Articles: postoperative-pain.
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Acta Anaesthesiol Scand · Oct 1981
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of epidural morphine and epidural bupivacaine for postoperative pain relief.
In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6-8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4-6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. ⋯ Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.
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Acta Anaesthesiol Scand · Oct 1981
Comparative StudyCaudal block for post-operative pain relief in children after genital operations. A comparison between bupivacaine and morphine.
Twenty-two children formed the basis for a controlled study of the effect and duration of the postoperatively applied caudal block on postoperative pain after genital operations. The purpose of the study was to compare the effect and duration of bupivacaine and morphine. Ten children (Group I, outpatients) underwent circumcision and 12 children (Group II, inpatients) underwent correction of hypospadias. ⋯ Outpatients were discharged after 4-5 h, and the caudal blocks with both bupivacaine and morphine were then still effective. In inpatients, the duration of pain relief was significantly longer using morphine (range 610-2195 min) than using bupivacaine (range 245-515 min). There were no complications of the caudal blocks.
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Comparative Study
Postoperative analgesia in major orthopaedic surgery. Epidural and intrathecal opiates.
Sixty-two patients were given morphine 2 mg and 69 patients were given diamorphine 0.5 mg by either the epidural or intrathecal route. All had undergone either total hip replacement or spinal disc surgery. ⋯ Headache, pruritus, urinary retention and nausea and vomiting were recorded, the incidence of the latter being unacceptably high, particularly when the drugs were administered by the intrathecal route: one patient required resuscitation. It is suggested that previously reported respiratory depression using these techniques is associated with the administration of other analgesics contemporaneously; that dosage should be limited to one-fifth of the estimation intramuscular dose; and that patients should be observed in a recovery ward for 24 hours.
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Comparative Study Clinical Trial
Postsurgical pain: zomepirac sodium, propoxyphene/-acetaminophen combination, and placebo.
Zomepirac sodium, a new, nonnarcotic analgesic agent, was compared with the combination of propoxyphene/acetaminophen in a placebo-controlled, double-blind, single-dose study in 196 hospitalized postsurgical patients with pain severe enough to require a prescription analgesic. Patients received 100 mg zomepirac sodium, 50 mg zomepirac sodium, 100 mg propoxyphene napsylate with 650 mg acetaminophen, or placebo. Total pain relief during the 6-hour observation period showed that 100 mg zomepirac sodium was significantly more effective than the propoxyphene combination. ⋯ Percentages of patients requiring remedication before the end of the study were: 77 per cent for placebo, 48 per cent for propoxyphene/acetaminophen, 43 per cent for 50 mg zomepirac sodium, and 29 per cent for 100 mg zomepirac sodium. The numbers of patients reporting side effects were not significantly different among the treatment groups. These results confirm those of other single-dose pain studies which showed 100 mg zomepirac sodium significantly more efficacious than the propoxyphene/acetaminophen combination.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of meptazinol and pethidine given i.v. on demand in the management of postoperative pain.
Meptazinol and pethidine were compared under double-blind conditions in 20 patients, using an on-demand analgesic system to provide pain relief after upper abdominal surgery. The degree of analgesia, subjectively assessed, was good with both meptazinol and pethidine; although meptazinol produced significantly more nausea than did pethidine (P less than 0.01), there was no statistically significant difference in the frequency of other side-effects. Over 24 h average consumption of meptazinol was 2.4 times that of pethidine, suggesting that, when given by i.v. injection, meptazinol is less potent that pethidine.