Articles: postoperative.
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Local wound perfusion with bupivacaine after elective abdominal surgery seems to be a promising method of reducing postoperative pain. Applicability, effectiveness, side effects and risks were tested in a pilot study with 28 patients. During closure of the laparotomy incision two catheters were inserted, one between peritoneum and fascia and the other subcutaneously. ⋯ No severe side effects occurred, but the study was interrupted nonetheless in 3 patients, 2 of whom had a transit syndrome while the third had more severe hypotension than could be explained by the bupivacaine blood level. No infections and no problems with wound healing occurred during the study. This study proved that the method tested leads to significant pain reduction after elective abdominal surgery and has no severe side effects.
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Nociceptive stimuli are modulated at the dorsal horn of the spinal cord. This modulation is performed by various systems working independently complementarily, additively or supra-additively. Non-opioid analgesics relieve pain without a motor blockade. ⋯ Lysine acetylsalicylic acid (L-ASA) has been given intrathecally for the therapy of severe cancer pain and chronic back pain. In most patients good analgesia was observed up to 2 months after a single injection. If neurotoxity can be excluded, L-ASA may be an alternative in the therapy of cancer pain before neurodestructive therapy is done.
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There have been major advances in knowledge and efficient techniques for pain relief have been developed during recent years. Nevertheless, many patients on surgical wards still suffer from severe pain following surgery or trauma. Therefore, in the University hospital of Kiel (Germany) an anaesthesiology-based acute pain service (APS) was established in 1985 to improve this situation.
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Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. ⋯ Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.