pain-relief-23.matches: pain relief
[Analgesic effects of epidurally administered fentanyl for postoperative pain relief--comparison with buprenorphine]

[Article in Japanese]

Kaetsu H, Takeshi M, Chigusa S, Sakaue M, Hasegawa M, Obara H.

Department of Anesthesia, Hyogo Medical Center for Adults, Akashi.

We did a retrospective study on 177 patients after upper and lower abdominal surgery, and compared the efficacy of epidural administration of fentanyl and that of buprenorphine for postoperative pain relief. In fentanyl (F) group, 73 patients received fentanyl 0.1 mg with saline 8 ml epidurally after operation, followed by a constant rate infusion of 0.025 mg.hr-1 for 18-24 hrs. In buprenorphine (B) group, 104 patients, received buprenorphine 0.2 mg with saline 9 ml epidurally. After upper abdominal surgery, 33 patients (76.7%) in F group and 27 patients (52.9%) in B group obtained satisfactory analgesia (P < 0.05). The difference of the degree of analgesia after lower abdominal surgery was not significantly different in both groups. Respiratory depression occurred in 19 patients in B group and 5 patients in F group (P < 0.05). It is concluded that epidural fentanyl delivered by continuous infusion offers a significant advantage compared with epidural buprenorphine for postoperative pain relief following upper abdominal surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1479653&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
Carcinoma of the superior pulmonary sulcus. Results of irradiation and radical resection.

Sartori F, Rea F, Calabro F, Mazzucco C, Bortolotti L, Tomio L.

First Department of Surgery, University of Padua, Italy.

Fifty-six patients with superior sulcus syndrome were evaluated at the First Surgical Department of the University of Padua between 1981 and 1990. Forty-two patients with the characteristic of Pancoast's tumor received preoperative irradiation and then en bloc resection of the tumor, chest wall, and adjacent structures. Seven lobectomies and 35 segmentectomies or wedge resections were performed. There was one early postoperative death. Median survival was 14 months, and actuarial survival was 25% at 5 years. Patients with pain relief had better 5-year survival (36.4%) than patients without pain relief (9%). We have no patients with vertebral invasion who survived more than 1 year. Of the five patients with subclavian artery invasion, only one survived more than 1 year. Of five patients with N2 disease, only one survived more than 1 year. Our results suggest that pain relief after irradiation is a good prognostic factor, whereas N2 involvement and vertebral body and great vessel invasion are ominous factors. Another ominous prognostic factor is the Claude Bernard-Horner syndrome even if it is not a contraindication to resection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1513156&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
A preliminary list to identify attitudes toward different conditions for discussing possible termination or refusal of medical treatment except for pain relief.

Westman AS, Lewandowski LM, Procter SJ.

Department of Psychology, Eastern Michigan University, Ypsilanti 48197.

Effective communication about decisions concerning termination or refusal of medical treatment except for pain relief necessitates clarifying the attitudes of those in the decision-making process. Effective communication increases the likelihood that a patient's advance directives are implemented and decreases the likelihood of litigation. Psychotherapists, counselors, chaplains, etc. can be facilitators of effective communication. This study generated a list for use in discussion by asking persons who cared for individuals with terminal illnesses, critical injuries or elderly people what conditions seemed appropriate for termination or refusal of medical treatment except for pain relief. The 182 out of 204 individuals who contributed conditions showed clear agreement on terminal illnesses, brain disorders, dependence on machines for life, and other irreversible deterioration or severe loss of quality of life, lack of suitable treatment, patient's wish, and concern about the effect of the patient's condition on others. Some specified further qualifications, such as at what point during a terminal illness termination or refusal was appropriate. The list with notes could be appended to a Living Will or a Durable Power of Attorney for Health Care. The notes should be updated periodically. Through use and research, the list also can be refined further.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7680811&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
Motor cortex stimulation as treatment of trigeminal neuropathic pain.

Meyerson BA, Lindblom U, Linderoth B, Lind G, Herregodts P.

Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden.

A report is given on first experiences with motor cortex stimulation in 10 patients with different forms of neuropathic pain. Three of them had central pain as sequelae of cerebrovascular disease. In none of them did the stimulation provide pain relief. Two patients had pain from peripheral nerve injuries. One did not respond, but the other obtained about 50% pain relief. The remaining 5 patients with trigeminal neuropathy experienced definite pain relief varying between 60 and 90%. During test stimulation most patients had one or two short-lasting generalized seizures. But no one had any motor effects after permanent implantation. Motor cortex stimulation appears to be a new and promising possibility of pain treatment, especially in cases with trigeminal neuropathy, but many problems have yet to be solved, before a clear indication could be given.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8109279&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Percutaneous stereotactic radiofrequency thermal rhizotomy for the treatment of trigeminal neuralgia.

