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Stimulating popliteal catheters for postoperative analgesia after hallux valgus repair.
Rodriguez J, Taboada M, Carceller J, Lagunilla J, Barcena M, Alvarez J.
Department of Anesthesiology, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. jaimerodriguezgarcia@nacom.es
Stimulating catheters have been recently introduced in clinical practice. We assessed the efficacy of stimulating and nonstimulating catheter placement for pain control and local anesthetic requirements after hallux valgus repair with continuous sciatic popliteal nerve block in this comparative, randomized, blinded-to-observer study of 48 patients. A stimulating catheter was placed in groups S-125 and S-0625. The same catheter was inserted without stimulation in group NS-125. An infusion of 0.125% levobupivacaine was given in groups S-125 and NS-125, whereas 0.0625% levobupivacaine was used in group S-0625. All patients received an infusion of the test drug at a basal rate of 3 mL/h, with the possibility of an additional bolus of 3 mL every hour. Verbal analog scale (VAS) scores for pain were assessed between 6-8 h and between 19-23 h postoperatively. Multiple attempts were required for catheter insertion in all patients in groups S-125 and S-0625. Lower median (range) VAS scores for pain (0-100 points) were found in group S-125 at 6-8 h postoperatively when compared with groups S-0625 and NS-125: 5 (0-17.5) versus 60 (15-80) and 70 (25-80), respectively (P < 0.05); and lower VAS scores for pain were also found in group S-125 at 19-23 h when compared with group NS-125: 0 (0-0) and 7.5 (0-10), respectively (P < 0.05). Fewer patients required IV opioid analgesia in group S-125 than in groups S-0625 and NS-125: 0, 5, and 7 patients, respectively (P < 0.05). We conclude that efficacy in pain control was increased with stimulating catheter placement.
Publication Types:
PMID: 16368839 [PubMed - indexed for MEDLINE]
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The efficacy of thoracic epidural neostigmine infusion after thoracotomy.
Chia YY, Chang TH, Liu K, Chang HC, Ko NH, Wang YM.
Department of Anesthesiology, Kaohsiung Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan.
Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-microg epidural neostigmine before anesthesia induction followed by infusion of 125 microg/h until the end of surgery. Post-neo patients received epidural saline during the same time periods plus bolus 500-microg epidural neostigmine at end of surgery. Patients in the control group received saline placebo during all three periods. Patients in the neostigmine groups postoperatively received patient-controlled epidural analgesia with morphine 0.02 mg/mL, bupivacaine 0.08 mg/mL, and neostigmine 7 microg/mL. Control patient-controlled epidural analgesia excluded neostigmine. Data were recorded for 6 postoperative days. Daily patient-controlled epidural analgesia consumption (mL) for Pre-neo patients was significantly less than that of post-neo and control group patients for postoperative days 1-6 (at least 10% and 16% less, respectively; P < 0.05). There was a modest decrease in pain intensity on postoperative days 3-6 for pre-neo patients versus other groups (P < 0.05). These results suggest that continuous thoracic epidural neostigmine started before anesthesia provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia for these patients without increasing the incidence of adverse effects.
Publication Types:
PMID: 16368830 [PubMed - indexed for MEDLINE]
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The effect of nefopam on morphine overconsumption induced by large-dose remifentanil during propofol anesthesia for major abdominal surgery.
Tirault M, Derrode N, Clevenot D, Rolland D, Fletcher D, Debaene B.
