Articles: pain.
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Surgery on the upper abdomen is associated with marked postoperative pulmonary dysfunction that results largely from restriction of lung expansion secondary to incisional pain. This study, utilizing three groups of patients (a control group, a sham group, and a group receiving transcutaneous electric nerve stimulation [TENS] for pain control), was designed to determine whether this modality is effective in alleviating postoperative pain. Spirometry, arterial blood gases, clinical as well as radiologic evidence of postoperative pulmonary complications, and the frequency of analgesic requests were determined. ⋯ There were a total of six postoperative pulmonary complications, all occurring in the groups not receiving TENS. Postoperative arterial Po2, vital capacity, and functional residual capacity were least depressed in the TENS group. The data suggest that TENS minimizes the tendency toward postoperative alteration in respiratory mechanics and decreases the incidence of pulmonary complications by alleviating incisional pain.
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MMW Munch Med Wochenschr · Mar 1981
[Double-blind clinical trial of tramadol capsules. First communication: Comparison with pentazocine and placebo (author's transl)].
A new administration form of tramadol (50 mg) was compared in a multicenter double-blind trial with pentazocine (50 mg) and with placebo in patients with acute pains. Each patient received a test preparation once. The preparations were available in identical capsules. ⋯ Both analgesics were superior in effect to the placebo, as was expected. The incidence of side effects from tramadol was less than that with the comparative substance, even if both analgesics had a higher incidence of side effects than the placebo. The results confirm earlier experience obtained with parenteral application of tramadol.
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A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. ⋯ The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.
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A clinical and light and electron microscopic study of three cases of painful neuroma, surgically resected, was made. It was found (a) that painful neuromas contain large numbers of small diameter, unmyelinated fibers, in an apparently much larger proportion than myelinated fibers and (b) that a consistent, unrestrained growth of perineurial cells parallels the constant regeneration of axis cylinders. ⋯ It is suggested that the increased numbers of unmyelinated axis cylinders in traumatic neuromas could be related to the painful symptoms in some patients. It is further postulated that the unrestricted growth of perineurial cells is an attempt to contain the regeneration of axis cylinders and that the maintenance of perineurial integrity by fascicle ligation is important in the relief of painful human neuromas.