pain-relief-22.matches: pain relief
[External fixator of the cervical spine--a new diagnostic tool]

[Article in German]

Grob D, Dvorak J, Panjabi MM, Antinnes JA.

Abteilung Wirbelsaule, Schulthess-Klinik Zurich.

Soft tissue injuries of the neck may cause severe long-standing pain. The clinical findings are sparse and the identification of the painful segments with conventional diagnostic tools is often impossible. Temporary segmental external fixation for a soft tissue injury of the cervical spine was performed as a diagnostic procedure in 24 patients. The instrumentation was applied according to the established techniques of the insertion of facet screws in the cervical spine. The segments to be instrumented were evaluated by clinical and radiological findings, such as local pain and increased mobility in the functional X-rays. However, none of these findings were convincing enough to proceed directly to fusion for pain relief. Evaluation of external fixation consisted of alternatively fixing different instrumented segments and having the patients rate their pain on a visual analogue pain scale. External fixation of the suspected segments resulted in marked pain relief, which was recorded subjectively by the visual analogue pain scale in 68% of the patients. The pain relief (8.2 points preoperatively--2.6 points postoperatively on average) could be permanently established by successful fusion of these segments in 17 patients. Four of the patients indicated no relief of pain at the follow-up (12.9 months postoperatively). No fusion was performed in 3 patients in whom the diagnostic procedure with external fixation allowed no conclusion about the painful segment. As it is an invasive procedure, external fixation of the cervical spine should be reserved for cases, in which conventional methods have failed to established a clear diagnosis of segmental instability and conservative therapy could not relieve the symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8378788&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Perceptions of pain and pain relief in labour: the gulf between experience and observation.

Rajan L.

In a national sample of 10,702 women delivered in one week in 1990 data on their perceptions of pain and the effectiveness of pain relief methods were compared with those of the professionals attending them. Professionals' conceptions of pain relief tended to be restricted to pharmacological methods. Overall, the level of agreement about effectiveness of pain relief was quite low, with medical staff commonly believing they were providing adequate pain relief while the women reported it as unsatisfactory. This was particularly the case for pethidine, while 'Entonox' was rated more highly by women than staff. Professionals were significantly more likely to agree with one another about effectiveness than to agree with the women, and were less likely to have responded where the women judged their pain relief as poor.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8412834&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Congenital anteroinferior instability treated by Bankart repair.

Post M, Grinblat E.

Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.

A subset of patients with symptomatic anteroinferior instability of the shoulder has been recognized. All patients had a history of minimal trauma that was not related to their symptoms. There were 29 men and four women, averaging 29 years of age. Forty-five percent of the patients had failed treatment for associated impingement syndrome. Eleven patients had 17 operations on the shoulder that failed to relieve pain. Preoperative duration of symptoms ranged from four to 130 months (average, 28 months). No Hill-Sachs lesions were present. After a Bankart stabilization, wherein 11 of 33 shoulders had labral tears, pain relief was achieved in 27 of 33 patients. Three additional patients had pain relief after a second-stage acromioplasty. Thus, three of 15 patients with associated impingement syndrome required a second-stage acromioplasty (20%). In summary, 30 of 33 patients had pain relief. There were three failures. Two of the three patients had multidirectional instability. One of these was lost to follow-up evaluation. Another, repaired by a capsular shift, has no further dislocations. One patient required a revision Bankart repair after he sustained a traumatic tear of the capsule ten days after his initial operation; there was no recurrence. The Bankart operation is a worthwhile procedure for congenital unidirectional anteroinferior instability with or without impingement syndrome. It should be done first rather than initially treating the associated impingement.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8504619&dopt=Abstract pain, pain medicine, pain relief



pain-relief-22.matches: pain relief
Triple arthrodesis in rheumatoid arthritis.

Figgie MP, O'Malley MJ, Ranawat C, Inglis AE, Sculco TP.

Hospital for Special Surgery, New York, NY 10021.

Fifty-five patients with rheumatoid arthritis were treated with 65 triple arthrodeses of the hindfoot from March 1975 through July 1985. Twelve patients (12 procedures) have died, and follow-up evaluation could not be completed on three patients (four procedures), leaving 40 patients (49 procedures) available for clinical and roentgenographic evaluation. There were 32 women and eight men, with an average age at the time of surgery of 50 years. The follow-up period averaged five years. Standard operative technique involved medial and lateral incisions with staple fixation and local bone grafting. Correction of deformity was performed with closing wedge osteotomies. All patients had moderate to severe pain preoperatively and difficulty with ambulation. Postoperatively, 94% of the patients had significant pain relief and 83% had complete pain relief. Ambulatory status was improved in 80% of the patients. Ninety percent were at least community ambulators at the time of review, whereas more than half the patients were limited to household ambulation preoperatively. Complications included four superficial wound infections, all of which responded to local care. One patient required revision surgery for pseudarthrosis, and three patients had progression of ankle disease and required pantalar arthrodeses. There was no significant progression of fore-foot or knee symptoms, however, and there was no progression of ankle symptoms in patients whose hindfeet were corrected to 0 degrees-10 degrees valgus. Triple arthrodesis in the rheumatoid population has a high union rate. Pain relief and ambulation improvement can be expected.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8519117&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
Thoracic paravertebral block in chronic postoperative pain.