Department of Anesthesiology and Intensive Care, Hopital J. Bernard, Poitiers, France. m.tirault@chu-poitiers.fr
Opioids may activate pain facilitatory systems opposing analgesia. We investigated whether large-dose remifentanil given during IV anesthesia caused postoperative morphine overconsumption and whether nefopam (a centrally acting analgesic) could reduce this. Sixty patients scheduled for abdominal surgery were included in this prospective, randomized study. The first 30 patients received either small-dose (Group S: 3 ng/mL) or large-dose (Group L: 8 ng/mL) remifentanil administrated by a target-controlled infusion during propofol anesthesia. Before skin closure, patients received morphine 0.15 mg/kg. Another 30 patients also received nefopam 20 mg intraoperatively. Postoperative pain was controlled by titration of morphine, followed by patient-controlled morphine analgesia (PCA). Morphine was requested earlier in Group L than in Group S (10 [1-63] min versus 37 [5-90] min, median [range]; P < 0.002). The dose of morphine by titration was larger in Group L than in Group S (0.28 [0.04-0.38] mg/kg versus 0.16 [0.03-0.41] mg/kg; P < 0.05). PCA morphine consumption and pain scores were similar. There were no differences between the nefopam groups in the time to first morphine request or in the dose of morphine by titration. Postoperative morphine overconsumption occurred after large-dose remifentanil and propofol anesthesia during the early postoperative period. Pretreatment with nefopam could be useful to prevent pain sensitization induced by opioids.
Publication Types:
PMID: 16368814 [PubMed - indexed for MEDLINE]
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Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study.
Ilfeld BM, Gearen PF, Enneking FK, Berry LF, Spadoni EH, George SZ, Vandenborne K.
Department of Anesthesiology, PUniversity of Florida, Gainesville, Florida, USA. bilfeld@ulf.edu
The average duration of hospitalization after total knee arthroplasty (TKA) in the United States is 4-5 days. In this two-phase study we investigated the feasibility of converting TKA into an overnight-stay procedure using a continuous femoral nerve block provided at home through postoperative day 4. Nine of 10 patients met discharge criteria and were discharged home the day after surgery. Pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.
PMID: 16368810 [PubMed - indexed for MEDLINE]
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Intrathecal and epidural anesthesia and analgesia for cardiac surgery.
Chaney MA.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois 60637, USA. mchaney@dacc.uchicago.edu
Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.
Publication Types:
PMID: 16368803 [PubMed - indexed for MEDLINE]
Acute pain management for patients receiving maintenance methadone or buprenorphine therapy.
Alford DP, Compton P, Samet JH.
Clinical Addiction Research and Education (CARE) Unit, Boston University Medical Center, Boston, Massachusetts 02118, USA.
More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.
PMID: 16418412 [PubMed - in process]
Naltrexone and problems in pain management.
Vickers AP, Jolly A.
Publication Types:
PMID: 16424470 [PubMed - in process]
Editorial II: Gabapentin: a new drug for postoperative pain?
Rowbotham DJ.
Leicester, UK.
PMID: 16415320 [PubMed - in process]
Regional anesthesia in hip surgery.
Indelli PF, Grant SA, Nielsen K, Vail TP.
Division of Orthopaedic Surgery, Department of Surgery Duke University Medical Center, Durham, NC, USA.
Historically, general anesthesia has been the "gold standard" for surgeons and patients when major hip surgery is being done. The recent introductions of improved techniques and catheters for continuous peripheral nerve blocks have made regional anesthesia more attractive to patients and surgeons. We focus on current trends and future directions in perioperative pain management for major orthopaedic procedures done on the hip. The use of epidural or spinal anesthesia during major hip surgery has been linked to a reduced risk of perioperative complications like deep venous thrombosis, less deterioration of cerebral and pulmonary functions in patients who are at high risk for complications, and overall reduced blood loss. In addition, continuous peripheral nerve blocks showed effective and safe postoperative pain control, allowing for lower opioids consumption, improved and earlier rehabilitation, and high patient satisfaction. Accurate patient selection and patient education are fundamental for the success of any regional anesthesia technique. Modern regional anesthesia for major hip surgery includes the use of a single shot and continuous epidural injections, single-shot and continuous spinal injection, continuous lumbar plexus blockade, and continuous peripheral blockade of the femoral and sciatic nerves. Continuous peripheral nerve blocks represent an adjunctive, effective, and safe technique for postoperative pain control after total hip arthroplasty. Future directions in postoperative pain control include the creation of a comprehensive system that supervises the use of continuous peripheral nerve blocks outside the acute inpatient setting for few days following the surgical procedure. Level of Evidence: Therapeutic study, Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.
