Articles: postoperative-pain.
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Br Med J (Clin Res Ed) · Jul 1985
Randomized Controlled Trial Clinical TrialRelief of pain by infusion of morphine after operation: does tolerance develop?
To see whether continuous intravenous infusion of opiates provides more effective postoperative relief of pain than conventional intramuscular injection these regimens were compared in a prospective double blind trial. Thirty patients undergoing elective cholecystectomy were allocated randomly to receive an infusion of morphine or an infusion of placebo (control group) for 24 hours. Both groups were allowed supplementary morphine boluses as requested. ⋯ Nausea and vomiting were more prevalent among the patients given the infusion of morphine. These results suggest that continuous infusion of morphine may be an inferior regimen to intermittent bolus administration in the relief of postoperative pain. This may be explained by the development of tolerance in patients who received the infusion of morphine.
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Regional-Anaesthesie · Jul 1985
[Catheter brachial plexus anesthesia for intra- and postoperative pain control. Plasma concentrations and analgesia interval in the use of bupivacaine].
In 15 orthopedic patients, undergoing plastic surgery of the upper extremity (elbow, forearm, hand) we studied plasma levels and pain free intervals, when performing catheter axillary plexus block with 0.5% and 0.25% bupivacaine as postoperative analgetic agent respectively. 30 minutes after injection of 40 ml of 0.5% bupivacaine maximum plasma levels were reached (means = 1.46 micrograms/ml), followed by a constant but slow decrease to 1 microgram/ml approximately after 2 h. 11.5 h (mean) after brachial plexus block there was a need for reinjection of local anesthetic solution for postoperative pain control. The pain free interval after 30 ml of 0.25% bupivacaine lasted 10.5 hours on the average. The 'top-up-dose' of 75 mg approximately equal to 30 ml of 0.25% bupicavaine caused only a small rise in plasma levels up to 0.6 micrograms/ml. Catheter brachial plexus block with bupivacaine is an appropriate procedure for both intra- and postoperative pain relief, especially in re-implantation surgery of the upper limb.
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Clinical Trial Controlled Clinical Trial
Epidural morphine prophylaxis of postoperative pain: report of a double-blind multicentre study.
In a double-blind placebo-controlled trial, 154 subjects, having intraperitoneal surgery or Caesarean section, and 53 patients undergoing lower limb orthopaedic surgery, received epidural morphine, 5 mg in 10 ml 0.9 per cent NaCl, or placebo, 10 ml 0.9 per cent NaCl, intraoperatively to determine duration of action and efficacy in preventing postoperative pain. Epidural morphine gave significantly longer postoperative analgesia (greater than 11 h) than placebo (3-6 h) in both groups (p less than 0.05) and patients who received morphine required less postoperative analgesic. Obstetric subjects experienced longer pain relief (18.3 +/- 1.3 h) than patients undergoing non-obstetric intraperitoneal surgery (9.2 +/- 1.2 h) (p less than 0.001). ⋯ Respiratory depression occurred in 2-7 per cent of subjects who received morphine; unpredictable in onset, it responded rapidly to naloxone. Epidural bupivacaine, if employed for the surgical procedure, appeared to prolong epidural morphine analgesia. We consider epidural morphine useful in preventing postoperative pain, but its use demands close observation of respiratory rate in a high density nursing area.
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Randomized Controlled Trial Comparative Study Clinical Trial
Suprofen compared to dextropropoxyphene hydrochloride and paracetamol (Cosalgesic) after extraction of wisdom teeth under general anaesthesia.
In a randomised double-blind trial in postoperative ambulant day case dental patients suprofen 200 mg (29 patients) was compared with dextropropoxyphene hydrochloride 65 mg and paracetamol 650 mg (Cosalgesic, 28 patients) both available four times daily for 3 days. Suprofen was better than cosalgesic in the patients' opinion of initial (p = 0.01) and overall pain relief (p = 0.08) compared to Cosalgesic and the second night's sleep was better (p = 0.01). Side effects were reported in six suprofen patients and 10 cosalgesic patients (two suffering from vomiting withdrew). Suprofen, a non-steroidal anti-inflammatory drug is as good as, or better than, a widely used opioid-paracetamol mixture for ambulant patients with postoperative dental pain.