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Items 1 - 29 of 29 |
One page. |
Paradoxical increase in pain requirements with midazolam premedication.
Friedberg BL.
Publication Types:
PMID: 15385399 [PubMed - in process]
-
Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally.
Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawal N.
Department of Clinical Medicine, Division of Anesthesiology, University Hospital, Orebro, Sweden. anil.gupta@orebroll.se
Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4-24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4-24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.
PMID: 15385371 [PubMed - in process]
-
Bradykinin antagonists have no analgesic effect on incisional pain.
Leonard PA, Arunkumar R, Brennan TJ.
Department of Anesthesia, University of Iowa, Iowa City, USA.
Bradykinin, an endogenous nonapeptide and an important mediator of inflammation, is also implicated in the initiation and maintenance of pain. Both des-Arg(8), Leu(8)-bradykinin (dALBK) and HOE-140, the prototypic bradykinin B1 and B2 receptor antagonists, respectively, have been shown to reduce pain behaviors and inflammation in animal models of persistent nociception. We studied them for activity against incision-induced pain behaviors in a rat model for postoperative pain. A 1-cm plantar incision was made in the hind paw of halothane-anesthetized rats and closed with 5-0 nylon. Withdrawal responses to punctate and nonpunctate mechanical stimuli were tested with von Frey filaments and a plastic disk attached to a von Frey filament, respectively. Withdrawal latency to radiant heat was also tested. Rats were tested 1 day before the incision, 1 h after the incision, and 0.5, 1, 1.5, and 2.5 h after the injection of the drug. They were then retested at the same times before and after the injection of the drug on each of the first 2 postoperative days. The rats received the saline vehicle dALBK (0.1, 0.3, 1.0, or 3.0 mg/kg) or HOE-140 (0.1, 0.3, 1.0, or 3.0 mg/kg) IV. Another group of rats had the drug injected 1 h before incision and tested as above. Statistical significance (P < 0.05) was determined with Kruskal-Wallis test and a two-way analysis of variance. None of the doses of either dALBK or HOE-140 affected the responses to punctate or blunt mechanical stimulation or heat, either as a pretreatment or as a posttreatment. These data support the unique mechanisms for incision-induced pain relative to inflammation-related pain. Although inflammation may represent a component of incisional pain, the etiology of inflammation and its role seem different than in other models.
PMID: 15385370 [PubMed - in process]
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Propofol-induced injection pain: comparison of a modified propofol emulsion to standard propofol with premixed lidocaine.
Adam S, van Bommel J, Pelka M, Dirckx M, Jonsson D, Klein J.
Department of Anesthesiology, Erasmus Medical Center Rotterdam, The Netherlands. s.adam@erasmusmc.nl
Propofol is well known for its association with pain on injection. The most frequently used method to reduce this pain is premixture with lidocaine. Recently, a modified lipid emulsion of propofol containing medium-chain triglycerides (MCT) with long-chain triglycerides (LCT), in contrast to the usual LCT formulation, has been advocated to alleviate pain. In a randomized, prospective, controlled, double-blind study on 222 surgical patients, we compared the effect of the two solutions on the incidence and intensity of injection pain. Patients were randomly allocated to receive either propofol MCT/LCT (group M; n = 109) or standard propofol LCT with the addition of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of propofol (group L; n = 113). Pain scores were assessed using a verbal analog scale (VAS) ranging from 0-10. Group L was found to have significantly less pain on the injection of propofol (mean VAS, 2.5 +/- 2.9) (mean +/- sd) than group M (mean VAS, 3.8 +/- 3.2; P = 0.002). Regarding postoperative recall of pain on injection, patients in group L indicated significantly less pain (mean VAS, 2.2 +/- 2.4) than patients in group M (mean VAS, 3.0 +/- 2.7; P = 0.02). Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol LCT causes less pain on injection than propofol MCT/LCT and thus increases patient comfort.
PMID: 15385353 [PubMed - in process]
Comment on:
Postoperative analgesia following total knee arthroplasty.
Lang SA, Rooney ME.
Publication Types:
PMID: 15333447 [PubMed - indexed for MEDLINE]
-
Levobupivacaine 0.2% or 0.125% for continuous sciatic nerve block: a prospective, randomized, double-blind comparison with 0.2% ropivacaine.
Casati A, Vinciguerra F, Cappelleri G, Aldegheri G, Grispigni C, Putzu M, Rivoltini P.
