Advertisement

Role of Non-Opioid Analgesics in the Peri-Operative Period

  • G. P. Joshi
  • B. Fredman
  • P. F. White
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 29)

Abstract

“Slapping the patient on the face and telling him or her that it’s all over’ is a complete inversion of the truth. As far as the patient is concerned,it is often just the beginning” (1). Although the currently available armamentarium of analgesic drugs and techniques is impressive (2), we have not fully exploited it for the benefit of patients undergoing outpatient operations (3). Management of acute postoperative pain is one of the primary responsibilities of anesthesiologists, however, it poses some unique problems following ambulatory surgery (4). The increasing number and complexity of operations being performed on an outpatient basis are presenting the practitioner with new challenges with respect to acute pain management. Outpatients undergoing day-care procedures require an analgesic technique that is effective, has minimal side effects, is intrinsically safe, and can be easily managed away from the hospital or surgery center (5).

Keywords

Postoperative Pain Postoperative Analgesia Transcutaneous Electrical Nerve Stimulation Ambulatory Surgery Postoperative Pain Relief 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Armitage EN: Postoperative pain-prevention or relief (editorial)? Br J Anaesth 63: 136–138, 1989PubMedCrossRefGoogle Scholar
  2. 2.
    White PF: Current and future trends in acute pain management. Clin J Pain 5: S51–S58, 1989PubMedCrossRefGoogle Scholar
  3. 3.
    Wildsmith JA: Symposium on aspects of pain. Br J Anaesth 63: 135, 1989CrossRefGoogle Scholar
  4. 4.
    White P: Pain management after day-case surgery. Curr Opinion in Anesthesiol 1: 70–75, 1988CrossRefGoogle Scholar
  5. 5.
    Poler S, Zelcer J, White P: Postoperative pain management. Outpatient Anesthesia. Edited by White P. New York, Churchill-Livingstone, 1990, pp. 417–451Google Scholar
  6. 6.
    Code W: NSAIDs and balanced analgesia (editorial). Can J Anaesth 40: 5, 401–405, 1993PubMedCrossRefGoogle Scholar
  7. 7.
    Cross GD, Barrett RF: Comparison of two regional techniques for postoperative analgesia in children following herniotomy and orchiopexy. Anaesthesia 42: 845–849, 1987PubMedCrossRefGoogle Scholar
  8. 8.
    Langer JC, Shandling B, Rosenberg M: Intraoperative bupivacaine during outpatient hernia repair in children: A randomized doubleblind trial. J Ped Surg 22: 267–270, 1987CrossRefGoogle Scholar
  9. 9.
    Ding Y, White P: Outpatient herniorrhaphy: Use of ilioinguinalhypogastric nerve block (IHNB) with 0.25% bupivacaine during MAC (abstract). Anesth Analg 76: S80, 1993Google Scholar
  10. 10.
    Hinkle RJ: Percutaneous inguinal blocks for the outpatient management of post-herniorrhaphy pain in children. Anesthesiology 67: 411–413, 1987PubMedCrossRefGoogle Scholar
  11. 11.
    Bunting P, McConachie I: Ilioinguinal nerve blockade for analgesia after caesarean section. Br J Anaesth 61: 773–775, 1988PubMedCrossRefGoogle Scholar
  12. 12.
    Elder P, Belman A, Hannallagh R, et al: Postcircumcision pain: A prospective evaluation of subcutaneous ring block of the penis. Reg Anesth 9: 48–49, 1984Google Scholar
  13. 13.
    Sfez M, Le Mapihan Y, Mazoit X, Dreux-Boucard H: Local anesthetic serum concentrations after penile nerve block in children. Anesth Analg 71: 423–426, 1990PubMedCrossRefGoogle Scholar
  14. 14.
    Alexander CD, Wetchler BV, Thompson RE: Bupivacaine infiltration of the mesosalpinx in ambulatory surgical laparoscopic tubal sterilization. Can J Anaesth 34: 362–365, 1987PubMedCrossRefGoogle Scholar
  15. 15.
    Baram D, Smith C, Stinson S: Intraoperative etidocaine for reducing postoperative pain after laparoscopic tubal ligation. J Rep Med 35: 407–410, 1990Google Scholar
  16. 16.
