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Items 1 - 20 of 20 |
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Intravenous Lidocaine Relieves Spinal Cord Injury Pain: A Randomized Controlled Trial.
Finnerup NB, Biering-Sorensen F, Johannesen IL, Terkelsen AJ, Juhl GI, Kristensen AD, Sindrup SH, Bach FW, Jensen TS.
* Research Fellow, section sign Research Nurse, # Consultant, ** Professor, Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark. dagger Medical Director, Clinic for Spinal Cord Injuries, The Neuroscience Centre, Rigshospitalet, Kobenhavn, Denmark. double dagger Consultant, The Spinal Cord Unit, Department of Rheumatology, Viborg Hospital, Viborg, Denmark. Professor, Department of Neurology, Odense University Hospital, Odense, Denmark.
BACKGROUND:: Neuropathic pain in spinal cord injury is a common challenging therapeutic condition. The current study examines the analgesic effect of the sodium channel blocker lidocaine on neuropathic pain in patients with spinal cord injury and the predictive role of concomitant evoked pain on pain relief with lidocaine. METHODS:: Twenty-four spinal cord injury patients with neuropathic pain at or below the level of injury were randomized and completed a double-blind crossover trial of 5 mg/kg lidocaine and placebo infused over 30 min. Twelve patients reported evoked pain, and 12 patients had no evoked pain. Spontaneous and evoked pains were assessed using a visual analog scale and quantitative sensory testing. RESULTS:: Lidocaine significantly reduced spontaneous pain in all patients (P < 0.01) and in each of the two groups with (P < 0.01) and without (P = 0.048) evoked pain, with no difference in number of responders (pain reduction >/= 33%) between the patients with (n = 6) and without (n = 5) evoked pain. Lidocaine significantly relieved both at-level and below-level neuropathic pain and decreased brush-evoked dysesthesia but not cold allodynia, pinprick hyperalgesia, or pain evoked by repetitive pinprick. CONCLUSIONS:: Lidocaine reduced neuropathic pain at and below the level of injury irrespective of the presence or absence of evoked pain. Results are consistent with a central-acting effect of sodium channel blockers acting on neuronal hyperexcitability. Agents (such as anticonvulsants or antiarrhythmics) with sodium channel-blocking properties may be a treatment option for spinal cord injury pain.
PMID: 15851891 [PubMed - as supplied by publisher]
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Forty-eight Hours of Postoperative Pain Relief after Total Hip Arthroplasty with a Novel, Extended-Release Epidural Morphine Formulation.
Viscusi ER, Martin G, Hartrick CT, Singla N, Manvelian G; the EREM Study Group.
* Director, Acute Pain Management, Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. dagger Chief, Orthopedics, Plastics, and Regional Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina. double dagger Director, Department of Anesthesia, William Beaumont Hospital, Royal Oak, Michigan. section sign Director of Clinical Research, Department of Anesthesiology, Huntington Memorial Hospital, Pasadena, California. parallel Medical Director, SkyePharma, Inc., San Diego, California. # A complete list of the EREM Study Group, along with affiliations, is in the .