Department of Anesthesiology, Vita-Salute University, IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. casati.andrea@hsr.it
In 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.125% levobupivacaine (n = 20) infused with a patient-controlled system starting 3 h after a 30-mL bolus of the 0.5% concentration of the study drug and for 48 h (baseline infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min; maximum incremental doses per hour, 3). No differences were reported in the intraoperative efficacy of the nerve block. The degree of pain was similar in the three groups throughout the study period, both at rest and during motion. Total consumption of local anesthetic solution during the first 24 h was 148 mL (range, 144-228 mL) with 0.2% ropivacaine, 150 mL (range, 144-200 mL) with 0.2% levobupivacaine, and 148 mL (range, 144-164 mL) with 0.125% levobupivacaine (P = 0.59). The volume of local anesthetic consumed during the second postoperative day was 150 mL (range, 144-164 mL) with 0.2% ropivacaine, 154 mL (range, 144-176 mL) with 0.2% levobupivacaine, and 151 mL (range, 144-216 mL) with 0.125% levobupivacaine (P = 0.14). A smaller proportion of patients receiving 0.2% levobupivacaine showed complete recovery of foot motor function as compared with 0.2% ropivacaine and 0.125% levobupivacaine, both at 24 h (35% vs 85% and 95%; P = 0.0005) and at 48 h (60% vs 100% and 100%; P = 0.001). We conclude that sciatic infusion with both 0.125% and 0.2% levobupivacaine provides adequate postoperative analgesia after hallux valgus repair, clinically similar to that provided by 0.2% ropivacaine; however, the 0.125% concentration is preferred if early mobilization of the operated foot is required.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15333432 [PubMed - indexed for MEDLINE]
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Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters.
Bubeck J, Boos K, Krause H, Thies KC.
Tagesklinik Heilbronn, Allee 38, 74072 Heilbronn, Germany. dr.bubeck@web.de
Bacterial colonization is regarded as a causative factor for septic complications of caudal catheters in children. To determine whether tunneling caudal catheters reduces the bacterial colonization rate effectively, we evaluated 506 children being treated with tunneled or untunneled caudal or untunneled lumbar epidural catheters. Four-hundred-nine children completed the study. After aseptic removal, the catheters were cultured and sent for microbiological assessment. We found a bacterial colonization rate of 29% in untunneled caudal catheters, 11% in tunneled caudal catheters, and 9% in untunneled lumbar catheters. No severe infectious complications were reported. There was no correlation between catheter retention time and bacterial colonization except for the first 24 h, during which no bacterial colonization was detected. The overall colonization rate remained constant at approximately 13%. We found a positive correlation between bacterial colonization and redness at the catheter entry site. We conclude that tunneled caudal epidural catheters can be used in children for postoperative analgesia without an increased risk of epidural infection.
PMID: 15333395 [PubMed - indexed for MEDLINE]
Comment on:
Self-extraction of intrathecal pump opioid.
Kittelberger KP, Buchheit TE, Rice SF.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15329620 [PubMed - indexed for MEDLINE]
Comment on:
Effects of long-term nerve blockade in the spared nerve injury model.
Kissin I, Lee SS.
Publication Types:
PMID: 15329619 [PubMed - indexed for MEDLINE]
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Reversal of minimum alveolar concentrations of volatile anesthetics by chromosomal substitution.
Stekiel TA, J Contney S, Bosnjak ZJ, Kampine JP, Roman RJ, Stekiel WJ.
Department of Physiology, The Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. tstekiel@mcw.edu
PMID: 15329608 [PubMed - indexed for MEDLINE]
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Intrathecal gabapentin enhances the analgesic effects of subtherapeutic dose morphine in a rat experimental pancreatitis model.
Smiley MM, Lu Y, Vera-Portocarrero LP, Zidan A, Westlund KN.
Department of Neurosciences and Cell Biology, University of Texas Medical Branch, Galveston, Texas 77555-1043, USA.
