Articles: postoperative-pain.
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Case Reports Comparative Study Clinical Trial Controlled Clinical Trial
Postoperative TENS pain relief after knee surgery: objective evaluation.
A comparison was made between the pain-relieving effect of placebo-transcutaneous electrical nerve stimulation (TENS), high frequency TENS, and epidural analgesia with dilute local anesthetics in 15 patients with open knee surgery. Assessment of pain was compared with the patients' ability to contract their quadriceps muscle; the ability was measured with integrated EMG (IEMG) before and after the different treatments. The results showed that placebo-TENS had no significant effect on either pain perception or on IEMG. ⋯ Epidural injection of a dilute local anesthetic decreased pain perception by 90% at rest and by 67% after contraction, and increased muscle contraction ability by 1,846%. TENS undoubtedly has a place in the postoperative pain treatment, although its effect is not as strong as that of epidural analgesia with local anesthetics. TENS, however, is easy to administer, lacks side effects, and can be administered by the patients themselves.
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Anesthesia and analgesia · Oct 1986
Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery.
Twenty patients scheduled for elective major abdominal surgery were matched into two groups with regard to age, sex, height, body weight, and surgical procedure. Both groups received general anesthesia plus lumbar epidural analgesia with similar loading doses of bupivacaine 0.5% (23.1 +/- 1.0 and 23.3 +/- 0.8 ml) (mean +/- SEM) followed by continuous infusion of plain bupivacaine 0.5% (8 ml/hr) plus, in one group, epidural morphine (0.5 mg/hr). Pain score on a 5-point scale and sensory analgesia (pin prick) were assessed hourly for 16 hours after skin incision. ⋯ Thus, within 10 hr after skin incision, seven patients in this group were discharged from the study, and 16 hr after incision only one patient maintained initial level of sensory analgesia. In contrast, each patient receiving bupivacaine plus morphine had stable sensory analgesia and was completely free of pain as indicated by a mean pain score of zero during the 16-hr observation period. Thus epidural morphine may improve pain relief and maintain analgesia during continuous epidural bupivacaine administration after abdominal surgery.
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Forty-five patients in four groups undergoing orthopaedic, upper abdominal, prolonged or cardiac surgery received a constant rate i.v. infusion of fentanyl 100 micrograms h-1, for 24 h starting 2 h before surgery. A single bolus dose was given i.v. at the induction of anaesthesia. ⋯ The elimination half-life was 7.3-9.7 h. This simple regimen produced effective analgesia.
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Randomized Controlled Trial Clinical Trial
Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy.
We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. ⋯ Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However, TENS had considerable patient appeal and many patients believed that it was effective.