    Tierney E, Lewis G, Hurtig JB, et al: Femoral nerve block with bupivacaine 0.25% for postoperative analgesia after open knee surgery. Can J Anaesth 34: 455–458, 1987PubMedCrossRefGoogle Scholar
  17. 17.
    Owen H, Galloway DJ, Mitchell KG: Analgesia by wound infiltration after surgical excision of benign breast lumps. Ann R Coll Surg Engl 67: 114–115, 1985PubMedGoogle Scholar
  18. 18.
    Moss G, Regal ME, Lichtig L: Reducing postoperative pain, narcotics, and length of hospitalization. Surgery 99: 206–210, 1986PubMedGoogle Scholar
  19. 19.
    Sinclair R, Cassuto J, Högström S, et al: Topical anesthesia with lidocaine aerosol in the control of postoperative pain. Anesthesiology 68: 895–901, 1988PubMedCrossRefGoogle Scholar
  20. 20.
    Casey WF, Rice LJ, Hannallah RS, Broadman L, et al: A comparison between bupivacaine instillation versus ilioinguinal/iliohypogastric nerve block for postoperative analgesia following inguinal herniorrhaphy in children. Anesthesiology 72: 637–639, 1990PubMedCrossRefGoogle Scholar
  21. 21.
    Tree-Trakarn T, Pirayavaraporn S: Postoperative pain relief for circumcision in children: Comparison among morphine, nerve block, and topical analgesia. Anesthesiology 62: 519–522, 1985PubMedCrossRefGoogle Scholar
  22. 22.
    Tree-Trakarn T, Pirayavaraporn S, Lertakyamanee J: Topical analgesia for relief of post-circumcision pain. Anesthesiology 67: 395–399, 1987PubMedCrossRefGoogle Scholar
  23. 23.
    Narchi P, Benhamou D, Fernandez H: Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet 338: 1569–1570, 1991PubMedCrossRefGoogle Scholar
  24. 24.
    Thomas DF, Lambert WG, Williams KL: The direct perfusion of surgical wounds with local anaesthetic solution: An approach to postoperative pain? Ann R Coll Surg Engl 65: 226–229, 1983PubMedGoogle Scholar
  25. 25.
    Gibbs P, Purushotam A, Auld C, Cuschieri RJ: Continuous wound perfusion with bupivacaine for postoperative wound pain. Br J Surg 75: 923–924, 1988PubMedCrossRefGoogle Scholar
  26. 26.
    Hashemi K, Middleton MD: Subcutaneous bupivacaine for postoperative analgesia after herniorrhaphy. Ann R Coll Surg Engl 65: 38–39, 1983PubMedGoogle Scholar
  27. 27.
    Levack ID, Robertson GS: The direct perfusion of surgical wounds with local anaesthetic solution (letter). Ann R Coll Surg Engl 66: 146, 1984PubMedGoogle Scholar
  28. 28.
    Levack ID, Holmes JD, Robertson GS: Abdominal wound perfusion for the relief of postoperative pain. Br J Anaesth 58: 615–619, 1986PubMedCrossRefGoogle Scholar
  29. 29.
    Cameron AE, Cross FW: Pain and mobility after inguinal herniorrhaphy: Ineffectiveness of subcutaneous bupivacaine. Br J Surg 72: 68–69, 1985PubMedCrossRefGoogle Scholar
  30. 30.
    Aull L, Woodward ER, Rout RW, Paulus DA: Analgesia and postoperative hypoxaemia after gastric partition with and without bupivacaine wound infiltration. Can J Anaesth 37: S53, 1990PubMedGoogle Scholar
  31. 31.
    Butterworth JF IV, Carnes RS III, Samuel MP, et al: Effect of adrenaline on plasma concentrations of bupivacaine following intraarticular injection of bupivacaine for knee arthroscopy. Br J Anaesth 65: 537–539, 1990PubMedCrossRefGoogle Scholar
  32. 32.
    Dahl MR, Dasta JF, Zuelzer W, McSweeney TD: Lidocaine local anesthesia for arthroscopic knee surgery. Anesth Analg 71: 670–674, 1990PubMedCrossRefGoogle Scholar
  33. 33.