BACKGROUND: Morphine sulfate has long been used for analgesia, but clinical applications can be limited by side effects, tolerance, and potential for addiction at therapeutic doses. An agent that produces therapeutic analgesia when coadministered with low-dose morphine could have important clinical uses. The anticonvulsant agent gabapentin has been identified as having antihyperalgesic properties acting on the alpha2delta1 subunit of N-type voltage-activated calcium channels on dorsal root ganglia neurons. In this study, intrathecal gabapentin, which by itself is ineffective when administered spinally, was combined with low-dose morphine and tested in an acute bradykinin-induced pancreatitis model in rats. METHODS: An intrathecal catheter was surgically inserted into the subarachnoid space of male Sprague-Dawley rats. A laparotomy was performed for ligation and cannulation of the bile-pancreatic duct. Rats were pretreated intrathecally with artificial cerebrospinal fluid, gabapentin, morphine, or combined gabapentin and morphine 30 min before bradykinin injection into the bile-pancreatic duct. Spontaneous behavioral activity (cage crossing, rearing, and hind limb extension) was monitored before drug injection (baseline) and after bradykinin injection into the bile-pancreatic duct to assess visceral pain. RESULTS: Spinal pretreatment with up to 300 microg gabapentin alone was not effective in reducing hind limb extension in this model, but did restore some cage crossing and rearing behaviors. Spinal treatment with low-dose morphine reduced hind limb extension only. Spinal pretreatment with combined gabapentin and subtherapeutic doses of morphine sulfate resulted in restoration of all spontaneous behaviors to surgical baseline levels including elimination of hind limb extension. CONCLUSION: Combined spinal administration of gabapentin and low doses of morphine significantly reduces pain-related behaviors in this acute rat pancreatitis model, whereas these agents were ineffective when used alone in this dose range. These data suggest that the alpha2delta1 subunit of the N-type voltage-activated Ca2+ channels is involved in transmission of this visceral pain, likely through effects on primary afferent endings in the spinal cord. Thus, gabapentin may be an effective adjuvant to initial low dose spinal opioid therapy for clinical management of visceral pain.
PMID: 15329602 [PubMed - indexed for MEDLINE]
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The spinal antinociceptive effect of nocistatin in neuropathic rats is blocked by D-serine.
Muth-Selbach U, Dybek E, Kollosche K, Stegmann JU, Holthusen H, Lipfert P, Zeilhofer HU.
Klinik fur Anaesthesiologie, Universitatsklinikum Dusseldorf, Dusseldorf, Germany. muthslb@uni-duesseldorf.de
BACKGROUND: The neuropeptide nocistatin (NST) has been implicated in the modulation of nociceptive responses in the spinal cord. Depending on the dose, both pronociceptive and antinociceptive effects have repeatedly been reported. The pronociceptive effect is most likely attributable to inhibition of synaptic glycine and gamma-aminobutyric acid release and a subsequent reduction in the activation of inhibitory glycine and gamma-aminobutyric acid receptors, but the mechanisms of its antinociceptive action have hitherto remained elusive. It has recently been demonstrated that synaptically released glycine contributes to N-methyl-D-aspartate receptor activation. The authors therefore investigated whether a reduction in glycine release might also account for the antinociceptive action of NST in neuropathic rats. METHODS: The authors analyzed the effects of spinally applied NST in the chronic constriction injury model of neuropathic pain. NST was injected intrathecally from nanomolar to picomolar doses and its effects on thermal paw withdrawal latencies were monitored. Furthermore, we tested whether D-serine (100 microg per rat), a full agonist at the glycine binding site of the N-methyl-D-aspartate receptor, would interfere with the effects of NST. RESULTS: At high doses (10 nmol/rat), intrathecally injected NST was pronociceptive, whereas lower doses (1 pmol/rat) elicited antinociception. The antinociceptive, but not the pronociceptive, action was occluded by intrathecal pretreatment with D-serine. L-serine, which does not bind to N-methyl-D-aspartate receptors, affected neither the pronociceptive nor the antinociceptive effect. CONCLUSIONS: These results demonstrate that NST produces a biphasic dose-dependent effect on neuropathic pain. The spinal antinociception by NST is most likely attributable to inhibition of glycine-dependent N-methyl-D-aspartate receptor activation.
PMID: 15329601 [PubMed - indexed for MEDLINE]
Comment on:
Summaries for patients. Manipulative therapy for patients with shoulder pain.
[No authors listed]
Publication Types:
- Comment
- Patient Education Handout
PMID: 15381538 [PubMed - indexed for MEDLINE]
Comment in:
Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial.
Bergman GJ, Winters JC, Groenier KH, Pool JJ, Meyboom-de Jong B, Postema K, van der Heijden GJ.