Publication Types:
PMID: 16331011 [PubMed - indexed for MEDLINE]
Prostate anaesthetic block with ropivacaine for urologic surgery.
Niccolai P, Carles M, Lagha K, Raucoules-Aime M.
Princesse Grace Hospital, Department of Anaesthesiology, Monte Carlo, Princedom of Monaco, France. patricknic@wanadoo.fr
BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate prostate anaesthetic block for haemodynamic tolerance and quality of analgesia during and after transurethral surgery. METHODS: Ninety adult males, ASA III/IV, were randomly assigned to receive a prostate anaesthetic block (n = 45) or spinal anaesthesia (n = 45). The main outcome measurement during anaesthesia, surgery and recovery was haemodynamic tolerance (number of hypotensive episodes, heart rate, systolic and mean blood pressures). Other outcome variables were pain scores during anaesthesia, surgery and every 4 h until 24 h after the end of surgery and amount of oral morphine required during the 24-h postoperative period. RESULTS: Sixty-six patients were ASA III and 24 ASA IV. Ongoing cardiovascular therapies were comparable between groups. All surgical procedures were performed under good conditions. For patients receiving prostate anaesthetic block, the blood pressure and heart rate did not change significantly during the study period. For patients receiving spinal anaesthesia, the hypotension rate was 55.6% (n = 25) compared to 0 in the prostate anaesthetic block group (P < 0.001); 25 and 4 patients, respectively, required vascular filling and additional ephedrine administration. In both groups, all pain scores were <40 (100 mm visual analogue scale) during the study period. Oral morphine was given during the postoperative period to two prostate anaesthetic block patients and four who had received spinal anaesthesia (not significant). CONCLUSION: Transurethral surgery under prostate anaesthetic block is safe and assures adequate analgesia during and after surgery.
Publication Types:
PMID: 16225723 [PubMed - indexed for MEDLINE]
Is use of epidural fibrin glue patch in patients with metastatic cancer appropriate?
Decramer I, Fuzier V, Franchitto N, Samii K.
Publication Types:
PMID: 16163922 [PubMed - indexed for MEDLINE]
Reduction of human experimental muscle pain by alfentanil and morphine.
Schulte H, Segerdahl M, Graven-Nielsen T, Grass S.
Department for Clinical Science, Intervention and Technology, Division of Anesthesiology, Karolinska Institute at Karolinska University Hospital - Huddinge SE 141 86, Stockholm, Sweden.
Musculoskeletal pain is a major clinical problem. By using various experimental models in humans, the understanding of the basic mechanisms behind muscle pain can increase, thereby giving hope for new and optimized treatment. Opioids are increasingly often used to treat muscle pain. There are, however, a limited number of previous studies on opioids and muscle pain, most of them using a relative low, single dose. Therefore, we wanted to further study the effect of two rather high doses of alfentanil (25 and 75ng/ml) and morphine (0.14 and 0.28mg/kg) in human volunteers. The study consisted of two parallel studies with morphine and alfentanil, respectively, and was conducted as randomized, double-blinded, placebo-controlled, 3-way cross-over. We used intramuscular infusion of hypertonic saline and intramuscular electrical stimulation to induce experimental pain. Visual analog scale (VAS)-score, intramuscular electrical pain thresholds and pain area (local and referred) were measured. Both alfentanil and morphine at their highest doses induced a 6 to 7-fold increase in pain thresholds to single and repetitive (5 stimulations, 2Hz) electrical stimulation. Alfentanil and morphine also reduced VAS score about 4 to 5-fold during suprathreshold electric stimulation and during infusion of hypertonic saline. None of the drugs decreased referred pain. There were no apparent differences between the drugs, in terms of effect or adverse reactions. In conclusion, this is the first study to compare two high doses of alfentanil and morphine on experimental muscle pain in humans. Both alfentanil and morphine reduced experimental muscle pain. There were no indications of any true pharmacodynamic differences between the two drugs.
PMID: 16414295 [PubMed - as supplied by publisher]
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Prevalence of pain in adults admitted to Catalonian hospitals: A cross-sectional study.