Mathews ES, Scrivani SJ.

Craniofacial Pain Center, and the Neurosurgical Service, Massachusetts General Hospital, Boston, USA.

BACKGROUND: Trigeminal neuralgia (TN) is the most common cephalic neuralgia in people over the age of fifty, with a mean incidence of 4 per 100,000. Percutaneous stereotactic differential radiofrequency thermal rhizotomy (RTR) is a well-recognized surgical treatment for TN. The purpose of this study was to evaluate a management algorithm for TN and to evaluate the effectiveness of RTR for TN after failure of pharmacologic management. METHODS: Two hundred and fifty-eight (258) patients underwent RTR from 1992-1996 and were prospectively evaluated. These patients were characterized by age, sex, side of the face and division(s) involved. Patients were evaluated for pain relief, recurrence requiring or not requiring re-operation, and the type and rate of complications. They were followed by serial clinical evaluation and telephone interview. Patients were grouped according to results: (A) Successful Result--excellent or good pain relief; (B) Unsuccessful Result--fair, poor or no pain relief. The RTR group was compared to historical controls. Follow-up ranged from 12-80 months (mean = 38 months). RESULTS: At early follow-up (defined as median postoperative period up to 6 months), pain relief that was excellent or good (successful results) occurred in 224/258 (87%). At long-term follow-up (> 6 months) recurrence of tic pain required re-operation in 31 patients (12%). In 37 patients (14%), recurrence of tic pain did not require re-operation. Dysesthesia developed in 20 patients (8%); corneal analgesia developed in 8 patients (3%). "Anesthesia dolorosa" developed in 5 patients (2%) and was medically managed. At the conclusion of the long-term follow-up period, 214/258 patients (83%) had excellent to good pain relief (successful result). There were no mortalities, no significant morbidity and a low rate of minor complications. CONCLUSION: With the use of this specific diagnostic and management algorithm, patients with TN can be successfully managed with RTR.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11021779&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
The effects of an education video on patients' requests for postoperative pain relief.

Hawkins R, Price K.

A patient education videotape called if it hurts, tell us was used to provide one of three groups of 20 preoperative patients with information about pain control and to encourage them to be assertive in their requests for postoperative pain relief. There were no significant differences in the levels of pain or requests for analgesia between the group which had been specifically encouraged by the education video to seek pain relief and the groups which had not seen the video. Patients in all three groups generally experienced a good deal of pain following surgery, but they were not dissatisfied with this experience and did not take available action to eliminate all their pain. While the literature suggests that improvements in postoperative pain management might be achieved by better staff education, patients' reluctance to eliminate their pain should also be considered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8240767&dopt=Abstract pain, pain medicine, pain relief



pain-relief-23.matches: pain relief
Postoperative pain relief, from the patients' and the nurses' point of view.

Juhl IU, Christensen BV, Bulow HH, Wilbek H, Dreijer NC, Egelund B.

Department of Anaesthesiology, Central Hospital, Nykobing, Denmark.

In this prospective, consecutive study, 191 patients were interviewed before and after surgery (orthopaedic, gynaecological, abdominal and urological operations) about their attitude to and the quality of received pain relief, respectively. In addition, nurses working in the surgical units involved in the study were asked to answer a questionnaire covering attitudes to postoperative pain and pain treatment. Of the patients, 47% were in pain at the time of the postsurgical interview, 10% had not any analgesic prescribed at all and 15% had received less than prescribed. In 36% of the cases there was a discrepancy between the amount of analgesic prescribed by the surgeon and the amount prescribed by the anaesthetist. In 80% of the patients the pain outlasted the first postoperative day, but only 64% would always tell the staff if they had pain. Seventeen per cent of the patients had never been asked about their postoperative pain status. Preoperative pain had a significant correlation to postoperative pain. Although the results are not impressive, they do constitute some improvement compared to previously published studies. Fifty-one nurses (71% of the total nursing staff) answered the questionnaire. Of these, 63% were sometimes in doubt about the physicians' prescriptions, 55% would occasionally refuse to give analgesics for various reasons, and 37% were not satisfied with the routines of pain control in their ward. Conclusion: Knowledge of pain treatment and communication between surgeons, anaesthesiologists, nurses and patients must be improved to make postsurgical pain relief adequate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8322570&dopt=Abstract pain, pain medicine, pain relief