Articles: postoperative.
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We report a case of severe respiratory depression during postoperative patient-controlled analgesia (PCA) in a 14-year-old boy. The medication cassette of a Pharmacia CADD-PCA 5200 was not properly connected, which led to a free-flow infusion of about 85 mg piritramide (strong mu-opioid agonist) within 15 min; the patient lost consciousness and developed apnea. He was successfully treated with artificial ventilation via ambu-bag and 0.2 mg naloxone i. v. The incident occurred approx. 2 h after the start of postoperative medication, when other infusions (suspended above the PCA device level) had been stopped, making the free-flow opioid infusion possible. As the PCA device was in a bedside pump enclosure, the disconnection was not immediately apparent. ⋯ Although PCA is considered a safe method, it can have potentially lethal complications: Technical problems or serious handling errors involve the risk of large volumes of analgesics being infused within a very short time. Therefore, we recommend apparative monitoring (e. g., pulse oximetry) as a necessary condition for the safe use of PCA.
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From August 1981 to May 1993 a total of 1263 percutaneous retrogasserian glycerol rhizotomies after Hakanson were performed. The intervention was performed with X-ray monitoring under local anaesthesia and rarely lasted longer than 20 min. It achieved good results in the treatment of idiopathic trigeminal neuralgia (TN) and symptomatic trigeminal neuralgia due to multiple sclerosis (TNMS). ⋯ Later, after 2 years, there was reduction in sensitivity of this type in only 20% of cases. In the follow-up 17.5% of our patients complained of dysaesthesia and in 21.4% corneal sensitivity was reduced or lost. We believe that glycerol rhizotomy, owing to its effectiveness, easy applicability, slight distress for the patients and low side effects, should be recommended as a first measure for non-conservative treatment of idiopathic trigeminal neuralgia as well as trigeminal neuralgia in multiple sclerosis.
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From 1 August 1983 to 6 June 1992, 284 patients underwent decompression of the trigeminal root in the rear part of the skull as treatment for tic douloureux. According to preoperative diagnosis and intraoperative inspection, a space-occupying process was the cause of the typical neuralgia in 13 cases (4 meningiomas, 3 epidermoid tumours, 3 acoustic neuromas and 2 trigeminal neuromas). In 271 cases (95.4%) microsurgical vascular decompression according to Jannetta was carried out. ⋯ In summary, the long-term results confirm that microsurgical vascular decompression can be offered as the method of choice for treatment of trigeminal neuralgia in younger patients, and in older patients when cardiopulmonary risk factors and cerebrovascular processes can be eliminated. Alternative methods are high-frequency lesionsing of the gasserian ganglion according to Sweet and chemorhizolysis of the gasserian ganglion, but these must be restricted exclusively to the treatment of typical trigeminal neuralgia with tic douloureux. Persistent neuropathic pain caused by atraumatic or drug-induced lesion to the trigeminal nerve cannot be positively influenced either by surgical decompression or by destructive operations on the gasserian ganglion.
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In a double-blind, randomized, placebo-controlled study, 112 patients scheduled for knee-joint arthrotomies or minor orthopaedic operations received 75 mg diclofenac, 600 mg apazone, the combination of 75 mg diclofenac and 600 mg apazone, or placebo (50 ml NaCl 0.9%) as a single i.v. dose immediately after operation. Postoperative pain intensity was measured by a numeric rating scale. All patients were allowed to self-administer piritramide from a PCA (patient-controlled analgesia) pump (Prominjekt, Pharmacia, Sweden) in 2-mg boluses every 5 min during the first 6 h and subsequently every 15 minfor another 18 h after surgery. ⋯ The incidence of typical side effects of opioids and antipyretic anti-inflammatory analgesics (nausea, vomiting, stomach ache, headache, vertigo) was low, and they were easily controlled in all cases. Postoperative combined application of the nonsteroidal anti-inflammatory analgesics diclofenac and apazone results in a significantly lower opioid requirement (about 60%) after minor orthopaedic surgery. The opioid-sparing effect appears to be superior to that of diclofenac (44%) or apazone (42%) alone, but this was not statistically significant.
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Int J Obstet Anesth · Oct 1994
Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia.
Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.