Vallano A, Malouf J, Payrulet P, Banos JE; on behalf of the Catalan Research Group for Studying Pain in Hospital.
Fundacio Institut Catala de Farmacologia, Servicio de Farmacologia Clinica, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Passeig Vall d' Hebron no. 119-129, 08035 Barcelona, Spain.
OBJECTIVE: To survey the prevalence of pain in patients admitted to different hospitals of Catalonia and to describe which factors are related to pain. METHODS: A cross-sectional study was performed in 1675 patients from fifteen hospitals in Catalonia (Spain). Clinical and demographic data, as well as the existence of pain intensity evaluations and analgesic therapy, were obtained from medical charts. Characteristics of pain were given by patients after being interviewed by trained interviewers. The main-outcome measure was the existence of pain (at the interview, in the previous 24h, at the admission and at any time after admission) that was assessed by a visual analogue scale (VAS). The relationship of prevalence of pain to patients' characteristics was carried out by means of a multiple-logistic-regression model with pain presence as the dependent variable of interest. RESULTS: A great variability in the prevalence and intensity of pain among different hospitals was observed. At the time of the interview, 48.5% (95% CI: 46.1-50.9%) of the patients had pain and the median VAS was 40mm (range: 10-100mm), and the prevalence of pain during the previous 24h was similar (47.6%; 95% CI: 45.2-50%). At admission, 26.7% (95% CI: 24.6-28.8%) of patients were in pain, whereas 62% (95% CI: 59.7-64.3%) reported having pain at some time during their stay. Pain intensity annotations were absent in 51.3% (95% CI: 47.9-54.7%) of the medical records of the patients with pain. The factors associated with pain were younger age, female gender, presence of surgery, orthopaedic surgery wards, large hospital and prescribed analgesics. CONCLUSION: A high prevalence of clinically relevant pain in in-patients was found as well as a great variability according to type of patients, clinical wards and hospitals. This study gives clear evidence of the lack of adequate management of pain in the majority of the hospitals and calls for the implementation of organisational and educational measurements that may settle this epidemic problem.
PMID: 16413801 [PubMed - as supplied by publisher]
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Impact of palliative care unit admission on symptom control evaluated by the edmonton symptom assessment system.
Modonesi C, Scarpi E, Maltoni M, Derni S, Fabbri L, Martini F, Sansoni E, Amadori D.
Palliative Care Unit, Department of Medical Oncology, Forlimpopoli Hospital, Italy.
The aim of the present study was to evaluate the impact of palliative care on patients' symptoms, using the Edmonton Symptom Assessment System (ESAS) to measure symptom intensity at the time of admission and variations registered during the first 7 days' hospitalization. Three hundred fourteen patients were admitted to the unit during its first year of activity. Of these, 162 patients (51.6%) completed, 62 (19.7%) partially completed, and 90 (28.7%) did not complete the ESAS. The mean (+/-SD) value of the Symptom Distress Score (SDS) (sum of the values of the different symptoms) for the 162 evaluable patients on Day 1 was 33.93 (+/-16.24). On Day 7 the mean was 28.14 (+/-15.11) (ANOVA for repeated measurements, P < 0.0001). ESAS values for patients with moderate-severe symptom intensity (average values Day 1-Day 7 and P value, ANOVA for repeated measurements) were as follows: pain (7.12-4.23, P < 0.0001), fatigue (7.46-5.68, P < 0.0001), nausea (7.12-1.96, P < 0.0001), depression (7.26-5.28, P < 0.0001), anxiety (7.13-5.14, P < 0.0001), drowsiness (7.42-6.40, P = 0.002), anorexia (7.33-4.33, P < 0.0001), well-being (6.83-3.85, P < 0.0001), and dyspnea (7.08-3.86, P < 0.0001). These data seem to indicate that the patients who benefit most from inpatient palliative care are those with the most complex symptomatology.
Publication Types:
PMID: 16256901 [PubMed - indexed for MEDLINE]
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Comment on:
Musical hallucinations and opioids: a word of caution.
Prommer E.
Publication Types:
PMID: 16256894 [PubMed - indexed for MEDLINE]
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Controversies in stable coronary artery disease.
