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Nitin B, Gupta M. To Compare the Effects of Post-tonsillectomy Intra-operative Infiltration of Ropivacaine Versus Bupivacaine in Tonsillar Fossa. Indian J Otolaryngol Head Neck Surg 2024; 76:1805-1818. [PMID: 38566710 PMCID: PMC10982168 DOI: 10.1007/s12070-023-04417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/30/2023] [Indexed: 04/04/2024] Open
Abstract
Tonsillectomy is one of the most common surgical procedures practiced in Otorhinolaryngology. A significant obstacle for the speedy and smooth recovery is early post- operative pain. Pain leads to negative outcomes such as poor intake, tachycardia, anxiety, delayed wound healing and insomnia. Aim to assess and compare the effect of post-incisional infiltration of 0.75% Ropivacaine v/s 0.5% Bupivacaine on post tonsillectomy pain, the on start of oral intake and stay in hospital and to investigate any complications that can arise due to infiltration of the said drugs. 60 Patients above the age of 5 years were posted for tonsillectomy or adenotonsillectomy under general anesthesia. Patients were blinded about the group in which they will be enrolled. Group A received Inj. ropivacaine (0.75%) 2 ml and Group B: received Inj. Bupivacaine (0.50%) 2 ml in each fossa. After surgery, no analgesics were given & patients were observed for the intensity of post-operative pain in the immediate post-operative period, at 2, 4, 6, 12, 24, 48 h and further if not discharged using VISUAL ANALOGUE SCORE (VAS) and VERBAL RATING SCALE(VRS). Post-operative pain assessment was done using VAS and VRS at 2nd, 4th, 6th, 12th, 24th and 48th hour which was found to be lower in Group 'A'. Patients in Group 'A' also started their oral intake sooner, had lesser hospitalization days than group 'B' patients. Longer time for Rescue analgesic and reduced total dose of analgesic required was seen in Group A compared to Group B. This comparative study on Post-incisional infiltration of 2 ml 0.75% Ropivacaine v/s 2 ml 0.5% Bupivacaine has shown that Ropivacaine is a more effective drug in reducing post-operative pain in comparison to Bupivacaine, proven statistically.
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Affiliation(s)
- B. Nitin
- Department of ENT and Head Neck Surgery, Maharishi Markandeshwar College of Medical Sciences and Research, Ambala, Haryana India
| | - Manish Gupta
- Department of ENT and Head Neck Surgery, Gian Sagar Hospital and Medical College, Banur Rajpura, Punjab India
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Cicirelli V, Lacalandra GM, Cshe S, Mrenoshki D, Lillo E, Bianchi FP, Aiudi GG. Analgesic comparison between topical irrigation (splash block) versus injection of lidocaine on the ovarian pedicle in canine ovariectomy. Vet Med Sci 2022; 8:1893-1897. [PMID: 35611806 PMCID: PMC9514456 DOI: 10.1002/vms3.843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to compare the analgesic efficacy of topical irrigation versus injection of lidocaine on the ovarian pedicle to provide analgesia in bitches ovariectomy. In the current study were monitored: increased blood pressure, heart rate and respiratory rate to identify an acute intraoperative nociceptive response. These parameters were registered at six times during the surgical procedure: grasping of the ovary (time 1), dissection of the mesosalpinx (time 2), tightening of the first loop ligature (time 3), tightening of the second loop ligature (time 4), transection of the ovarian pedicle (time 5) and release of the ovary (time 6). Material and Methods Forty healthy bitches were randomly assigned in two groups (n = 20) to receive topical irrigation (splash block) of 2% lidocaine (C group) on both ovarian pedicle (2 mg/kg each), or an equal volume of lidocaine was injected at the same sites (R group). Results The results of the present study suggest that splash block may provide intraoperative analgesic effects equivalent to injection in the ovarian pedicle in dogs that have undergone ovariectomy. The lidocaine improved surgical analgesia during canine ovariectomy in both groups, and this action is not affected by the inoculation technique. Clinical significance Pain management in veterinary patients is a crucial component of appropriate patient care. Therefore, the need for achieving safer anaesthesia for surgical intervention is gaining much attention. Ovariectomy is a common surgical procedure in bitches with medium level of pain. This study concluded that considering its relative simplicity, low cost, and safety, both techniques could be used in daily clinical practice.
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Affiliation(s)
- Vincenzo Cicirelli
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | | | - Sandor Cshe
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Daniela Mrenoshki
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Edoardo Lillo
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Paolo Bianchi
- Department and Clinic of Obstetrics and Animal Reproduction, University of Veterinary Medicine, Budapest, Hungary
| | - Giulio Guido Aiudi
- Department of Veterinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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Park SK, Yoon S, Kim BR, Choe SH, Bahk JH, Seo JH. Pre-emptive epidural analgesia for acute and chronic post-thoracotomy pain in adults: a systematic review and meta-analysis. Reg Anesth Pain Med 2020; 45:1006-1016. [DOI: 10.1136/rapm-2020-101708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Background and objectivesEpidural analgesia is the gold standard for post-thoracotomy pain management and can be started before or after surgical incision. This systematic review and meta-analysis investigated whether pre-emptive epidural analgesia before thoracotomy incision reduces acute and chronic post-thoracotomy pain in adults compared with epidural analgesia after incision.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing epidural analgesia initiated before (pre-emptive group) and after (control group) thoracotomy incision in adults. The primary outcomes were the pain intensity during rest and coughing within 72 hours after surgery and the incidence of pain 1 to 6 months after surgery. Data were combined with random-effects meta-analyses. We rated the quality of evidence as high, moderate, low, and very low using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe included 19 trials with 1062 participants involving 529 in the pre-emptive group and 533 in the control group. The pain intensity was significantly lower at rest within 72 hours after surgery (19 studies, n=1062) and during coughing within 48 hours after surgery (11 studies, n=638), and the incidence of pain was significantly lower 1 to 6 months after surgery (6 studies, n=276) in the pre-emptive group than in the control group. The quality of evidence was moderate or low in the primary outcomes.ConclusionsOur review provides low-quality evidence that pre-emptive epidural analgesia reduces the intensity of acute pain and the incidence of chronic pain after thoracotomy in adults.Protocol registration numberCRD42019131620.
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Abbas AE. Commentary: Liposomal bupivacaine intercostal nerve block. All that is gold does not glitter. J Thorac Cardiovasc Surg 2020; 161:1662-1663. [PMID: 32111427 DOI: 10.1016/j.jtcvs.2020.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Abbas E Abbas
- Division of Thoracic Surgery, Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
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Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study. J Oral Maxillofac Surg 2019; 77:1990-1997. [DOI: 10.1016/j.joms.2019.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
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Zibura AE, Posner LP, Ru H, Westermeyer HD. A preoperative bupivacaine retrobulbar block offers superior antinociception compared with an intraoperative splash block in dogs undergoing enucleation. Vet Ophthalmol 2019; 23:225-233. [PMID: 31566883 DOI: 10.1111/vop.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Investigate nociception differences in dogs undergoing enucleation administered bupivacaine either via preoperative retrobulbar block (pRB) or intraoperative splash block (iSB). METHODS Prospective, randomized, double-masked, clinical comparison study. Dogs undergoing unilateral enucleation were randomized to two groups: one received bupivacaine pRB and saline iSB of the same volume, and the other received saline pRB and bupivacaine iSB. The following intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end-tidal CO2 (EtCO2 ); systolic, mean, and diastolic arterial blood pressure (SAP, MAP, and DAP respectively); inspired end-tidal isoflurane concentration (EtISOIns), and expired end-tidal isoflurane concentration (EtISOExp). Pain scores were recorded pre- and postoperatively. Analgesic rescue was documented. Surgical hemorrhage and postoperative bruising and swelling were graded subjectively by the surgeon (HDW) and study coordinator (AEZ). RESULTS A significant (P = .0399) increase from baseline in overall mean heart rate was recorded in iSB bupivacaine patients (n = 11) compared with pRB bupivacaine patients (n = 11), with no significant differences in other intraoperative physiologic parameters, or pain scores. More analgesic rescue events occurred in iSB bupivacaine patients compared to pRB bupivacaine patients. A near-significant increase in intraoperative bleeding (P = .0519), and a significant increase in bruising (P = .0382) and swelling (P = .0223) was noted in the iSB bupivacaine group. CONCLUSIONS Preoperative retrobulbar block bupivacaine is more effective than an iSB bupivacaine at controlling both intraoperative and postoperative nociception in dogs undergoing enucleation. Additionally, iSB causes more postoperative bruising and swelling and may be associated with increased intraoperative hemorrhage.