BACKGROUND:: Epidural morphine has proven analgesic efficacy in the postoperative period and is widely used. This study evaluated the efficacy of extended-release epidural morphine (EREM; DepoDur; Endo Pharmaceuticals Inc., Chadds Ford, PA; SkyePharma, Inc., San Diego, CA) in providing pain relief for 48 h after surgery. METHODS:: Patients (n = 200) scheduled to undergo total hip arthroplasty were randomized to receive a single dose of 15, 20, or 25 mg EREM or placebo. After surgery and after asking for pain medication, patients had access to intravenous patient-controlled analgesia fentanyl for breakthrough pain as needed. Postoperative intravenous patient-controlled analgesia fentanyl use, time to first postoperative fentanyl use, pain intensity at rest and with activity, patient and surgeon ratings of pain control, and adverse events were recorded. RESULTS:: All EREM dosages reduced the mean (+/- SD) fentanyl use versus placebo (510 +/- 708 vs. 2,091 +/- 1,803 mug; P < 0.0001) and delayed the median time to first dose of fentanyl (21.3 vs. 3.6 h; P < 0.0001). All EREM groups had significantly improved pain control at rest through 48 h postdose (area under the curve [0-48 h]) compared with placebo (P < 0.0005). More EREM-treated patients rated their pain control as good or very good compared with placebo (at 24 h: 90 vs. 65%, P < 0.0001; at 48 h: 83 vs. 67%, P < 0.05). No supplemental analgesia was needed in 25% of EREM-treated patients and 2% of placebo-treated patients at 48 h (P < 0.05). The safety profile of EREM was consistent with that of other epidurally administered opioid analgesics. CONCLUSIONS:: EREM provided significant postoperative pain relief over a 48-h period after hip surgery, without the need for indwelling epidural catheters.
PMID: 15851890 [PubMed - as supplied by publisher]
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Intravenous Butorphanol, Meperidine, and Their Combination Relieve Pain and Distress in Women in Labor.
Nelson KE, Eisenach JC.
* Assistant Professor of Anesthesiology, dagger FM James, III Professor of Anesthesiology.
BACKGROUND:: Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia. METHODS:: Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration. RESULTS:: All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects. CONCLUSIONS:: These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.
PMID: 15851889 [PubMed - as supplied by publisher]
Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair--a double-blind randomized study.
Andersen FH, Nielsen K, Kehlet H.
Surgical Clinic Charlottenlund, Copenhagen, Denmark.
BACKGROUND: Local infiltration anaesthesia for inguinal hernia repair is cost-effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether a combined ilioinguinal blockade and local infiltration anaesthesia improves intra-operative analgesia. METHODS: We performed a double-blind randomized study in 160 patients undergoing inguinal hernia mesh repair under local infiltration anaesthesia with or without additional ilioinguinal blockade. Intra-operative pain and pain at 24 and 48 h postoperatively and analgesic requirements (acetaminophen, ibuprofen, and tramadol) were assessed. RESULTS: Median intra-operative pain scores were reduced (P=0.02) from 13 to 9 with additional ilioinguinal blockade, with no differences in requirement for sedation. There were significantly (P<0.05) more patients with intra-operative visual analogue pain scale >/=30 in the placebo group vs the ilioinguinal blockade group. Postoperative pain scores and analgesic requirements were similar. CONCLUSION: Combined ilioinguinal blockade and local infiltration anaesthesia is recommended for groin hernia repair to reduce intra-operative pain.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15695545 [PubMed - indexed for MEDLINE]
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Comparison of caudal steroid epidural with targeted steroid placement during spinal endoscopy for chronic sciatica: a prospective, randomized, double-blind trial.
Dashfield AK, Taylor MB, Cleaver JS, Farrow D.
Eric Angel Pain Management Centre, Level 07, Derriford Hospital, Plymouth PL6 8DH, UK. adrian.dashfield@phnt.swest.nhs.uk
BACKGROUND: Chronic sciatica can be managed by caudal steroid epidural or by targeted steroid placement during spinal endoscopy. Spinal endoscopy is a new unproven procedure. We aimed to compare the two pain management techniques and to investigate whether the site of steroid placement within the epidural space was significant. METHODS: We randomized 60 patients with a 6-18 months history of sciatica to either targeted epidural local anaesthetic and steroid placement with a spinal endoscope or caudal epidural local anaesthetic and steroid treatment. Pre-treatment and 6-week, 3-month, and 6-month SF-MPQ and HAD scores were recorded. RESULTS: No significant differences were found between the groups for any of the measures at any time. However, there were significant differences within both groups compared with pre-treatment values. For the caudal group, significant improvements were found for descriptive pain at 6 months (P=0.031), VAS at 6 weeks (P=0.036), 3 months (P=0.026), and 6 months (P=0.003), present pain intensity (PPI) at 3 months (P=0.013) and 6 months (P=0.01); anxiety at 6 weeks (P=0.008), 3 months (P=0.004), and 6 months (P=0.001) and depression at 6 months only (P=0.037). For the epiduroscopy group there were fewer significant changes. PPI was significantly reduced at 6 weeks (P=0.004) and at 6 months (P=0.02). Anxiety was reduced at 6 months only (P=0.03). CONCLUSION: The targeted placement of epidural steroid onto the affected nerve root causing sciatica does not significantly reduce pain intensity and anxiety and depression compared with untargeted caudal epidural steroid injection. When analysed individually, both techniques benefited patients.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15695544 [PubMed - indexed for MEDLINE]
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Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials.