    Hultin J, Hamberg P, Stenström A: Knee arthroscopy using local anesthesia. Arthroscopy 8: 239–241, 1992PubMedCrossRefGoogle Scholar
  34. 34.
    Wredmark T, Rolf L: Arthroscopy under local anaesthesia using controlled pressure-irrigation with prilocaine. J Bone Joint Surg: 64: 583–585, 1982Google Scholar
  35. 35.
    Katz J, Kaeding CS, Hill JR, Henthorn TK: The pharmacokinetics of bupivacaine when injected intra-articularly after knee arthroscopy. Anesth Analg 67: 872–875, 1988PubMedGoogle Scholar
  36. 36.
    Solanki DR, Enneking FK, Ivey FM, et al: Serum bupivacaine concentrations after intraarticular injection for pain relief after knee arthroscopy. Arthroscopy 8: 44–47, 1992PubMedCrossRefGoogle Scholar
  37. 37.
    Chirwa SS, MacLeod BA, Day B: Intraarticular bupivacaine (Marcaine) after arthroscopic meniscectomy: A randomized doubleblind controlled study. Arthroscopy 5: 33–35, 1989PubMedCrossRefGoogle Scholar
  38. 38.
    Kaeding CC, Hill JA, Katz J, Benson L: Bupivacaine use after knee arthroscopy: Pharmacokinetics and pain control study. Arthroscopy 6: 33–39, 1990PubMedCrossRefGoogle Scholar
  39. 39.
    Smith I, Van Hemelrijck J, White P, Shively R: Effects of local anesthesia on recovery after outpatient arthroscopy. Anesth Analg 73: 536–539, 1991PubMedGoogle Scholar
  40. 40.
    Milligan KA, Mowbray M, Mulrooney L, Standen P: Intra-articular bupivacaine for pain relief after arthroscopic surgery of the knee joint in daycase patients. Anaesthesia 43: 563–564, 1988PubMedCrossRefGoogle Scholar
  41. 41.
    Hughes DG: Intra-articular bupivacaine for pain relief in arthroscopic surgery (letter). Anaesthesia 40: 821, 1985PubMedCrossRefGoogle Scholar
  42. 42.
    Henderson RC, Campion ER, DeMasi RA, Taft TN: Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation. Am J Sports Med 18: 614–617, 1990PubMedCrossRefGoogle Scholar
  43. 43.
    Joshi GP, McCarroll SM, Cooney CM, et al: Intra-articular morphine for pain relief after knee arthroscopy. J Bone Joint Surg 74: 749–751, 1992Google Scholar
  44. 44.
    Stein C, Comisel K, Haimerl E, et al: Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 325: 1123–1126, 1991PubMedCrossRefGoogle Scholar
  45. 45.
    Khoury GF, Chen AC, Garland DE, Stein C: Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 77: 263–266, 1992PubMedCrossRefGoogle Scholar
  46. 46.
    Corpataux J-B, Van Gessel E, Forster A, Gamulin Z: Does the addition of acetylsalicylic acid to local anesthetic during the Bier block improve postoperative analgesia? Anesthesiology 77: A811, 1992CrossRefGoogle Scholar
  47. 47.
    Stein C: Peripheral mechanisms of opioid analgesia. Anesth Analg 76: 182–191, 1993PubMedCrossRefGoogle Scholar
  48. 48.
    Raja SN, Dickstein RE, Johnson CA: Comparison of postoperative analgesic effects of intraarticular bupivacaine and morphine following arthroscopic knee surgery. Anesthesiology 77: 1143–1147, 1992PubMedCrossRefGoogle Scholar
  49. 49.
    Heard SD, Edwards WT, Ferrari D, et al: Analgesic effect of intraarticular bupivacaine or morphine after arthroscopic knee surgery: A randomized, prospective, double-blind study. Anesth Analg 74: 822–826, 1992PubMedCrossRefGoogle Scholar
  50. 50.
    Smith I, Shively RA, White PF: Effects of ketorolac and bupivacaine on recovery after outpatient arthroscopy. Anesth Analg 75: 208–212, 1992PubMedCrossRefGoogle Scholar
  51. 51.
