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Biomedical subjects

W I Campbell

Publications and source records attributed to W I Campbell.

16 recordsLinked to original sources
PubMed1998

Quantifying meaningful changes in pain.

One hundred and thirty-eight nurses were asked to indicate the smallest meaningful reduction in pain from each of four hypothetical pain intensities: 100, 75, 50 and 25, on 100 mm visual analogue scales. The median values for the smallest meaningful reductions in pain were 31, 24, 18 and 10 mm, respectively, representing reductions in pain intensity of 31%, 32%, 36% and 40%, respectively. These tests were repeated in 110 patients before and after they had a lower third molar extraction under general anaesthesia. The patients' expectations of pain relief, pre- and postoperatively, were very similar to those observed in the nurses. For each of the four hypothetical pain intensities the median values for meaningful reductions in pain became greater following surgery. The pre-operative median reductions from the hypothetical pains 100, 75, 50 and 25 mm were 26, 20, 15 and 11 mm (26%, 27%, 29% and 44%), respectively. The corresponding postoperative reductions were 31, 24, 19 and 12 mm (31%, 32%, 38% and 48%). To achieve a meaningful reduction in pain postoperatively in 50% of patients it is necessary to reduce pain as represented by the visual analogue scale, by between 31 and 48%, depending on its initial intensity.

Adult↗
PubMed1998

Balanced pre-emptive analgesia: does it work? A double-blind, controlled study in bilaterally symmetrical oral surgery.

We studied 32 patients undergoing bilateral symmetrical lower third molar surgery under general anaesthesia to determine if the combined effects of pre-emptive local anaesthetic block using 0.5% bupivacaine, together with i.v. tenoxicam and alfentanil had any benefits over postoperative administration. Patients acted as their own controls and were allocated randomly to have surgery start on one side, the second side always being the pre-emptive side. Difference in pain intensity between the two sides was determined using visual analogue scales completed by each individual at 6 h, and at 1, 3 and 6 days after operation. A long-form McGill pain questionnaire was also used to assess difference in pain intensity between the two sides on the morning after surgery. There was no significant difference in pain intensity at any time after surgery. Our findings indicate that the combined use of pre-emptive analgesia from 0.5% bupivacaine, tenoxicam and alfentanil did not reduce postoperative pain intensity in patients undergoing molar exodontia.

Adolescent↗
PubMed1998

Dextromethorphan and pain after total abdominal hysterectomy.

Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist which has been shown to inhibit the development of cutaneous secondary hyperalgesia after tissue trauma. We studied 60 ASA I-II patients undergoing total abdominal hysterectomy in a randomized, double-blind, placebo-controlled study. Patients received either dextromethorphan 27 mg capsules, two doses before operation and three doses in the first 24 h after operation, or placebo. Visual analogue pain scores (VAS) at 24 and 48 h were assessed at rest, on coughing and on sitting up, and were not significantly different between groups. Morphine consumption from a patient-controlled analgesia (PCA) device was also not significantly different between groups. Evidence of secondary hyperalgesia was assessed with von Frey hairs 10 cm above the Pfannenstiel incision. Both groups of patients exhibited evidence of secondary hyperalgesia after 24 and 48 h but there were no significant differences between groups. There was also no difference between groups in VAS scores at 1 month.

Adult↗
PubMed1997

Pre-emptive analgesia using local anaesthesia: a study in bilaterally symmetrical surgery.

Two studies were carried out in patients undergoing bilaterally symmetrical lower third molar surgery under general anaesthesia. In the first study observations were carried out in 40 patients, using McGill pain questionnaires and visual analogue scales (VAS), to assess the variation in pain intensity between the two sides in each individual on the morning after surgery. The within-patient variation in pain intensity indicated that a sample size exceeding 30 was required to show a difference of more than 10 mm on the VAS and achieve a power of 90% at the 5% level of significance. The second study was carried out to determine if local anaesthesia administered before rather than after tooth removal rendered any benefit. Each of the 38 patients acted as their own control; one side was allocated randomly to receive the local anaesthetic before operation and the other side after operation. The difference in pain between the pretreated and post-treated sides in each individual was assessed using a McGill pain questionnaire on the morning after surgery in addition to two VAS (one for each operation side) after operation, at 6 h, 1 and 6 days after surgery. There were no significant differences in pain at any time using any of the above methods.

