5 mg/kg) in adrenaline solution (1:200,000) injected into the perianal area, or equivalent volumes of adrenaline solution. ⋯ Although the median time interval between surgery and first analgesic demand was nearly four times greater for patients receiving bupivacaine compared with adrenaline solution, there was no difference in the levels of pain recorded or in the overall opiate requirements. Local injection of bupivacaine after hemorrhoidectomy provides initial pain relief, but patients do not obtain an overall analgesic benefit.
-
The use of spinal opioids in the management of acute pain is now widely accepted. The development of acute pain services has provided standardized approaches to the management of this modality. This article discusses technical considerations, monitoring, and benefits of this approach.