pain-relief-22.matches: pain relief
[Patient-controlled analgesia (PCA) for postoperative pain relief. A prospective observational study for evaluating the technology in a ward routine]

[Article in German]

Ure BM, Neugebauer E, Ullmann K, Driever R, Troidl H.

Chirurgische Klinik, II. Lehrstuhls fur Chirurgie, Universitat Koln.

Patient-controlled analgesia (PCA) is rarely used on surgical wards despite described advantages of this method as compared to conventional techniques. Uncertainties in patient selection and insufficient evaluation of this technique may explain these circumstances. The aim of our study was to evaluate PCA on general surgery and traumatology wards by means of standardized criteria for technology assessment (i.e. safety, practicability, benefit for patients and medical staff) and the efficacy of pain relief. In a prospective study we investigated 120 patients. In phase I, we performed analgesic therapy with tramadol/metamizol (50 ASA status I-IV patients). In phase II, piritramid had been applied to 70 ASA status I-II patients after an intermediate analysis of phase I. In 7% of the patients technical problems led to an early interruption even at the end of the study period. There were, however, no incidents which caused vital problems for the patients. A mean postoperative pain level of 55 visual analogue scale points (0-100 point scale) was achieved with tramadol/metamizol. PCA was stopped in 16% of the patients due to the occurrence of nausea or vomiting and in two patients due to insufficient pain relief. The use of piritramid in phase II led to lower pain levels and no interruptions of PCA because of ineffectivity or nausea/vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8269745&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Long-term intrathecal infusion of morphine and morphine/bupivacaine mixtures in the treatment of cancer pain: a retrospective analysis of 51 cases.

Van Dongen RT, Crul BJ, De Bock M.

Institute for Anesthesiology and Pain Treatment, University Hospital Nijmegen, Netherlands.

A retrospective analysis of 51 patients with cancer pain treated with a continuous i.t. morphine infusion through a tunnelled percutaneous catheter was undertaken. Because of insufficient pain relief with morphine only, 17 of these patients received a morphine/bupivacaine mixture. Pain relief subsequently improved significantly in 10 patients and a moderate improvement was present in 4 patients. An additional analgesic effect of bupivacaine was not shown in 3 patients with clinical signs of severe mental depression. Bupivacaine-induced side effects were absent below a daily dosage of 30 mg by continuous infusion. In all patients a gradual dose increment was observed. No serious complications, neurologic sequelae or meningitis occurred. It is concluded that long-term i.t. infusion of morphine through a tunnelled catheter can provide adequate pain relief in cancer patients with an acceptable risk-benefit ratio. The effects of long-term intrathecal co-administration of local anesthetics, especially bupivacaine, await further prospective evaluation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8278204&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Comparison of buprenorphine and fentanyl for postoperative pain relief by continuous epidural infusion]

[Article in Japanese]

Hayashi H, Nishiuchi T, Tamura H, Takeda K.

Department of Anesthesia, Osaka National Hospital.

This study examined analgesic efficacy and adverse effects of buprenorphine and fentanyl for the postoperative pain relief by continuous epidural infusion. Fifty patients after upper or lower abdominal surgeries were assigned to two groups and buprenorphine and fentanyl were epidurally administered postoperatively. Buprenorphine (B) group received bolus injection of B 0.1mg + saline 8 ml and continuous infusion of B 0.8 mg+saline 92 ml (2 ml.h-1). Fentanyl group received bolus injection of F 0.1 mg+saline 6 ml and continuous infusion of F 0.6 mg+saline 84 ml (2 ml.h-1). There was no significant difference between the two groups in the analgesic efficacy, which became lower from 2 to 12 hours postoperatively. However, compared with buprenorphine group, the incidence of nausea or vomiting and dizziness was significantly less in the fentanyl group (11 vs. 4 cases and 7 vs. 1 cases). These results imply that the major site of action of epidurally administered fentanyl is the spinal cord. In contrast, analgesic effect of epidural buprenorphine appears to be enhanced by the supraspinal action. We conclude that fentanyl is superior to buprenorphine for postoperative pain relief by continuous epidural infusion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8301822&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Postoperative pain therapy: a survey of patient attitudes to postoperative pain relief]

[Article in Japanese]

Mitsuhata H, Hirabayashi Y, Saitoh K, Inoue S, Kawakami T, Shimizu R.

Department of Anesthesiology, Jichi Medical School, Tochigi.

We surveyed the attitudes of general surgical patients to the management of their postoperative pain relief. Elective surgical patients (n = 232) were asked postoperatively about their experienced pain which was expressed according to verbal pain scale, the duration of experienced pain, satisfaction with pain relief and medication, and expectations of pain on the 5th to 7th postoperative day. Thirteen percent of the patients had no pain, 47% of whom had no rest pain but pain on moving or coughing, 32% of whom had rest and moving pain, and 0.4% of whom experienced horrible and excruciating pain. Duration of postoperative pain was 2.5 +/- 1.9 days, and 76% of the patients experienced pain only for 3 postoperative days. Results of the interviews indicated that 80% of these patients were satisfied with their postoperative pain relief. Although 80% expressed satisfaction, 39% of whom did have rest pain. In the patients with continuous epidural infusion of buprenorphine and 0.25% bupivacaine, incidence of complained rest pain was significantly low compared with those with intermittent i.v. and/or im injection of analgesics on demands of patients. Lag between patient's demand and nurse's response concerning medication correlated significantly to the satisfaction. There was no relation between satisfaction and age, the nature of operation or sex. Fifty-two percent of the patients reported that degree of experienced pain had been less than expected preoperatively. In conclusion, 80% of the patients were satisfied, but our postoperative pain therapy was still insufficient because 39% of them had rest pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8301823&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[The effect of wound perfusion on the relief of postoperative pain]

[Article in Japanese]

Suzuki A, Yoshikawa M, Matsuzawa N.