Adolescent↗
PubMed1997

The effect of pre-operative administration of bupivacaine compared with its postoperative use.

Eighty patients undergoing lower third molar surgery under general anaesthesia were assigned to one of two groups to receive local anaesthetic blockade either 10 min prior to surgery or after surgery just before leaving the operating theatre. Patients in both groups received the local anaesthetic block whilst unconscious. Pain was assessed using visual analogue scales at 6 h and 1, 3 and 6 days after surgery. A McGill Pain Questionnaire was also completed on the morning following surgery. At no time was it possible to detect any significant difference in pain between the two groups. The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing this type of surgery. The local anaesthetic, however, does provide excellent analgesia during the first few hours following surgery.

Adult↗
PubMed1996

Rectal controlled-release morphine: plasma levels of morphine and its metabolites following the rectal administration of MST Continus 100 mg.

Eight patients undergoing major maxillary surgery were given sustained-release morphine (100 mg MST Continus) rectally, immediately after induction of general anaesthesia. Blood samples for assay were taken just prior to morphine administration, together with a further 11 samples over the following 24 h. Assay of the plasma for morphine, morphine-3-glucuronide and morphine-6-glucuronide was carried out using a validated high-performance liquid chromatography technique. Morphine Tmax ranged from 3 h to 12 h (median 6 h), Cmax 8.0-40.0 ng/ml and AUC0-24 90.1-429.7 ng/h/ml in subjects offering blood samples over the 24-h period. Likewise, morphine-3-glucuronide Tmax ranged from 3 h to 24 h (median 9 h), Cmax 153-370 ng/ml and AUC0-24 2776-4390 ng/h/ml. Morphine-6-glucuronide Tmax ranged from 8 h to 12 h (median 10 h), Cmax 24-59 ng/ml and AUC0-24 137-803 ng/h/ml. Morphine and morphine metabolite AUC0-24 ratios were calculated, but they did not correlate with analgesic needs. The AUC0-24 ratios were similar to those following oral and rectal dosing in other studies involving cancer patients. The wide variation of individual morphine and metabolite plasma levels, and their AUC ratios indicates considerable interpatient variability in the absorption and metabolism of rectal sustained-release morphine. This large interpatient variation may indicate that it is not suitable for acute pain, because analgesic requirements change much more rapidly than in the chronic pain situation where individual patient titration can take place.

Administration, Rectal↗
PubMed1992

Two approaches to the axillary brachial plexus. Loss of resistance to saline or paraesthesia?

A new technique of cannulation of the axillary neurovascular sheath, using loss of resistance to saline, was evaluated and compared to the established technique of eliciting paraesthesiae with a short-bevelled needle. The cannulation technique produced a more reliable block of axillary, musculocutaneous and radial nerves, significantly fewer incomplete blocks and a lower incidence of accidental vessel puncture.

Adolescent↗
PubMed1992

What do medical students know about chronic pain and its management?

A questionnaire on chronic pain management was completed by 114 third year, and 80 fifth (final) year medical students. The results demonstrated a significant improvement in most facets of chronic pain knowledge and management by the end of the medical course. A postal survey was undertaken of all pain clinics in Northern Ireland to identify current activity, as these figures are not collected in Korner returns. Despite the improvement in knowledge by final year, there were still many students who did not know what type of problem to refer to a pain clinic (30%), who ran the clinics (> 40%), or the types of treatment commonly employed. More formal education is required on this subject, at both undergraduate and postgraduate level.

Chronic Disease↗
PubMed1991

Postoperative dental pain--a comparative study of anti-inflammatory and analgesic agents.

