Articles: postoperative-pain.
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A 2-day study to assess the safety and efficacy of a combination analgesic, Stopayne (Rio Ethicals), was conducted in 23 postoperative plastic surgery patients with pain of moderate to severe intensity. Statistically significant pain relief was attained, with 2 (9%) patients reporting complete relief 1 hour after taking the tablets and 19 (82%) reporting satisfactory relief (P less than 0.01). ⋯ The average time taken for analgesia to occur was 37.7 min and it lasted an average of 3.8 h. On being woken by pain 18 (78%) patients reported that they were able to sleep again after taking the study drug; 19 patients reported that the tablets helped them to fall asleep.
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Previous erratic use of intermittent intramuscular and intravenous morphine or pethidine for postoperative analgesia prompted a prospective trial of continuous intravenous morphine delivered by an infusion pump. The rate was adjusted to keep the patient free of pain--as assessed by observation in the infant and enquiry in the older child. ⋯ The results of a cohort of 20 patients (aged 3 months-12 years) are presented. Thanks to positive parental and nursing staff support, and absence of complications, administration of postoperative analgesia with continuous intravenous morphine infusion is now standard practice in this unit.
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Randomized Controlled Trial Clinical Trial
Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery.
An assessment was made, in a randomised double-blind fashion, of the pain relief afforded by femoral nerve block (FNB) performed at the end of ligament reconstruction of the knee, using 0.25 per cent bupivacaine in ten patients, and normal saline in ten patients. All patients commenced "continuous passive motion" (CPM) of the operated knee after arrival in the Recovery Room. The postoperative analgesic requirement, both for intravenous fentanyl in the Recovery Room, and intramuscular and oral analgesia on the ward, was then studied. ⋯ The bupivacaine group also required significantly less intravenous fentanyl in the Recovery Room. On the ward, there was no difference between the two groups in the total dose of intramuscular meperidine given in the first 12 hours postoperatively. We conclude that femoral nerve block is a useful adjunct in pain management after ligament reconstruction of the knee, especially in the early postoperative period, but does not decrease the total intramuscular dose of analgesia in the first 12 postoperative hours.
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Acute postoperative pain has an important psychological component. This psychological element could be registered by observing or measuring interindividual differences in pain experience, expressions of pain, and pain-coping behavior. Emotions such as anxiety, anger, and helplessness accompany postoperative pain, and postoperative pain can also be elicited by very intense preoperative anxiety. ⋯ Psychological factors also influence pain reduction. Postoperative aggression and its underlying metabolism facilitates recovery if the physicians or nurses can cope with the anger of the patient. Providing sensory descriptions of the pain during the preoperative visit and careful attention to both the pain-experiencing and the pain-free patient help to reduce pain or prevent its escalation.