Opie LH, Commerford PJ, Gersh BJ.
Hatter Institute for Heart Research, Cape Heart Centre and Department of Medicine, University of Cape Town Medical School, Observatory 7925, South Africa. Opie@capeheart.uct.ac.za
Coronary heart disease is still highly prevalent worldwide, and stable angina pectoris is one of its more common presentations. Three major controversies are risk factor management, drug therapy, and intervention. As well as the major risk factors stated by the Framingham study and European guidelines, other factors include abdominal obesity, metabolic syndrome, and psychological stress. How should these additional factors be rated? With respect to drug therapy, apart from aspirin, all patients with stable angina should be assessed for statin treatment. Although statins will reduce coronary events by about one third in patients with vascular disease, the absolute benefit depends on the absolute risk. Non-controversially, all patients should be considered for angiotensin-converting-enzyme inhibitors. The concept that beta blockers are protective from future coronary events can be disputed. Percutaneous coronary intervention can relieve symptoms without extending lifespan beyond medical therapy. However, strong mortality data favour coronary-artery bypass grafting in individuals with triple-vessel or even double-vessel disease. Thus, effort angina needs comprehensive assessment, lifestyle changes, and treatment tailored to the individual patient.
Publication Types:
PMID: 16399156 [PubMed - indexed for MEDLINE]
Case records of the Massachusetts General Hospital. Case 2-2006. A 31-year-old, HIV-positive man with rectal pain.
Davis BT, Thiim M, Zukerberg LR.
Infectious Disease Unit, Massachusetts General Hospital, USA.
Publication Types:
PMID: 16421370 [PubMed - in process]
Pain medicine and regional anesthesia: inseparable roles?
Bridenbaugh PO.
Department of Anesthesia, University of Cincinnati College of Medicine, Cincinnati, OH.
PMID: 16418029 [PubMed - in process]
The bilateral superficial cervical plexus block with 0.75% ropivacaine administered before or after surgery does not prevent postoperative pain after total thyroidectomy.
Herbland A, Cantini O, Reynier P, Valat P, Jougon J, Arimone Y, Janvier G.
Department of Anesthesiology and Intensive Care 2, Centre Hospitalier Universitaire (CHU) de Bordeaux. Universite Bordeaux, 2 Victor Segalen, Bordeaux, France.
BACKGROUND AND OBJECTIVES: Patients undergoing thyroid surgery need postoperative pain management. Bilateral superficial cervical plexus block by administration of 0.25% bupivacaine with 1:200000 epinephrine at the end of surgery has been shown to improve postoperative analgesia. The objective of this study was to assess the analgesic efficacy in the first 36 postoperative hours after total thyroidectomy of bilateral superficial cervical plexus block with 0.75% ropivacaine administered before the incision or on completion of the surgical procedure. METHODS: We performed a prospective double-blinded, randomized controlled trial that compared 3 parallel groups: the CONT group did not receive any block, the PRE group received bilateral superficial cervical plexus block before surgery while under general anesthesia, and the POST group received bilateral superficial cervical plexus block after surgery while under general anesthesia. The study included 111 patients (37 in each group). Postoperative pain was assessed every 4 hours by use of a 0 to 10 numeric rating scale. All patients received paracetamol every 6 hours. Morphine was administered following a standardized protocol if the numeric rating scale was 4 or higher. The main outcome variables were the proportion of patients given morphine during the 36 hours period, pain intensity scores, and morphine consumption. RESULTS: No intergroup differences were observed in terms of percentage of patients who required morphine, morphine delivery, pain scores, and intraoperative opioid consumption. CONCLUSIONS: Bilateral superficial cervical plexus block with 0.75% ropivacaine administered before or after surgery does not improve postoperative analgesia after total thyroidectomy.
PMID: 16418022 [PubMed - in process]
Efficacy of intra-articular bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac on postoperative pain relief after ambulatory arthroscopic knee surgery: a randomized double-blind study.
Ng HP, Nordstrom U, Axelsson K, Perniola AD, Gustav E, Ryttberg L, Gupta A.