Intravenous dexamethasone and diclofenac were evaluated in a double blind randomised trial, relative to an opioid (pentazocine) and placebo (saline), in 160 patients undergoing extraction of impacted lower third molar teeth. Test drugs were administered intravenously before surgery to provide postoperative analgesia. Following the operation, pain was assessed using a 10 cm visual analogue scale. Patients who received diclofenac reported significantly less pain than others 30 minutes after surgery (p less than 0.05). Pain scores on the day following surgery were also significantly lower in the diclofenac group compared to the opioid and placebo groups (p less than 0.05) but not less than those who received dexamethasone--possibly indicating a long term advantage of the anti-inflammatory drugs. Vomiting was a problem in the opioid group.

Adolescent↗
PubMed1990

Analgesic side effects and minor surgery: which analgesic for minor and day-case surgery?

A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. Less than 50% of the orthopaedic patients in these groups required any postoperative analgesia. However, there was a high incidence of vomiting (40%) in those receiving an opioid during operation, associated with overnight admission in more than 50% of those who vomited. In the patients undergoing oral surgery, ibuprofen administered before operation significantly reduced analgesic requirement, without unwanted side effects. The use of codeine-paracetamol or a non-steroidal anti-inflammatory agent before body surface surgery appeared to be advantageous in reducing postoperative analgesic needs, without causing problems associated with the stronger opioids.

Acetaminophen↗
PubMed1990

Intravenous diclofenac sodium. Does its administration before operation suppress postoperative pain?

Intravenous diclofenac sodium was evaluated in a double-blind randomised trial relative to intramuscular diclofenac, intravenous fentanyl, and intramuscular placebo in 160 patients undergoing extraction of impacted lower third molar teeth. The test drug was administered before operation in an attempt to alleviate postoperative pain. A 10-cm visual analogue scale was used to assess pain at 30 minutes and one day after surgery, if the patients stayed overnight. Patients who received intravenous diclofenac had significantly less pain than the other groups 30 minutes after operation. They also had significantly less pain one day after surgery than the placebo or opioid groups, but not less than the intramuscular diclofenac group. Capillary bleeding time, in comparison with placebo, was significantly prolonged after the use of intramuscular diclofenac, and a similar but nonsignificant trend was observed in the intravenous diclofenac group. No problems were encountered with excessive bleeding in any group.

Adolescent↗
PubMed1990

Visual analogue measurement of pain.

Two separate studies were carried out to determine if three visual analogue scales for various feelings including pain could be marked consistently by patients, without reference to previously completed scales. Sixty patients undergoing extraction of their lower third molars had measurements of acute preoperative anxiety, expected postoperative pain and postoperative perceived pain three times in quick succession. There was no significant difference between the three measurements for any of the feelings. Although a correlation was detected between expected pain and preoperative anxiety, there was no meaningful relationship between perceived postoperative pain and expected pain or preoperative anxiety. Eighty patients suffering from a wide range of chronic painful states completed three identical scales for pain, anxiety, depression and mood during their first visit. These measurements were repeated at a later time following a treatment, with the addition of a visual analogue scale for pain relief. Mean scores for anxiety, mood and pain relief were consistent, but mean pain scores were more variable. There was a very close correlation between any two feelings expressed on these visual analogue scales during both the initial and second visits. Litigation or social problems were not associated with increased pain scores.

Adolescent↗
PubMed1989

Venous sequelae following i.v. administration of diclofenac.

Diclofenac sodium (Voltarol) was administered i.v. to 149 consecutive patients who were thought likely to benefit from its anti-inflammatory action. Patients were allocated randomly to one of two groups: group A received the undiluted i.m. preparation (25 mg ml-1) and group B the i.m. preparation diluted in normal saline (5 mg ml-1). Diclofenac 1 mg kg-1 administered over a 10-min period via a 23-gauge needle into a vein at either the antecubital fossa or the dorsum of the hand. No local or systemic problems were encountered in either group, at the time of injection. A high incidence of painless local venous thrombosis occurred in both hand and arm veins, 72 h after administration in group A (85% and 58%, respectively). The incidence of thrombosis was reduced markedly after administration of the diluted drug: 38% hand veins; 8% antecubital fossa veins.

Adult↗