Articles: postoperative-pain.
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Comparative Study Clinical TrialPost-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. The effects of per- and post-operative analgesia on morbidity.
One hundred and twenty-nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v. nicomorphine during surgery and epidural nicomorphine post-operatively (epidural group, n = 58) or to balanced intravenous anaesthesia without i.v. opiates but with high thoracic epidural regional block during the operation and with post-operative intramuscular nicomorphine (intramuscular group, n = 71). Post-operative nicomorphine was only given at the request of the patients, and as frequently as needed to obtain satisfactory pain relief. ⋯ The requirements of nicomorphine over a period of 3 days were significantly lower in the epidural group 42 mg (s.d. = 18) versus 92 mg (s.d. = 33) in the intramuscular group. Significantly fewer pulmonary complications were observed in the epidural group: 7 atelectases compared to 27 in the intramuscular group. The epidural group showed no signs of ventilatory depression in spite of a catheter inserted at the T3-T4 level.
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Clin. Pharmacol. Ther. · Oct 1987
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesic efficacy of two ibuprofen-codeine combinations for the treatment of postepisiotomy and postoperative pain.
Our purpose was to compare the analgesic efficacy and safety of single oral doses of the combination of ibuprofen 400 mg plus codeine 60 mg and the combination of ibuprofen 200 mg plus codeine 30 mg with ibuprofen 400 mg alone, codeine sulfate 60 mg alone, and placebo. One hundred ninety-five patients with severe pain resulting from episiotomy, cesarean section, or gynecologic surgery completed a randomized, double-blind, stratified, parallel-group study. Patients were observed during a 4-hour period after medication. ⋯ The mean effect of the combination of ibuprofen 400 mg plus codeine 60 mg was significantly superior to the mean effect of ibuprofen 400 mg alone 1/2, 1, and 2 hours after medication and to the mean effect of ibuprofen 400 mg alone and codeine 60 mg alone for SPID, TOTPAR, and other measures as well. The low-dose combination was significantly more effective than codeine 60 mg for a few hourly measures but was not significantly superior to ibuprofen 400 mg. Based on these findings it appears that the combination of ibuprofen 400 mg plus codeine 60 mg, particularly in the first few hours after medication, is more efficacious than its constituents.
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Acta Anaesthesiol Scand · Oct 1987
Randomized Controlled Trial Clinical TrialThe effect of thoracic epidural analgesia on respiratory function after cholecystectomy.
To assess the effect of thoracic epidural analgesia (TEA) on postoperative respiratory function and pulmonary complications, a prospective randomized trial was conducted in patients undergoing cholecystectomy. One hundred patients were allocated to TEA (n = 30), TEA + general anesthesia (TEA + GA) (n = 30), or general anaesthesia (GA) (n = 40) groups. Respiratory function was analysed by measuring forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), total lung capacity (TLC), peak expiratory flow (PEF) in the supine and sitting postures, and arterial blood gases. ⋯ The preoperative difference of 27% in FRC between the sitting and supine postures was maintained after operation. PaO2 decreased by 0.8 kPa after TEA, by 1.5 kPa after TEA + GA with the lowest value on the 2nd postoperative day and by 1.5 kPa after GA, with the lowest value immediately after operation. Simultaneous hypercarbia indicated hypoventilation, which may have contributed to impaired respiratory function on the following days.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Oct 1987
Randomized Controlled Trial Comparative Study Clinical TrialEffects of lidocaine infusion on the sympathetic response to abdominal surgery.
Activation of afferent nerves in the area of surgery is a cause for surgical pain and stress. Intravenous (IV) lidocaine has been shown to inhibit postoperative pain. In the present double-blind study, the effects of a continuous IV infusion of lidocaine (2 mg/min) on the sympathoadrenal stress response to surgery were evaluated in 38 patients scheduled for elective cholecystectomy who were randomly assigned to two groups. ⋯ Urinary catecholamine concentrations did not differ significantly in the two groups during the first postoperative day, but during the second postoperative day urinary output of epinephrine and norepinephrine were significantly less in the group of patients receiving lidocaine infusion. It was concluded that the IV infusion of lidocaine during and after major abdominal surgery suppresses extubation-induced hypertension and tachycardia but does not inhibit the general sympathetic response during the first postoperative day. However, lidocaine infusion reduces urinary output of catecholamines during the second postoperative day, suggesting a more rapid decline in the sympathoadrenal response postoperatively in the experimental group.
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Anesthesia and analgesia · Oct 1987
The effects of age, epinephrine, and operative site on duration of caudal analgesia in pediatric patients.
The effects of age, operative site (penoscrotal or inguinal), and the addition of epinephrine 1:200,000 to bupivacaine on duration of postoperative analgesia after caudal block were prospectively and blindly evaluated in 341 children aged 13 months to 17 yrs. At the conclusion of the surgical procedures under halothane/N2O/O2 anesthetics (n = 419), caudal blocks were performed with 0.5 ml/kg of either 0.25% bupivacaine or 0.25% bupivacaine with 1:200,000 epinephrine injected at a rate of 0.5 ml/sec. ⋯ There were no major complications. The authors conclude that duration of analgesia is significantly influenced by age, operative site, and the addition of epinephrine 1:200,000 to bupivacaine.