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Biomedical subjects

J B Dahl

Publications and source records attributed to J B Dahl.

At least 19 recordsLinked to original sources
PubMed1992

[Patients' activity and length of stay after hip arthroplasty with balanced analgesia and early mobilization].

Thirteen consecutive patients were submitted to hip-replacement by Müller's method under epidural analgesia and were treated for postoperative pain with balanced analgesia by means of continuous epidural infusion of a mixture of bupivaine (0.625 mg/ml) and morphine (0.05 mg/ml) 4 ml hourly for 96 hours and supplemented by 600 mg ibuprofen every eight hour orally. The analgesic treatment was combined with intensive mobilization regime and altered postoperative care as regards early normalization of daily activities and reduced duration of hospitalization. The patients were found to be effectively relieved of pain during rest and also during mobilization and, together with suitable care and rehabilitation, this had the result that more than half of the patients were mobilized from bed for more than eight hours from the second postoperative day and that all of the patients were able to carry out ordinary everyday functions after the fourth postoperative day, with the assistance of the aids which the hip regimen required. Eleven of the patients were ready for discharge on the sixth postoperative day while two patients were not discharged until the eighth and ninth postoperative days on account of slight surgical complications. All of the patients were discharged to their homes and to outpatient rehabilitation for three weeks. Compared with the usual duration of hospitalization of approximately 13 days in corresponding patients, this pilot investigation appears to show that the analgesic regime employed was extremely effective but that traditional attitudes and routines in the postoperative care and mobilization must be revised if this is to be utilized for more rapid restitution and reduced duration of hospitalization.

Aged↗
PubMed1992

Effect of pre- vs postoperative inguinal field block on postoperative pain after herniorrhaphy.

The analgesic effects of an identical inguinal field block, performed before or immediately after inguinal herniorrhaphy, were evaluated in 32 healthy patients in a double-blind, randomized study. During surgery, all patients received a light general anaesthesia with thiopentone, alfentanil and nitrous oxide in oxygen. After induction of general anaesthesia, patients were allocated randomly to receive an inguinal field block with lignocaine, either 15 min before operation or immediately after operation, after closure of the surgical wound, but before the patients were awake. Pain score on a visual analogue scale and on a verbal scale at rest, during mobilization from supine into sitting position and during cough was assessed 1, 2, 4, 6, 8 and 24 h, and 7 days after operation. No significant differences between the groups were observed in VAS scores or verbal pain scores during rest or ambulation at any time. There was no significant difference in time to first request for morphine or total morphine consumption. These results do not show pre-emptive analgesia with a conventional inguinal field block to be of clinical importance compared with a similar block administered after operation.

Adult↗
PubMed1992

Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery.

We have studied the effect of continuous extradural analgesia with bupivacaine and morphine, initiated before or after colonic surgery, in a double-blind, randomized study. Thirty-two patients were allocated randomly to receive an identical extradural block initiated 40 min before surgical incision (n = 16) or at closure of the surgical wound (n = 16). The extradural regimen consisted of a bolus of 7 ml of plain bupivacaine 7.5 mg ml-1 plus morphine 2 mg and continuous extradural infusion of a mixture of bupivacaine 7.5 mg ml-1 plus morphine 0.05 mg ml-1, 4 ml h-1 for 2 h, followed by a continuous extradural infusion of a mixture of bupivacaine 2.5 mg ml-1 plus morphine 0.05 mg ml-1, 4 ml h-1, continued for 72 h after operation. In addition, all patients received similar general anaesthesia. There was no significant difference in request for additional morphine and no significant differences between the groups in pain scores (visual analogue scale or verbal) during rest or ambulation at any time of measurement. These results do not suggest that timing of analgesia with a conventional extradural regimen is of major clinical importance in patients undergoing colonic surgery.

Aged↗
PubMed1992

Pain sensation and nociceptive reflex excitability in surgical patients and human volunteers.