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Affiliation(s)
- Ashley E Zibura
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Lysa P Posner
- Anesthesiology, Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Hongyu Ru
- Department of Population Health and Pathobiology, College of Veterinary Medicine, Raleigh, NC, USA
| | - Hans D Westermeyer
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Mostafa MF, Herdan R, Fathy GM, Hassan ZEAZ, Galal H, Talaat A, Ibrahim AK. Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double-blind study. Eur J Pain 2019; 24:182-191. [PMID: 31461801 DOI: 10.1002/ejp.1476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4 ) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. METHODS A randomized double-blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 μg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. RESULTS VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. CONCLUSION Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4 . No significant adverse effects to the parturients or newborns.
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Affiliation(s)
- Mohamed F Mostafa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ragaa Herdan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Golnar M Fathy
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Zein E A Zareh Hassan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hanan Galal
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Talaat
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ibrahim
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
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Reyad RM, Shaker EH, Ghobrial HZ, Abbas DN, Reyad EM, Abd Alrahman AAM, AL‐Demery A, Issak ERH. The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study. Eur J Pain 2019; 24:159-170. [DOI: 10.1002/ejp.1473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Raafat M. Reyad
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Ehab H. Shaker
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Hossam Z. Ghobrial
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Dina N. Abbas
- Department of Anesthesia and Pain Medicine National Cancer Institute Cairo University Cairo Egypt
| | - Ehab M. Reyad
- Department of Clinical Pathology National Hepatology and Tropical Medicine Research Institute Cairo Egypt
| | | | - Amr AL‐Demery
- Department of Surgical Oncology National Cancer Institute Cairo University Cairo Egypt
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Zayas‐González H, González‐Hernández A, Manzano‐García A, Hernández‐Rivero D, García‐Cuevas MA, Granados‐Mortera JC, Vaca‐Aguirre L, Flores‐Fierro S, Martínez-Lorenzana G, Condés‐Lara M. Effect of local infiltration with oxytocin on hemodynamic response to surgical incision and postoperative pain in patients having open laparoscopic surgery under general anesthesia. Eur J Pain 2019; 23:1519-1526. [DOI: 10.1002/ejp.1427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Hector Zayas‐González
- Departamento de Neurobiología del Desarrollo y Neurofisiología Instituto de Neurobiología, Universidad Nacional Autónoma de México Querétaro México
- Hospital Regional de Petróleos Mexicanos Salamanca México
| | - Abimael González‐Hernández
- Departamento de Neurobiología del Desarrollo y Neurofisiología Instituto de Neurobiología, Universidad Nacional Autónoma de México Querétaro México
| | - Alfredo Manzano‐García
- Departamento de Neurobiología del Desarrollo y Neurofisiología Instituto de Neurobiología, Universidad Nacional Autónoma de México Querétaro México
| | | | | | | | | | | | | | - Miguel Condés‐Lara
- Departamento de Neurobiología del Desarrollo y Neurofisiología Instituto de Neurobiología, Universidad Nacional Autónoma de México Querétaro México
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Lee J, Kim S. The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study. Medicine (Baltimore) 2019; 98:e15385. [PMID: 31045789 PMCID: PMC6504301 DOI: 10.1097/md.0000000000015385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. METHODS We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. RESULTS Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 μg vs 1047.7 μg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups. CONCLUSIONS Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS.
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Affiliation(s)
- Jungwon Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Liu J, Wang F. Preoperative celecoxib analgesia is more efficient and equally tolerated compared to postoperative celecoxib analgesia in knee osteoarthritis patients undergoing total knee arthroplasty: A randomized, controlled study. Medicine (Baltimore) 2018; 97:e13663. [PMID: 30572485 PMCID: PMC6320042 DOI: 10.1097/md.0000000000013663] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to evaluate the efficacy and safety of preoperative celecoxib administration in alleviating postoperative pain in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA).A total of 226 knee OA patients underwent TKA were consecutively recruited and randomized into preoperative analgesia group and postoperative analgesia group as 1:1 ratio. Preoperative analgesia group received celecoxib before and post operation; postoperative analgesia group received celecoxib post operation, all patients received TKA and intravenous patient-controlled analgesia (PCA) post operation. Pain visual analog scale (VAS), patient's global assessment (PGA), flexional angles, PCA consumption, percentage of patients receiving pethidine, pethidine consumption, and adverse events were assessed.Pain VAS scores at rest and at flexion were both lower in preoperative analgesia group compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, and 24 hours post operation. Preoperative analgesia group also exhibited decreased PGA score compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours post operation. Meanwhile, active flexional angle and passive flexional angle in preoperative analgesia group were larger than that in postoperative analgesia group at 72 hours post operation. More interestingly, preoperative analgesia group patients consumed less PCA compared to postoperative analgesia group patients at 72 hours post operation. No difference of adverse event incidences between 2 groups was observed.Preoperative administration of celecoxib exhibits better efficacy and equal safety profiles compared to postoperative administration of celecoxib in knee OA patients undergoing TKA.
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Noguera MA, Romero CA, Martinez AG, Rotger ML, Roman HDS, Espeche FA. Free-standing ambulatory endoscopic transthoracic sympathectomy made with a urological resectoscope. J Minim Access Surg 2018; 16:289-291. [PMID: 30178765 PMCID: PMC7440017 DOI: 10.4103/jmas.jmas_135_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The endoscopic transthoracic sympathectomy (ETS) is an efficient procedure designed to treat palmar/axillary hyperhidrosis, now, we can present an original form to do this surgery with a single incision and using an urological resectoscope, always in a free-standing ambulatory public system in the province of Tucumán, in Argentina.
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Affiliation(s)
- Miguel Angel Noguera
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Cesar Alejandro Romero
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Aldo Gustavo Martinez
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Mariano Luis Rotger
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Hugo Diaz San Roman
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
| | - Federico A Espeche
- Department of Ambulatory Surgery, General Surgery Unit, President Nestor Kirchner Hospital, San Miguel de Tucuman, Argentina
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Anwar S, O'Brien B. The role of intraoperative interventions to minimise chronic postsurgical pain. Br J Pain 2017; 11:186-191. [PMID: 29123663 DOI: 10.1177/2049463717720640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic postsurgical pain (CPSP) is the most common complication following surgery, with increasing evidence of both its prevalence and severity. While awareness of the various risk factors for this long-term condition is also increasing, effective prevention remains elusive. In this review, we describe the increasing evidence for preventive or 'protective' strategies. Controversies and conflicting human data are presented along with suggestions for improved future study.
