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Patient-controlled analgesia

Qiuxia Wan, Wengang Ding, Xiaoguang Cui, Xianzhang Zeng
BACKGROUND: We have previously shown that epidural dexmedetomidine, when used as an adjunct to levobupivacaine for control of postoperative pain after open colonic resection, improves recovery of gastrointestinal motility compared with morphine. METHODS: Sixty patients undergoing laparoscopic colonic resection were enrolled and allocated randomly to treatment with dexmedetomidine (group D) or morphine (group M). Group D received an epidural loading dose of dexmedetomidine (5 mL, 0...
June 2018: Medicine (Baltimore)
Patricia A Walicke, Franz Hefti, Roxanne Bales, Shiao-Ping Lu, Jon L Ruckle, Mark T Brown, Christine R West, David L Shelton
Introduction: The neurotrophin nerve growth factor has a demonstrated role in pain transduction and pathophysiology. Objectives: Two randomized, double-blind, placebo-controlled, phase 1 studies were conducted to evaluate safety, tolerability, and analgesic efficacy of single doses of tanezumab, a humanized anti-nerve growth factor monoclonal antibody, in chronic or acute pain. Methods: In the first study (CL001), patients with moderate to severe pain from osteoarthritis (OA) of the knee received a single intravenous infusion of tanezumab (3-1000 μg/kg) or placebo in a dose-escalation (part 1; N = 42) or parallel-arm (part 2; N = 79) study design...
May 2018: Pain Reports (Baltimore, Md.)
Y L Yu, D H Cao, B Chen, Z H Yang, K Z You
The purpose of this study is to observe and compare the effects of continuous femoral nerve block (cFNB) and patient-controlled intravenous analgesia (PCIA) on postoperative analgesia and Th1/Th2 in patients undergoing total knee arthroplasty (TKA). Forty-six TKA were selected and randomly divided into two groups: the cFNB group and PCIA group. Patients in the two groups all underwent general anesthesia using a laryngeal mask. In the cFNB group, the femoral nerve block and catheterization were performed after induction of general anesthesia: 0...
May 2018: Journal of Biological Regulators and Homeostatic Agents
J Su, J H Tian, X X Gao, Y F Wu, J M Zu, K F Dong, L G Duan
Objective: To observe the value of multimodal analgesia in patients with OSAHS undergoing multiplanar surgery. Method: A total number of 90 patients with obstructive sleep apnea hypopnea syndrome with tongue hypertrophy or hyperplasia of the root lymphoid tissue were collected. All patients underwent improved uvulatopharyngeal angioplasty (H-UPPP) and tongue root partial resection, or simultaneous tongue ablation at the same time, and they were randomly divided into two groups,45 patients in each group.In multi-modal analgesic group, the parrixibub sodium 40 mg were given intravenously 0...
June 5, 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Ana Kowark, Rolf Rossaint, Friedrich Pühringer, András P Keszei, Harald Fritz, Gebhard Fröba, Christopher Rex, Hansjörg Haas, Volker Otto, Mark Coburn
BACKGROUND: Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE: We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol...
June 18, 2018: European Journal of Anaesthesiology
V Baliuliene, A Macas, K Rimaitis
BACKGROUND: The study aim was to evaluate the efficacy and safety of different low concentrations of two local anesthetics for labor analgesia using patient-controlled epidural analgesia. METHODS: A double-blind, randomized controlled trial recruiting healthy nulliparous women was conducted from 2014 to 2016. Epidural analgesia was provided using local anesthetic and fentanyl. Patients were allocated to six groups, according to the concentration of bupivacaine or levobupivacaine (0...
May 18, 2018: International Journal of Obstetric Anesthesia
Ulrich J Spreng, Vegard Dahl, Johan Ræder
Background and objective Perioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis. Methods Seventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1-2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine...
