pain-relief-25.matches: pain relief
The King Edward Memorial Hospital 1,000 mother survey of methods of pain relief in labour.

Paech MJ.

Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia.

A survey of one thousand women having a vaginal delivery in an obstetric teaching hospital was conducted in order to ascertain maternal opinions of various methods of pain relief in labour. Women were questioned on the day following delivery as to their pain experience, the degree of analgesia obtained, their satisfaction with and criticisms of the analgesic method or methods used, and their overall satisfaction with their childbirth experience. More pain than expected was reported significantly more often by primiparous women (P less than 0.001) and those having induced or augmented labour (P less than 0.04). Epidural analgesia was significantly more effective and resulted in greater satisfaction than other methods alone, or when used in combination (P less than 0.0001). 'Inadequate analgesia' was also reported less frequently by women using non-pharmacological methods alone (P less than 0.0001). Dissatisfaction with their experience was reported by 5% of women and was most frequently related to inadequate pain relief. Although uncommonly cited as a reason, instrumental delivery was statistically associated with dissatisfaction (P less than 0.003). The incidence of dissatisfaction did not significantly differ with respect to the analgesic method or methods used.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1767909&dopt=Abstract pain, pain medicine, pain relief



pain-relief-25.matches: pain relief
[Continuous epidural perfusion of morphine and bupivacaine for post-thoracotomy analgesia. Comparison between thoracic and lumbar epidural analgesia]

[Article in Spanish]

Rodriguez Huertas F, Bustos Rivera A, Munoz Alcantara M, Fuentes Rodriguez R, Almarcha Lopez JM, Torres Morera LM.

Servicio de Anestesiologia y Reanimacion, Hospital del SAS, Cadiz.

Relief of postoperative pain and the incidence of side effects occurring after continuous epidural infusion of morphine and bupivacaine were evaluated in patients undergoing a thoracotomy. We also studied the relevance of a close proximity of the epidural catheter to the metameric segment were the pain originated. The study involves 17 patients divided into two groups. In one series (lumbar group) (LG) the catheter was located at the lumbar region and in the other series (thoracic group) (TG) the catheter was localized at the thoracic area. The study was carried out during the first 48 hours following surgery. Bupivacaine 2% and 0.2 mg/ml of morphine hydrochloride were administered at an initial rate of 1.5 ml/h. The total dose required for pain relief was greater in LG than in TG (p less than 0.05). There were no significant group differences in the hemodynamic and respiratory parameters measured in this study. Only respiratory rate was occasionally lower in LG. Three patients presented postoperative atelectasis (2 in TG and 1 in LG) and required bronchoscopy. One patient of LG complained pruritus and another one of the same group presented nausea and vomiting. The epidural perfusion was interrupted in only one patient of TG due to the presence of arterial hypotension. The association of narcotics and local anesthetics in continuous epidural perfusion was an excellent method for achieving pain relief with minimum side effects. We conclude that both thoracic and lumbar epidural routes are advisable for post-thoracotomy pain relief.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1798842&dopt=Abstract pain, pain medicine, pain relief



pain-relief-11.matches: pain relief
Determinants of patient satisfaction with migraine therapy.

Davies GM, Santanello N, Lipton R.

Merck Research Laboratories, West Point, PA 19486-0004, USA. glenn_davies merck.com

Determinants of patient satisfaction with migraine treatment are not well understood. The objective of this study was to evaluate which treatment outcomes influence patient satisfaction with treatment. Analyses were performed on data from 1506 migraineurs from two clinical trials of rizatriptan for treatment of migraine. Satisfaction with treatment was assessed 2 h after initial treatment and prior to use of rescue therapy. Over 90% of patients who were pain-free at 2 h were at least somewhat satisfied with treatment compared with <10% of patients with moderate or severe pain. Only 60-70% of patients with mild pain at 2 h experienced some level of satisfaction with treatment. For patients with mild pain at 2 h, results showed subjects who reported severe pain at baseline, absence of associated symptoms at 2 h and pain relief within the first 90 min had at least a 76% probability of being at least somewhat satisfied. This probability decreased with the presence of associated symptoms, slower pain relief and moderate baseline pain intensity. Fast, complete pain relief is one important factor in determining short-term patient satisfaction with treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11075838&dopt=Abstract pain, pain medicine, pain relief



pain-relief-25.matches: pain relief
The effect of patient age, gender, and tibial component fixation on pain relief after cementless total knee arthroplasty.

Whiteside LA.

Department of Orthopaedic Surgery, DePaul Health Center, Bridgeton, Missouri 63044.