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Affiliation(s)
- Sibtain Anwar
- Department of Perioperative Medicine, Barts Heart Centre, London, UK.,NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Ben O'Brien
- Department of Perioperative Medicine, Barts Heart Centre, London, UK.,NIHR Biomedical Research Centre at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
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Haeseler G, Schaefers D, Prison N, Ahrens J, Liu X, Karch A. Combatting pain after orthopedic/trauma surgery- perioperative oral extended-release tapentadol vs. extended-release oxycodone/naloxone. BMC Anesthesiol 2017; 17:91. [PMID: 28693439 PMCID: PMC5504600 DOI: 10.1186/s12871-017-0383-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High post-operative pain scores after "minor" orthopedic/trauma surgery are in part attributed to inadequate prescription of opioid analgesics. Novel concepts aiming to achieve sufficient analgesia while minimizing opioid-related side effects by avoiding fluctuating plasma levels are based on perioperative oral administration of extended-release opioids beginning with the first dose pre-operatively. This is the first study to evaluate analgesic efficacy and side effect rates of extended-release tapentadol compared to oxycodone/naloxone following orthopedic/trauma surgery. METHODS This randomized, observer-blinded, active-controlled prospective clinical trial had 2 co-primary endpoints: (1) Analgesic efficacy: Mean pain level on a numeric rating scale (NRS) from 0 to 10 during exercise over 5 days. (2) Safety: Side effect sum score of the following events: Nausea, vomiting, constipation, sedation, vertigo, somnolence. The study was powered to detect superiority of tapentadol for at least one endpoint pending statistical proof of non-inferiority for both endpoints in a first step. RESULTS Two hundred sixty-six trauma patients were randomized to receive either tapentadol (n = 133) or oxycodone/naloxone (n = 133). Analgesic efficacy: Mean (±SD) daily pain levels in the first five post-operative days were 2.8 ± 1.3 in both groups. Mean maximum pain intensity during exercise in the first 24 h after surgery was 3.8 ± 1.9 (tapentadol) and 3.8 ± 2.1 (oxycodone/naloxone). Statistically tapentadol was non-inferior but not superior to oxycodone/naloxone. SAFETY Vomiting on day 1 occurred in 11%, constipation in 35% of the tapentadol patients and in 16% and 30% of the oxycodone/naloxone patients (p = 0.60 and 0.33), respectively. The incidence of sedation/ vertigo was <10%, that of somnolence <2% in both groups (p > 0.3, respectively). The sum score of side effect events was 51% in the tapentadol vs. 49% in the oxycodone/naloxone group; risk difference 3% [95% CI, -8 to 14%]; p = 0.6). Non-inferiority of tapentadol could not be concluded as the pre-defined non-inferiority margin was exceeded. CONCLUSIONS With both concepts, mean maximum pain intensity during exercise within the first 24 h after orthopedic/trauma surgery was reduced to a score of <4. This analgesic efficacy came at the cost of mainly gastro-intestinal side effects. Thus, we now use a prophylaxis against nausea and vomiting and pre-emptive laxatives as part of these concepts. TRIAL REGISTRATION https://eudract.ema.europa.eu (EudraCT- Nr. 2011-003238-15 ); October 24th, 2012.
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Affiliation(s)
- Gertrud Haeseler
- Department of Anesthesia, Katholisches Klinikum Ruhrgebiet Nord (KKRN) GmbH, Hervester Str. 57, D-45768, Marl, Germany.
| | - Dirk Schaefers
- Department of orthopedic and trauma surgery, KKRN, Hervester Str. 57, D-45768, Marl, Germany
| | - Natalie Prison
- Department of anesthesia, KKRN, Hervester Str. 57, D-45768, Marl, Germany
| | - Jörg Ahrens
- Department of Anesthesia, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Xiaofei Liu
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, D-30652, Hannover, Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, D-30652, Hannover, Germany
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Tan P, Martin M, Shank N, Myers L, Wolfe E, Lindsey J, Metzinger S. A Comparison of 4 Analgesic Regimens for Acute Postoperative Pain Control in Breast Augmentation Patients. Ann Plast Surg 2017; 78:S299-S304. [PMID: 28459704 PMCID: PMC6686898 DOI: 10.1097/sap.0000000000001132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients undergoing breast augmentation are treated with multiple combinations of medications for pain control including ketorolac, liposomal bupivacaine, bupivacaine, and intravenous and oral narcotics. There is no current consensus on the optimal combination; therefore, all are used at the discretion of the surgeon. METHODS This was a single-center, retrospective study. The total number of patients included was 132. Comparisons were made between 4 groups: bupivacaine only (B); bupivacaine and liposomal bupivacaine (BL); bupivacaine and liposomal bupivacaine plus intraoperative ketorolac (BLKi); and bupivacaine and liposomal bupivacaine plus postoperative ketorolac (BLKp). Average pain scores immediately postoperative and before discharge were recorded and correlated to percentage of patients who received narcotic in the post-anesthesia care unit (PACU). Additional end points noted were side effects including nausea and time spent in PACU postoperatively. RESULTS Those receiving intraoperative ketorolac had the lowest pain on discharge (P < 0.0001) and the lowest percentage of patients receiving narcotics (P = 0.009) out of all 4 groups. There was no significant difference between the 4 groups in terms of time spent in PACU, pain immediately after the procedure, or amount of antiemetic given. No bleeding complications were noted for those who did or did not receive ketorolac. CONCLUSIONS When given options for pain control in breast augmentation, intraoperative ketorolac should be considered, because its inclusion was significant in decreasing use of narcotics and pain upon discharge. Addition of other costly drugs such as liposomal bupivacaine may not provide additional benefit in the immediate postoperative setting for procedures with a short recovery period such as breast augmentation.
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Affiliation(s)
- Pamela Tan
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Morgan Martin
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Nina Shank
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Leann Myers
- Tulane University Department of Biostatistics and Bioinformatics, New Orleans, LA
| | - Emily Wolfe
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - John Lindsey
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
| | - Stephen Metzinger
- Tulane University Division of Plastic and Reconstructive Surgery, New Orleans, LA
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16
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Nistal-Nuño B. No preemptive analgesic effect of preoperative ketorolac administration following total abdominal hysterectomy: A randomized study. Saudi J Anaesth 2017; 11:169-176. [PMID: 28442955 PMCID: PMC5389235 DOI: 10.4103/1658-354x.203011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Experimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements. METHODS In a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction. RESULTS There were neither significant differences in VAS scores between groups (P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point (P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group (P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h (P = 0.02) and 4 h (P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h (P = 0.013). The respiratory rate showed no differences between groups, except at 8 h (P = 0.017), 16 h (P = 0.011), and 24 h (P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate (P > 0.05). CONCLUSIONS Preoperative ketorolac neither showed a preemptive analgesic effect nor was it effective as an adjuvant for decreasing opioid requirements or postoperative pain in patients receiving IV analgesia with tramadol after abdominal hysterectomy.
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Affiliation(s)
- Beatriz Nistal-Nuño
- Department of Cardiac and Thoracic Anesthesiology, The John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, United Kingdom
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17
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Mojsa IM, Stypulkowska J, Novak P, Lipczynski K, Szczeklik K, Zaleska M. Pre-emptive analgesic effect of lornoxicam in mandibular third molar surgery: a prospective, randomized, double-blind clinical trial. Int J Oral Maxillofac Surg 2017; 46:614-620. [PMID: 28057390 DOI: 10.1016/j.ijom.2016.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/14/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
The aim of this study was to establish whether the pre-emptive use of lornoxicam (16mg) in third molar surgery ensures successful postoperative analgesia and reduces rescue analgesic intake when compared to postoperative application, and in comparison with placebo. Ninety patients were split randomly into three groups: group A received lornoxicam 60min before surgery and placebo 60min after surgery; group B received placebo 60min before surgery and lornoxicam 60min after surgery; group C received placebo 60min before surgery and placebo 60min after surgery. Postoperative pain was recorded on a visual analogue scale and on a numerical rating scale at 1, 2, 4, 6, 8, 12, and 24h after surgery. The patients recorded total dose of paracetamol intake during the 24h after the procedure. The efficacy of postoperative analgesia was greater in lornoxicam groups when compared to the placebo group; there was no difference between the two lornoxicam groups (A and B). Patients in group C took their first rescue analgesic dose earlier after surgery than patients in the two lornoxicam groups. The average dose of paracetamol taken in group C was 1000mg, while it was500 mg in the lornoxicam groups.
