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Biomedical subjects

C R Goucke

Publications and source records attributed to C R Goucke.

18 recordsLinked to original sources
PubMed2001

Outcome of intrathecal opioids in chronic non-cancer pain.

Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction. The most common diagnosis in this group was lumbar spinal or radicular pain after failed spinal surgery (n= 55, 63%). At the time of follow-up, mean pain relief was 60% with 74% of patients (36 of 49) reporting increased activity levels. Oral medication intake was significantly reduced (Medication Quantification Scale Score prior to implantation 31.0+/-2.6 and at follow-up 12.7+/-1.4; n= 48; p< 0.0001). These gains were not accompanied by a change in work status (43 of 50 working age patients not working at follow-up). There were frequent reports of opioid side-effects, including sexual dysfunction and menstrual disturbance. Technical complications occurred with the drug administration device, most often catheter related, requiring at least one further surgical procedure in 32 patients (40%). Patient satisfaction with intrathecal opioids was high, with 45 of 51 (88%) reporting satisfaction. Mean intrathecal morphine dose increased from 9.95+/-1.49 mg/day (mean+/-SEM) at 6 months to 15.26+/-2.52 mg/day 36 months after initiation of therapy. Drug administration systems were permanently removed in five patients (6%). Intrathecal opioid therapy appears to have a place in the management of chronic non-cancer pain. Therapy does not seem to be significantly inhibited by the development of tolerance.

Activities of Daily Living↗
PubMed2001

Australian management strategies for oral opioid use in non-malignant pain.

Chronic non-cancer pain is a complex biopsychosocial phenomenon; as such it is unlikely that any one treatment modality will achieve relief. There is increasing availability of oral opioid preparations and an associated increased level of prescribing; consequently in 1997 the Australian Pain Society drew up some management strategies for their use. This paper reviews the principles of those strategies, stressing that oral opioids should not be used in isolation nor used to treat 'distress' often associated with chronic pain. The place of a trial of opioid and informed consent are discussed.

Administration, Oral↗
PubMed2001

Retro-orbital tumour--an uncommon cause of headache in pregnancy.

Retro-orbital tumour was the cause of headache and neuropathic facial pain in a 31-year-old pregnant woman. The diagnosis had been overlooked as a result of a long history of migraine. There was exacerbation of the pain throughout the pregnancy, particularly in the third trimester. Pharmacological agents commonly used to manage neuropathic pain states were relatively contraindicated due to potential adverse effects on the fetus. Cognisant of such limitations imposed by pregnancy, we used multimodal therapy in an attempt to control the pain. This included morphine, paracetamol, amitriptyline, ketamine and psychological support. The management challenges are described.

Adult↗
PubMed1999

The effect of midazolam on persistent postoperative nausea and vomiting.

The effect of intravenous midazolam on persistent postoperative nausea and vomiting (PONV) was compared to placebo in a prospective randomized double-blind study. Twenty patients aged 18 to 82 years with persistent PONV resistant to standard anti-emetics and present for greater than six hours were randomized to receive either an intravenous infusion of midazolam 1.0 mg/h or placebo. Nausea (P = 0.04), vomiting (P = 0.02) and the use of rescue anti-emetics (P = 0.003) were significantly less in the midazolam group. We conclude that low-dose intravenous infusion of midazolam significantly reduces persistent PONV.

Adult↗
PubMed1998

Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position.

A technique of subclavian vein catheterization is described, tailored to the individual patient, to reduce the risk of right atrial placement with central venous catheter (CVC) insertion. Using data gathered retrospectively for Quality Improvement purposes, CVC tip location was assessed. The standard technique used in our cardiac anaesthesia unit at that time was to insert all CVCs to a depth of 15 cm from the skin. We then compared CVC tip location using a new "tailored" technique. The tailored method involved measuring the distance from the skin at which venepuncture occurred and using this distance to determine depth of CVC insertion. Using the tailored technique significantly decreases the frequency with which CVC tips enter the right atrium (P < 0.001). An advantage of the tailored technique is that the distance between the most proximal and the distal ports of multi-lumen CVCs is taken into consideration, reducing the risk of extravasation via the proximal port.