Remy C, Marret E, Bonnet F.
Department of Anesthesiology and Critical Care, Tenon University Hospital, Paris VI University, Assistance Publique-Hopitaux de Paris, Paris, France.
BACKGROUND: Acetaminophen is commonly used for the management of perioperative pain. However, there is a marked discrepancy between the extent to which acetaminophen is used and the available evidence for an analgesic effect after major surgery. The aim of this systematic review is to determine the morphine-sparing effect of acetaminophen combined with patient-controlled analgesia (PCA) with morphine and to evaluate its effects on opioid-related adverse effects. METHODS: MEDLINE and the Cochrane Library were searched to select randomized controlled trials which compared PCA morphine alone with PCA morphine plus acetaminophen administered orally or intravenously. Studies were evaluated for their quality based on the Oxford Quality Scale. Outcome measures were morphine consumption over the first 24 h after surgery, patient satisfaction and the incidence of morphine side-effects, including nausea and vomiting, sedation, urinary retention, pruritus and/or respiratory depression. RESULTS: Seven prospective randomized controlled trials, including 265 patients in the group with PCA morphine plus acetaminophen and 226 patients in the group with PCA morphine alone, were selected. Acetaminophen administration was not associated with a decrease in the incidence of morphine-related adverse effects or an increase in patient satisfaction. Adding acetaminophen to PCA was associated with a morphine-sparing effect of 20% (mean, -9 mg; CI -15 to -3 mg; P=0.003) over the first postoperative 24 h. CONCLUSION: Acetaminophen combined with PCA morphine induced a significant morphine-sparing effect but did not change the incidence of morphine-related adverse effects in the postoperative period.
Publication Types:
PMID: 15681586 [PubMed - indexed for MEDLINE]
Peripheral involvement of the nitric oxide-cGMP pathway in the indomethacin-induced antinociception in rat.
Ventura-Martinez R, Deciga-Campos M, Diaz-Reval MI, Gonzalez-Trujano ME, Lopez-Munoz FJ.
Facultad de Medicina, Departamento de Farmacologia, Universidad Nacional Autonoma de Mexico, Ciudad Universitaria Coyoacan, C.P. 04510, Mexico, DF, Mexico.
The role of nitric oxide (NO) in the antinociceptive effect of indomethacin was assessed in the pain-induced functional impairment model in the rat (PIFIR model), a model of inflammatory and chronic pain similar to that observed in clinical gout. Oral administration of indomethacin (5.6 mg/kg), a nonselective cyclooxygenase inhibitor, significantly decreased the nociceptive response elicited by uric acid injected into the knee joint of the right hind limb (2.0+/-3.0 and 149.7+/-18.0 area units [au], in the absence and the presence of indomethacin, respectively). This effect of indomethacin was reduced in nearly 50% by local pretreatment with the nonselective inhibitor of NO synthase, N G-L-nitro-arginine methyl ester (L-NAME) (72.9+/-10.7 vs. 149.7+/-18.0 au, P<0.05). On the other hand, local administration of L-arginine (a NO synthase substrate) or sodium nitroprusside (a non-enzymatic NO donor) each increased in almost 40% the antinociceptive effect of indomethacin (230.9+/-12.6 and 226.6+/-9.7 vs. 149.7+/-18.0 au, P<0.05), whereas D-arginine (the inactive isomer of arginine) had no effect on the indomethacin antinociceptive response (208.0+/-34.9 vs. 149.7+/-18.0 au). These results suggest that, the antinociceptive effect of indomethacin involves, at least in part, the NO-cyclic GMP pathway at peripheral level.
