Articles: postoperative-pain.
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Acta Anaesthesiol Scand · Jan 1985
Epidural morphine for postoperative pain: experience with 1085 patients.
A prospective study of the effect and side-effects of epidural morphine for pain relief in 1085 patients after thoracic, abdominal, urologic, or orthopaedic surgery was performed. Morphine chloride was diluted in saline or bupivacaine and administered through an epidural catheter placed at a segmental level appropriate for the type of surgery. The initial dose was 4 or 6 mg morphine and supplementary doses were given when needed to obtain complete freedom from pain during deep breathing or nursing care. ⋯ Postoperative nausea or vomiting was more frequent in women than in men (P less than 0.001). There was a higher incidence of nausea or vomiting in men experiencing pain than in men who were completely pain-free after abdominal surgery (P less than 0.001). Respiratory depression was rare and occurred as a gradually decreasing respiratory rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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A questionnaire was sent to 302 qualified nurses in an attempt to elicit their current practice of administering postoperative analgesics, knowledge of the drugs, opinions regarding prescribing habits and comments on how pain control could be improved; 211 nurses replied (70% response). Knowledge was good but practice poor in that 56% give less than six doses postoperatively and the majority of nurses do not give analgesics until the patient is in pain; 66% thought the amount of analgesic given was a poor indication of pain experienced; 62% felt that prescribing by doctors was inconsistent and 90% thought it could be improved. ⋯ The nurses wished for more involvement in pain management and for more education of patients preoperatively. A selection of comments is included and possible simple methods for improving pain control are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of patient-controlled versus conventional analgesia for postoperative pain.
Patient-controlled i.v. administration and intramuscular administration of morphine sulfate were compared in a crossover study to determine their relative effectiveness in relieving postoperative pain. Twenty adult patients scheduled for abdominal surgery were randomly assigned to one of two groups; one group received i.v. morphine sulfate for 24 hours using a patient-controlled analgesia (PCA) device, after which they were given morphine sulfate i.m. for 24 hours. The treatment order was reversed for the other group. ⋯ No significant differences in amount of narcotic used, respiratory rate, nausea and vomiting, or levels of activity or sedation were noted for the two regimens. Patients' rankings of the two treatment modes did not differ significantly, but a majority of patients indicated a preference for future use of PCA. In these postoperative patients, administration of i.v. morphine sulfate by PCA was as safe as i.m. administration and possibly more effective in relieving pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Acetylsalicylic acid compared with acetylsalicylic acid plus codeine as postoperative analgesics after removal of impacted mandibular third molars.
In a multicenter, double blind clinical trial a combination of acetylsalicylic acid 500 mg + codeine phosphate 30 mg has been compared with acetylsalicylic acid 500 mg as postoperative analgesics in patients with pain after surgical removal of impacted mandibular third molars. Evaluation of the results from 129 patients showed that the combination of acetylsalicylic acid and codeine provided better pain relief and also the number of tablets used was smaller and the time intervals between repeated doses were longer than with acetylsalicylic acid only. Adverse effects were few and similar for both drugs. It may be concluded that the combination of 500 mg acetylsalicylic acid and 30 mg codeine phosphate provides a useful analgesic for more severe pain conditions in oral surgery.