Pain threshold, nociceptive flexion reflex (NFR) threshold and responses to suprathreshold stimulation were investigated in 15 female patients (mean age 32 yr (range 22-48 yr)) before and 68 (range 48-96) h after gynaecological laparotomy. Control measurements were performed in 17 healthy human volunteers (five males, age 30 yr (range 24-41 yr)). In the surgical patients, pain threshold decreased and pain to suprathreshold stimulation increased significantly (P = 0.006 and P = 0.04, respectively) from before to after surgery. A corresponding trend was demonstrated in neurophysiological measurements, although the decrease in NFR threshold and increase in NFR amplitude to suprathreshold stimulation were not significant (P = 0.08 and P = 0.24, respectively). The correlations between the relative change in pain and reflex thresholds, and time from surgery, were statistically significant (pain threshold: rs = 0.53, P = 0.04; NFR thresholds: rs = 0.54, P = 0.04). In the healthy volunteers, no significant differences in thresholds and responses to suprathreshold stimulation were observed between two recordings with an interval of at least 48 h. The allodynia and hyperalgesia observed in postsurgical patients may be related to postoperative sensitization of central neurones.

Adult↗
PubMed1992

Effects of lidocaine aerosol on postoperative pain and wound tenderness following minor gynaecological laparotomy.

Twenty-four female patients undergoing sterilization through a minor lower laparotomy received, in a double-blind, randomized study, either lidocaine spray 200 mg or placebo in the surgical wound. Postoperative pain intensity was evaluated on a verbal and a visual analogue scale and wound tenderness with an algometer. During mobilisation from the supine to the sitting position, VAS-score was lower (P less than 0.05) in the lidocaine group 2 h postoperatively, but not 4, 6 and 8 h postoperatively (P greater than 0.05). No significant differences were found in VAS-scores at rest or during cough, or in verbal scale ratings during rest, cough or mobilisation, and postoperative consumption of morphine was similar in the two groups. Pressure pain thresholds were higher (P less than 0.05) 2 h postoperatively in the lidocaine group, but not 4, 6 and 8 h postoperatively. In conclusion, topically applied lidocaine aerosol in the surgical wound leads to very short and clinically insignificant relief of postoperative pain.

Aerosols↗
PubMed1992

Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy.

The effect of thoracic (T7-8) epidural etidocaine 1.5%, 9 ml, and continuous per- and postoperative epidural infusion of etidocaine 1.5%, 4 ml/h, on early (less than 500 ms) somatosensory evoked potentials (SEPs), and cortisol and glucose in plasma during cholecystectomy, was examined in ten patients. Spread of analgesia (pin-prick) was T3 (T1-T3) to L2 (T11-L3) 35 min after injection of etidocaine, and T3 (T2-T4) to T12 (T8-L4) 3 h after surgical incision (median (range)). Before operation, epidural etidocaine had no significant effects on peak-to-peak amplitude of SEPs to electrical stimulation at the L1, T10 or T6 dermatomal level (P greater than 0.09). SEPs were abolished in only two patients at T6, and no patient had SEPs abolished at T10 or L1. The plasma concentrations of cortisol and glucose were significantly increased 20 min after surgical incision and remained increased throughout the study. No correlation was found between the block-induced decrease in the peak-to-peak amplitude at T6 or T10 and increase in plasma cortisol, except for a negative correlation at T10 and the initial increase in cortisol (Rs = 0.72, P = 0.03). In conclusion, thoracic epidural administration of 9 ml of etidocaine 1.5% does not provide total afferent somatic blockade assessed by SEP and the stress response to cholecystectomy.

Adult↗
PubMed1992

Direct spinal effect of intrathecal acetaminophen on visceral noxious stimulation in rabbits.

The aim of this study was to investigate the effect of intrathecal acetaminophen on visceral and somatic noxious stimulation in the intact, non-anesthetized rabbit. Sixteen rabbits had intrathecal catheters implanted surgically. Visceral noxious stimulation was induced by intestinal distension of the distal colon and somatic stimulation with increasing electrical current through skin electrodes placed in either the cervical or the lumbar area. The effect on visceral noxious stimulation was assessed following intrathecal injection of 0.5, 2.5 and 5 mg of acetaminophen and following 10 and 50 mg acetaminophen intravenously. Naloxone 0.2 mg and yohimbine 0.1 mg were administered intrathecally prior to intrathecal injection of acetaminophen 5 mg. A dose-dependent effect of intrathecal acetaminophen against the visceromotor reflex produced by intestinal distension was shown. No effects on thresholds to lumbar or cervical electrical stimulation or intestinal distension were observed following i.v. administration. Thresholds to noxious electrical stimulation were only significantly elevated at the lumbar level following i.t. injection of 5 mg acetaminophen. Naloxone failed to antagonize the effect of intrathecal acetaminophen, whereas intrathecal yohimbine attenuated the effect of intrathecal acetaminophen in both tests. In conclusion, a spinal, dose-dependent, naloxone-irreversible, and yohimbine-reversible effect of intrathecal acetaminophen on electrical and visceral noxious stimulation was demonstrated.