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Affiliation(s)
- I M Mojsa
- Department of Oral Surgery, Jagiellonian University Medical College, Krakow, Poland.
| | - J Stypulkowska
- Department of Oral Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - P Novak
- Department of Oral Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - K Lipczynski
- Department of Oral Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - K Szczeklik
- Department of Integrated Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - M Zaleska
- Department of Oral Surgery, Jagiellonian University Medical College, Krakow, Poland
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Aceves M, Bancroft EA, Aceves AR, Hook MA. Nor-Binaltorphimine Blocks the Adverse Effects of Morphine after Spinal Cord Injury. J Neurotrauma 2016; 34:1164-1174. [PMID: 27736318 DOI: 10.1089/neu.2016.4601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Opioids are frequently used for the treatment of pain following spinal cord injury (SCI). Unfortunately, we have shown that morphine administered in the acute phase of SCI results in significant, adverse secondary consequences including compromised locomotor and sensory recovery. Similarly, we showed that selective activation of the κ-opioid receptor (KOR), even at a dose 32-fold lower than morphine, is sufficient to attenuate recovery of locomotor function. In the current study, we tested whether activation of the KOR is necessary to produce morphine's adverse effects using nor-Binaltorphimine (norBNI), a selective KOR antagonist. Rats received a moderate spinal contusion (T12) and 24 h later, baseline locomotor function and nociceptive reactivity were assessed. Rats were then administered norBNI (0, 0.02, 0.08, or 0.32 μmol) followed by morphine (0 or 0.32 μmol). Nociception was reassessed 30 min after drug treatment, and recovery was evaluated for 21 days. The effects of norBNI on morphine-induced attenuation of recovery were dose dependent. At higher doses, norBNI blocked the adverse effects of morphine on locomotor recovery, but analgesia was also significantly decreased. Conversely, at low doses, analgesia was maintained, but the adverse effects on recovery persisted. A moderate dose of norBNI, however, adequately protected against morphine's adverse effects without eliminating its analgesic efficacy. This suggests that activation of the KOR system plays a significant role in the morphine-induced attenuation of recovery. Our research suggests that morphine, and other opioid analgesics, may be contraindicated for the SCI population. Blocking KOR activity may be a viable strategy for improving the safety of clinical opioid use.
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Affiliation(s)
- Miriam Aceves
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Bryan, Texas
| | - Eric A Bancroft
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Bryan, Texas
| | - Alejandro R Aceves
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Bryan, Texas
| | - Michelle A Hook
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Bryan, Texas
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Anıl A, Kaya FN, Yavaşcaoğlu B, Mercanoğlu Efe E, Türker G, Demirci A. Comparison of postoperative analgesic efficacy of intraoperative single-dose intravenous administration of dexketoprofen trometamol and diclofenac sodium in laparoscopic cholecystectomy. J Clin Anesth 2016; 32:127-33. [DOI: 10.1016/j.jclinane.2016.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/01/2016] [Accepted: 02/18/2016] [Indexed: 10/21/2022]
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Ince I, Yoruk O, Ahiskalioglu A, Aksoy M, Dostbil A, Celik M. Does Montelukast Have an Effect on Post-tonsillectomy Pain Control in Children? A Randomized Trial Study. Otolaryngol Head Neck Surg 2015; 153:269-74. [PMID: 25883103 DOI: 10.1177/0194599815580976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids. Pain control is still a big problem after tonsillectomy surgery. We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management. This is the first-time use of montelukast in post-tonsillectomy pain. STUDY DESIGN Double-blind, controlled-randomized study. SETTINGS University teaching and research hospital. SUBJECTS AND METHODS A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist class I-II, scheduled for elective tonsillectomy were enrolled in this clinical trial study. The patients were randomized into 2 groups: the montelukast group (group M, n = 30) and control group (group C, n = 30). Group M recieved an oral montelukast tablet and group C recieved placebo at 2400pm on the morning before surgery. Post-tonsillectomy pain was evaluated with the Wong-Baker FACES Scale during the 24 hours after surgery. Patients' intraoperative hemodynamic parameters and intraoperative and postoperative complications were recorded. RESULTS There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores (P < .05). In the 24 hours after surgery, the total number of patients using rescue analgesics was higher in group C than in group M, and the difference was statistically significant (P < .001). There was no significant difference in demographic parameters (P > .05). There were no significant differences in postoperative nausea and vomiting, otalgia, trismus, fever, or halitosis between the groups (P > .05). CONCLUSION Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children.
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Affiliation(s)
- Ilker Ince
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ozgur Yoruk
- Department of Otorhinolaryngology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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Nistal-Nuño B, Freire-Vila E, Castro-Seoane F, Camba-Rodriguez M. Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study. F1000Res 2014; 3:226. [PMID: 25671084 PMCID: PMC4309164 DOI: 10.12688/f1000research.5258.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery. METHODS In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kg-¹∙h-¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction. RESULTS No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05). CONCLUSIONS Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.
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Affiliation(s)
- Beatriz Nistal-Nuño
- Department of Anesthesiology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Enrique Freire-Vila
- Department of Anesthesiology, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Francisco Castro-Seoane
- Department of Anesthesiology, Complexo Hospitalario Arquitecto Marcide - Profesor Novoa Santos, Ferrol, Spain
| | - Manuel Camba-Rodriguez
- Department of Anesthesiology, Complexo Hospitalario Arquitecto Marcide - Profesor Novoa Santos, Ferrol, Spain
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22
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Kaygusuz K, Gokce G, Ozdemir Kol I, Ayan S, Gursoy S. Efficacy of preventive analgesia with tramadol or lornoxicam for percutaneous nephrolithotomy: a prospective, randomized, double-blind, placebo-controlled study. Curr Ther Res Clin Exp 2014; 68:205-16. [PMID: 24683211 DOI: 10.1016/j.curtheres.2007.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prevention of postoperative pain provides better and more rapid convalescence for patients. OBJECTIVE The aim of this study was to compare the preventive analgesic effect of tramadol and lornoxicam in the early postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS Patients who were scheduled for elective PCNL at the Cumhuriyet University Hospital, Sivas, Turkey, were enrolled in this prospective, double-blind, placebo-controlled study. The patients were randomly assigned to 1 of 3 groups: tramadol, lornoxicam, and normal saline (NS). Ten minutes before induction of anesthesia, the tramadol group received tramadol 100 mg IV, the lornoxicam group received lornoxicam 8 mg IV, and the NS group received NS 2 mL IV. Anesthesia was induced using fentanyl 1 μg/kg and thiopental sodium 4 to 7 mg/kg. Vecuronium 0.1 mg/kg was used for muscle relaxation. Desflurane 4% to 6% and 50%:50% oxygen/nitrous oxide were used for maintenance. Oxygen saturation, heart rate, and mean blood pressure were recorded before induction and during the postoperative period. During the postoperative period, visual analogue scale O/AS) scores, time to first analgesic (TFA), total analgesic consumption (TAC), and patient satisfaction scores were determined. Data about postoperative nausea and vomiting and other adverse events and complications were also collected. RESULTS Seventy-three patients were assessed for enrollment and 60 (33 women, 27 men; mean [SD] age, 44.69 [11.27] years; age range, 20-62 years) were included in the study. The baseline demographic characteristics and duration of surgery were similar in all 3 groups. The mean (SD) VAS scores in the tramadol group were significantly lower than in the NS group at 15 and 30 minutes and 1, 2, 4, and 12 hours after surgery (all, P < 0.05). The VAS scores in the lornoxicam group were significantly lower than in the NS group at 15 and 30 minutes and 1 hour (all, P < 0.05). The VAS score at 1 hour after surgery was significantly lower in the tramadol group than in the lornoxicam group (18 [8] vs 32 [16]; P < 0.05); however, there were no other significant differences in VAS scores between the active groups. A significantly shorter TFA was associated with the NS group when compared with the tramadol and lornoxicam groups (46 [27] vs 354 [187] and 180 [118], respectively; both, P < 0.05). TFA was significantly shorter in the lornoxicam group when compared with the tramadol roup (180 [118] vs 354 [187]; P < 0.05). TAC was significantly higher in the NS group than in the tramadol and lornoxicam groups (270 [47] vs 115 [74] and 145 [72], respectively; both, P < 0.05). Patient satisfaction score (range) was significantly lower in the NS group when compared with the tramadol and lornoxicam groups (0 [0-1] vs 3 [0-3] and 2 [0-3], respectively; both, P < 0.05). There were no other significant between-group differences observed. CONCLUSIONS Tramadol and lornoxicam were more effective than NS in preventing early postoperative pain. The preventive analgesic effect of tramadol was comparable with that of lornoxicam, except at 1 hour when tramadol was more effective among these patients undergoing PCNL. Both drugs were well tolerated.