    Meridy HW: Criteria for selection of ambulatory surgical patients and guidelines for anesthetic management: A retrospective study of 1553 cases. Anesth Analg 61: 921–926, 1982PubMedCrossRefGoogle Scholar
  52. 52.
    Dahl JB, Rosenberg J, Dirkes WE, et al: Prevention of postoperative pain by balanced analgesia. Br J Anaesth 64: 518–520, 1990PubMedCrossRefGoogle Scholar
  53. 53.
    Wall PD: The prevention of postoperative pain (editorial). Pain 33: 289–290, 1988PubMedCrossRefGoogle Scholar
  54. 54.
    Woolf CJ: Recent advances in the pathophysiology of acute pain. Br J Anaesth 63: 139–146, 1989PubMedCrossRefGoogle Scholar
  55. 55.
    Tverskoy M, Cozacov C, Ayache M, et al: Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesth Analg 70: 29–35, 1990PubMedCrossRefGoogle Scholar
  56. 56.
    Jebeles JA, Reilly JS, Gutierrez JF, et al: The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia. Pain 47: 305–308, 1991PubMedCrossRefGoogle Scholar
  57. 57.
    Dahl JB, Kehlet H: The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth 70: 434–439, 1993PubMedCrossRefGoogle Scholar
  58. 58.
    Vane JR: Inhibition of prostaglandin synthesis as a mechanism of action for the aspirin-like drugs. Nature New Biol 231: 232–236, 1971PubMedGoogle Scholar
  59. 59.
    Moncada S, Vane JR: Arachidonic acid metabolites and the interactions between platelets and blood-vessel walls. N Engl J Med 300: 1142–1147, 1979PubMedCrossRefGoogle Scholar
  60. 60.
    Trang LE: Prostaglandins and inflammation. Semin Arthritis Rheum 9: 153–190, 1980PubMedCrossRefGoogle Scholar
  61. 61.
    Abramson SB, Weissman G: The mechanisms of action of nonsteroidal anti-inflammatory drugs. Arthritis Rheum 32: 1–9, 1989PubMedCrossRefGoogle Scholar
  62. 62.
    Dahl J, Kehlet H: Non-steroidal antiinflammatory drugs: Rational for use in severe postoperative pain. Br J Anaesth 66: 703–712, 1991PubMedCrossRefGoogle Scholar
  63. 63.
    Malmberg AB, Yaksh TL: Hyperalgesia mediated by spinal glutamate or substance P receptor blocked by spinal cyclooxygenase inhibition. Science 257: 1276–1278, 1992PubMedCrossRefGoogle Scholar
  64. 64.
    Jurna I, Brune K: Central effect of the non-steroid anti-inflammatory agents, indomethacin, ibuprofen, and diclofenac, determined in C fibre-evoked activity in single neurons of the rat thalamus. Pain 41: 71–80, 1990PubMedCrossRefGoogle Scholar
  65. 65.
    Yee JP, Koshiver JE, Allbon C, et al: Comparison of intramuscular ketorolac tromethamine and morphine sulphate for analgesia of pain after major surgery. Pharmacotherapy 6: 253–261, 1986PubMedGoogle Scholar
  66. 66.
    O’Hara DA, Fragen RJ, Kinzer MM et al: Ketorolac tromethamine as compared with morphine sulphate for the treatment of postoperative pain. Clin Pharm Ther 41: 556–561, 1987CrossRefGoogle Scholar
  67. 67.
    Powell H, Smallman JM, Morgan M: Comparison of intramuscular ketorolac and morphine in pain control after laparotomy. Anaesthesia 45: 538–542, 1990PubMedCrossRefGoogle Scholar
  68. 68.
    Murray AW, Brockway MS, Kenny GN: Comparison of the cardiorespiratory effects of ketorolac and alfentanil during propofol anesthesia. Br J Anaesth 63: 601–603, 1989PubMedCrossRefGoogle Scholar
  69. 69.
    Kenney G, Mcardle C, Aitkin H: Parenteral Ketorolac: Opiate-sparing effect and the lack of cardiorespiratory depression in the perioperative patient. Pharmacotherapy 10: 127S–131S, 1990Google Scholar
  70. 70.