Acetaminophen↗
PubMed1992

Differential analgesic effects of low-dose epidural morphine and morphine-bupivacaine at rest and during mobilization after major abdominal surgery.

In a double-blind, randomized study, epidural infusions of low-dose morphine (0.2 mg/h) combined with low-dose bupivacaine (10 mg/h) were compared with epidural infusions of low-dose morphine (0.2 mg/h) alone for postoperative analgesia at rest and during mobilization and cough in 24 patients after elective major abdominal surgery. All patients in addition received systemic piroxicam (20 mg daily). No significant differences were observed between the groups at any assessment of pain at rest (P greater than 0.05), whereas pain in the morphine/bupivacaine group was significantly reduced during mobilization from the supine into the sitting position 12 and 30 h after surgical incision and during cough 8, 12, and 30 h after surgical incision (P less than 0.05). We conclude, that low-dose epidural bupivacaine potentiates postoperative low-dose epidural morphine analgesia during mobilization and cough. Evaluation of postoperative analgesic regimens should include assessment of pain during various activities as different analgesics may have differential effects on pain at rest and during mobilization.

Abdomen↗
PubMed1992

Are perioperative nonsteroidal anti-inflammatory drugs ulcerogenic in the short term?

It is well documented that long term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of peptic ulcer and that gastroduodenal mucosal erosions can be demonstrated in volunteers within 1 week of treatment initiation. However, long term studies in nonsurgical patients have not documented gastroduodenal complications within the first week of treatment. Cumulative data from controlled studies of perioperative (> or = 48 hours and < or = 7 days) treatment with NSAIDs do not suggest an increased risk of gastroduodenal complications (such as bleeding/perforation) within this time frame. We conclude that the otherwise well documented gastrointestinal side effects of prolonged treatment with NSAIDs should not hinder short term NSAID treatment for improved analgesia after surgery.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

[Minicholecystectomy].

Mini-cholecystomectomy was performed in 24 unselected patients with symptomatic gallbladder stones with pain control by intra- and postoperative epidural analgesia. Twenty three patients were discharged on the second postoperative day, while one patient who required re-laparotomy for haemostasis had recovered completely on the third day postoperatively. Median pain score (VAS) was 0 at rest, during coughing and mobilisation. Pulmonary function was not influenced significantly and postoperative fatigue normalized after 48 hours. These preliminary, uncontrolled observations suggest that mini-cholecystectomy is advantageous compared to conventional cholecystectomy, and may represent an alternative to laparoscopic cholecystectomy.

Adult↗
PubMed1991

[Peroperative and early postoperative hypoxemia].

Arterial hypoxaemia is observed during operation and also in the recovery room. Hypoxaemia during operation may be due to altered pulmonary mechanical conditions, drug-induced physiological changes and technical errors. Early postoperative hypoxaemia is frequently observed after general anaesthesia and may, among other things, be due to diffusion hypoxaemia, hyperventilation-induced hypoventilation, residual curarization, hypoventilation induced by sedatives or analgesics and ventilation/perfusion alterations. The clinical significance of peroperative and early postoperative hypoxaemia is not yet elucidated and treatment consists primarily of increasing the oxygen concentration in the inspired air.

Humans↗
PubMed1991

A quantitative double-blind evaluation of the antinociceptive effects of perineurally administered morphine compared with lidocaine.