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Affiliation(s)
- Kenan Kaygusuz
- Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Gokhan Gokce
- Department of Urology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Iclal Ozdemir Kol
- Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Semih Ayan
- Department of Urology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Sinan Gursoy
- Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Erturk E, Aydogdu Kaya F, Kutanis D, Besir A, Akdogan A, Geze S, Tugcugil E. The effectiveness of preemptive thoracic epidural analgesia in thoracic surgery. BIOMED RESEARCH INTERNATIONAL 2014; 2014:673682. [PMID: 24745020 PMCID: PMC3972946 DOI: 10.1155/2014/673682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. MATERIAL AND METHODS Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. RESULTS RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. CONCLUSION We consider that preemptive TEA may offer better analgesia after thoracotomy.
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Affiliation(s)
- Engin Erturk
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ferdane Aydogdu Kaya
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Dilek Kutanis
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ahmet Besir
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ali Akdogan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Sükran Geze
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Ersagun Tugcugil
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Recep Tayyip Erdoğan University, 53100 Rize, Turkey
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Townsend JA, Hagan JL, Smiley M. Use of local anesthesia during dental rehabilitation with general anesthesia: a survey of dentist anesthesiologists. Anesth Prog 2014; 61:11-7. [PMID: 24697820 PMCID: PMC3975608 DOI: 10.2344/0003-3006-61.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 12/07/2013] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to document current practices of dentist anesthesiologists who are members of the American Society of Dentist Anesthesiologists regarding the supplemental use of local anesthesia for children undergoing dental rehabilitation under general anesthesia. A survey was administered via e-mail to the membership of the American Society of Dentist Anesthesiologists to document the use of local anesthetic during dental rehabilitations under general anesthesia and the rationale for its use. Seventy-seven (42.1%) of the 183 members responded to this survey. The majority of dentist anesthesiologists prefer use of local anesthetic during general anesthesia for dental rehabilitation almost always or sometimes (90%, 63/70) and 40% (28/70) prefer its use with rare exception. For dentist anesthesiologists who prefer the administration of local anesthesia almost always, they listed the following factors as very important: "stabilization of vital signs/decreased depth of general anesthesia" (92.9%, 26/28) and "improved patient recovery" (82.1%, 23/28). There was a significant association between the type of practice and who determines whether or not local anesthesia is administered during cases. The majority of respondents favor the use of local anesthesia during dental rehabilitation under general anesthesia.
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Affiliation(s)
- Janice A. Townsend
- Associate Professor, Department of Pediatric Dentistry, Louisiana State University Health Science Center School of Dentistry, New Orleans, Louisiana
| | - Joseph L. Hagan
- Research Statistician, Texas Children's Hospital, Houston, Texas
| | - Megann Smiley
- Dentist Anesthesiologist, Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Associate Clinical Professor, Department of Pediatric Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio
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Jenerette CM, Brewer CA, Edwards LJ, Mishel MH, Gil KM. An Intervention to Decrease Stigma in Young Adults With Sickle Cell Disease. West J Nurs Res 2013; 36:599-619. [DOI: 10.1177/0193945913512724] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young adults with sickle cell disease (SCD) are often stigmatized when they seek care for pain. The purpose of this pilot study was to test an intervention to decrease health-related stigma during care-seeking. Young adults with SCD ages 18 to 35 years ( n = 90) were randomized to either the care-seeking intervention (CSI) or an attention control group that participated in life review interviews. The two groups were compared by t tests and longitudinal data analyses on the change from baseline to the last time point in total health-related stigma and health-related stigma by doctors. Findings suggest that the CSI was associated with significant increased awareness of perceived total stigma and stigma by doctors compared with the attention control group. These findings are promising in terms of lessons learned from a pilot intervention that focused on the role communication skills play in decreasing health-related stigma in young adults with SCD.
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Affiliation(s)
| | | | | | | | - Karen M. Gil
- The University of North Carolina at Chapel Hill, NC, USA
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26
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Effectiveness of preemptive analgesia on postoperative pain following third molar surgery: Review of literatures. JAPANESE DENTAL SCIENCE REVIEW 2013. [DOI: 10.1016/j.jdsr.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study. J Arthroplasty 2013; 28:1274-7. [PMID: 23608085 DOI: 10.1016/j.arth.2013.03.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 02/01/2023] Open
Abstract
Pain control is necessary for successful rehabilitation and outcome after total knee arthroplasty. Our goal was to compare the clinical efficacy of periarticular injections consisting of a long-acting local anesthetic (ropivacaine) and epinephrine with and without combinations of an α2-adrenergic agonist (clonidine) and/or a nonsteroidal anti-inflammatory agent (ketorolac). In a double-blinded controlled study, we randomized 160 patients undergoing total knee arthroplasty to receive 1 of 4 intraoperative periarticular injections: Group A, ropivacaine, epinephrine, ketorolac, and clonidine; Group B, ropivacaine, epinephrine, and ketorolac; Group C, ropivacaine, epinephrine, and clonidine; Group D (control), ropivacaine and epinephrine. Compared with Group D, Group A and B patients had significantly lower postoperative visual analog pain scores and nurse pain assessment and Group C patients had a significantly greater reduction in physical therapist pain assessment. We found no differences in other parameters analyzed.
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Okamoto T, Mitsuse T, Kashiwagi T, Iwane E, Sakata Y, Masuda K, Ogata S. Prophylactic epidural administration of fentanyl for the suppression of tourniquet pain. J Anesth 2013; 10:5-9. [PMID: 23839544 DOI: 10.1007/bf02482060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/1994] [Accepted: 04/04/1995] [Indexed: 11/25/2022]
Abstract
Severe dull pain on the side of tourniquet application and marked rises in blood pressure and heart rate associated with that pain are often observed even under adequate regional analgesia. The purpose of this study was to evaluate the effect of epidural fentanyl on the suppression of tourniquet pain during orthopedic surgical procedures. Forty-five patients undergoing orthopedic surgery of the lower extremities with a tourniquet were maintained by continuous epidural anesthesia with 2% lidocaine through an epidural indwelling polyethylene catheter (L3-4). The patients were randomly allocated to the following three groups: epidural fentanyl (100μg) (epidural group,n=15); intravenous fentanyl (100μg) (intravenous group,n=15); control (no fentanyl) (control group,n=15). The epidural or intravenous fentanyl was administered at the time of the second lidocaine injection. The severity of tourniquet pain based on the patient's level of complaint and the total dose of supplemental analgesics requested in the epidural group were significantly lower than those in the control group. Blood pressure during tourniquet application in the epidural group was more stable than in the other two groups. No severe side-effects were observed in any patient. Prophylactic epidural administration of fentanyl might be useful in the suppression of tourniquet pain.
