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Sellami M, Zouche I, Ben Ayed M, Bouhali M, Ben Ayed K, Ktata S, Hammami B, Chaabouni MA, Charfeddine I. Ketamine infiltration improves analgesia after thyroid surgery. F1000Res 2023; 12:206. [PMID: 38314321 PMCID: PMC10835105 DOI: 10.12688/f1000research.127562.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 02/06/2024] Open
Abstract
Background: Postoperative pain increases the risk of postoperative complications and may predispose patients to chronic post-surgical pain. This study aims to evaluate the impact of ketamine wound infiltration versus placebo at the end of thyroid surgery on postoperative pain and analgesic requirements. Methods: In this randomized controlled trial, we prospectively studied patients who underwent thyroid surgery. Patients were randomized into two groups: group S, where local infiltration was performed using 10 ml of a physiological saline solution; and group K, where 10 ml of a solution containing 2 mg/kg ketamine was infiltrated. Standardized thyroidectomies were performed in the 2 groups. Pain perception was measured using a visual analog scale (VAS) every 10 minutes in the post-anesthetic care unit (PACU) for 2 hours and thereafter every 6 hours during the first 24 hours. The opioid requirement in the PACU was evaluated. A comparison between the 2 groups was carried out. Results: Postoperatively, the mean VAS was higher in group S compared to group K during all PACU stay periods and the first 24 hours. Pain scores during swallowing were significantly lower for group K in the PACU at 0, 10, and 20 minutes. The mean morphine consumption in the PACU was 0.71 mg and 0 mg respectively in group S and group K (p=0.03). The incidence of nausea and vomiting was similar in both groups. Conclusions: Ketamine wound infiltration is an efficient modality to reduce postoperative opioid consumption compared to a placebo after thyroid surgery.
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Affiliation(s)
- Moncef Sellami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouche
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariam Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Maroua Bouhali
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Khadija Ben Ayed
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Ktata
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Anesthesia, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Boutheina Hammami
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ilhem Charfeddine
- Faculty of Medicine of Sfax, Sfax, Tunisia
- University of Sfax, Sfax, Tunisia
- Department of Otorhinolaryngology, Head and Neck Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
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Becker E, Hernandez A, Greene H, Gadbois K, Gallus D, Wisbach G. Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial. Obes Surg 2023; 33:555-561. [PMID: 36564620 DOI: 10.1007/s11695-022-06417-x] [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: 07/05/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program. METHODS We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019. Primary outcomes were postoperative morphine milligram equivalents per day (MME/day) and average subjective inpatient pain level. Secondary outcomes were length of hospital stay (LOS) and adverse events (AEs). RESULTS Of the 100 patients enrolled, 78 were randomly assigned to LB (42) or PB (36). Thirty-four received the ERAS protocol, and 44 did not. The mean MME/day use did not differ significantly by the bupivacaine group [median, IQR PB: 20.3 (40.95); LB: 33.0 (42.9); p = .314], but it did differ by the ERAS group [median, IQR no ERAS 33.2 (47.1), ERAS 24.0 (34.0); p = .049]. Length of stay, inpatient pain score, and AEs did not differ significantly by either the bupivacaine or the ERAS group. CONCLUSIONS In our study, liposomal bupivacaine did not significantly decrease postoperative opioid use either before implementation of ERAS or as part of an enhanced recovery after surgery program for minimally invasive bariatric surgery procedures.
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Affiliation(s)
- Elise Becker
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Amy Hernandez
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Howard Greene
- Clinical Investigation Department, Navy Medicine Readiness & Training Command, San Diego, CA, 92134, USA
| | - Kyle Gadbois
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - David Gallus
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Gordon Wisbach
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
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Zhe Xu C, Can G, Xin W, Jiang Sheng H. Drugs used in regional block analgesia for thyroidectomy: A network meta-analysis of randomized controlled trials. Int J Surg 2022; 100:106598. [DOI: 10.1016/j.ijsu.2022.106598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/18/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
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Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: A systematic review and meta-analysis. Surg Oncol 2022; 41:101731. [DOI: 10.1016/j.suronc.2022.101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
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Gorain B, Al-Dhubiab BE, Nair A, Kesharwani P, Pandey M, Choudhury H. Multivesicular liposome: A lipid-based drug delivery system for efficient drug delivery. Curr Pharm Des 2021; 27:4404-4415. [PMID: 34459377 DOI: 10.2174/1381612827666210830095941] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
The advancement of delivery tools for therapeutic agents has brought several novel formulations with increased drug loading, sustained release, targeted delivery, and prolonged efficacy. Amongst the several novel delivery approaches, multivesicular liposome has gained potential interest because this delivery system possesses the above advantages. In addition, this multivesicular liposomal delivery prevents degradation of the entrapped drug within the physiological environment while administered. The special structure of the vesicles allowed successful entrapment of hydrophobic and hydrophilic therapeutic agents, including proteins and peptides. Furthermore, this novel formulation could maintain the desired drug concentration in the plasma for a prolonged period, which helps to reduce the dosing frequencies, improve bioavailability, and safety. This tool could also provide stability of the formulation, and finally gaining patient compliance. Several multivesicular liposomes received approval for clinical research, while others are at different stages of laboratory research. In this review, we have focused on the preparation of multivesicular liposomes along with their application in different ailments for the improvement of the performance of the entrapped drug. Moreover, the challenges of delivering multivesicular vesicles have also been emphasized. Overall, it could be inferred that multivesicular liposomal delivery is a novel platform of advanced drug delivery with improved efficacy and safety.