Department of Anaesthesiology, University Hospital, Orebro, Sweden.
BACKGROUND: Effective pain relief is important after diagnostic and therapeutic arthroscopic knee surgery to permit early discharge and improve comfort and mobility at home. The aim of this study was to assess the efficacy of bupivacaine, ropivacaine, or a combination of ropivacaine, morphine, and ketorolac injected intra-articularly for postoperative pain relief after arthroscopic knee surgery. METHODS: Sixty-three healthy patients undergoing knee arthroscopy under local anesthesia (LA) were randomized to receive 1 of the following substances intra-articularly postoperatively: group B: 30 mL of bupivacaine (150 mg); group R: 30 mL of ropivacaine (150 mg); and group RMK: ropivacaine 150 mg, morphine 4 mg, and ketorolac 30 mg in normal saline (total volume 30 mL). Oral paracetamol 1g and tramadol 50 mg were used as rescue drugs. Postoperatively, pain was assessed at rest and movement, and side effects were recorded. The patients were asked to self-assess pain for 7 days and record analgesic consumption as well as activities of daily living (ADLs). Plasma concentration of LA was measured in another 8 patients. RESULTS: All groups had excellent analgesia at 0 and 4 hours postoperatively. Group RMK had significantly lower visual analog pain score at rest at 8 hours and during movement at 8 and 24 hours compared with the other groups (P < .05). Group RMK required less paracetamol and tramadol on day 1 (P < .05), had less sleep disturbances because of pain, more patients were ready to work on days 1 and 2 (P < .05), and were more satisfied on days 1 and 4 to 7. Postoperatively, plasma concentrations of ropivacaine and lidocaine were far below known systemic toxic concentrations in all patients. CONCLUSION: Addition of morphine and ketolorac to ropivacaine intra-articularly enhances analgesic efficacy of LA, reduces postdischarge analgesic consumption, and improves ADLs without increasing side effects after ambulatory arthroscopic knee surgery.
PMID: 16418021 [PubMed - in process]
The effect of cyclooxygenase-2 inhibition on acute and chronic donor-site pain after spinal-fusion surgery.
Reuben SS, Ekman EF, Raghunathan K, Steinberg RB, Blinder JL, Adesioye J.
Department of Anesthesiology and Pain Medicine, Baystate Medical Center and the Tufts University School of Medicine, Springfield, MA, USA.
BACKGROUND AND OBJECTIVES: The development of chronic pain after spinal-fusion surgery represents a significant source of morbidity. One of the predictive factors for the development of chronic postsurgical pain is inadequate acute postoperative pain management. Further, the up-regulation of cyclooxygenase-2 (COX-2) after surgery may result in neuroplastic changes that may contribute to a progression from acute to chronic pain. The goal of this prospective, randomized, double-blind study was to examine the effect of perioperative COX-2 inhibition on acute and chronic donor-site pain in patients undergoing spinal-fusion surgery. METHODS: Eighty patients scheduled to undergo instrumented posterior spinal fusion were randomized to either receive celecoxib 400 mg 1 hour before surgery, and then 200 mg every 12 hours after surgery for the first 5 days or receive matching placebo at similar time intervals. Patients were administered morphine via patient-controlled analgesia pump for the first 24 hours, and then acetaminophen and oxycodone tablets. Patients were asked to quantify their average pain on postoperative days 1 to 5. At 1 year after surgery, patients were questioned about the presence and subjective characteristics of any residual donor-site pain. RESULTS: Patients administered celecoxib reported lower pain scores and less opioid use during the first 5 postoperative days. Chronic donor-site pain was significantly higher (P < .01) in the placebo group (12 of 40, or 30%) compared with the celecoxib group (4 of 40, or 10%) at 1 year after surgery. CONCLUSIONS: The administration of celecoxib for the first 5 days after spinal-fusion surgery resulted in improved analgesia and a reduction in chronic donor-site pain at 1 year after surgery.
PMID: 16418018 [PubMed - in process]
30 Plus Years-An Anniversary Celebration of ASRA and Regional Anesthesia and Pain Medicine.
Neal JM.