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Affiliation(s)
- T Okamoto
- Department of Anesthesia, Kumamoto City Hospital, 1-1-60 Kotoh, 862, Kumamoto, Japan
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Yorozu T, Morisaki H, Kondoh M, Toyoda Y, Miyazawa N, Shigematsu T. Epidural anesthesia during upper abdominal surgery provides better postoperative analgesia. J Anesth 2013; 10:10-5. [PMID: 23839545 DOI: 10.1007/bf02482061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/1995] [Accepted: 08/09/1995] [Indexed: 10/24/2022]
Abstract
Since repeated noxious stimuli may sensitize neuropathic pain receptors of the spinal cord, we tested the hypothesis that the appropriate blockade of surgical stimuli with epidural anesthesia during upper abdominal surgery would be beneficial for postoperative analgesia. Thirty-six adult patients undergoing either elective gastrectomy or open cholecystectomy were randomly allocated to receive either inhalational general anesthesia alone (group G) or epidural anesthesia along with light general anesthesia (group E) throughout the surgery. Postoperative pain management consisted of patient-controlled analgesia (PCA) with bupivacaine accompanied by the continuous infusion of buprenorphine. To assess postoperative pain, a visual analogue scale (VAS) was employed at 2, 24, and 48 h postoperatively. While there was no significant difference in the bupivacaine dose, more patients undergoing gastrectomy in group G required supplemental analgesics than those in group E, and the VAS scores in group E demonstrated significantly better postoperative analgesia compared to group G after both types of surgery. Thus, an appropriate epidural blockade during upper abdominal surgery likely provides better postoperative pain relief.
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Affiliation(s)
- T Yorozu
- Department of Anesthesiology, Tokyo Metropolitan Otsuka Hospital, 2-8-1 Minamiotsuka, Toshima-ku, 170, Tokyo, Japan
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Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial. The Journal of Laryngology & Otology 2013; 127:383-91. [DOI: 10.1017/s0022215113000364] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:This double-blind, controlled, parallel-group study was designed to determine the efficacy of pre-emptive triple analgesia for paediatric post-tonsillectomy pain management.Materials and methods:One hundred and thirty-five children were randomised into two groups: pre-emptive triple analgesia (n = 55) and control (n = 80). Pain was assessed using a visual analogue scale (in hospital) and the Parent's Postoperative Pain Measure (at home), and scores recorded.Results:Visual analogue scale scores on awakening and for 6 hours post-surgery were significantly better in the study group than the control group (p < 0.05). The Parent's Postoperative Pain Measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia.Conclusion:The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.
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Bang YS, Chung KH, Lee JH, Hong SK, Choi SH, Lee JY, Lee SY, Yang HJ. Comparison of clinical effects according to the dosage of sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol 2012; 63:321-6. [PMID: 23115684 PMCID: PMC3483490 DOI: 10.4097/kjae.2012.63.4.321] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/07/2012] [Accepted: 05/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background Subarachnoid block is a widely used technique for cesarean section. To improve the quality of analgesia and prolong the duration of analgesia, addition of intrathecal opioids to local anesthetics has been encouraged. We compared the effects of sufentanil 2.5 µg and 5 µg, which were added to intrathecal hyperbaric bupivacaine. Methods We enrolled 105 full term parturients were randomly divided into 3 groups: Group 1 (control), Group 2 (sufentanil 2.5 µg), and Group 3 (sufentanil 5 µg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We determined the maximum level of sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and side effects. Results There were no significant differences among the 3 groups in the maximum level of the sensory block and motor block. Recovery rate of the sensory block, however, was significantly slower in Group 3 than Group 1. Quality of intraopertive analgesia, muscle relaxation, and duration of effective analgesia were enhanced by increasing the dosage of intrathecal sufentanil. Frequencies of hypotension, maximum sedation level, and pruritus were directly related to the dosage of intrathecal sufentanil, whereas nausea and vomiting occurred only in the groups using sufentanil. Conclusions The addition of sufentanil 2.5 µg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia with minimal adverse effects on the mother.
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Affiliation(s)
- Yun Sic Bang
- Department of Anesthesiolgy and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Melzack R, Katz J. Pain. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2012; 4:1-15. [DOI: 10.1002/wcs.1201] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Paraskeva A, Diamantis M, Petropoulos G, Siafaka I, Fassoulaki A. Postoperative analgesic requirements after subarachnoid or epidural anesthesia with ropivacaine 0.75% in cesarean section. A double-blind randomized trial. Curr Med Res Opin 2012; 28:1497-504. [PMID: 22937725 DOI: 10.1185/03007995.2012.722990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Postoperative analgesic requirements and pain scores were compared after subarachnoid versus epidural anesthesia with plain ropivacaine 0.75% for elective cesarean section. STUDY DESIGN Ropivacaine 0.75% was randomly administered for subarachnoid or epidural anesthesia in 108 parturients, scheduled for cesarean section. Times for the sensory block to reach T4 level and to regress to T6 level were recorded. At 2, 4, 8 and 24 h postoperatively, pain scores at rest and cough, morphine consumption as well as patient satisfaction, incidence of headache, nausea and/or vomiting were measured. RESULTS Median (min-max) time for the sensory block to reach T4 was 7 (3-0) min versus 24 (16-73) min and to regress to T6 was 126 (70-332) min versus 200 (98-439) min in the subarachnoid and epidural groups, respectively (p=0.001). Although the subarachnoid had more analgesic consumption than the epidural group at 2 and 4 h postoperatively (7.3±4.7 vs. 1.8±2.4 mg, p=0.001 and 9±5.7 vs. 3.3±3.8 mg, p=0.001, respectively) no difference was observed at 8 or 24 h postoperatively (p=0.14 and p=0.38, respectively). VAS scores at rest and after cough (p=0.56, p=0.35, respectively), patient satisfaction (p=0.61), incidence of headache (p=1.0), nausea and/or vomiting (p=0.78) did not differ between the two groups. CONCLUSIONS Postoperative pain, analgesic requirements, patient satisfaction and adverse effects did not differ when subarachnoid or epidural anesthesia with ropivacaine 0.75% was used for elective cesarean section. Nevertheless, subarachnoid provides faster onset and offset of the block, compared to epidural anesthesia. The key limitation of this study is the lack of postoperative serum ropivacaine measurements taken with concurrent pain score measurements.
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Koop O, Gries A, Eckert S, Ellermeier S, Hoksch B, Branscheid D, Beshay M. The role of intercostal nerve preservation in pain control after thoracotomy. Eur J Cardiothorac Surg 2012; 43:808-12. [PMID: 22922695 DOI: 10.1093/ejcts/ezs453] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pain control after thoracotomy is an important issue that affects the outcome in thoracic surgery. Intercostal nerve preservation (ICNP) has increased interest in the outcomes of conventional thoracotomy. The current study critically evaluates the role of preservation of the intercostal nerve in early and late pain control and its benefit in patients undergoing thoracotomy. METHODS Data obtained prospectively between January 2006 and December 2010 by a study colleague at our division of General Thoracic Surgery were retrospectively analysed. There were 491 patients who underwent thoracotomy. Eighty-one patients were excluded from the study due to incompatible data. Patients were divided into two groups according to the intercostal nerve state: Group I consisted of patients with ICNP and Group II consisted of patients with intercostal nerve sacrifice. RESULTS Group I consisted of 288 patients [206 male (71%), P < 0.001, mean age 66 years]. Group II consisted of 122 patients [79 male (64%), P = 0.001, mean age 66 years]. There was less use of opiate in Group I (P = 0.019). Early mobilization of the patients was significantly higher in Group I (P = 0.031). The rate of pneumonia and re-admission to the intensive care unit was higher in Group II (P = 0.017 and 0.023, respectively). The rate of pain-free patients at discharge was significantly higher in Group I (P = 0.028). A 2-week follow-up after hospital discharge showed parasternal hypoesthesia to be more in Group II (P = 0.034). Significant patient contentment in Group I was noticed (P = 0.014). Chronic post-thoracotomy pain (CPTP) was higher in Group II (P = 0.016). CONCLUSIONS ICNP without harvesting an intercostal muscle flap achieves excellent outcomes in controlling acute post-thoracotomy pain and CPTP. ICNP is an effective, simple method to perform, and it should be considered as standard in performing thoracotomy.