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Affiliation(s)
- Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Science, Taylor's University, Subang Jaya, Selangor. Malaysia
| | - Bandar E Al-Dhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa. Saudi Arabia
| | - Anroop Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa. Saudi Arabia
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi. India
| | - Manisha Pandey
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur. Malaysia
| | - Hira Choudhury
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur. Malaysia
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Jiang Y, Zhang Z, Liang B, Xu S, Ye Y, Chen R, Li Y, Yu M, Zou Z. The effect of bupivacaine on postoperative pain following thyroidectomy: a systematic review and meta-analysis. MINERVA CHIR 2020; 75:193-202. [PMID: 32550728 DOI: 10.23736/s0026-4733.20.08255-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Thyroid surgery, which is usually followed by moderate postoperative pain, has gained increasing attention in recent years. A systematic review and meta-analysis was conducted to assess the effect of prophylactic bupivacaine on postoperative pain following thyroidectomy. EVIDENCE ACQUISITION We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for specific keywords. RevMan 5.0 and Stata 12.0 software were used to perform meta-analyses. The endpoints were postoperative pain, rescue analgesic requirement, and postoperative nausea and vomiting (PONV) during the immediate 24 h postoperative period. EVIDENCE SYNTHESIS A total of 18 randomized controlled trials (RCTs) with 1308 patients were included in the meta-analysis. A significant reduction of pain according to the postoperative pain scale at 1 hour (P<0.05) and rescue analgesic requirement (P<0.05) was observed following local infiltration with bupivacaine. A bilateral superficial cervical plexus block (BSCPB) with bupivacaine also significantly reduced postoperative pain at 1 hour (P<0.01) and 24 hours (P<0.01), as well as rescue analgesic requirement (P<0.00001) and PONV (P<0.01). Compared with BSCPB, local infiltration with bupivacaine provides a better effect in terms of postoperative analgesia (P<0.05). CONCLUSIONS We recommend local infiltration with bupivacaine ranged from 20 to 75 mg before or after skin closure or BSCPB with bupivacaine ranged from 25 to 100 mg to reduce postoperative pain after thyroidectomy.
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Affiliation(s)
- Yaofei Jiang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China.,Hubei Key Laboratory of Tumor Biology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zulei Zhang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China.,Nanchang University, Nanchang, China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Suming Xu
- Nanchang University, Nanchang, China
| | - Yuan Ye
- Nanchang University, Nanchang, China
| | | | - Yimin Li
- Nanchang University, Nanchang, China
| | - Mengqi Yu
- Nanchang University, Nanchang, China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China -
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A Double-Blind, Randomized Controlled Trial of Pre-incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post-operative Pain Relief in Open Thyroid and Parathyroid Surgery. World J Surg 2020; 44:2656-2666. [DOI: 10.1007/s00268-020-05458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Babina YN, Konoplitsky VS, Kalinchuk OO, Dmytriiev DV, Nazarchuk OA, Andriets EV. Experience in the local use of 0.25% bupivacaine for the treatment of postoperative pain. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v4i1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
According to British scientists, about 300 million operations are performed around the world annually. They cause acute postoperative pain, the management of which is crucial for improving patient outcomes and reducing healthcare costs. Local anesthetic infiltration before closing the surgical incision is a commonly used technique in the operating room. This review focuses on the use of local anesthetic infiltration, 0.25% bupivacaine, into surgical incisions to reduce postoperative pain, as confirmed by an estimate of a reduction in the use of postoperative opioids and a visual analogue scale (VAS). The presented clinical cases and the combined analgesia scheme with infiltration of a local anesthetic into the postoperative wound were used to make it possible to argue about the effectiveness of anesthesia because on the peripheral mechanism of pain. Infiltration analgesia reduced the need for opioids and the time of stay in hospitals. It was concluded that there is a need for further research on methods of delivering anesthetics to postoperative wounds for pain management and improving the quality of treatment.
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Contini S. Wound infiltration with bupivacaine 0.5% with or without adrenaline does not decrease pain after thyroidectomy. A randomized controlled study. Saudi Med J 2018; 39:428. [PMID: 29619499 PMCID: PMC5938661 DOI: 10.15537/smj.2018.4.22487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sandro Contini
- Department of Surgical Sciences, Parma University, Parma PR, Italy. E-mail.
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Sellami M, Feki S, Triki Z, Zghal J, Zouche I, Hammami B, Charfeddine I, Chaari M, Ghorbel A. Bupivacaine wound infiltration reduces postoperative pain and analgesic requirement after thyroid surgery. Eur Arch Otorhinolaryngol 2018. [DOI: 10.1007/s00405-018-4933-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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