December 29, 2017: Scandinavian Journal of Pain
K K Lemberg, T E Heiskanen, M Neuvonen, V K Kontinen, P J Neuvonen, M-L Dahl, E A Kalso
Oxycodone is a strong opioid and it is increasingly used in the management of acute and chronic pain. The pharmacodynamic effects of oxycodone are mainly mediated by the μ-opioid receptor. However, its affinity for the μ-opioid receptor is significantly lower compared with that of morphine and it has been suggested that active metabolites may play a role in oxycodone analgesia. Oxycodone is mainly metabolized by hepatic cytochrome (CYP) enzymes 2D6 and 3A4. Oxycodone is metabolized to oxymorphone, a potent μ-opioid receptor agonist by CYP2D6...
December 29, 2017: Scandinavian Journal of Pain
Amrat Anand, Collin J Sprenker, Rachel Karlnoski, James Norman, Branko Miladinovic, Bruce Wilburn, Roger A Southall, Devanand Mangar, Enrico Camporesi
Background and methods Minimally invasive parathyroidectomy requires limited analgesia and short recovery times. The preferred post-operative analgesic regimen for this patient population has not been established but non-narcotic components would be quite appropriate. The aim of the study was to determine whether intravenous (IV) acetaminophen (1 g) or ketorolac (30 mg) provide better pain control after parathyroidectomy. A parallel, randomized, double blind, comparative study was completed on 180 patients scheduled for outpatient parathyroidectomy utilizing general anesthesia...
December 29, 2017: Scandinavian Journal of Pain
Kristian B Nilsen, Sunniva E Christiansen, Line B Holmen, Trond Sand
Background and purpose In animal studies, enhanced sensitivity to painful stimuli succeeding chronic stress has been reported, while acute stress is reported to induce analgesia. Human studies on the effect of mental stress on pain are more equivocal. A disturbed stress-response resulting in an increased sensitivity to painful stimuli has also been discussed as a potential mechanism for e.g., the fibromyalgia syndrome. Endogenous analgesia may be studied in humans by measuring the analgesic effect of heterotopic noxious conditioning stimulation...
December 29, 2017: Scandinavian Journal of Pain
K V Andersen, L Nikolajsen, V Haraldsted, N T Andersen, C F Jepsen, K Soeballe
Background/aims Optimal pain treatment with minimal side-effects is essential for early mobilization and recovery in patients undergoing total knee replacement surgery. Local infiltration analgesia (LIA) with local anaesthetic might be effective and adjuncts such as ketorolac may provide additional effects on opioid requirements and pain. We tested the hypothesis that adding ketorolac significantly improves analgesia after total knee replacement surgery. Methods Sixty patients were enrolled in this prospective double-blinded study and allocated to either group R (placebo) or Group RK (ketorolac 120 mg)...
December 29, 2017: Scandinavian Journal of Pain
Fatin Affas, Carl-Olav Stiller, Eva-Britt Nygårds, Niclas Stephanson, Per Wretenberg, Christina Olofsson
Pain after total knee arthroplasty (TKA) is difficult to control. A recently developed and increasingly popular method for postoperative analgesia following knee and hip arthroplasty is Local Infiltration Analgesia (LIA) with ropivacaine, ketorolac and epinephrine. This method is considered to have certain advantages, which include administration at the site of traumatized tissue, minimal systemic side effects, faster postoperative mobilization, earlier postoperative discharge from hospital and less opioid consumption...
December 29, 2017: Scandinavian Journal of Pain
Leila Niemi-Murola, Jani Unkuri, Katri Hamunen
Introduction and aim Pain is a frequent symptom in emergency patients and opioids are commonly used to treat it at emergency departments and at pre-hospital settings. The aim of this systematic review is to examine the efficacy and safety of parenteral opioids used for acute pain in emergency medicine. Method Qualitative review of randomized controlled trials (RCTs) on parenteral opioids for acute pain in adult emergency patients. Main outcome measures were: type and dose of the opioid, analgesic efficacy as compared to either placebo or another opioid and adverse effects...