Publication Types:
PMID: 16418017 [PubMed - in process]
Preventing chronic pain after surgery: who, how, and when?
Eisenach JC.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC.
Publication Types:
PMID: 16418016 [PubMed - in process]
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Re: Hurwitz et al. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA Neck Pain Study. Spine 2005; 30: 1477-84.
Haneline MT, Cooperstein R.
Publication Types:
PMID: 16418656 [PubMed - in process]
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Re: Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine 2005; 30: 1477-84.
Dagenais S, Moher D.
Publication Types:
PMID: 16418654 [PubMed - in process]
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Re: Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine 2005; 30: 1477-84.
Krippendorf DJ.
Publication Types:
PMID: 16418650 [PubMed - in process]
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Re: Hurwitz EL, Morgenstern H, Vassilaki M, Chiang L-M. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine 2005;30: 1477-84.
Giles LG.
Publication Types:
PMID: 16418649 [PubMed - in process]
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A review of the 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group.
Kwon B, Katz JN, Kim DH, Jenis LG.
Boston Spine Group, Boston, MA 02120, USA. bkwon@nebh.org
The current debate over the efficacy of lumbar fusion for low back pain has not been settled. Fritzell et al published a landmark paper entitled "Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish lumbar spine study group." Their goal was to provide objective evidence supporting lumbar fusion. While it was well designed and important to our knowledge base, it has limitations. We set out to review their work in an unbiased yet critical manner. Our goals are to summarize the strengths and weaknesses of the paper, place it in the context of current knowledge, and highlight its significance for present-day practice and research. From technical and study design perspectives, Fritzell et al were able to validate the use of lumbar fusion for the treatment of low back pain. However, their use of "usual nonoperative" care and nonspecific definition of low back pain precluded a truly genuine comparison of operative and nonoperative groups. We commend the Swedish lumbar spine study group and their remarkable efforts; they elevated the sophistication of spine research and spawned many more excellent works to help settle the ongoing controversy on the ideal treatment of low back pain.
Publication Types:
PMID: 16418648 [PubMed - in process]
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School-based interventions for spinal pain: a systematic review.
Steele EJ, Dawson AP, Hiller JE.
Department of Public Health, University of Adelaide, North Terrace, Adelaide, South Australia, Australia. emily.steele@adelaide.edu.au
STUDY DESIGN: Systematic review. OBJECTIVES: To establish the effectiveness of school-based spinal health interventions in terms of: 1) improving knowledge about the spine/spinal care; 2) changing spinal care behaviors; and 3) decreasing the prevalence of spinal pain. SUMMARY OF BACKGROUND DATA: Spinal pain is a significant problem in children and adolescents that has been addressed through school-based spinal health interventions. No systematic review has been carried out on this topic to date. METHODS: A systematic literature review sought studies that evaluated school-based spinal health interventions. Using clearly defined study inclusion criteria, 11 databases were searched from their inception to March 2004. To identify further literature, three relevant journals were hand searched, reference lists were checked, and authors of included papers were contacted. Two reviewers independently appraised the quality of identified papers and extracted data regarding intervention and study characteristics, statistical analyses performed, and study results. Data were examined using a narrative synthesis of results, and the outcomes of interest were considered individually (knowledge, behaviors, pain prevalence). RESULTS: Twelve papers were included in this review; all papers received a "weak" quality rating. Results of these studies indicate that school-based spinal health interventions may be effective in increasing spinal care knowledge and decreasing the prevalence of spinal pain. However, overall the evidence is inconclusive regarding spinal care behaviors. CONCLUSIONS: The poor quality of the reviewed studies limits the conclusions that can be made regarding the effectiveness of school-based spinal health interventions.
PMID: 16418645 [PubMed - in process]
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Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes.
Wasiak R, Kim J, Pransky G.
Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA. radoslaw.wasiak@libertymutual.com
STUDY DESIGN: Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. OBJECTIVE: To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. SUMMARY OF BACKGROUND DATA: Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. METHODS: All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. RESULTS: The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. CONCLUSIONS: Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.
PMID: 16418644 [PubMed - in process]
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