Articles: postoperative.
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The alpha(2)-adrenoceptor agonist clonidine has analgesic properties comparable to those of opioids after systemic administration. It also has antihypertensive, antiemetic, anxiolytic, sedative and antisialogogue effects and reduces the incidence of shivering. Thus, the pharmacodynamic profile of clonidine seems to suit it quite well for the special problems related to recovery from anaesthesia. ⋯ This paper reviews previous experience with systemic administration of alpha(2)-adrenoceptor agonists for postoperative pain relief. Especially in combination with low-dose opioids, clonidine leads to a similar or even better level of pain relief with significantly reduced adverse side effects compared with opioid mono-therapy, perhaps because different sites of action are addressed and influence nociception. Therefore, balanced postoperative analgesia including alpha(2)-adrenoceptor agonists, therefore seems to be a beneficial addition to differentiated postoperative pain relief.
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Introduction Spinal epidural abscess is a rare cause of neurological disability, which is frequently, preceded by local spinal pain. There are only a few case series in the literature and the prognosis for this disease has not improved significantly over the past 50 years. Patients and methods Seven patients were treated neurosurgically with laminectomy and abscess drainage for spinal epidural abscesses from 1991 to 1994. ⋯ Elevated blood sedimentation rates in conjunction with local pain of the vertebral column should direct attention to the possibility of an epidural abscess. Magnetic resonance imaging is the radiological technique of choice for establishment of the diagnosis. Conventional X-rays are of no value for early diagnosis because neurological signs and symptoms precede bony changes of the vertebrae.
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Postoperative pain therapy often appears to be inadequate in children. The present study was a retrospective investigation of the administration of analgesics given to 133 children and adults following surgery for funnel chest between 1983 and 1994. ⋯ Children received smaller quantities of narcotics than adults when postoperative analgesia was performed with PRN administration. PCA led to delivery of larger quantities of narcotic drugs than PRN medication in children.
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[Development of a screening questionnaire to predict good and poor outcome of lumbar disc surgery.].
The aims were: (1) to investigate the prognostic value of pain history, sociodemographic, psychodiagnostic and medical factors for long-term outcome after lumbar disc surgery and (2) to develop a screening checklist of reliable predictors that distinguish between good and poor outcomes. ⋯ It is possible to determine for each patient a predictor sum that is prognostic for the individual risk of a poor operation outcome.
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This study was conducted on patients undergoing third molar surgery to evaluate their opinions on surgery and the follow-up period. Two groups were formed, as patients were able to choose between local anaesthesia alone or with additional conscious sedation by means of intravenous Midazolam. ⋯ Following the evaluation of surgery as more "pleasant" by sedated patients, it might be expected that this would contribute to a similar experience of the follow-up period. In this study, however no such connection was found. It is possible that preoperative self-selection of the patients (more sensitive and cautious persons preferred conscious sedation) might be responsible for these results.