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Affiliation(s)
- Olga Koop
- Division of General Thoracic Surgery, Center of Pulmonary Diseases, Evangelic Hospital Bielefeld, Bielefeld, Germany
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Jabalameli M, Pakzadmoghadam SH. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial. Adv Biomed Res 2012; 1:7. [PMID: 23210066 PMCID: PMC3507037 DOI: 10.4103/2277-9175.94430] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/21/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is uncertainty as to whether addition of magnesium sulfate to spinal local anesthetics improves quality and duration of block in the caesarean section. In this randomized double blind clinical trial study, we investigated the effect of adding different doses of intrathecal magnesium sulfate to bupivacaine in the caesarean section. MATERIALS AND METHODS After institutional approval and obtaining informed patient consent, 132 ASA physical status I-II women undergoing elective cesarean section with spinal anesthesia were randomized to four groups: 1 - 2.5 cc Bupivacaine 0.5%+ 0.2 cc normal saline (group C) 2 - 2.5 cc Bupivacaine 0.5%+ 0.1 cc normal saline+ 0.1 cc magnesium sulfate 50% (group M(50)) 3- 2.5 cc Bupivacaine 0.5%+ 0.05 cc normal saline+ 0.15 cc magnesium sulfate 50% (group M(75)) 4- 2.5 cc Bupivacaine 0.5%+ 0.2 cc magnesium sulfate 50% (group M(100)). Patients and staff involved in data collections were unaware of the patient group assignment. We recorded the following: onset and duration of block, time to complete motor block recovery, and analgesic requirement. RESULTS Magnesium sulfate caused a delay in the onset of both sensory and motor blockade. The duration of sensory and motor block were longer in M(75) and M(100) groups than group C (P < 0.001). Recovery time was shorter in group C (P < 0.001) and analgesic requirement was more in group C than others (P < 0.001). CONCLUSIONS In patients undergoing the caesarean section under hyperbaric bupivacaine spinal anesthesia, the addition of 50, 75, or 100 mg magnesium sulfate provides safe and effective anesthesia, but 75 mg of this drug was enough to lead a significant delay in the onset of both sensory and motor blockade, and prolonged the duration of sensory and motor blockade, without increasing major side effects.
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Affiliation(s)
- Mitra Jabalameli
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Li SG, Wang JY, Luo F. Adult-age inflammatory pain experience enhances long-term pain vigilance in rats. PLoS One 2012; 7:e36767. [PMID: 22574223 PMCID: PMC3344941 DOI: 10.1371/journal.pone.0036767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/12/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Previous animal studies have illustrated a modulatory effect of neonatal pain experience on subsequent pain-related behaviors. However, the relationship between chronic pain status in adulthood and future pain perception remains unclear. METHODOLOGY/PRINCIPAL FINDINGS In the current study, we investigated the effects of inflammatory pain experience on subsequent formalin-evoked pain behaviors and fear conditioning induced by noxious stimulation in adult rats. Our results demonstrated an increase of the second but not the first phase of formalin-induced pain behaviors in animals with a history of inflammatory pain that have recovered. Similarly, rats with persistent pain experience displayed facilitated acquisition and prolonged retention of pain-related conditioning. These effects of prior pain experience on subsequent behavior were prevented by repeated morphine administration at an early stage of inflammatory pain. CONCLUSIONS/SIGNIFICANCE These results suggest that chronic pain diseases, if not properly and promptly treated, may have a long-lasting impact on processing and perception of environmental threats. This may increase the susceptibility of patients to subsequent pain-related disorders, even when chronic pain develops in adulthood. These data highlight the importance of treatment of chronic pain at an early stage.
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Affiliation(s)
- Sheng-Guang Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- The Graduate University, Chinese Academy of Sciences, Beijing, China
| | - Jin-Yan Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Fei Luo
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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da Costa Araújo FA, de Santana Santos T, de Morais HHA, Laureano Filho JR, de Oliveira E Silva ED, Vasconcellos RJH. Comparative analysis of preemptive analgesic effect of tramadol chlorhydrate and nimesulide following third molar surgery. J Craniomaxillofac Surg 2012; 40:e346-9. [PMID: 22421470 DOI: 10.1016/j.jcms.2012.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022] Open
Abstract
The aim of this prospective, randomized, controlled, paired trial was to perform a comparative analysis of the preemptive analgesic effect of nimesulide and tramadol chlorhydrate during third molar surgery. The study was carried out between March and November 2009, involving 94 operations in 47 male and female patients with bilateral impacted lower third molars in comparable positions. The sample was divided into two groups. Group A received an oral dose of 100 mg of nimesulide 1 h prior to surgery. Group B received an oral dose of 100 mg of tramadol chlorhydrate 1 h prior to surgery. The following aspects were evaluated in the postoperative period: adverse effects of the drugs; amount of rescue medication used (acetaminophen 750 mg); and pain 5, 6, 24, 36, 48, 60, 72 and 84 h after surgery using a visual analog pain scale. Peak pain occurred 5 h after surgery in both groups, with a mean pain score of 2.3 in Group A and 3.0 in Group B; this difference did not achieve statistical significance (p > 0.141). Based on the sample studied, nimesulide and tramadol chlorhydrate demonstrate similar preemptive analgesic effects when used in lower third molar surgeries.
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Dalury DF, Lieberman JR, MacDonald SJ. Current and innovative pain management techniques in total knee arthroplasty. J Bone Joint Surg Am 2011; 93:1938-43. [PMID: 22012532 DOI: 10.2106/jbjs.9320icl] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Behdad A, Hosseinpour M, Khorasani P. Preemptive use of ketamine on post operative pain of appendectomy. Korean J Pain 2011; 24:137-40. [PMID: 21935491 PMCID: PMC3172326 DOI: 10.3344/kjp.2011.24.3.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/05/2011] [Accepted: 08/08/2011] [Indexed: 11/25/2022] Open
Abstract
Background Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. Methods In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). Results Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 ± 6.7 minutes for the case group and 18.1 ± 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 ± 0.6 for the case group and 2.0 ± 0.8 for the controls (P = 0.032). There were no drug side effects for the case group. Conclusions A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.
