Articles: postoperative-pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cryoanalgesia for post-thoracotomy pain.
Intercostal block by a freezing technique was compared with blockade by local anaesthetics or no blockade as a method of treating post-thoracotomy pain. The 15 patients who received cryotherapy had significantly less postoperative pain than the 9 patients whose nerves were blocked by local anaesthetics or who did not receive any nerve block. The interruption of nerve function produced by cryotherapy was temporary (not more than 30 days), and there were no adverse sequelae.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind comparison of meptazinol with pethidine in postoperative pain.
Three groups each of 24 patients who had undergone total abdominal hysterectomy were studied on the 1st day after operation. Under double-blind conditions, group 1 compared meptazinol 60 mg with pethidine 100 mg, group 2, meptazinol 75 mg with pethidine 100 mg and group 3, meptazinol 100 mg with pethidine 100 mg. ⋯ From the pain relief score, pethidine was not significantly better than any dose of meptazinol in relieving pain. Patients preferred pethidine 100 mg to meptazinol 60 mg (P less than 0.01, McNemar's test), but there was no significant difference between meptazinol and pethidine for observer or patient preference when the dose of meptazinol was increased to 75 mg or 100 mg.
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The human intercostal space has been studied by excision of the posterior part of the rib cage at autopsy, followed by fixation, decalcification, section and staining. Injection of India ink was used to simulate local anaesthetic. At a point 7 cm from the midline, the distance from the posterior aspect of the rib to the pleura averaged 8 mm. ⋯ An injection of 3 ml will also spread medially to enter the paravertebral space and surround the sympathetic chain. A small clinical study gave excellent analgesia after operation for a mean duration of 12.3 h following unilateral intercostal block with 3 ml of bupivacaine 0.5% (with adrenaline) into each of the intercostal spaces T5-11, before cholecystectomy through a subcostal incision. There were no complications in the series.
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Our experience in treating 10 patients with intractable pain with paraplegia employing percutaneous epidural or dorsal column stimulation is presented. Initial and long-term results in this group are contrasted with those of 9 patients with intractable post-amputation or post-traumatic neuroma pain. The successful results of neurostimulation treatment of peripheral nerve pain contasts with the disappointing results in the treatment of paraplegic pain.
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The effect of local nerve blockade on the relief of postoperative pain is reported in a series of 167 patients who underwent surgery of the arm, knee or foot. In 80% of cases analgesics were not required within 4 hours postoperatively, and in 39% analgesics were not required within 8 hours. Conventional methods of postoperative pain relief are not always effective. Local nerve blockade can be used to provide complete analgesia after limb surgery and is therefore of great value to postoperative care.