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Thigh swelling and pain in a 35-year-old woman.
Nagi ON, Mathew M, Kumar S, Aggarwal S, Saikia UN.
Department of Orthopaedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. profnagi@yahoo.co.in
Publication Types:
PMID: 16331029 [PubMed - indexed for MEDLINE]
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Patient-perceived outcomes in thigh pain after primary arthroplasty of the hip.
Lavernia C, D'apuzzo M, Hernandez VH, Lee DJ.
Orthopaedic Institute at Mercy Hospital and the University of Miami School of Medicine, Department of Epidemiology, Miami, FL 33133, USA. clavernia@mercymiami.org
Thigh pain after arthroplasty first was identified in the joint replacement literature in 1988; little information has been published about the functional status of patients who develop this complication. Eleven patients who reported thigh pain at 2 years after cementless primary total hip arthroplasty were matched with patients who did not report thigh pain on the following characteristics: age, gender, diagnosis, bone type, and surgical procedure (ie, unilateral or bilateral). Preoperative WOMAC function scores were different in these two groups (53.5 versus 39.7). There were no differences in SF-36 and Quality of Well Being scores in the two patient groups. There were also no differences in the WOMAC, SF-36, and Quality of Well Being scores at the 2-year followup. However, item analysis of the WOMAC indicated that patients with thigh pain were more likely to report at least some functional deficit relative to patients without thigh pain at the 2-year followup. Thigh pain does not seem to affect 2-year postoperative quality of life severely in patients who have had cementless hip arthroplasties with a tapered stem design. Selected functional activities will be impacted by the presence of thigh pain. Level of Evidence: Prognostic study, Level III (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.
PMID: 16331014 [PubMed - indexed for MEDLINE]
Peroperative ketamine and morphine for postoperative pain control after lumbar disk surgery.
Aveline C, Hetet HL, Vautier P, Gautier JF, Bonnet F.
Department of Anaesthesiology and Surgical Intensive Care, Polyclinique Sevigne, 3 Rue du Chene Germain, 35510 Cesson-Sevigne, France.
BACKGROUND: Ketamine, a N-methyl-d-aspartate receptor antagonist, may reduce postoperative opioid demand and improve postoperative analgesia. METHODS: Sixty-nine patients scheduled for lumbar disk surgery under general anaesthesia were enrolled in a randomised, double-blind study comparing three analgesic combinations that were started before surgical incision: morphine 0.1mgkg(-1) alone (group M; n=23); ketamine 0.15mgkg(-1) alone (group K; n=22); and a combination of morphine 0.1mgkg(-1) with ketamine 0.15mgkg(-1) (group KM; n=23). Postoperatively patient-controlled analgesia was provided with intravenous morphine. Morphine consumption was assessed during 24 H, and pain scores were measured using a visual analogue scale (VAS) at rest and on mobilisation, during the first two postoperative days. RESULTS: In group KM, less i.v. morphine was administered in the post anaesthesia care unit than in group M (median [range]: 0mg [0-2] vs. 7mg [6-9], P=0.009). Cumulative 24 H morphine consumption was reduced by 57% in group KM vs. group M, and by 48% in group KM vs. group K. Postoperative VAS scores were lower in group KM vs. groups K and M. Maximal VAS score on mobilization was reduced in group KM compared to groups K and M (38mm [35-45] vs. 52mm [48-59] and vs. 59mm [55-64], in groups KM, K and M, respectively, P=0.05 and P=0.002). The incidence of postoperative nausea and vomiting was decreased in group KM compared to group M (21.7% vs. 43.5%, P=0.001). CONCLUSION: Ketamine small-dose, combined with morphine improves postoperative analgesia and reduces opioid-related side effects in lumbar disk surgery.
PMID: 16324861 [PubMed - as supplied by publisher]
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The use of infraorbital nerve block for postoperative pain control after transsphenoidal hypophysectomy.
McAdam D, Muro K, Suresh S.
Department of Pediatric Anesthesiology, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
OBJECTIVES: The transsphenoidal approach for pituitary resection is often used for a suprasellar tumor. The use of infraorbital nerve block for pain control in the postoperative period is described in this case report. CASE REPORT: An 11-year old male was scheduled for a transsphenoidal approach to a pituitary tumor. After induction of general anesthesia and placement of an endotracheal tube, bilateral infraorbital nerve blocks (maxillary division of the trigeminal nerve) were performed using an intraoral approach. This block was repeated at the conclusion of surgery. The patient was very comfortable in the postoperative period without need for additional analgesia. CONCLUSIONS: Bilateral infraorbital nerve blocks may provide adequate pain control following transsphenoidal hypophysectomy. The avoidance of opioids may allow better neurological examination following major neurosurgical procedures.
PMID: 16326343 [PubMed - in process]
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Perioperative pain management education: a short structured regional anesthesia course compared with traditional teaching among medical students.
Hanna MN, Donnelly MB, Montgomery CL, Sloan PA.
Department of Anesthesiology, The Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA. mhanna9@jhmi.edu
BACKGROUND AND OBJECTIVES: Previous research has demonstrated that a brief course on pain management improved knowledge and attitudes toward analgesic use among medical students. The purpose of this study is to compare a structured clinical instruction course on regional anesthesia techniques for perioperative pain management with traditional teaching given to senior medical students. METHODS: During a 1-month clerkship in anesthesiology, 40 fourth-year medical students were randomly and equally divided into 2 groups. The study group received a 2-hour structured course on regional anesthesia techniques for pain management, whereas the control group received a 1-hour lecture tutorial on regional anesthesia techniques for perioperative pain management and 1 hour of bedside teaching on acute pain management. Each student completed an objective structured clinical examination (OSCE) 2 weeks after completion of the course. RESULTS: The study group performed better on each of the 11 items of the OSCE and on the total performance scores (mean +/- SD of 36.2 +/- 7.3 for study group versus 14.8 +/- 8.4 for the control group; P < .05). All students rated the clinical course highly valuable (4.7 +/- 0.5). CONCLUSION: A structured clinical instructional course on regional techniques for perioperative pain management given to fourth-year medical students can significantly improve their understanding and knowledge compared with traditional teaching.
PMID: 16326336 [PubMed - in process]
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Correlation of postoperative pain to quality of recovery in the immediate postoperative period.
Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC, Fleisher LA.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA. chwu@jhmi.edu
BACKGROUND AND OBJECTIVES: It is unclear whether the severity of postoperative pain may affect patients' quality of recovery in the immediate postoperative period (within 2 weeks of surgery). METHODS: This was a prospective, observational study in patients undergoing elective radical retropubic prostatectomy. All patients received a standardized intraoperative general or spinal anesthetic followed by intravenous patient-controlled analgesia. Visual analog scores for pain at rest, pain with activity, and nausea along with the QoR, an instrument validated to assess quality of recovery in the postoperative period, and Brief Fatigue Inventory were assessed on postoperative days 1 to 3, 7, and 30. The Epworth Sleepiness Scale was assessed on postoperative days 7 and 30. RESULTS: We found that the severity of pain both at rest and with activity correlated with a decrease in quality of recovery as assessed by the QoR. CONCLUSIONS: Our findings suggest that an increase in postoperative pain is correlated with a decrease in a patient's quality of recovery in the immediate postoperative period.
PMID: 16326335 [PubMed - in process]
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