University of Groningen and University Hospital of Groningen, Groningen, The Netherlands. g.j.d.bergman@med.rug.nl
BACKGROUND: Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking. OBJECTIVE: To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction. DESIGN: Randomized, controlled trial. SETTING: General practices in Groningen, the Netherlands. PATIENTS: 150 patients with shoulder symptoms and dysfunction of the shoulder girdle. INTERVENTIONS: All patients received usual medical care from their general practitioners. Only the intervention group received additional manipulative therapy, up to 6 treatment sessions in a 12-week period. MEASUREMENTS: Patient-perceived recovery, severity of the main complaint, shoulder pain, shoulder disability, and general health. Data were collected during and at the end of the treatment period (at 6 and 12 weeks) and during the follow-up period (at 26 and 52 weeks). RESULTS: During treatment (6 weeks), no significant differences were found between study groups. After completion of treatment (12 weeks), 43% of the intervention group and 21% of the control group reported full recovery. After 52 weeks, approximately the same difference in recovery rate (17 percentage points) was seen between groups. During the intervention and follow-up periods, a consistent between-group difference in severity of the main complaint, shoulder pain and disability, and general health favored additional manipulative therapy. LIMITATIONS: The sample size was small, and assessment of end points was subjective. CONCLUSION: Manipulative therapy for the shoulder girdle in addition to usual medical care accelerates recovery of shoulder symptoms.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15381516 [PubMed - indexed for MEDLINE]
Comment on:
Back pain and physiotherapy.
MacAuley D.
Publication Types:
PMID: 15388588 [PubMed - indexed for MEDLINE]
Comment in:
Randomised controlled trial of physiotherapy compared with advice for low back pain.
Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S.
Division of Health in the Community, Warwick Medical School, University of Warwick, Warwick CV4 7AL. h.frost.1@warwick.ac.uk
OBJECTIVE: To measure the effectiveness of routine physiotherapy compared with an assessment session and advice from a physiotherapist for patients with low back pain. DESIGN: Pragmatic, multicentre, randomised controlled trial. SETTING: Seven British NHS physiotherapy departments. PARTICIPANTS: 286 patients with low back pain of more than six weeks' duration. INTERVENTION: Routine physiotherapy or advice on remaining active from a physiotherapist. Both groups received an advice book. MAIN OUTCOME MEASURES: Primary outcome was scores on the Oswestry disability index at 12 months. Secondary outcomes were scores on the Oswestry disability index (two and six months), scores on the Roland and Morris disability questionnaire and SF-36 (2, 6 and 12 months), and patient perceived benefit from treatment (2, 6, and 12 months). RESULTS: 200 of 286 patients (70%) provided follow up information at 12 months. Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or generic outcome measures (mean difference in change in Oswestry disability index scores at 12 months -1.0%, 95% confidence interval -3.7% to 1.6%). The most common treatments were low velocity spinal joint mobilisation techniques (72%, 104 of 144 patients) and lumbar spine mobility and abdominal strengthening exercises (94%, 136 patients). CONCLUSIONS: Routine physiotherapy seemed to be no more effective than one session of assessment and advice from a physiotherapist.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15377573 [PubMed - indexed for MEDLINE]
Role of {beta}-blockade in anaesthesia and postoperative pain management after hysterectomy.
Chia YY, Chan MH, Ko NH, Liu K.
Department of Anaesthesiology, Kaohsiung Veterans General Hospital, and School of Medicine, National Yang-Ming University, 386, Ta-Chung First Road, Kaohsiung 813, Taiwan.
BACKGROUND: Perioperative use of beta-blockers has been advocated as a strategy to prevent cardiac sequelae. This study evaluated the influence of perioperative esmolol administration upon anaesthesia and postoperative pain management amongst patients undergoing hysterectomy. METHODS: Ninety-seven ASA I-II patients, undergoing abdominal total hysterectomy, were randomly divided into one of two groups. Patients in the Esmolol group received an i.v. loading dose of esmolol 0.5 mg kg(-1) followed by infusion of 0.05 mg kg(-1) min(-1) before anaesthesia induction. The infusion was documented at the completion of surgery. The Control group received a volume of normal saline. After surgery, all patients were treated with patient-controlled i.v. analgesia (PCA), which was programmed to deliver 1 mg of morphine on demand for 3 consecutive days. Pain intensity on movement and at rest, sedation score, and side effects were recorded. RESULTS: The two groups were comparable with respect to their characteristics. Patients in the esmolol group received significantly lower end-tidal isoflurane concentrations (1.0 (0.3) vs 1.4 (0.5)%, respectively; P<0.001) and fentanyl (0.9 (0.2) vs 1.2 (0.5) micro g kg(-1), respectively; P=0.006) during anaesthesia. They also showed a reduced heart rate and arterial pressure response to tracheal intubation, skin incision, and tracheal extubation. The Esmolol group consumed less PCA morphine in 3 days (37.3 (8.4) vs 54.7 (11.2) mg, respectively; P=0.005). Pain intensity and medication side effects were similar in the two groups. CONCLUSION: The results suggest that perioperative esmolol administration during anaesthesia reduces the intraoperative use of inhalation anaesthetic and fentanyl, decreases haemodynamic responses, and reduced morphine consumption for the first 3 postoperative days.
