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Items 1 - 19 of 19 |
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[Analgesic effect of continuous intravenous nefopam after urological surgery]
[Article in French]
Merle JC, Vandroux D, Odin I, Dupuis JL, Bougault A, Mehaddi Y, Nathan N.
Departement d'anesthesie-reanimation chirurgicale, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
OBJECTIVES:To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly used by continuous infusion by many anaesthetists to reduce its adverse effects. However whether the analgesic effect of an intermittent administration of nefopam has been proven, the efficacy of continuous infusion has not been established. STUDY DESIGN: Double-blind placebo controlled prospective randomised study. PATIENTS AND METHODS: Sixty patients ASA 1 to 3 undergoing planned urological surgery with laparotomy were included. At the end of surgery, bolus doses of placebo (Group 3) or nefopam 20 mg (Group 1 and 2) were administered to all the patients. Placebo (Group 3), nefopam 80 mg (Group 1) or 120 mg (Group 2) was thereafter continuously infused over 24 hours. All patients received additional analgesia with PCA morphine. We measured pain at rest and on cough with VAS.Adverse side effects such as nausea and vomiting, sedation and respiratory depression were evaluated. Mental performance was measured with mini mental status tests. RESULTS: Patients were older in the placebo group by approximately six years but anesthetic and surgical variables were not different between groups. Pain at rest and on cough was not statistically different between groups. In the placebo group, the median (interquartile range) morphine consumption reached 29 mg (13-53) whereas in patients receiving 80 and 120 mg nefopam, it levelled to 44 mg (11-54) and 35 mg (9-82) respectively (p > 0.05). Patients needed morphine during the same time period whether they received nefopam or not. Patients suffering from adverse effects were similar between groups. CONCLUSION: In this study, continuous administration of nefopam did not reduce morphine consumption nor ameliorate analgesia and thus may not be recommended in urological surgery. Nefopam pharmacokinetics when used with continuous infusion as well as surgery types and differences in age between groups may explain these results.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15661459 [PubMed - indexed for MEDLINE]
Comment on:
Managing osteoarthritis of the knee: holistic approach is important.
Mitchell CA, Adebajo A.
Publication Types:
PMID: 15775013 [PubMed - indexed for MEDLINE]
Comment on:
Managing osteoarthritis of the knee: glucosamine-chondroitin should be prescribed by doctors.
Chalmers R.
Publication Types:
PMID: 15775012 [PubMed - indexed for MEDLINE]
Comment on:
Specialist palliative care in dementia: ...and hope for terminal care at home is needed in developed countries.
Treloar A, Newport J, Venn-Treloar J.
Publication Types:
PMID: 15775008 [PubMed - indexed for MEDLINE]
Comment on:
Managing osteoarthritis of the knee: conclusions about use of NSAIDs are misleading.
Tubach F, Ravaud P, Giraudeau B.
Publication Types:
PMID: 15775007 [PubMed - indexed for MEDLINE]
Comment on:
Perioperative analgesia for knee arthroplasty.
Vanarase MY, Pandit HG, Dodd CA, Murray DW, Popat MT.
Publication Types:
PMID: 15779128 [PubMed - indexed for MEDLINE]
Comment on:
Perioperative analgesia for knee arthroplasty.
Kuhne J.
Publication Types:
PMID: 15703307 [PubMed - indexed for MEDLINE]
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The preoperative administration of ketoprofen improves analgesia after laparoscopic cholecystectomy in comparison with propacetamol or postoperative ketoprofen.
Boccara G, Chaumeron A, Pouzeratte Y, Mann C.
Department of Anaesthesiology and Critical Care, Hospital Saint-Joseph, 75674 Paris, France. gboccara@hopital-saint-joseph.org
BACKGROUND: Non-opioid analgesics, paracetamol and non-steroid anti-inflammatory drugs (NSAIDs) are proposed for pain relief after laparoscopy. We compared perioperative propacetamol (P) and ketoprofen (K) to provide analgesia after laparoscopic cholecystectomy. METHODS: After ethical committee approval, we included 104 ASA I-II patients, without preoperative analgesic drugs, who were scheduled to undergo laparoscopic cholecystectomy. Anaesthesia was standardized using propofol, fentanyl, atracurium, isoflurane and N(2)O 50%. Ketoprofen 100 mg or propacetamol 2 g or a saline drip (a 100-ml unit of saline in 10 min) was infused blindly and randomly. Patients received either ketoprofen (group K1) or propacetamol (group P1) before induction of anaesthesia and saline after surgery, or saline before surgery and ketoprofen (group K2) or propacetamol (group P2) after surgery. Postoperative visual analogue pain scores (VAS 0-100 mm) were recorded during 24 h. If VAS was >30, a second dose (placebo, ketoprofen or propacetamol) was infused. Nalbuphine 0.2 mg kg(-1) i.v. was given as rescue analgesic if VAS was > or =50. RESULTS: Ninety-eight patients were studied The number of patients not requiring the second analgesic was greater in K1 (33.5%) than the others (K2 0%, P1 0%, P2 7.5%). VAS scores were significantly lower in K1 (P=0.001), with less nalbuphine consumption compared with P1. VAS and opioid request were similar in K2 and P2. CONCLUSION: Preoperative administration of ketoprofen improves postoperative analgesia after laparoscopic cholecystectomy compared with its postoperative administration and pre- and postoperative propacetamol.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15619603 [PubMed - indexed for MEDLINE]
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Epidural analgesia after spinal surgery via intervertebral foramen.
