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Hi-TENS combined with PCA-morphine as post caesarean pain relief.

https://arctichealth.org/en/permalink/ahliterature142298
Source
Midwifery. 2011 Aug;27(4):547-52
Publication Type
Article
Date
Aug-2011
Author
Pauline Binder
Annica Gustafsson
Kerstin Uvnäs-Moberg
Eva Nissen
Author Affiliation
Department of Women's and Children's Health, IMCH, Akademiska Hospital/Uppsala University, Drottninggatan 4, 4th Floor, SE-75185 Uppsala, Sweden.pauline.binder@kbh.uu.se
Source
Midwifery. 2011 Aug;27(4):547-52
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Analgesia, Patient-Controlled - methods
Analgesics, Opioid - administration & dosage
Cesarean Section - adverse effects
Combined Modality Therapy
Female
Humans
Morphine - administration & dosage
Pain Measurement
Pain, Postoperative - etiology - therapy
Postpartum Period
Pregnancy
Sweden
Transcutaneous Electric Nerve Stimulation - methods
Treatment Outcome
Young Adult
Abstract
to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth.
randomised, controlled study.
a county hospital in south-west Sweden.
42 multiparous women.
participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2 ± 12.6 mg and morphine alone was 33.1 ± 20.9 mg (p = 0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p = 0.045), especially between three and 12 hours post partum (p = 0.011).
pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.
PubMed ID
20615594 View in PubMed
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Pain and bleeding are the main determinants of unscheduled contacts after outpatient tonsillectomy.

https://arctichealth.org/en/permalink/ahliterature127454
Source
Dan Med J. 2012 Feb;59(2):A4382
Publication Type
Article
Date
Feb-2012
Author
Therese Ovesen
Gintaras Kamarauskas
Mads Dahl
Jan Mainz
Author Affiliation
Øre-, Næse- Og Halsafdelingen, Aarhus Sygehus, Nørrebrogade 44, 8000 Aarhus C, Denmark. theroves@rm.dk
Source
Dan Med J. 2012 Feb;59(2):A4382
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Ambulatory Surgical Procedures
Child
Child, Preschool
Denmark
Female
Hospitalization - statistics & numerical data
Humans
Infant
Male
Middle Aged
Office visits - statistics & numerical data
Pain, Postoperative - etiology - therapy
Postoperative Hemorrhage - etiology - therapy
Tonsillectomy - adverse effects
Young Adult
Abstract
The objective of this prospective cohort study was to measure the medical technical quality of outpatient tonsillectomy in Danish ear, nose & throat practices by indicators, standards and prognostic factors.
According to standardised and validated specific questionnaires, quality of surgery was measured in terms of postoperative bleeding, pain, gastrointestinal problems and infection.
A total of 614 patients were included. 11% were younger than four years, and 93% were observed for less than four hours. A total of 23% had unscheduled postoperative contacts. Almost 12% of the patients contacted a physician due to pain; a percentage that exceeds the chosen standard of 10%. 4% were hospitalised due to bleeding exceeding the chosen standard of 1%. Secondary haemostatic procedures were performed in 2% of the patients. The indication chronic tonsillitis, being an adult, and a postoperative observation shorter than four hours increased the risk of unscheduled contacts.
Outpatient tonsillectomy seems safe in Denmark. A minimum postoperative observation period of four hours will reduce the need for postoperative contacts. Because of the potentially life-threatening risk related to tonsillectomy, careful patient selection is mandatory and continuous monitoring of the quality of the procedure is essential.
Not relevant.
PubMed ID
22293052 View in PubMed
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Pain management in post-craniotomy patients: a survey of canadian neurosurgeons.