PMID: 15377583 [PubMed - as supplied by publisher]
-
Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty.
Davies AF, Segar EP, Murdoch J, Wright DE, Wilson IH.
Department of Anaesthesia, R D and E Hospital, Exeter, UK. Anthony.Davies@phnt.swest.nhs.uk
BACKGROUND: Peripheral neural blockade appears to provide effective analgesia with potentially less morbidity than central neuraxial techniques. We compared the relative benefits of combined femoral (3-in-1) and sciatic nerve block with epidural blockade for postoperative knee arthroplasty analgesia. METHODS: Sixty patients, ASA I-III, undergoing unilateral knee replacement were prospectively randomized to receive either a lumbar epidural infusion or combined single-shot femoral (3-in-1) and sciatic blocks (combined blocks). All patients received standard general anaesthesia. Visual analogue pain scores and rescue opioid requirements were recorded at four time points postoperatively. Patient satisfaction, morbidity, block insertion time, perioperative blood loss and rehabilitation indices were also assessed. RESULTS: In both groups, pain on movement was well controlled at discharge from recovery and 6 h postoperatively but increased at 24 and 48 h. Median (95% CI) analogue scale scores were 0 (0-0), 15 (0-30), 55 (38-75) and 54 (30-67) mm for epidural block and 0.5 (0-22), 21.5 (10-28), 40 (20-50) and 34.5 (21-55) mm for combined block. VAS pain scores with the combined blocks were significantly lower at 24 h (P=0.004). Total morphine usage was low in both groups: median epidural group 17 mg (8-32) versus combined blocks 13 mg (7.8-27.5). Patient satisfaction was high in both groups with median (95% CI) scores of 100 (85-100), 83 (70-100) and 82 (57-90) mm for epidural and 90 (73-100), 100 (77-100) and 97 (80-100) mm for combined blocks (not significant). Perioperative blood loss and rehabilitation indices were also similar. CONCLUSIONS: Combined femoral (3-in-1) and sciatic blocks offer a practical alternative to epidural analgesia for unilateral knee replacements.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15247111 [PubMed - indexed for MEDLINE]
-
Right thoracic paravertebral analgesia for hepatectomy.
Ho AM, Karmakar MK, Cheung M, Lam GC.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People's Republic of China. hoamh@cuhk.edu.hk
Haemostatic deficiencies, common among cirrhotic patients, may deteriorate further after hepatectomy, increasing the bleeding risk associated with the use of thoracic epidural analgesia. We describe two patients who enjoyed immediate post-operative tracheal extubation and satisfactory analgesia using mainly right thoracic paravertebral analgesia after right lobe hepatectomy.
Publication Types:
PMID: 15220169 [PubMed - indexed for MEDLINE]
-
Epidural oxycodone or morphine following gynaecological surgery.
Yanagidate F, Dohi S.
Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu 501-1194, Japan.