    Ding Y, White PF: Comparative effects of ketorolac, dezocine, and fentanyl as adjuvants during outpatient anesthesia. Anesth Analg 75: 566–571, 1992PubMedCrossRefGoogle Scholar
  71. 71.
    Wong HY, Carpenter RL, Kopacz DJ: A randomized double-blind evaluation of ketorolac tromethamine for postoperative analgesia in ambulatory surgery patients. Anesthesiology 78: 6–14, 1993PubMedCrossRefGoogle Scholar
  72. 72.
    Bosek BV, Smith DB, Cox C: Ketorolac or fentanyl to supplement local anesthesia? J Clin Anesth 4: 480–483, 1992PubMedCrossRefGoogle Scholar
  73. 73.
    Ding Y, White PF: Use of ketorolac and fentanyl during ambulatory surgery. Anesthesiology 77: A5, 1992CrossRefGoogle Scholar
  74. 74.
    Ding Y, Fredman B, White P: Use of ketorolac and fentanyl during outpatient gynecological surgery. Anesth Analg (in press) 1993Google Scholar
  75. 75.
    Green C, Pandit S, Kothary S et al: No fentanyl sparing effect of intraoperative IV ketorolac after laparoscopic tubal ligation. Anesthesiology 77: A7, 1992CrossRefGoogle Scholar
  76. 76.
    Liu J, Ding Y, White PF, et al: Effects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecystectomy. Anesth Analg 76: 1061–1066, 1993PubMedCrossRefGoogle Scholar
  77. 77.
    Fredman B, Jedeikin R, Olsfanger D, Aronheim M: The opioid-sparing effect of diclofenac sodium in outpatient extracorporeal shock wave lithotripsy (ESWL). J Clin Anesth 5: 141–144, 1992CrossRefGoogle Scholar
  78. 78.
    McLoughlin C, McKinney MS, Fee JP, et al: Diclofenac for day-care arthroscopy surgery: Comparison with a standard opioid therapy. Br J Anaesth 65: 620–623, 1990PubMedCrossRefGoogle Scholar
  79. 79.
    Gillberg LE, Harsten AS, Stahl LB: Preoperative diclofenac sodium reduces post-laparoscopy pain. Can J Anaesth 40: 406–408, 1993PubMedCrossRefGoogle Scholar
  80. 80.
    Comfort VK, Code WE, Rooney ME, Yip RW: Naproxen premedication reduces postoperative tubal ligation pain. Can J Anaesth 4: 349–352, 1992Google Scholar
  81. 81.
    Rosenblum M, Weller RS, Conrad PL, et al: Ibuprofen provides longer lasting analgesia than fentanyl after laparoscopic surgery. Anesth Analg 73: 255–259, 1991PubMedCrossRefGoogle Scholar
  82. 82.
    Dueholm S, Forrest M, Hjortso E, et al: Pain relief following herniotomy: a double-blind randomized comparison between naproxen and placebo. Acta Anaesthesiol Scand 33: 391–394, 1989PubMedCrossRefGoogle Scholar
  83. 83.
    Monahan S, Johnson C, Downing J, et al: Post arthroscopy analgesia with intra-articular ketorolac. Anesthesiology 77: A854, 1992CrossRefGoogle Scholar
  84. 84.
    Baer GA, Rorarius MG, Kolehmainen S, et al: The effect of paracetamol or diclofenac administered before operation on postoperative pain and behavior after adenoidectomy in small children. Anaesthesia 47: 1078–1080, 1992PubMedCrossRefGoogle Scholar
  85. 85.
    Watcha MF, Ramirez-Ruiz M, White PF, et al: Perioperative effects of oral ketorolac and acetaminophen in children undergoing bilateral myringotomy. Can J Anaesth 39: 649–654, 1993Google Scholar
  86. 86.
    Watcha MF, Jones MB, Lagueruela RG, et al: Comparison of ketorolac and morphine as adjuvants during pediatric surgery. Anesthesiology 76: 368–372, 1992PubMedCrossRefGoogle Scholar
  87. 87.