December 29, 2017: Scandinavian Journal of Pain
Anne-Li Lind, Magnus Wetterhall, Marcus Sjödin, Torsten Gordh
Aims Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system affecting approximately 2% of the population. Current pharmacological treatments are ineffective for more than 50% of the patients and often give much adverse effects. Spinal cord stimulation (SCS) is an alternative cost-effective treatment with high efficacy, prolonged pain relief, few side effects. We have compared the cerebrospinal fluid (CSF) proteomes from neuropathic pain patients during pain relief induced by SCS and during pain sensation without SCS, to gain further insights into the mechanisms behind the obtained analgesia...
December 29, 2017: Scandinavian Journal of Pain
A Basnet, S Butler, P Hartvig Honoré, M Butler, T E Gordh, K Kristensen, O J Bjerrum
Aims The clinical relevance of adding the acetylcholinesterase inhibitor donepezil to existing gabapentin treatment in patients with post-traumatic neuropathic pain was explored in this open-label study. The two drugs have previously shown synergism following co-administration in nerve-injured rats [1,2]. Methods The study comprised two consecutive periods of minimum six weeks: (1) titration of gabapentin until highest tolerable dose or maximum 24GG mg daily; and (2) addition of donepezil 5 mg once daily to the fixed gabapentin dose...
December 29, 2017: Scandinavian Journal of Pain
Maurice S Albin
Background The United States Civil War (1861-1865) pitted the more populous industrialized North (Union) against the mainly agricultural slaveholding South (Confederacy). This conflict cost an enormous number of lives, with recent estimates mentioning a total mortality greater than 700,000 combatants [1]. Although sulfuric ether (ETH) and chloroform (CHL) were available since Morton's use of the former in 1846 and the employment of the latter in 1847, and even though inhalational agents were used in Crimean war (1853-1856) and the Mexican-American War (1846-1848), the United States Civil War gave military surgeons on both sides the opportunity to experience the use of these two agents because of the large number of casualties...
December 29, 2017: Scandinavian Journal of Pain
Serkan Tulgar, Mahmut Sertan Kapakli, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, Zeliha Ozer
STUDY OBJECTIVE: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DESIGN: Single-blinded, prospective, randomized, efficiency study. SETTING: Tertiary university hospital, postoperative recovery room & ward...
June 15, 2018: Journal of Clinical Anesthesia
Renee Muirhead, Kathryn Kynoch
The review question is: How safe is parent/nurse controlled analgesia and what is its effectiveness on patient outcomes in the neonatal intensive care unit?
June 15, 2018: JBI Database of Systematic Reviews and Implementation Reports
Adriana Miclescu, Martin Schmelz, Torsten Gordh
Background Both peripheral nerve injury and neuroma pain are the result of changes in sodium channel expression. Lidocaine selectively inhibits the spontaneous ectopic activity by binding to sodium channels. Subanesthetics concentrations of lidocaine are able to produce a differential block of the ectopic discharges, but not propagation of impulses, suppressing differentially the associated neuropathic pain symptoms. The aim of this study was to investigate the differences between the analgesic effects of lidocaine 0...
December 29, 2017: Scandinavian Journal of Pain
Anna-Maria Kuivalainen, Freja Ebeling, Eira Poikonen, Per H Rosenberg
Background and aims Bone marrow aspiration and/or biopsy (BMAB), performed under local anaesthesia in adults, is a common and often painful procedure. Anxiety is known to intensify pain during the procedure. Nitrous oxide (N2O), known for its sedative and analgesic benefit in various short medical procedures and labour pain, could be advantageous also for pain relief during bone marrow examination. N2O acts rapidly and is eliminated in a couple of minutes once the inhalation is stopped, and occasional side effects (e...
December 29, 2017: Scandinavian Journal of Pain
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