Cases reported "Pain, Postoperative"

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1/5. Incisional hernia: an unusual cause of acute pain and swelling following renal transplant.

    We present a case in which a strangulated incisional hernia following a renal transplant was sonographically diagnosed. The patient presented with acute pain and swelling over the transplant site 6 weeks after surgery. Sonograms showed a normal-sized kidney with normal echotexture, no evidence of hydronephrosis, and no perinephric collections. color Doppler sonography and spectral analysis demonstrated normal blood flow throughout the kidney. Sonograms showed that the palpable mass was a dilated loop of fluid-filled small bowel. Sonography allowed the correct diagnosis to be established, and early surgical intervention allowed revascularization of viable bowel.
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keywords = acute pain
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2/5. Positron emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation.

    Previous neuroimaging studies suggested that the neuronal network underlying the perception of chronic pain may differ from that underlying acute pain. To further map the neural network associated with chronic pain, we used positron emission tomography (PET) to determine significant regional cerebral blood flow (rCBF) changes in a patient with chronic facial pain. The patient is implanted with a chronic stimulation electrode in the left ventroposterior medial thalamic nucleus with which he can completely suppress his chronic pain. The patient was scanned in the following conditions: before thalamic stimulation (pain, no stimulation), during thalamic stimulation (no pain, stimulation) and after successful thalamic stimulation (no pain, no stimulation). Comparing baseline scans during pain with scans taken after stimulation, when the patient had become pain-free, revealed significant rCBF increases in the prefrontal (Brodmann areas (BA) 9, 10, 11 and 47) and anterior insular cortices, hypothalamus and periaqueductal gray associated with the presence of chronic pain. No significant rCBF changes occurred in thalamus, primary and secondary somatosensory cortex and anterior cingulate cortex, BA 24'. Significant rCBF decreases were observed in the substantia nigra/nucleus ruber and in the anterior pulvinar nucleus. During thalamic stimulation, blood flow significantly increased in the amygdala and anterior insular cortex. These data further support that there are important differences in the cerebral processing of acute and chronic pain.
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keywords = acute pain
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3/5. morphine overdose from error propagation on an acute pain service.

    PURPOSE: To highlight a case in which multiple errors occurred during programming and administration of analgesia via a patient-controlled analgesia (PCA) pump, and to formulate recommendations on how to avoid such errors in the future. CLINICAL FEATURES: Following lumbar surgery, a 43-yr-old woman was switched from epidural analgesia to a PCA pump. This change was associated with numerous errors at several points of delivery of her care. Errors included incorrect connection of the PCA adapter, incorrect pump programming, and communication lapses which resulted in a morphine overdose and subsequent respiratory arrest. The patient was promptly resuscitated, and she had an uneventful recovery. The event resulted in a complete review of pain management equipment and the training and education of staff using this equipment at our institution. CONCLUSION: This case highlights how multiple individual errors can combine to result in a serious adverse event. While equipment design was an important factor in this adverse event, human factors played a critical role at multiple levels.
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keywords = acute pain
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4/5. The effect of transcutaneous electrical nerve stimulation on ocular pain.

    The effect of transcutaneous electrical nerve stimulation (TENS) on pain originating in the eye was studied in 10 patients. All three patients subjected to TENS during panretinal photocoagulation reported marked reduction in pain. Three of five patients who had persistent pain following scleral buckling and/or vitrectomy reported partial or complete relief of pain during the application of TENS. One patient had equivocal relief of pain when TENS was used during retinal cryopexy; 1 patient with acute pain following paracentesis and 1 patient with persistent pain following cyclocryotherapy had no relief. Among those patients whose pain was reduced by TENS, referred brow pain was relieved more than globe pain.
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keywords = acute pain
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5/5. The national pain management guideline: implications for neonatal intensive care. Agency for health Care policy and research.

    A wide range of acute pain management strategies is used in various patient populations throughout the united states. A guideline, developed by an interdisciplinary panel convened by the Agency for health Care policy and research, offers health care providers a "coherent yet flexible approach to pain assessment and management for use in daily practice." The goal of the guideline and application to daily practice in the NICU are described.
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keywords = acute pain
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