PMID: 15496294 [PubMed - indexed for MEDLINE]
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Validation of a modified version of the brief pain inventory for painful diabetic peripheral neuropathy.
Zelman DC, Gore M, Dukes E, Tai KS, Brandenburg N.
California School of Professional Psychology-Alliant International University, San Francisco, California 94133-1221, USA.
Neuropathic pain is the focus of current clinical research, clinical identification, and treatment. It is unique from nociceptive pain and requires evaluation of the relevance and utility of common pain measures created for other painful conditions. This study evaluated the psychometric properties of a modified Brief Pain Inventory (BPI) for patients with painful diabetic peripheral neuropathy (BPI-DPN). Participants were patients with painful DPN (n=255) enrolled in a DPN Burden of Illness survey referred through 17 outpatient settings (primary care physicians, endocrinologists, neurologists, and anesthesiologists). Patients completed the BPI-DPN, and self-report measures of health-related quality of life, mood sleep, and healthcare utilization. Construct, criterion and discriminant validity, and internal consistency reliability were evaluated. Principal axis factoring with oblimin rotation revealed two interpretable factors (eigenvalues>1.0), consistent with most published BPI validation studies; a severity scale comprising the four BPI Severity items and an interference scale comprising the seven Interference items, which satisfied criteria for interpretability and model fit. Cronbach's alpha was high (0.94) for both scales. Mean pain Severity was highly correlated with Bodily Pain from the Medical Outcomes Study Short Form-12, version 2 (rs=0.63, P < 0.001), the Pain/Discomfort item in the Euro-QoL (rs=0.58, P < 0.001), and a verbal rating scale measure of pain severity (rs=0.74, P < 0.001). Individual BPI-DPN Interference domains were moderately correlated (rs's >0.5, P < 0.001) with analogous measures, and the Sleep Interference item had a high, significant association with the three primary Medical Outcome Study-Sleep scale subscales (rs's=0.66-71, P < 0.001). Worst Pain and Interference ratings were significantly associated with hospital utilization and outpatient visits due to DPN. These results replicate, in a pure peripheral neuropathic pain condition, the BPI psychometric characteristics documented in populations with nociceptive or mixed pain conditions. The BPI-DPN is a promising instrument in the evaluation of painful DPN.
PMID: 15857744 [PubMed - in process]
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Are there phases to the vaso-occlusive painful episode in sickle cell disease?
Jacob E, Beyer JE, Miaskowski C, Savedra M, Treadwell M, Styles L.
Department of Hematology/Oncology, Texas Children's Cancer Center, Houston, Texas 77030, USA.
The purpose of this study was to describe the pain experience of children with sickle cell disease who were hospitalized for vaso-occlusive painful episodes. The pain experience, and signs and symptoms prior to admission and during hospitalization, are presented in the context of whether there is evidence to support the existence of phases to a vaso-occlusive painful episode. Children were interviewed about the onset of the painful episode and were asked to describe their pain from the day of admission to the day of discharge from the hospital. They were also observed for the absence or presence of signs and symptoms associated with the painful vaso-occlusive episode. Findings from this study provide some evidence to support previous observations related to changes during the evolution of painful episodes that may be occurring in phases (e.g., evolving, inflammatory, resolving), as previously described in adults and children. These phases had different names, although the concepts were similar.
PMID: 15857743 [PubMed - in process]
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Cannabis use in HIV for pain and other medical symptoms.