Department of Anesthesia, Matsubara Hospital.

The efficacy of wound perfusion (WP) with lidocaine for postoperative pain relief was studied in patients with median incision for cholecystectomy. Twenty four patients were divided into 3 groups according to the method of postoperative pain relief; group C, n = 8: intramuscular injections of penta-zocine 30 mg administered on demand, group WP, n = 8: WP with continuous lidocaine perfusion for 24 hours (plus pentazocine on demand); group EPI, n = 8: buprenorphine administered epidurally for 24 hours (plus pentazocine on demand). Pain scores at 0, 6, 12, 24, 48, hours after operation were examined. Arterial blood gas analysis, FVC and FEV1 were measured preoperatively and on the first postoperative day. Pain scores at 0 and 24 hours in group WP and EPI were significantly lower than those in group C. There were no significant differences in the scores between group WP and EPI at all the points. Analgesic requirement was significantly reduced in group WP and EPI compared with group C. FVC, FEV1 and PaO2 were significantly reduced postoperatively in every group but there were no differences among three groups. PaCO2 significantly increased postoperatively in group C and EPI. We conclude that the technique of wound perfusion with lidocaine is effective and safe for postoperative pain relief.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8309062&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Management of intractable pain with percutaneous epidural spinal cord stimulation: differences in pain-relieving effects among diseases and sites of pain.

Shimoji K, Hokari T, Kano T, Tomita M, Kimura R, Watanabe S, Endoh H, Fukuda S, Fujiwara N, Aida S.

Department of Anesthesiology, Niigata University School of Medicine, Japan.

This study is a survey of the overall clinical results achieved with our pain treatment method, percutaneous epidural low-frequency (1.6-8.0 Hz) spinal cord stimulation. It examines the relationship between the effectiveness of epidural spinal cord stimulation (ESCS) and diseases or sites of pain. Continuous indwelling of the catheter electrodes in the posterior epidural space ranged from 3 to 67 days, and the duration of percutaneous ESCS varied from less than 1 wk to more than 1 yr. Complete pain relief (100%) was achieved during stimulation in 11.5% of the patients (52 of 454). Complete (100%) to partial (more than 30%) pain relief occurred in 71.1% of the patients. In six (1.3%) patients pain was aggravated by stimulation. Analgesics and/or sedatives were discontinued completely after treatment in 52 patients (11.5%) and reduced in 263 patients (57.9%). The number of patients who rated pain relief better than 50% was significantly more in carcinoma/sarcoma and causalgia (P < 0.001), and significantly less in postherpetic neuralgia and thromboangitis obliterans/arterial sclerosis obliterans (P < 0.001) than the average in all diseases. There was a significantly high responsiveness to ESCS in female patients in comparison to male patients (P < 0.05). Pain in the head/face, neck/upper extremities, and trunk responded more to ESCS than pain in the lower extremities. Alleviation of pain by ESCS was lower when the verbal pain score was high. There were no major complications in percutaneous ESCS. Thus, we have demonstrated that pain-alleviating effects of ESCS varies significantly by disease and site of pain, and that this simple percutaneous method can be used for a relatively long period.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8317715&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
[Postoperative pain relief by preanesthetic administration of buprenorphine suppository in elective mastectomy]

[Article in Japanese]

Kakehata J, Ogino H, Sasaki K, Mashio H, Gohda Y, Komura Y, Imai M, Kemmotsu O.

Department of Anesthesia, Hakodate Central Hospital.

Seventy female patients scheduled for elective mastectomy were divided into three groups: Buprenorphine suppository (BPS) 0.4 mg group (n = 29); BPS 0.2 mg (n = 23) group; and control (scopolia extract and tannic acid suppository) group (n = 18). Suppositories were administered rectally to patients of each group one hour before induction of anesthesia. Plasma buprenorphine concentrations, sedation scores at entering the operating room, postoperative pain scores and side effects were evaluated. There were no significant differences in sedation effects of suppository among the three groups. Although there were significant differences in pain scores except at the time when patients left the operating room between BPS 0.2 mg group and the control group, postoperative pain relief in BPS 0.2 mg group was judged not enough. However, postoperative pain relief was more satisfactory in the BPS 0.4 mg group. Plasma concentrations of the BPS 0.4 mg group were higher than those of the BPS 0.2 mg group. Although nausea and vomiting were observed in 5 patients (17.2%) of the BPS 0.4 mg group and 4 patients (17.4%) of the BPS 0.2 mg group, respiratory depression and changes in blood pressure and heart rate were not observed in all groups. In conclusion, preanesthetic administration of the BPS 0.4 mg seemed to be useful for postoperative pain relief after elective mastectomy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8366559&dopt=Abstract pain, pain medicine, pain relief