Kirvela O, Antila H.

Department of Anaesthesiology, Turku University Hospital, Finland.

BACKGROUND AND OBJECTIVES. Chronic postoperative pain in thoracic dermatomes is common. The most frequently used methods of pain relief in this area are posterior multidermatomal intercostal nerve or thoracic epidural blocks. Compared with these methods, thoracic paravertebral block may have some advantages. Usually only one injection is needed, and the use of larger volumes of local anesthetic (up to 25 ml) results in widespread unilateral analgesia including sympathetic block without the potential risk of hypotension and motor block associated with epidural block. METHODS. We retrospectively analyzed 281 thoracic paravertebral blocks performed for chronic postoperative pain (post-thoracotomy and postmastectomy) from 1986 to 1990 in our pain clinic. RESULTS. In post-thoracotomy group, patients were without pain for at least a month after 58% of the blocks; in 30%, the effect lasted for at least two months; in 8%, more than four months and, in 3%, more than five months. In 88% of patients with postmastectomy pain, the achieved pain relief with thoracic paravertebral block was less than a month. No severe complications occurred. CONCLUSIONS. Thoracic paravertebral block proved to be a reliable and safe technique for unilateral pain relief in chronic post-thoracotomy pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1286056&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
[The efficacy of intravenous fentanyl patient-controlled analgesia for postoperative pain relief]

[Article in Chinese]

Chen CL, Yang SF, Goo TS, Chou WK, Tsai MH, Lee HL.

Department of Anesthesiology, Changhua Christian Hospital, Taiwan, R.O.C.

The safety and efficacy of patient-controlled analgesia used for postoperative pain relief were evaluated. Cumulative 24-hour requirements were analyzed for possible correlation with patient characteristics. All patients who used a patient-controlled analgesia device for postoperative pain relief were reviewed from June to October 1991. The device Baxter's basal/bolus infusor with patient control module, was used to deliver fentanyl in 379 patients. The fentanyl requirement, verbal analog pain score, first passage of flatus, side effects, sedative score, and degree of satisfaction were examined. The fentanyl requirement during the first 24 hours after operation was analyzed with regard to age, body weight, and sex. The daily fentanyl consumption in the first three postoperative days was 928 +/- 352 micrograms (n = 338), 553 +/- 259 micrograms (n = 220), and 490 +/- 222 micrograms (n = 71), respectively. The requirement for fentanyl during the first 24 hours after surgery was significantly higher than for the next two days (p-value < 0.001). Fentanyl consumption correlated well with body weight, and inversely with age. No difference was found between fentanyl consumption and sex (p-value = 0.4687). The mean time to the first passage of flatus in patients with abdominal surgery was 54.6 +/- 26.4 hours. The incidence of nausea, vomiting, and dizziness was similar, about 20% of patients. Itching was noted in 7% of patients. Oversedation (class 4) was found in three patients during the first operative day, the sedative score for other patients were around class 1-3. No patient exhibited signs of respiratory depression or withdrawal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1344240&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
[Postoperative pain relief by continuous epidural infusion of bupivacaine and buprenorphine]

[Article in Japanese]

Hirabayashi Y, Fukuda H, Saitou K, Tamagawa K, Ikeno S, Furuya K, Mitsuhata H, Akazawa S, Kasuda H, Shimizu R.

Department of Anesthesiology, Jichi Medical School, Tochigi.

Continuous postoperative pain relief produced by epidural block with bupivacaine and buprenorphine was evaluated in 12 patients after thoracotomy, 19 patients after upper abdominal surgery, and 14 patients after lower abdominal surgery. Patients initially received 8 ml of 0.25% bupivacaine and 0.1 mg of buprenorphine at recovery room in operating theater and continuously received the mixture of 0.25% bupivacaine and 5 micrograms.ml-1 buprenorphine at a rate of 1 ml.h-1 using a portable pump. About fifty percent of the patients did not need additional narcotics during 48 postoperative hours. About ninety percent of the patients needed one additional narcotics during 48 postoperative hours. The authors conclude that epidural analgesia with the mixture of bupivacaine and buprenorphine produces satisfactory postoperative pain relief.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1433832&dopt=Abstract pain, pain medicine, pain relief