Sice PJ, Chan D, MacIntyre PA.
Department of Anaesthesia, Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter, UK. paulsice@aol.com
Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications.
Publication Types:
PMID: 15619602 [PubMed - indexed for MEDLINE]
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Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study.
Mannion S, O'Callaghan S, Murphy DB, Shorten GD.
Department of Anaesthesia and Intensive Care, Cork University Hospital, University College Cork, Cork, Ireland. mannionstephen@hotmail.com
BACKGROUND: Tramadol has been administered peripherally to prolong analgesia after brachial plexus and neuraxial blocks. Our aim was to evaluate the systemic and perineural effects of tramadol as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. METHODS: In a randomized, prospective, double-blinded trial, 60 patients (ASA I-III), aged 49-88 yr, undergoing primary total hip or knee arthroplasty underwent PCB and subsequent bupivacaine spinal anaesthesia. Patients were randomized into three groups. Each patient received PCB with levobupivacaine 0.5%, 0.4 ml kg(-1). The control group (group L, n=21) received i.v. saline, the systemic tramadol group (group IT, n=19) received i.v. tramadol 1.5 mg kg(-1) and the perineural tramadol group (group T, n=20) received i.v. saline and PCB with tramadol 1.5 mg kg(-1). Postoperatively patients received regular paracetamol 6-hourly and diclofenac sodium 12-hourly. Time to first morphine analgesia, 24-hour morphine consumption, sensory block, pain and sedation scores and haemodynamic parameters were recorded. RESULTS: Time (h) to first morphine analgesia was similar in the three groups [mean (SD)]: group L, 11.2 (6.6); group T, 14.5 (8.0); group IT, 14.6 (6.8); P=0.35. Twenty-four-hour cumulative morphine (mg) consumption was also similar in the three groups [group L, 21.9 (10.1); group T, 19.8 (6.7), group IT, 16.5 (9.5)], as were durations of sensory and motor block. There were no differences in the incidence of adverse effects except that patients in group IT were more sedated at 14 h than group L (P=0.02). CONCLUSION: We conclude that our data do not support a clinically important local anaesthetic or peripheral analgesic effect of tramadol as adjunct to PCB with levobupivacaine 0.5%.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15608044 [PubMed - indexed for MEDLINE]
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Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children.
Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti A, Di Marco S, Fumagalli R.
Anaesthesia and Intensive Care Department, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy.
BACKGROUND: The rationale for replacing racemic bupivacaine with the s-enantiomers levobupivacaine and ropivacaine is to provide a wider margin of safety with the same analgesic efficacy and less postoperative motor block. In a randomized, double-blind, phase III, controlled trial we compared the caudal administration of levobupivacaine 0.25% and ropivacaine 0.25% with bupivacaine 0.25% in children. METHODS: Ninety-nine ASA I-II children less than 10 yr old scheduled for elective sub-umbilical surgery were randomized to receive caudal block with bupivacaine 0.25%, ropivacaine 0.25% or levobupivacaine 0.25%. The primary outcome of the study was the clinical efficacy of the caudal block during the operation. Secondary outcome measures were analgesic onset time, pain relief after the operation and residual motor blockade. RESULTS: The proportion of children with effective analgesia during the operation was similar among groups. There were no significant differences in the analgesic onset time of the caudal block. Bupivacaine produced a significant incidence of residual motor block compared with levobupivacaine or ropivacaine at wake-up (P<0.01). There were no significant differences in the number of patients receiving rescue analgesia after surgery. However, analgesic block lasted significantly longer in patients receiving bupivacaine (P=0.03). CONCLUSION: During sub-umbilical surgery, caudal levobupivacaine, ropivacaine and bupivacaine provided comparable analgesic efficacy. Bupivacaine produced a higher incidence of residual motor blockade and a longer analgesic block than ropivacaine and levobupivacaine.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase III
- Randomized Controlled Trial
PMID: 15608043 [PubMed - indexed for MEDLINE]
Comment on:
Looking for the role of NSAIDs in cancer pain.