    Maunaksela EL, Kokki H, Bullingham RE: Comparison of intravenous ketorolac with morphine for postoperative pain in children. Clin Pharmacol Ther 52: 436–443, 1992CrossRefGoogle Scholar
  88. 88.
    Smallman JM, Powell H, Ewart MC, et al: Ketorolac for postoperative analgesia in elderly patients. Anaesthesia 47: 149–152, 1992PubMedCrossRefGoogle Scholar
  89. 89.
    Takeshige C, Sato T, Mera T, et al: Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull 29: 617–634, 1992PubMedCrossRefGoogle Scholar
  90. 90.
    Yonehara N, Sawada T, Matsuura H, Inoki R: Influence of electroacupuncture on the release of substance P and the potential evoked by tooth pulp stimulation in the trigeminal nucleus caudalis of the rabbit. Neurosci Lett 142: 53–56, 1992PubMedCrossRefGoogle Scholar
  91. 91.
    Cheng RS, Pomeranz BH: Electroacupuncture analgesia is mediated by stereospecific opiate receptors and is reversed antagonists of type I receptors. Life Sci 26: 631–638, 1980PubMedCrossRefGoogle Scholar
  92. 92.
    Mayer D, Price D, Rafii A: Antagonism of acupuncture analgesia in man by narcotic antagonist naloxone. Brain Res 121: 368–372, 1977PubMedCrossRefGoogle Scholar
  93. 93.
    Tyler E, Caldwell C, Ghia JN: Transcutaneous electrical nerve stimulation: an alternative approach to the management of postoperative pain. Anesth Analg 61: 449–456, 1982PubMedCrossRefGoogle Scholar
  94. 94.
    Ali J, Yaffe CS, Serrette C: The effect of transcutaneous nerve stimulation on postoperative pain and pulmonary function. Surgery 89: 507–512, 1981PubMedGoogle Scholar
  95. 95.
    Jensen JE, Conn RR, Hazelrigg G, Hewett JE: The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery. Am J Sports Med 13: 27–35, 1985PubMedCrossRefGoogle Scholar
  96. 96.
    McCallum MI, Glynn C, Moore RA, et al: Transcutaneous electrical nerve stimulation in the management of acute postoperative pain. Br J Anaesth 61: 308–312, 1988PubMedCrossRefGoogle Scholar
  97. 97.
    Smedley F, Taube M, Wastell C: Transcutaneous electrical nerve stimulation for pain relief following inguinal hernia repair: a controlled trial. Eur Surg Res 20: 233, 1988PubMedCrossRefGoogle Scholar
  98. 98.
    Cooperman AM, Hall B, Mikalacki K et al: Use of transcutaneous electrical stimulation in the control of postoperative pain. Am J Surg 133: 185–187, 1977PubMedCrossRefGoogle Scholar
  99. 99.
    Kho HG, van Egmond J, Zuang CF, et al: Acupuncture anaesthesia observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital. Anaesthesia 45: 480–485, 1990PubMedCrossRefGoogle Scholar
  100. 100.
    Khiroya RC, Davenport HT, Jones JG: Cryoanalgesia for pain after herniorrhaphy. Anaesthesia 41: 73–76, 1986PubMedCrossRefGoogle Scholar
  101. 101.
    Hashish I, Hai HK, Harvey W, et al: Reduction of postoperative pain and swelling by ultrasound treatment: A placebo effect. Pain 33: 303–311, 1988PubMedCrossRefGoogle Scholar
  102. 102.
    Houle M, McGrath PA, Moran G, Garrett OJ: The efficacy of hypnosis and relaxation-induced analgesia on two dimensions of pain for cold pressor and electrical tooth pulp stimulation. Pain 33: 241–251, 1988PubMedCrossRefGoogle Scholar
  103. 103.
    Wood G, Lloyd JW, Bullingham RE, et al: Postoperative analgesia for day-case herniorrhaphy patients: A comparison of cryoanalgesia, paravertebral blockade and oral analgesia. Anaesthesia 36: 603, 1981PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1994

Authors and Affiliations

  • G. P. Joshi
  • B. Fredman
  • P. F. White

There are no affiliations available

Personalised recommendations