Articles: postoperative.
-
Intravenous administration of local anaesthetics has repeatedly been recommended for the treatment of chronic pain. Some authors have also reported on their use in postoperative pain management. However, most of these publications are case reports or refer to rather old studies or investigations based on study designs that fail to meet present scientific standards. ⋯ During the first 24 h after surgery 12 patients in the lidocaine group required a total of 550 mg meperidine in addition, while 8 patients in the control group required a total of 300 mg meperidine. The postoperative meperidine consumption was not significantly diffent between the lidocaine group and the control group. Intravenous lidocaine infusion did not significantly reduce postoperative pain after tonsillectomy in the dosage used.
-
Opioids have been used for analgesia in nearly all civilizations. In paediatrics their use has become widely accepted for combating severe pain, especially postoperative pain and tumour pain. Receptors in the central nervous system are the best known sites of action of opioids, but the existence of peripheral receptors is also probable. ⋯ Tramadol is widely used for emergencies, as it has the least sedative action; but it has disadvantages in causing nausea and vomiting. Codeine is widely used for its antitussive action. While the necessity of good analgesia for even the smallest infant cannot be overstated, the opioid used must be carefully selected with reference to the age of the child and the pain to be controlled.
-
alpha(2)-Adrenozeptoragonisten agonists have shown antinociceptive and analgesic effects, which are not antagonized by naloxone. Therefore, the mechanism of action should be independent of opioid receptors. Most studies on this topic have been performed using clonidine. Experimentally the analgesic effect of clonidine can be suppressed by the inhibition of central adrenergic receptors. Furthermore, clonidine has analgesic effects at the spinal level. During recent years numerous studies have shown the analgesic effect of spinally or epidurally administered clonidine in humans. However, only very few studies have investigated the analgesic effect of parenterally administered clonidine in humans. ⋯ In our study the analgesic effect of 150 mug clonidine i.v. was equivalent to that of 5 mg morphine i.v. and 50 mg tramadol. Our results in humans confirm the dosage relationship of 1ratio30 found by Eisenach in sheep. Further studies on the use of parenteral clonidine for postoperative analgesia seem to be warranted.
-
In 60 women undergoing vaginal hysterectomy, a total of 420 pain evaluations of postoperative pain intensity were performed by an observer and the patients. Pain intensity was rated by the observer on a visual analogue scale. The patients themselves evaluated their pain on a visual analogue scale and on a 101-point numerical rating scale. ⋯ The correlation between patients' self-assessments and observers' ratings was poor (r (2)=0.28;y=0.66x+31.3). There was also no clear correlation between pain intensity and heart rate or arterial blood pressure. A reliable assessment of pain intensity can only be performed by patients' self-assessment and not by observers' ratings.
-
Perioperative myocardial ischaemia is common in patients who have or are at risk of coronary artery disease, occurring frequently in the pre-, intra- and postoperative periods. The majority of perioperative ischaemic episodes are silent, being unaccompanied by any symptoms of angina. ⋯ Maintenance of haemodynamic stability is important to reduce the incidence of myocardial ischemia, but ischaemia may occur in the absence of adverse haemodynamic changes. Although our efforts have largely been devoted to the prevention and treatment of intraoperative ischaemia, it is hoped that similar efforts outside the operating room in the postoperative period will further improve patient care and outcome.