Woolridge E, Barton S, Samuel J, Osorio J, Dougherty A, Holdcroft A.
Magill Department of Anesthesia, Imperial College London, United Kingdom.
Despite the major benefits of antiretroviral therapy on survival during HIV infection, there is an increasing need to manage symptoms and side effects during long-term drug therapy. Cannabis has been reported anecdotally as being beneficial for a number of common symptoms and complications in HIV infections, for example, poor appetite and neuropathy. This study aimed to investigate symptom management with cannabis. Following Ethics Committee approval, HIV-positive individuals attending a large clinic were recruited into an anonymous cross-sectional questionnaire study. Up to one-third (27%, 143/523) reported using cannabis for treating symptoms. Patients reported improved appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paresthesia (85%). Many cannabis users (47%) reported associated memory deterioration. Symptom control using cannabis is widespread in HIV outpatients. A large number of patients reported that cannabis improved symptom control.
PMID: 15857739 [PubMed - in process]
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Palliation of bone pain in prostate cancer using chemotherapy and strontium-89. A randomized phase II study.
Nilsson S, Strang P, Ginman C, Zimmermann R, Edgren M, Nordstrom B, Ryberg M, Kalkner KM, Westlin JE.
Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Strontium-89 is an established alternative for the alleviation of bone pain in prostate cancer. There are few data evaluating the effect on pain of palliative chemotherapy. The aim of this randomized phase II study was to assess and compare the analgesic efficacy of strontium-89 and chemotherapy (FEM=5-FU, epirubicin, and mitomycin C) in 35 patients with disseminated, hormone-refractory prostate cancer suffering from persisting bone pain despite analgesic treatment. In order to minimize the risk for imbalances regarding the two patient groups, a double-blind randomization was performed. A significant reduction in pain intensity and pain frequency was registered in both patient groups (P < 0.01 in both groups after 3 weeks). Side effects were generally mild in the strontium-89 group and significantly more severe in the FEM group. The effect of FEM on pain is surprising as chemotherapy has generally only limited effect on tumor growth in bone metastases due to prostate cancer. A possible explanation is that FEM has an inhibitory activity on the inflammatory component of metastases.
PMID: 15857738 [PubMed - in process]
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Subanesthetic ketamine for cancer pain: by insisting on level I/II evidence, do we risk throwing the baby out with the bath water?
Jackson K, Ashby M, Goodchild C.
Publication Types:
PMID: 15857732 [PubMed - in process]
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The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation.
Francoeur RB.
Columbia University School of Social Work, New York, NY 10027, USA.
Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising.
Publication Types:
- Clinical Trial
- Multicenter Study
PMID: 15733806 [PubMed - indexed for MEDLINE]
Comment in:
Chest pain and fleeting neurological signs.
Beggs AD, Al-Rawi H, Parfitt A.
Emergency Department, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Publication Types:
PMID: 15850639 [PubMed - indexed for MEDLINE]
Comment on:
Anesthesiologists, injectionists?
Aldrete JA.
Publication Types:
PMID: 15635528 [PubMed - indexed for MEDLINE]
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Panic attacks and hyperventilation may mimic local anesthesia toxicity.
Schulz-Stubner S.
Publication Types:
PMID: 15635524 [PubMed - indexed for MEDLINE]
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Anesthetic and analgesic management of mitral stenosis during pregnancy.
Pan PH, D'Angelo R.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Publication Types:
- Case Reports
- Review
- Review, Tutorial
PMID: 15635522 [PubMed - indexed for MEDLINE]
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A clinical comparison of equal concentration and volume of ropivacaine and bupivacaine for interscalene brachial plexus anesthesia and analgesia in shoulder surgery.
Eroglu A, Uzunlar H, Sener M, Akinturk Y, Erciyes N.