In two double-blind, placebo-controlled investigations, morphine and lidocaine were administered perineurally to the ulnar nerve. Thresholds (warmth and pain) and pain-evoked brain potentials (amplitude and latency) to argon laser stimulation were measured up to 120 min after the injection. Hypalgesia to laser pain was detected 15 min after the injection of morphine and 5 min after the injection of lidocaine. The duration of hypalgesia and analgesia was less than 15 min for morphine and 85 min for the lidocaine injection. Both morphine and lidocaine increased the latency of the brain potentials, which indicates that the same blocking mechanisms could be involved. Pin-prick analgesia was obtained 5 min after the injection of lidocaine, but 15-30 min elapsed before the laser pain was inhibited maximally. Laser pulses can activate larger skin areas than needle pricks, indicating that a central summation of the activity from many cutaneous nociceptors is important in order to obtain a reliable indicator of adequate analgesia.

Adult↗
PubMed1990

[Treatment of postoperative pain].

Intensive research during recent years concerning treatment of postoperative pain has demonstrated that the majority of operation patients can be rendered free from pain but that this is far from being the case in clinical practice. This article reviews the physiological mechanisms of acute pain and the methods available for treatment of pain related to acute physiology of pain. Postoperative treatment of pain should be aggressive with the object of preventing pain and normalizing the vital functions with the object of reducing the perioperative morbidity and mortality. A series of recommendations are given for treatment of pain after surgical intervention.

Analgesia↗
PubMed1990

[Inguinal paravascular block (3-in-1 block)].

The three main nerves from the lumbar plexus may be blocked by injection of local anesthetic into the facial envelope of the femoral nerve ("three-in-one block"). The femoral nerve may be localized by obtaining paresthesia, by employing a nerve stimulator or by the loss of resistance technique. We prefer the use of a nerve stimulator. The "three-in-one block" may be employed for immediately pain relief of pain and for treatment of postoperative pain from fractures in the hip, femur and knee. Introduction of a catheter into the femoral nerve sheath is recommended to provide continuous block of the lumbar plexus for relief of postoperative pain.

Anesthesia, Local↗
PubMed1990

[Post-dural puncture headache].

Post dural puncture headache is one of the major complications of spinal anaesthesia. In order to establish this diagnosis, the headache must be dependent on the position of the patient. The symptoms are probably due to leakage of cerebro-spinal fluid from the subarachnoid space to the epidural space which results in intracranial hypotension and tension of the nociceptive intracranial structures. The incidence is highest in young patients and the complication is observed more frequently in women than in men. In all age groups, the frequency and severity of the condition depend upon the calibre of the puncture needle and, for this reason, the finest possible needle should be employed. The only well proved prophylactic and curative treatment consists of establishing an epidural blood-patch. This procedure should be considered as the primary method of treatment in patients in whom post dural puncture headache contributes to prolongation of the period of convalescence.

Adolescent↗
PubMed1990

Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia.

One hundred patients aged 18-49 yr, undergoing elective arthroscopy of the knee joint, were allocated randomly to either spinal anaesthesia using a 29-gauge spinal needle or general anaesthesia. Dural puncture was considered difficult in 18% of the patients receiving spinal anaesthesia. In three patients (6%) it was necessary to supplement the spinal anaesthetic with general anaesthesia. Spinal and general anaesthesia were otherwise uneventful in all patients. The incidence of postoperative headache was similar in the two groups. One patient developed post dural puncture headache following spinal anaesthesia. This headache was of short duration and disappeared without treatment. Spinal anaesthesia caused more backache than general anaesthesia, otherwise the frequency of postoperative complaints was the same or lower. Ninety-six percent of the patients receiving spinal anaesthesia would prefer the same anaesthetic for a similar procedure in the future.

Adolescent↗
PubMed1990

Prevention of postoperative pain by balanced analgesia.

Fourteen patients undergoing colorectal surgery received an intraoperative afferent neural block with combined intrathecal and extradural local anaesthetics plus a balanced postoperative low-dose regimen of extradural bupivacaine 10 mg h-1-morphine 0.2 mg h-1 and systemic piroxicam 20 mg/24 h. Postoperative pain, assessed repeatedly during the initial 48 h, was prevented during rest, mobilization from the supine to the sitting position and during walking, in all but one patient; slight pain was observed intermittently during coughing in four patients.

Adult↗