Adult↗
PubMed1997

The use of oral opioids in patients with chronic non-cancer pain. Management strategies.

BACKGROUND: The use of oral opioids in non-cancer pain is increasing, but it is not clear that this is improving outcomes for patients. These management strategies were developed as a consensus view between the two authors, who are both Directors of the Australian Pain Society. The strategies were subsequently reviewed and approved by the other Directors of the Society: four anaesthetists specialising in pain management, a pharmacist, a rheumatologist, two rehabilitation physicians and an occupational therapist. EVIDENCE BASE: A MEDLINE search of the literature since 1966 produced 163 relevant articles, including two randomised controlled trials of oral opioids in non-cancer pain. MANAGEMENT CONSENSUS: A small group of patients with chronic non-cancer pain can benefit from the use of oral opioids. Thorough attention to diagnosis and patient history must precede any decision to prescribe opioids. Patients should be psychologically stable. Patient and doctor should-agree beforehand on how to assess the outcome of therapy. Only one doctor (the patient's regular primary carer or pain specialist) should prescribe opioids and assess the response. Sustained release morphine preparations are the drug of choice. A trial of therapy, with goals and endpoint agreed between patient and doctor, should precede any decision to prescribe opioids in the long term.

Administration, Oral↗
PubMed1993

Control of intractable pain in erythromelalgia by using spinal cord stimulation.

A 69-yr-old woman with severe, long-standing erythromelalgia possibly secondary to multiple deep-vein thromboses, was treated with transcutaneous electrical nerve stimulation for the burning pain in her legs and feet. Problems developed, and she was subsequently successfully managed with spinal cord stimulation. The relief was reproduced after a 6-mo period of no stimulation by reestablishing spinal cord stimulation.

Aged↗
PubMed1990

The effect of diclofenac and nefopam on postoperative dental pain.

Eighty-two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.

Adult↗
PubMed1989

Prophylaxis against venous thromboembolism.

Death from venous thromboembolism occurs in the perioperative period at a rate varying between 0.1% and 7.0%. The risk factors and methods of prophylaxis are reviewed and current recommendations presented.

Humans↗
PubMed1986

Cardiopulmonary resuscitation skills of hospital medical and nursing staff members.

The cardiopulmonary resuscitation skills of 160 staff members at a large metropolitan teaching hospital were assessed by a multiple choice questionnaire and a practical test of basic life support skills on a manikin. Medical staff members performed significantly better than did nurses in the multiple choice test, but significantly worse in the practical test; 48 (60%) of 80 nurses and only 26 (32.5%) of 80 doctors passed the practical test. Training in resuscitation by the St John Ambulance Association as a medical student may have improved the basic life support skills of doctors but there is clearly a need for continued revision and assessment of resuscitation skills.

Clinical Competence↗
PubMed1985

Mortality following surgery for fractures of the neck of femur.

The mortality following surgery for hip fractures during 1982 is reviewed. 91 procedures were performed on 89 patients. The mortality rate at 4 weeks following general anaesthesia was 2.7%. This is much lower than previously reported. Possible reasons for the variation in mortality between this series and others, are discussed.

Aged↗
PubMed1980

One practice's review of its use of a general practitioner hospital.

For a period of six months a record was kept of every attendance at a general practitioner hospital by a patient from a four-partner practice with a list of 10,500 patients.During the six-month period one in 17 of the practice population was x-rayed; one in 50 attended the physiotherapy department, and the rate for general practitioner surgery consultations was one per person.I believe that in semi-rural North Yorkshire the general practitioner hospital has a continuing role to play and such a hospital can provide a better and more comprehensive service to patients, and give professional satisfaction and stimulation to the primary health care team.

Adolescent↗