Department of Anesthesiology, Karadeniz Technical University, 61080 Trabzon, Turkey. aheroglu@hotmail.com
BACKGROUND AND OBJECTIVES: The aim of this study was to compare the same volume and concentration of bupivacaine and ropivacaine for interscalene brachial plexus block anesthesia and postoperative analgesia in shoulder surgery. METHODS: Forty-four patients scheduled for elective shoulder surgery were prospectively randomized to receive in a double-blind fashion 30 mL of either 0.5% bupivacaine or ropivacaine for interscalene block. The block was prolonged after surgery by using a patient-controlled interscalene analgesia with 0.15% of either bupivacaine or ropivacaine. The mean onset times of surgical blocks were determined after interscalene block. Pain relief was regularly assessed by using a visual analog scale, side effects were noted, and the patients were asked to rate their satisfaction at the end of the study. RESULTS: Two patients with bupivacaine and 1 with ropivacaine failed to achieve surgical block and were excluded. The mean onset times of surgical blocks were 18 +/- 12 minutes with ropivacaine and 21 +/- 13 minutes with bupivacaine. The pain scores, total volume infused of local anesthetics, incremental dose requested and received, total rescue analgesic, and side effects were similar between the groups. Postoperative pain control was similarly effective and patient satisfaction was high in both groups. CONCLUSIONS: This study shows that the same volume and concentration of bupivacaine and ropivacaine (30 mL of 0.5%) for interscalene brachial plexus block anesthesia produce similar surgical block. When prolonging the block with a patient-controlled interscalene analgesia infusion, 0.15% bupivacaine or ropivacaine provide adequate pain relief, similar side effects, and high patient satisfaction after shoulder surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15635512 [PubMed - indexed for MEDLINE]
Comment in:
Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients.
Wu CL, Hurley RW, Anderson GF, Herbert R, Rowlingson AJ, Fleisher LA.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21287, USA. chwu@jhmi.edu
BACKGROUND: Because of the uncertainty and limitations in available randomized controlled trials, we performed an analysis of the Medicare claims database to determine whether an association exists between postoperative epidural analgesia and mortality. METHODS: A 5% nationally random sample of Medicare beneficiaries from 1997 to 2001 was analyzed to identify patients undergoing segmental excision of the lung (International Statistical Classification of Diseases, Ninth Revision, Clinical Modification codes 32.3 and 32.4), complete pneumonectomy (code 32.5), partial excision of large intestine (codes 45.73 and 45.76), anastomosis of the esophagus (codes 42.5 and 42.6), total knee replacement/revision (codes 81.54 and 81.55), total/radical abdominal hysterectomy (codes 68.4 and 68.6), partial/radical pancreaticoduodenectomy (codes 52.5 and 52.7), partial/complete nephrectomy (codes 55.4 and 55.5), partial/complete cystectomy (codes 57.6 and 57.7), hepatotomy/lobectomy of the liver (codes 50.0 and 50.3), partial/total gastrectomy (codes 43.5 to 43.9), and radical retropubic prostatectomy (codes 60.4 and 60.5). Patients were divided into 2 groups, depending on the presence or absence of postoperative epidural analgesia. The rate of major morbidity and death at 7 and 30 days after surgery were compared. Multivariate regression analyses incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status were performed. RESULTS: The presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38 to 0.73; P = .0001) and 30 days (OR, 0.74; 95% CI, 0.63 to 0.89; P = .0005) after surgery; however, no difference was seen between the groups with regard to overall major morbidity, with the exception of an increase in pneumonia at 30 days for the epidural group (OR, 1.91;[95% CI, 1.09 to 3.34; P = .02). CONCLUSIONS: Postoperative epidural analgesia may contribute to lower odds of death after surgery.
PMID: 15635510 [PubMed - indexed for MEDLINE]
Comment on:
Anesthesia and surgical outcomes: an orphean ambition.
Yeager MP, Carli F.
Publication Types:
PMID: 15635507 [PubMed - indexed for MEDLINE]
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