BACKGROUND: The analgesic action of oxycodone is of rapid onset, in contrast to morphine, and is mediated by kappa-opioid receptors of the spinal cord. We compared analgesia and side-effects of epidural oxycodone with those of morphine after gynaecological surgery. METHODS: We studied prospectively in 75 women in a double-blind, randomized manner: epidural morphine 6 mg day(-1) (n=25), epidural oxycodone 6 mg day(-1) (n=25) and epidural oxycodone 12 mg day(-1) (n=25). All patients underwent gynaecological surgery under general (isoflurane and nitrous oxide) and epidural anaesthesia. Visual analogue scale (VAS) pain scores at rest and on coughing, verbal descriptive scale (VDS) satisfaction scores, sedation scores, pruritus scores and nausea/vomiting scores were recorded for 3 days after surgery. RESULTS: VAS pain scores at rest in patients who received oxycodone 6 mg day(-1) were higher than in patients who received morphine 6 mg day(-1) at 6 h and on the first postoperative day and were significantly higher than in patients who received oxycodone 12 mg day(-1) on the first postoperative day. Scores for nausea, vomiting and pruritus in patients who received oxycodone 6 mg day(-1) and 12 mg day(-1) were lower than those in patients who received morphine. No significant differences were seen in VAS at cough and VDS satisfaction scores between the three groups. CONCLUSION: Epidural oxycodone was as effective as morphine at the doses investigated, with fewer side-effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15220165 [PubMed - indexed for MEDLINE]
-
General anaesthesia combined with bilateral paravertebral blockade (T5-6) vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomized clinical trial.
Naja MZ, Ziade MF, Lonnqvist PA.
Makassed General Hospital, Department of Anaesthesia and Pain Medicine, Beirut, Lebanon. zouhnaja@yahoo.com
BACKGROUND AND OBJECTIVE: The efficiency of bilateral paravertebral blockade combined with general anaesthesia (active) vs. general anaesthesia alone (control) in reducing postoperative pain following laparoscopic cholecystectomy was evaluated using a prospective randomized study design. METHODS: Patients were randomly assigned to either group. Nerve-stimulator guided paravertebral blockade at the T5-6 level was performed with a local anaesthetic mixture (0.30 mL kg(-1)). Twenty millilitres of the mixture contained lidocaine 2% 6 mL; lidocaine 2% 6 mL with epinephrine 1/200 000; bupivacaine 0.5% 5 mL; fentanyl 1 mL (50 microg mL(-1)) and clonidine 2 mL (150 microg mL(-1)). Postoperative pain and consumption of opioids were assessed during the first 72 h. RESULTS: Two-times 30 patients were analysed. Patient characteristics data, and pre- and peroperative variables were similar in both groups. Mean pain scores visual analogue scale were significantly less with active compared with control (P < 0.05) at 6h (1.56 +/- 1.58 vs. 4.78 +/- 1.67), at 12 h (1.52 +/- 1.58 vs. 3.81 +/- 1.63), at 24 h (1.16 +/- 1.34 vs. 2.71 +/- 1.50), at 36h (0.68 +/- 1.02 vs. 2.29 +/- 1.41), at 48h (0.60 +/- 1.04 vs. 1.61 +/- 1.33) and at 72 h (0.40 +/- 0.86 vs. 1.19 +/- 1.16). The number of patients consuming supplemental analgesics was significantly less (P < 0.05) with active compared with control, at 6 h (6 vs. 29), at 12 h (2 vs. 26), at 24 h (1 vs. 23) and at 36 h (2 vs. 15). More patients were free from nausea (P < 0.05) with active compared with control at 6 h (23 vs. 9) and at 12 h (29 vs. 19). CONCLUSION: When used as a complement to general anaesthesia, bilateral nerve-stimulator guided paravertebral blockade with lidocaine, bupivacaine, fentanyl and clonidine may improve postoperative pain relief.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15248630 [PubMed - indexed for MEDLINE]
-
Ibuprofen vs. acetaminophen vs. ibuprofen and acetaminophen after arthroscopically assisted anterior cruciate ligament reconstruction.
Dahl V, Dybvik T, Steen T, Aune AK, Rosenlund EK, Raeder JC.