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Affiliation(s)
- Akbar Behdad
- Medical University of Isfahan, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Mellor DJ, Stafford KJ. Acute castration and/or tailing distress and its alleviation in lambs. N Z Vet J 2011; 48:33-43. [PMID: 16032116 DOI: 10.1080/00480169.2000.36156] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSES AND APPROACH: Acute castration and/or tailing distress in lambs has been examined extensively during the last decade. At least 59 different approaches to assessing and alleviating this distress have been reported so that the literature is quite complex. The purpose of this paper is to provide an overview of the literature on castration and/or tailing distress, where the distress was assessed using acute changes in plasma cortisol concentrations. A method of analysis involving the integrated cortisol response (i.e. the areas under the cortisol curves while the plasma concentration is above pretreatment values) to each treatment and using treatments which were common to different studies as reference points, allowed meaningful comparison within and between studies. A 6-point ranking scale emerged, where rank 1 represented the least distress and rank 6 the most distress. COMPARISON OF ACUTE DISTRESS RESPONSES This analysis revealed the following major points. Surgical methods of castration and/or tailing cause the greatest cortisol responses (rank 5 or 6). Most ring and ring plus clamp methods of castration plus tailing or castration, used without a local anaesthetic or systemic analgesic, cause rank 4 responses. One form of ring plus clamp castration (i.e. applying the clamp for 10 s across the full width of the scrotum distal to the ring in lambs aged no more than 1 week) reduces the cortisol response to rank 1. When these lambs are also tailed by applying a ring and clamp in a similar manner to the tail, they also exhibit a rank 1 response. Local anaesthetic given 10-20 or 12 min or 10-15 s before or immediately after ring only castration and/or tailing can virtually abolish the cortisol response (rank 1), depending on the site(s) of injection. For ring or ring plus clamp castration, the most effective sites (as judged by cortisol responses) are the neck of the scrotum or the testes. Delivery of local anaesthetic to achieve successful nerve blockade can be by needle, high-pressure needleless administration or, for the tail only, by an aerosol spray. Local anaesthetic injected into the scrotal neck, spermatic cords and/or testes has little effect on the overall cortisol response to clamp castration. Reductions in cortisol responses to clamp castration or to ring tailing can occur after administration of non-steroidal anti-inflammatory drugs. Most tailing methods elicit cortisol responses that are several ranks lower than those caused by castration plus tailing or castration alone. Although tailing by most methods elicits rank 1 cortisol responses, the use of local anaesthetic or non-steroidal anti-inflammatory drugs can reduce the response within the rank 1 range. RECOMMENDATION Farmers should be encouraged to choose the lowest ranked method that is economically and practically feasible for them. Specific methods such as surgical castration should be discouraged.
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Affiliation(s)
- D J Mellor
- Animal Welfare Science and Bioethics Centre, Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand
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Hasani A, Soljakova M, Ustalar-Ozgen S. The management of postoperative pain in children with caudal blocks. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Hasani
- Department of Anesthesiology and Reanimation, University Clinical Centre of Kosovo, Pristina, Republic of Kosovo
| | - M Soljakova
- Department of Anesthesiology and Reanimation, University “Sv. Kiril i Metodij”, Skopje, Republic of Macedonia
| | - S Ustalar-Ozgen
- Department of Anesthesiology and Reanimation, Ozel Acibadem University, Istanbul, Turkey
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Katz J, Melzack R. A Conceptual Framework for Understanding Pain in the Human. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Keita A, Pagot E, Prunier A, Guidarini C. Pre-emptive meloxicam for postoperative analgesia in piglets undergoing surgical castration. Vet Anaesth Analg 2010; 37:367-74. [PMID: 20636569 DOI: 10.1111/j.1467-2995.2010.00546.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of preoperative meloxicam administration on postoperative stress and pain induced by surgical castration in piglets. STUDY DESIGN Prospective, blinded, randomized clinical trial. ANIMALS One hundred and eighty male piglets of <1 week of age. METHODS Castration was performed on 150 piglets which had received either an intramuscular injection of 0.4 mg kg(-1) meloxicam or a placebo 10-30 minutes before the procedure. Blood cortisol and ACTH concentrations were determined at 30 minutes post-castration and haptoglobin was measured at 24 hours post-castration. Presence or absence of foreleg movements, hind leg movements, urine or faeces emission, tremors or other body movements were recorded during the castration procedure. Scores for presence or absence of prostration, tremors, tail movements and isolation were recorded at 30 minutes, and at 1, 2, 4 and 24 hours post-castration and combined in a global behaviour score (GBS). Blood samples were taken from a further 30 piglets which did not undergo castration. RESULTS Mean blood cortisol and ACTH concentrations at 30 minutes post-castration were both significantly lower in the meloxicam group than in the placebo group (p < or = 0.01). The mean haptoglobin concentration at 24 hours was not significantly reduced (p = 0.178). The distribution of the GBS during castration was similar in both groups. There were significant differences in the GBS after castration at both 2 and 4 hours post-castration with a greater proportion of piglets in the meloxicam group showing no behavioural alterations (82.7%versus 68.0% at both time points). The score distribution was similar in both groups at 30 minutes, 1 and 24 hours after castration. CONCLUSION AND CLINICAL RELEVANCE This study suggests that pre-emptive administration of meloxicam is able to produce some postoperative analgesia after surgical castration of young piglets.
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Abstract
Health-related stigma is increasingly becoming a major public health issue that is receiving more attention. Young adults with sickle cell disease (SCD) are at risk for health-related stigmatization due to the many challenges of the disease. SCD includes the lifelong challenges of managing the chronic illness while accessing and navigating the health care system. The burdens of the disease can affect all aspects of the lives of individuals with SCD to include physiological, psychological, and social well-being. Although others may be involved in the process of stigmatization, the purpose of this paper was to support the need to develop patient-oriented interventions to prevent and treat health-related stigma in young adults with SCD, as these individuals may face health-related stigma throughout their lives, but especially immediately after transitioning from pediatric to adult care. Additionally, the Revised Theory of Self-Care Management for Sickle Cell Disease is offered as a framework from which theory-based interventions can be derived.
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Affiliation(s)
- Coretta M Jenerette
- School of Nursing, The University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC, USA.
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Park SY, Kim SH, Noh JI, Lee SM, Kim MG, Kim SH, Ok SY, Kim SI. The effect of intravenous low dose ketamine for reducing postoperative sore throat. Korean J Anesthesiol 2010; 59:22-6. [PMID: 20651994 PMCID: PMC2908222 DOI: 10.4097/kjae.2010.59.1.22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/06/2010] [Accepted: 04/20/2010] [Indexed: 11/10/2022] Open
Abstract
Background This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). Methods This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 µg/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. Results No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). Conclusions Intravenous injection of low dose ketamine was not effective for reducing POST.
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Affiliation(s)
- Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Korea
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Ozgür E, Dagtekin O, Straub K, Engelmann U, Gerbershagen HJ. [Postoperative pain therapy after radical prostatectomy with and without epidural analgesia]. Urologe A 2009; 48:1182-8. [PMID: 19768449 DOI: 10.1007/s00120-009-2039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epidural analgesia for postoperative pain treatment is favored, for example, within the scope of so-called fast-track surgery, especially abdominal surgery. To improve pain care for our urological patients, we examined the quality of postoperative pain therapy with and without epidural analgesia after radical prostatectomy. After the investigation was approved by the local ethics committee, patients were questioned in detail about the pain they experienced for 7 days after radical prostatectomy. For all 7 postoperative observation days, significantly less pain was measured for patients receiving epidural analgesia compared with patients without epidural analgesia. This could be shown for the average and strongest pain intensity at rest as well as for pain during mobilization. Patients with epidural analgesia were discharged, on average, 1 day earlier. After radical prostatectomy, postoperative pain therapy with epidural analgesia seems to offer advantages with regard to the quality of analgesia and the average length of hospital stay.
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Affiliation(s)
- E Ozgür
- Klinik und Poliklinik für Urologie, Universitätsklinikum Köln.
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‘Scheduled’ dosing of lornoxicam provides analgesia superior to that provided by ‘on request’ dosing following craniotomy. Eur J Anaesthesiol 2009; 26:633-7. [DOI: 10.1097/eja.0b013e328329b0c6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papadima A, Lagoudianakis EE, Antonakis P, Filis K, Makri I, Markogiannakis H, Katergiannakis V, Manouras A. Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy. Surgery 2009; 146:475-82. [PMID: 19715804 DOI: 10.1016/j.surg.2009.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 04/09/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. METHODS A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. RESULTS The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. CONCLUSION Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.
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Affiliation(s)
- Artemisia Papadima
- Department of Anesthesiology, Hippocrateion Hospital, Athens Medical School, University of Athens, Athens, Greece
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