Procedural pain

Basically there are three types of pain acute pain, chronic pain associated with malignant disease, and chronic pain not associated with malignant disease Acute pain is of short duration and lasts less than 3 to 6 months. Intensity of acute pain is from mild to severe Causes of acute pain include postoperative pain, procedural pain, and traumatic pain. Acute pain usually subsides when the injury heals. 

The eyelids are very vascular and are very forgiving, and secondary infection after an eyelid procedure is rare. However, an application of antibiotic ointment is gently applied to the area and is prescribed foim times a day for 3 days. It is important to inform the patient that the eyelid is going to look worse immediately after the procedure than it did before the procedure.The trauma created by the injections, the clamp tightening, and the incision and curettage make the lid appear swollen. By the next day the lid will be markedly improved in appearance. There should be total resolution of the lesion within 2 to 3 weeks with no evidence of the procedure. Pain after the procedure and after the anesthetic wears off is virtually nonexistent. If there is discomfort, ibuprofen is prescribed for pain control. 

Patients should be warned pain is the most common reason for re-admission [105]. On discharge, analgesia is switched to oral medications, consisting of non-steroidal anti-inflammatories (NSAlDs) and narcotics. The NSAIDs should be taken around the clock for approximately 10 days with narcotics used as needed. The peak of the pain usually occurs during the first 8-12 h although once they are discharged from the hospital, their pain may be more troublesome for the first day home and will gradually resolve within the next week. If, after improvement of the initial post-procedure pain, the patient develops recurrence of pain, she should immediately report back to the interventionalist since this can represent infection or possibly fibroid expulsion. 

Most of the medications used in uterine artery embolization are focused on post-procedure pain... 

Although there are theoretical advantages to the use of Embospheres, clinical studies have not shown an advantage over PVA particles [27]. The volume decrease ofthe fibroids, and the uterine volume reduction is similar between Embospheres and PVA [54]. The volume of microspheres required for an embolization is larger than the volume of PVA required to complete an embolization [27]. In both retrospective and prospective study there does not seem to be a difference in post procedure pain or the use of narcotic use between PVA and microspheres [27,55]. 

Bilateral occlusion of the uterine arteries during uterine artery embolization clearly increases the risk of global uterine ischemia and subsequent infarction in patients undergoing this procedure [10]. In fact, it is not unreasonable to assume that uterine ischemia occurs in all patients undergoing this procedure and that this ischemia likely contributes to the post-procedure pain that is commonly experienced by most patients after embolization. However, rarely this transient ischemia worsens to the point where the uterus becomes globally infarcted. There have been reports of diffuse uterine ischemia and necrosis after uterine artery embolization [84, 85]. The typical presentation of uterine ischemia consists of long-standing pelvic pain which persists for several weeks associated... 

Comparative studies Propofol and ketamine have been compared in procedural sedation in the Emergency Department [34. Patients were randomized to propofol 1+0.5 mg/kg every 3 minutes if needed ( =50) or the same doses of ketamine ( =47). There was a higher rate of subclinical respiratory depression with ketamine, but the number of clinical interventions in the two groups was the same. Recovery agitation was more common with the ketamine group than propofol (17% versus 4%), but procedural pain was less common (2.1% versus 6.0%). Recall and patient satisfaction were similar (13% versus 12% and 100% versus 100%). 

During the first few hours after the procedure, pain should be controlled by analgesics. Fever usually occurs in particular after a large necrosis. The septic risk is reduced by strict sterility. Neurological com-pKcations are avoided by sound anatomical knowledge of the treated region and precise CT control. 

The rationale to use spasmolytic agents is a possible improved colonic distention, and reduced procedural pain. 

The reason is the subjective impression of reduced procedural pain, and the fact that procedural spasm can mimick tumor (see below) or impedes adequate evaluation. 

In a randomized blind comparison, patients undergoing sedation for emergency procedures received either ketamine 0.3 mg/kg or fentanyl 1.5 micrograms/kg followed by intravenous propofol 0.4 mg/ kg bolus [62 ]. All five severe events were in those who received fentanyl and fentanyl caused more mild (OR = 5.9), moderate (OR = 3.8), and severe (OR = 12.3) adverse events. Desaturation was the main contributor to this difference. Fentanyl was 5.1 times more likely to cause sedation than ketamine, and this persisted after adjustment for age, weight, procedure type, and pre-procedure pain (OR = 4.6). 

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