Volvat Medical Centre, Department of Anesthesia, Oslo, Norway. dr.dahl@online.no
BACKGROUND AND OBJECTIVE: The analgesic potency of non-steroidal anti-inflammatory drugs and acetaminophen are still being debated. We have assessed the relative analgesic effect of ibuprofen, acetaminophen or the combination of both after orthopaedic surgery. METHODS: Sixty-one ASA I patients, scheduled for an elective anterior cruciate ligament reconstruction under general anaesthesia were randomized, in a double blind fashion, into one of three groups. The ibuprofen group (n = 17) received ibuprofen 800 mg orally 1 h before operation and again at 6 and 12 h after the initial dose. The acetaminophen group (n = 20) received of acetaminophen 1 g orally at the same time intervals. The combination group (n = 24) received both ibuprofen 800 mg and acetaminophen 1 g. Surgery was performed under general anaesthesia with propofol and fentanyl for induction and maintenance with propofol and nitrous oxide in oxygen. The patients were monitored for 24 h thereafter, and the following variables were assessed: pain by visual analogue and verbal scales, need for rescue intravenous opioid analgesia (i.e. ketobemidone) and adverse events. RESULTS: The ibuprofen group and the combination group experienced significantly less pain during the first 6 h after surgery than the acetaminophen group using the visual analogue and the verbal scales. The acetaminophen group also had a significantly higher average consumption of opioids during the first 6 and 24 h. There were no significant differences between the ibuprofen group and the combination group in respect of experienced pain or consumption of rescue analgesia. The incidence of side-effects, postoperative haemoglobin concentration and renal function, judged by creatinine clearance, were identical between the groups. CONCLUSION: Ibuprofen 800 mg thrice daily reduced pain to a greater degree than acetaminophen 1 g thrice daily, after anterior cruciate ligament reconstruction under general anaesthesia. The combination of acetaminophen and ibuprofen did not provide any superior analgesic effect.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15248627 [PubMed - indexed for MEDLINE]
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Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine.
Ogawa Y, Toyama Y, Chiba K, Matsumoto M, Nakamura M, Takaishi H, Hirabayashi H, Hirabayashi K.
Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
OBJECT: Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior-posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results. METHODS: Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 +/- 0.4; at 3 years postoperatively, the JOA score was 14.2 +/- 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 +/- 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results. CONCLUSIONS: Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.
PMID: 15347002 [PubMed - indexed for MEDLINE]
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Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation.
Hwang SL, Lin CL, Lieu AS, Lee KS, Kuo TH, Hwang YF, Su YF, Howng SL.
Division of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China.
OBJECT: Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for the treatment of one- and two-level degenerative disc disease (DDD). To the authors' knowledge, clinical results after three- and four-level interbody cage-augmented ACDF have not been reported in the literature. The authors investigated the safety and effectiveness of titanium cages used in such procedures and evaluated the results in cases with or without plate fixation. METHODS: Fifty-six patients suffering from cervical DDD were divided into two groups. Group 1 included 32 patients who underwent titanium cage-assisted ACDF; Group 2 included 24 patients who underwent the same procedure, supplemented with plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, the height of the foramina, and spinal stability. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) scores. Neck pain was graded using a 10-point visual analog scale (VAS). The follow-up period ranged from 13 to 28 months (mean 17.2 months). In both Groups 1 and 2 significant increase (p < 0.001) was demonstrated in the JOA scores (preoperatively 10.7 +/- 2.4 and 11.1 +/- 2, postoperatively 13.9 +/- 2.2 and 14.1 +/- 2.3, respectively) and VAS pain scores (preoperatively 8.8 +/- 0.9 and 8.5 +/- 1, postoperatively 3.1 +/- 2.1 and 2.8 +/- 1.8, respectively); however, there was no significant intergroup difference. A significant increase in the cervical lordosis, foraminal height, and segmental height was observed in both groups. Good stability of cage fusion was obtained in both groups 12 months postoperatively (90.6% in Group 1 and 91.7% in Group 2); however, there were no statistically significant intergroup differences. The complication rate in Group 2 was higher than that in Group 1. The hospital length of stay in Group 1 was significantly lower than in Group 2 (p < 0.001). CONCLUSIONS: Analysis of these findings demonstrated that titanium cage-assisted ACDF provided long-term stabilization, increased lordosis, increased segmental height, and increased foraminal height. In both groups good neurological outcomes were achieved and donor site morbidity was avoided. The lower complication rate and shorter hospital stay, however, make the cage-assisted fusion without plate fixation better than with plate fixation.
Publication Types:
PMID: 15347001 [PubMed - indexed for MEDLINE]
Comment in:
Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial.
de Lemos JA, Blazing MA, Wiviott SD, Lewis EF, Fox KA, White HD, Rouleau JL, Pedersen TR, Gardner LH, Mukherjee R, Ramsey KE, Palmisano J, Bilheimer DW, Pfeffer MA, Califf RM, Braunwald E; A to Z Investigators.
Donald W. Reynolds Cardiovascular Clinical Research Center, the University of Texas Southwestern Medical Center, Dallas 75390-9047, USA. james.delemos@utsouthwestern.edu).
