Postoperative pain

Oral morphine for postoperative pain after minor pediatric surgery, while increasingly popular, is not supported by evidence. We evaluated whether oral morphine was superior to ibuprofen for at-home management of children's postoperative pain. We conducted a randomized superiority trial comparing oral morphine (0.5 mg/kg) with ibuprofen (10 mg/kg) in children 5 to 17 years of age who had undergone minor outpatient orthopedic surgery (June 2013 to September 2016). Participants took up to 8 doses of the intervention drug every 6 hours as needed for pain at home. The primary outcome was pain, according to the Faces Pain Scale - Revised, for the first dose. Secondary outcomes included additional analgesic requirements, adverse effects, unplanned health care visits and pain scores for doses 2 to 8. We analyzed data for 77 participants in each of the morphine and ibuprofen groups. Both interventions decreased pain scores with no difference in efficacy. The median difference in pain sc...

Tramadol is a synthetic opioid agonist used extensively in human and, to a lesser extent, veterinary medicine throughout the world. The clinical efficacy and pharmacokinetic profile of intravenous (i.v.) and extradural (e.d.) tramadol (2 mg/kg) and its o-desmethyl metabolite were studied in dogs undergoing tibial plateau levelling osteotomy (TPLO). Intra-operative cardiorespiratory variables were monitored and post-operative pain was assessed using the short form of the Glasgow Composite Pain Scale. A rapid (<5 min) and effective production of o-desmethyl tramadol was recorded. The pharmacokinetic profile was similar for tramadol and its metabolite irrespective of the route of administration. E.d. tramadol provided sufficient intra- and post-operative analgesia without significant clinical side-effects, but the post-operative analgesia was comparable to that following i.v. administration and the e.d. route could therefore not be considered a practical alternative to the i.v. route.

To investigate the incidence of pain following discharge from reproductive day surgery. Cross-sectional descriptive study. A public hospital for women in Melbourne. 315 women participated in phone interviews and 10 in face-to-face interviews. Self-reports of pain were assessed in relation to age, English and non-English speaking background, prior experience of day surgery, type of surgery, time in recovery, information provision prior to surgery, and access to significant others at home. Older women were less likely to report having pain immediately following discharge (regression coefficient = -0.72, 95% CI, 0.58 to 0.88, p < or = 0.01), or within 48 hours following discharge (regression coefficient = - 0.71, 95% CI, 0.57 to 0.88, p < or = 0.05). Women with a prior experience of day surgery were 1.9 times more likely to be in pain within 48 hours following surgery (regression co-efficient 1.88, 95% CI, 1.134 to 3.10, p < or = 0.05). Women who understood information were le...

Surgical strategy regarding nerve identification and resection in relation to chronic postoperative pain remains controversial. A central question is whether nerves in the operation field, when identified, should be preserved or resected. In the present study, the hypotheses that the identification and consequent resection of nerves 'at risk' have no influence on postoperative pain has been tested. A single-centre study was conducted in 525 patients undergoing Lichtenstein hernioplasty. One surgeon (364 operations, Group A) consequently resected nerves 'at risk' for being injured and nine surgeons (161 operations, Group B) adhered to the general routine of nerve preservation. All cases were ambulatory surgery on anaesthetised patients and the groups were similar with regard to age, body mass index (BMI) and preoperative pain. Self-reported pain at 3 months was recorded on a 10-box visual analogue scale (VAS). The identification and resection of nerves were continuous...

Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy. We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received standard medication only. The standardized pain therapy after tonsillectomy was orally administered nonsteroidal anti-inflammatory drugs (NSAID) (diclofenac 3 × 50 mg oral). The patients (n = 123) treated with NSAID were asked about their acute pain after taking a sip of water between the first and fifth postoperative day. Participants’ pain was assessed using visual analog (VAS) [zero (0) for no pain up to ten (10) for the acute reported outset pain] before and 20 min, 1, 2 and 3 h after acupuncture treatment or standard pain medication, respectively. The functional assessment of diagnosis and treatment point-combination occurred by means of the “Heidelberg Model” of Traditional Chinese Medicine (TCM). Verum acupuncture lead to a significant additional pain relief. In comparison to the acupuncture, they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID. This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy. It may particularly serve as an alternative pain treatment in case of NSAID intolerances.

Hernia surgery has been associated with severe pain within the first 24 h postoperatively. The application of cold or cryotherapy has been in use since at least the time of Hippocrates. The physiological and biological effects from the reduction of temperature in various tissues include local analgesia, inhibited oedema formation and reduced blood circulation. Our hypothesis was that cold therapy, applied by means of ice packs, following inguinal hernia surgery, controlled pain postoperatively. Forty patients scheduled for inguinal hernia repair were enrolled in a double-blind, randomized study. Postoperatively, chipped ice in a plastic bag (cold group), and a plastic bag containing only room temperature water (control) were placed over the incision for 20 min. Postoperative pain data were collected at 2, 6 and 24 h after operation according to the well validated visual analogue scale (VAS). The highest pain levels were recorded 2 h postoperatively for both groups. Pain levels then gradually decreased for both the trial groups during the first 24 h postoperatively. There were significant differences in the VAS scores between the groups at 2, 6 and 24 h. We conclude that local cooling is a safe and effective technique for providing analgesia following inguinal hernia repair.

BACKGROUND Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia. AIM The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery. PATIENTS AND METHODS The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoper...

Music has been used in the acute clinical care setting as an adjunct to current treatment modalities. Previous studies have indicated that some types of music may benefit patients by reducing pain and anxiety, and may have an effect on physiological measures. To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing. The research questions for this pilot study were: Does live harp playing have an effect on patient perception of anxiety, pain, and satisfaction? Does live harp playing produce statistically and clinically significant differences in physiological measures of heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation? A prospective, quasiexperimental, repeated measures design was used with a convenience sampling. Orlando Regional Medical Center, Orlando Fla. Subjects wer eligible for the study if they were postoperative and admitted to a hard-wired-bedside-monitored room of the Vascular Thoracic ...

The frequency of claw regrowth, bony remnants, and complications in cats that underwent forelimb onychectomy using laser, scalpel, or guillotine techniques were evaluated. Eighty-seven client-owned cats were recruited from 27 veterinary clinics in the Canadian Atlantic provinces. At least 1 year after onychectomy the cats underwent a physical examination, gait analysis, and radiographic evaluation by 1 of 2 authors. There was no significant difference in the frequency of claw regrowth among the 3 methods (P = 0.283). Significantly more cats had bony remnants following guillotine onychectomy (P < 0.001). Bony remnants were significantly associated with claw regrowth (P = 0.001). Cats that underwent laser onychectomy had significantly less post-operative complications (P = 0.023). The long-term outcome was not significantly different among the 3 methods. We conclude that leaving remnants of the third phalanx in situ is associated with an increased frequency of claw regrowth. Laser ...