Articles: postoperative-pain.
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The study was undertaken to evaluate the postoperative pain control ability of ketamine injected into the epidural space. We conclude that it produces potent postoperative analgesia without major respiratory depression or other side effects.
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The comparative effects of low doses (0.03-0.04 mg/kg) of epidural morphine on a nociceptive flexion reflex of the lower limb and on postoperative pain in volunteer patients were studied after orthopedic surgery on one knee. According to the stimulation parameters, it was found that 40-50 min after the injection, morphine produced an increase of 87% and 83% of the reflex threshold and of the threshold of maximal reflex response, respectively, as well as a 80-90% depression of the nociceptive responses when elicited by a constant level of stimulation. Onset of pain relief occurred by the 25th min and increased to a maximum stable level 40-50 min after the injection. These data support the hypothesis that the main site of the pain-relieving effect of epidural morphine is located directly at a spinal level.
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Comparative Study
Manometric diagnosis of sphincter of Oddi spasm as a cause of postcholecystectomy pain and the treatment by endoscopic sphincterotomy.
Seventeen patients with postcholecystectomy pain and nine controls were studied by nonoperative biliary manometry with stimulation of sphincter of Oddi spasm by morphine. The controls remained asymptomatic despite an elevation of bile duct pressure after morphine. In 13 patients with postcholecystectomy pain, morphine induced pain paralleling a pressure rise. ⋯ Endoscopic sphincterotomy provided complete (8), moderate (3), or slight (1) relief of pain to 12 patients with the parallel pain-pressure relationship. Postsphincterotomy manometry showed disappearance of both the pressure elevation and pain induction, and the morphine-Prostigmin test turned negative. It is concluded that morphine-induced bile duct pressure elevation coinciding with pain is diagnostic of sphincter spasm as a cause of postcholecystectomy pain, the morphine-Prostigmin test, although helpful, is less specific and less sensitive in diagnosing sphincter spasm than the manometry, and endoscopic sphincterotomy relieves the pain due to this condition in most cases.
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Randomized Controlled Trial Comparative Study Clinical Trial
Patient-controlled postoperative analgesia with alfentanil. Adaptive, on-demand intravenous alfentanil or pethidine compared double-blind for postoperative pain.
A double-blind study comparing alfentanil and pethidine given intravenously by an adaptive, patient-controlled on-demand analgesic system is described. It was demonstrated that, despite its well-known rapid onset of effect, alfentanil took several hours to achieve good quality analgesia. ⋯ Alfentanil was associated with significantly less sedation during the postoperative period than pethidine, and was also associated with a significantly greater urine output during the 24-hour period of study. There was no evidence of tolerance or accumulation with either of the two drugs.