CONTEXT: Limited data are available evaluating how the timing and intensity of statin therapy following an acute coronary syndrome (ACS) event affect clinical outcome. OBJECTIVE: To compare early initiation of an intensive statin regimen with delayed initiation of a less intensive regimen in patients with ACS. DESIGN, SETTING, AND PARTICIPANTS: International, randomized, double-blind trial of patients with ACS receiving 40 mg/d of simvastatin for 1 month followed by 80 mg/d thereafter (n = 2265) compared with ACS patients receiving placebo for 4 months followed by 20 mg/d of simvastatin (n = 2232), who were enrolled in phase Z of the A to Z trial between December 29, 1999, and January 6, 2003. MAIN OUTCOME MEASURE: The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, readmission for ACS, and stroke. Follow-up was for at least 6 months and up to 24 months. RESULTS: Among the patients in the placebo plus simvastatin group, the median low-density lipoprotein (LDL) cholesterol level achieved while taking placebo was 122 mg/dL (3.16 mmol/L) at 1 month and was 77 mg/dL (1.99 mmol/L) at 8 months while taking 20 mg/d of simvastatin. Among the patients in the simvastatin only group, the median LDL cholesterol level achieved at 1 month while taking 40 mg/d of simvastatin was 68 mg/dL (1.76 mmol/L) and was 63 mg/dL (1.63 mmol/L) at 8 months while taking 80 mg/d of simvastatin. A total of 343 patients (16.7%) in the placebo plus simvastatin group experienced the primary end point compared with 309 (14.4%) in the simvastatin only group (40 mg/80 mg) (hazard ratio [HR], 0.89; 95% confidence interval [CI] 0.76-1.04; P =.14). Cardiovascular death occurred in 109 (5.4%) and 83 (4.1%) patients in the 2 groups (HR, 0.75; 95% CI, 0.57-1.00; P =.05) but no differences were observed in other individual components of the primary end point. No difference was evident during the first 4 months between the groups for the primary end point (HR, 1.01; 95% CI, 0.83-1.25; P =.89), but from 4 months through the end of the study the primary end point was significantly reduced in the simvastatin only group (HR, 0.75; 95% CI, 0.60-0.95; P =.02). Myopathy (creatine kinase >10 times the upper limit of normal associated with muscle symptoms) occurred in 9 patients (0.4%) receiving simvastatin 80 mg/d, in no patients receiving lower doses of simvastatin, and in 1 patient receiving placebo (P =.02). CONCLUSIONS: The trial did not achieve the prespecified end point. However, among patients with ACS, the early initiation of an aggressive simvastatin regimen resulted in a favorable trend toward reduction of major cardiovascular events.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15337732 [PubMed - indexed for MEDLINE]
Comment on:
High-dose statins in acute coronary syndromes: not just lipid levels.
Nissen SE.
Publication Types:
PMID: 15337731 [PubMed - indexed for MEDLINE]
Comment in:
Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial.
Poole-Wilson PA, Lubsen J, Kirwan BA, van Dalen FJ, Wagener G, Danchin N, Just H, Fox KA, Pocock SJ, Clayton TC, Motro M, Parker JD, Bourassa MG, Dart AM, Hildebrandt P, Hjalmarson A, Kragten JA, Molhoek GP, Otterstad JE, Seabra-Gomes R, Soler-Soler J, Weber S; A Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system investigators.
Cardiac Medicine, Imperial College London, Dovehouse Street, London SW3 6LY, UK. p.poole-wilson@imperial.ac.uk
BACKGROUND: Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris. METHODS: We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4.9 years (SD 1.1). Analysis was by intention to treat. FINDINGS: 310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1.53 per 100 patient-years; hazard ratio 1.07 [95% CI 0.91-1.25], p=0.41). Primary endpoint rates were 4.60 per 100 patient-years for nifedipine and 4.75 per 100 patient-years for placebo (0.97 [0.88-1.07], p=0.54). With nifedipine, rate of death and any cardiovascular event or procedure was 9.32 per 100 patient-years versus 10.50 per 100 patient-years for placebo (0.89 [0.83-0.95], p=0.0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction. INTERPRETATION: Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15351192 [PubMed - indexed for MEDLINE]
Comment on:
Analgesia in prostate biopsy.
Fowler AW.
Publication Types:
PMID: 15351189 [PubMed - indexed for MEDLINE]
Comment on:
Contemplating ACTION--long-acting nifedipine in stable angina.
Psaty BM, Furberg CD.
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA. psaty@u.washington.edu
Publication Types:
PMID: 15351169 [PubMed - indexed for MEDLINE]
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