Mercadante S.
Publication Types:
PMID: 15800352 [PubMed - indexed for MEDLINE]
Comment on:
Combination therapy for neuropathic pain--which drugs, which combination, which patients?
Raja SN, Haythornthwaite JA.
Publication Types:
PMID: 15800235 [PubMed - indexed for MEDLINE]
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Case records of the Massachusetts General Hospital. Case 10-2005. A 73-year-old man with weakness and pain in the legs.
Heller HM, Telford SR 3rd, Branda JA.
Infectious Disease Unit, Massachusetts General Hospital, Boston, USA.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15800232 [PubMed - indexed for MEDLINE]
Comment in:
Morphine, gabapentin, or their combination for neuropathic pain.
Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL.
Department of Anesthesiology, Queen's University, Kingston, Ont, Canada. gilroni@post.queensu.ca
BACKGROUND: The available drugs to treat neuropathic pain have incomplete efficacy and dose-limiting adverse effects. We compared the efficacy of a combination of gabapentin and morphine with that of each as a single agent in patients with painful diabetic neuropathy or postherpetic neuralgia. METHODS: In this randomized, double-blind, active placebo-controlled, four-period crossover trial, patients received daily active placebo (lorazepam), sustained-release morphine, gabapentin, and a combination of gabapentin and morphine--each given orally for five weeks. The primary outcome measure was mean daily pain intensity in patients receiving a maximal tolerated dose; secondary outcomes included pain (rated according to the Short-Form McGill Pain Questionnaire), adverse effects, maximal tolerated doses, mood, and quality of life. RESULTS: Of 57 patients who underwent randomization (35 with diabetic neuropathy and 22 with postherpetic neuralgia), 41 completed the trial. Mean daily pain (on a scale from 0 to 10, with higher numbers indicating more severe pain) at a maximal tolerated dose of the study drug was as follows: 5.72 at baseline, 4.49 with placebo, 4.15 with gabapentin, 3.70 with morphine, and 3.06 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). Total scores on the Short-Form McGill Pain Questionnaire (on a scale from 0 to 45, with higher numbers indicating more severe pain) at a maximal tolerated dose were 14.4 with placebo, 10.7 with gabapentin, 10.7 with morphine, and 7.5 with the gabapentin-morphine combination (P<0.05 for the combination vs. placebo, gabapentin, and morphine). The maximal tolerated doses of morphine and gabapentin were lower (P<0.05) with the combination than for each drug as single agent. At the maximal tolerated dose, the gabapentin-morphine combination resulted in a higher frequency of constipation than gabapentin alone (P<0.05) and a higher frequency of dry mouth than morphine alone (P<0.05). CONCLUSIONS: Gabapentin and morphine combined achieved better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects. Copyright 2005 Massachusetts Medical Society.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15800228 [PubMed - indexed for MEDLINE]
Comment in:
Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery.
Nussmeier NA, Whelton AA, Brown MT, Langford RM, Hoeft A, Parlow JL, Boyce SW, Verburg KM.
Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77225-0345, USA. nnussmeier@heart.thi.tmc.edu
BACKGROUND: Valdecoxib and its intravenous prodrug parecoxib are used to treat postoperative pain but may involve risk after coronary-artery bypass grafting (CABG). We conducted a randomized trial to assess the safety of these drugs after CABG. METHODS: In this randomized, double-blind study involving 10 days of treatment and 30 days of follow-up, 1671 patients were randomly assigned to receive intravenous parecoxib for at least 3 days, followed by oral valdecoxib through day 10; intravenous placebo followed by oral valdecoxib; or placebo for 10 days. All patients had access to standard opioid medications. The primary end point was the frequency of predefined adverse events, including cardiovascular events, renal failure or dysfunction, gastroduodenal ulceration, and wound-healing complications. RESULTS: As compared with the group given placebo alone, both the group given parecoxib and valdecoxib and the group given placebo and valdecoxib had a higher proportion of patients with at least one confirmed adverse event (7.4 percent in each of these two groups vs. 4.0 percent in the placebo group; risk ratio for each comparison, 1.9; 95 percent confidence interval, 1.1 to 3.2; P=0.02 for each comparison with the placebo group). In particular, cardiovascular events (including myocardial infarction, cardiac arrest, stroke, and pulmonary embolism) were more frequent among the patients given parecoxib and valdecoxib than among those given placebo (2.0 percent vs. 0.5 percent; risk ratio, 3.7; 95 percent confidence interval, 1.0 to 13.5; P=0.03). CONCLUSIONS: The use of parecoxib and valdecoxib after CABG was associated with an increased incidence of cardiovascular events, arousing serious concern about the use of these drugs in such circumstances. Copyright 2005 Massachusetts Medical Society.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15713945 [PubMed - indexed for MEDLINE]
A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain.