Cementless total knee arthroplasties (TKAs) were prospectively evaluated for pain relief in 1110 knees. The effect of screws in the tibial component, the age of the patients, and the gender of the patients were studied to determine the effect of these parameters on pain relief one and two years postsurgery. The group with screws in the tibial component (Ortholoc II) had a significantly higher percentage of pain-free knees at one year than at two years postsurgery, and the older patients had a significantly higher rate of pain-free knees at one- and two years postsurgery than the younger patients. Older female patients with Ortholoc I TKAs had a significantly higher percentage of pain-free knees than did older male patients at one-year postsurgery, but not at two years. The group with screws in the tibial components (Ortholoc II) had a higher percentage of pain-free knees at one-year postsurgery than did the Ortholoc I knees, but there was no difference between Ortholoc I and II at two-years postsurgery. In the Ortholoc II group, there was also no difference in results among sexes or between patients older and younger than 65 years old. The correlation coefficient was calculated to evaluate the relationship between body weight and the degree of pain after TKA. No significant correlation could be found at one and two years after surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1914298&dopt=Abstract pain, pain medicine, pain relief



pain-relief-25.matches: pain relief
[Interpleural administration of 1.0% and 1.5% lidocaine with epinephrine for pain relief after thoracotomy]

[Article in Japanese]

Kawamata M, Mayumi T, Sumita S, Fujita S, Nagai H, Nakayama M, Namiki A.

Department of Anesthesiology, Asahikawa City General Hospital.

Pain relief following thoracotomy and arterial concentration profiles after interpleural administration of lidocaine were studied in 23 adult patients. They were allocated to three groups and given interpleural injection of 20 ml each of 1.0% (group 1, N = 9, non-pneumonectomy patients), 1.5% (group 2, N = 10, non-pneumonectomy patients), and 1.5% (group 3, N = 4, pneumonectomy patients) lidocaine with epinephrine (5 micrograms.ml-1). Complete pain relief was obtained within 20 min after injection in all patients. The mean duration of analgesia was 2.8 hr, 3.1 hr, and 5.1 hr in group 1, 2, and 3, respectively. The maximum plasma concentrations of lidocaine (Cmax) were 1.7 +/- 1.0 (mean +/- SD) microgram.ml-1, 2.2 +/- 0.6 micrograms.ml-1, and 0.7 +/- 0.2 micrograms.ml-1 in group 1, 2, and 3, respectively. The mean duration of analgesia was significantly longer in group 3 than in group 2 (P less than 0.01). Cmax was significantly lower in group 3 than in group 2 (P less than 0.01). In conclusion, we consider interpleural injection of lidocaine with epinephrine to be an effective method of providing postoperative analgesia after thoracotomy. Our data also suggest that the duration of analgesia may increase and the plasma levels of lidocaine may remain quite low in total pneumonectomy patients, because local anesthetic solution is not absorbed through the visceral pleura but absorbed only through the parietal pleura alone in these patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1920783&dopt=Abstract pain, pain medicine, pain relief



pain-relief-25.matches: pain relief
Contradictory correlations between derived scales.

Thompson MJ, Hand DJ, Everitt BS.

Faculty of Mathematics, Open University, Milton Keynes, U.K.

In a clinical trial one scale of pain relief is scored backwards relative to another (high on one corresponding to low on the other), with a consequent large negative correlation. But two derived scales of total pain, obtained by multiplying average pain relief on each scale by duration of pain (common to both pain relief measurements) gave an almost zero correlation. This apparent contradiction is explained by the inverse relationship between the pain relief scales and the large differences in duration of pain experienced by the patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1925163&dopt=Abstract pain, pain medicine, pain relief



pain-relief-25.matches: pain relief
Intrathecal morphine in younger patients for postoperative pain following spinal fusion.

Blackman RG, Reynolds J, Shively J.

Intrathecal morphine in an average dose of 0.01 mg/kg was given to 33 patients between ages 11 and 16 years who had spinal arthrodesis for idiopathic scoliosis. The morphine was administered intrathecally as a 10 cc bolus at the conclusion of the arthrodesis, but before closure. The goal was to study safety in terms of respiratory depression and pain relief. Respirations occurred spontaneously in 30 of the 33 patients within 15 minutes of cessation of anesthesia. Respiratory depression occurred in five patients, four of whom had arterial blood pCO2 levels greater than 60 mm Hg. Thirty-one patients had relief of pain for 8 to greater than 40 hours, averaging 18 hours. Two patients had no noticeable pain relief. There appeared to be no relation between dose and pain relief in this limited dose range. We were unable to duplicate the long duration of pain relief reported elsewhere. We also were unable to decrease the side effects of respiratory depression and nausea to a level reported by others. It may be that the 10 cc bolus injected intrathecally circulates to the brain and ventricles faster than desired, or that factors relating to type of anesthesia or dose need to be considered. Low-dose intrathecal morphine does provide noticeable pain relief in younger patients undergoing spinal fusion. The side effects of nausea and respiratory depression can be managed safely with medication.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1926302&dopt=Abstract pain, pain medicine, pain relief