https://arctichealth.org/en/permalink/ahliterature135030
Source
Can J Neurol Sci. 2011 May;38(3):456-60
Publication Type
Article
Date
May-2011
Author
Basil Hassouneh
John E Centofanti
Kesava Reddy
Author Affiliation
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Source
Can J Neurol Sci. 2011 May;38(3):456-60
Date
May-2011
Language
English
Publication Type
Article
Keywords
Analgesics - therapeutic use
Canada - epidemiology
Craniotomy - adverse effects
Health Surveys
Humans
Pain Measurement - methods
Pain, Postoperative - etiology - therapy
Patient Satisfaction - statistics & numerical data
Professional Practice - statistics & numerical data
Abstract
Despite the growing recognition for analgesic needs in post-craniotomy patients, this remains a poorly studied area in neurological surgery. The class and regimen of analgesia that is most suitable for these patients remains controversial. The objective of this study is to examine the current beliefs and practices of Canadian neurosurgeons when managing post-craniotomy pain.
A survey was sent to all practicing Canadian neurosurgeons to examine the following aspects of analgesia in craniotomy patients: type of analgesics used, common side effects encountered, satisfaction with current regimen and the rationale for their practice.
Of 156 potential respondents, 103 neurosurgeons (66%) completed the survey. Codeine (59%) was the most prescribed first line analgesic followed by morphine (38%). The use of a second-line opioid was significantly higher among codeine prescribers compared to morphine, 53% compared to 28% (p
Notes
Comment In: Can J Neurol Sci. 2011 May;38(3):390-121515493
PubMed ID
21515506 View in PubMed
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A randomized study of coronary artery bypass surgery performed with the Resting Heart™ System utilizing a low vs a standard dosage of heparin.

https://arctichealth.org/en/permalink/ahliterature121356
Source
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):834-9
Publication Type
Article
Date
Nov-2012
Author
Johan Nilsson
Sara Scicluna
Gunnar Malmkvist
Leif Pierre
Lars Algotsson
Per Paulsson
Henrik Bjursten
Per Johnsson
Author Affiliation
Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skåne University Hospital and Lund University, 221 85 Lund, Sweden.
Source
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):834-9
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - administration & dosage - adverse effects
Blood Transfusion
Cardiopulmonary Bypass - adverse effects - instrumentation
Coated Materials, Biocompatible
Cognition
Coronary Artery Bypass - adverse effects - instrumentation
Equipment Design
Female
Heparin - administration & dosage - adverse effects
Heparin Antagonists - therapeutic use
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Mobility Limitation
Oxygen Inhalation Therapy
Pain, Postoperative - etiology - therapy
Postoperative Hemorrhage - etiology - therapy
Prospective Studies
Protamines - therapeutic use
Reoperation
Respiration, Artificial
Surgical Procedures, Elective
Sweden
Time Factors
Treatment Outcome
Abstract
Allogeneic blood transfusion and reoperation for postoperative bleeding after the coronary artery bypass grafting have a negative impact on the patient outcome. This study aimed at evaluating the effects of reduced doses of heparin and protamine on the patient outcome, using a heparin-coated mini-cardiopulmonary bypass (CPB) system.
Sixty patients undergoing elective first-time CPB were prospectively randomized either to have a reduced systemic heparinization [activated clotting time (ACT) = 250 s] or to a control group perfused with a full heparin dose (ACT = 420 s). Blood transfusions, ventilation time, early postoperative bleeding, ICU stay, reoperations for bleeding, postoperative cognitive status and the level of mobilization were registered.
Twenty-nine patients were randomized to the control group, 27 patients to the low-dose group and 4 patients were excluded because of protocol violations. Four patients in the control group received a total of 10 units of packed red blood cells, and in the low-dose group, no transfusions were given, P = 0.046. No patient was reoperated because of bleeding. The ICU stay was significantly shorter in the low-dose group (8.4 vs 13.7 h, P = 0.020), less dependent on oxygen on the first postoperative day (78 vs 97%, P = 0.034), better mobilized (89 vs 59%, P = 0.006) and had less pain (visual analogue scale 2.0 vs 3.5, P = 0.019) compared with the control group.
The use of a mini-CPB system combined with a low dose of heparin reduced the need for blood transfusions and may facilitate the faster mobilization of the patients.
Notes
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PubMed ID
22914806 View in PubMed
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