van der Hulst M, Vollenbroek-Hutten MM, Ijzerman MJ.
Roessingh Research and Development, Rehabilitation Center Het Roessingh, Roessinghsbleekweg, Enschede, The Netherlands. m.vanderhulst@rrd.nl
STUDY DESIGN: A systematic review. OBJECTIVE: To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. METHODS: Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. RESULTS: Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain--> worse outcome), several work-related parameters (e.g., high satisfaction--> better outcome), and coping style (less active coping--> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. CONCLUSIONS: It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.
PMID: 15803086 [PubMed - in process]
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An epidemiologic study of MRI and low back pain in 13-year-old children.
Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T.
The Back Research Center, Backcenter Funen and University of Southern Denmark, Lindevej, Denmark. pkrj@shf.fyns-amt.dk
STUDY DESIGN: Cross-sectional cohort study of a general population. OBJECTIVE: To describe associations between "abnormal" lumbar magnetic resonance imaging (MRI) findings and low back pain (LBP) in 13-year old children. SUMMARY AND BACKGROUND DATA: Very little is known about the distribution of lumbar MRI findings and how they are associated with LBP in youngsters. METHODS: Disc abnormalities, as well as nerve root compromise, endplate changes, and anterolisthesis were identified from MRI studies of 439 children. LBP was identified from structured interviews. Associations are presented as odds ratios (OR). RESULTS: Signs of disc degeneration were noted in approximately 1/3 of the subjects. Reduced signal intensity and irregular nucleus shape in the upper 3 lumbar discs were significantly associated with LBP within the last month (OR, 2.5-3.6), whereas reduced signal intensity and disc protrusion at L5-NS1 were associated with seeking care (OR, 2.8 and 7.7, respectively). Endplate changes in relation to the L3 discs were associated with LBP month and seeking care (OR, between 9.7 and 22.2). Anterolisthesis at L5 was associated with seeking care (OR, 4.3). There were obvious differences between genders: degenerative disc changes in the upper lumbar spine were more strongly associated with LBP in boys, while disc abnormalities in the lower lumbar spine were more strongly associated with seeking care in girls. CONCLUSIONS: In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference. Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.
PMID: 15803084 [PubMed - in process]
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A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain.
Lewis JS, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S.
Therapy Department, Chelsea & Westminster Healthcare National Health Service Trust, London, United Kingdom. jeremy.lewis@chelwest.nhs.uk
STUDY DESIGN: A randomized clinical trial with blinded assessment. OBJECTIVES: To investigate the clinical efficacy of 2 active interventions for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Manual therapy and exercise prescription are treatments frequently prescribed for patients with chronic low back pain. The evidence for the relative benefit of these treatments is limited, and questions concerning the most appropriate type of intervention remain unanswered. METHODS: Eighty patients with chronic low back pain (>3 months) were randomized to one of the following treatments, involving 8 treatments over 8 weeks; 1) one-to-one treatment involving 30 minutes of manual therapy (mobilizations to the spine) and spinal stabilization exercises, and 2) a 10 station exercise class involving aerobic exercises, spinal stabilization exercises, and manual therapy. Three physiotherapists led the hour long group with a maximum of 10 patients. Questionnaires were completed, and physical measurements were taken by a blinded observer before randomization, at the completion of treatment, and at 6 months and 12 months after the completion of treatment. The intention-to-treat principle was used in data analysis. RESULTS: Eleven patients dropped out of the individual treatment sessions and 7 dropped out of the exercise group. There was a significant reduction (reduced disability) in the questionnaire score in both groups, and there were significant increases in range for all the physical movements tested in both groups. The exercise group was 40% more cost effective than the individual treatments. CONCLUSION: Both forms of intervention were associated with significant improvement. On-going clinical research is necessary to provide guidance as to the clinical efficacy of various forms of intervention.
PMID: 15803071 [PubMed - in process]
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