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Li G, Xiao Y, Qi X, Wang H, Wang X, Sun J, Li Y, Li Y. Combination of sufentanil, dexmedetomidine and ropivacaine to improve epidural labor analgesia effect: A randomized controlled trial. Exp Ther Med 2020; 20:454-460. [PMID: 32537010 PMCID: PMC7282115 DOI: 10.3892/etm.2020.8730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 01/04/2023] Open
Abstract
Opioids and α2-agonists have been used as epidural adjuvants in local anesthetics for a long time, but the effect of the combination of opioids and α2-agonists as epidural adjuvants is not completely understood. In the present study, the combination of dexmedetomidine (Dex) and sufentanil as adjuvants to ropivacaine for epidural labor analgesia was investigated. A total of 108 parturient women receiving labor epidural analgesia were randomly divided into three groups: i) Group RD received 0.1% ropivacaine + 0.5 µg/ml Dex; ii) Group RS received 0.1% ropivacaine + 0.5 µg/ml sufentanil; and iv) Group RDS received 0.1% ropivacaine + 0.25 µg/ml Dex + 0.25 µg/ml sufentanil. Patients received a 10 ml loading dose followed by a maintenance by patient controlled epidural analgesia. The visual analog scale scores, onset time, local anesthetic requirements, motor blockage and adverse effects were recorded. Group RDS displayed an improved labor analgesia effect compared with Groups RD and RS. Group RDS displayed a shorter onset time compared with Groups RD and RS, and a reduced local anesthetic requirement compared with Group RS. The motor blockage in Groups RDS and RS was significantly lower compared with Group RD, and the incidence of pruritus in Groups RDS and RD was lower compared with Group RS. In conclusion, the combined use of 0.25 µg/ml Dex and 0.25 µg/ml sufentanil as adjuvants to 0.1% ropivacaine for epidural labor analgesia displayed an improved analgesia effect compared with the use of either 0.5 µg/ml sufentanil or 0.5 µg/ml Dex alone. The present study was registered with the Chinese Clinical Trial Registry Center on 23 February, 2018 (registration no. ChiCTR-IOR-1800014943).
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Affiliation(s)
- Gehui Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Yuci Xiao
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Xiaofei Qi
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Hao Wang
- Department of Food Safety, Market Supervision Administration of Shenzhen Municipality, Shenzhen, Guangdong 518040, P.R. China
| | - Xiaoguang Wang
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Jing Sun
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Yong Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
| | - Yuantao Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong 518028, P.R. China
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Yunus AA, Ugwu EM, Ali Y, Olagunju G. Postoperative Pain Management in Emergency Surgeries: A One-year Survey on Perception and Satisfaction among Surgical Patients. Niger J Surg 2020; 26:42-47. [PMID: 32165835 PMCID: PMC7041353 DOI: 10.4103/njs.njs_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/20/2019] [Accepted: 09/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Postoperative pain varies from an individual to individual. It also varies with types and extent of surgery. In general, postoperative pain is inadequately managed in most centers worldwide, especially in developing countries. Therefore, this study presents the perception and satisfaction of postoperative pain management in emergency surgeries. Methods: A 1-year prospective study of the 891 patients who underwent emergency general surgeries at Ahmadu Bello University Teaching Hospital, from January to December 2018 is hereby presented. Pain scores and patient's satisfaction toward postoperative pain management were considered at 8 and 24 h postoperatively through a predesigned questionnaire. Numeric Pain Rating Scale was used to determine pain intensity and the level of satisfaction following postoperative pain management. Student's t-test was used to compare the pain scores and patient's level of satisfaction of the postoperative pain management. Results: A total of 891 patients were recruited for this study, with a mean age of 36.4 ± 8.9 years with a male-to-female ratio of 1.3:1. Postoperative pain management satisfaction score for patients (98%) who had pain 8-h postoperative period was 4.8 ± 1.6. Similarly, 96.4% of the patients who had pain 24 h postoperatively scored 2.8 ± 1.7. Majority of the patients 481 (54%) were of the American Society of Anesthesiologist physical Class II. Most of the patients underwent general surgery using the technique of general anesthesia. Conclusion: This study indicated that the perception and level of patient's satisfaction regarding postoperative pain management are inadequate. The health professionals and policy makers should be aware that postoperative pain management is suboptimal, as patients still have severe postoperative pain. Therefore, the need for improved postoperative pain management.
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Affiliation(s)
- AbdulGhaffar A Yunus
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Euphemia M Ugwu
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Yunusa Ali
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
| | - Ganiyat Olagunju
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
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Jang JS, Hwang SM, Kwon Y, Tark H, Kim YJ, Ryu BY, Lee JJ. Is the transdermal fentanyl patch an efficient way to achieve acute postoperative pain control?: A randomized controlled trial. Medicine (Baltimore) 2018; 97:e13768. [PMID: 30572528 PMCID: PMC6319953 DOI: 10.1097/md.0000000000013768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUPD This study investigated the plasma fentanyl concentration and efficacy of transdermal fentanyl patch (TFP) (25 μg/h) in the management of acute postoperative pain. METHODS Patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups. The TFP group (n = 30) received a single TFP 25 μg/ h to the anterior chest wall 14 h before operation. The IV group (n = 30) received a placebo patch. After the operation, intravenous fentanyl infusion (25 μg/h) was begun with loading dose 25 μg in the IV group and only normal saline in the TFP group. Plasma fentanyl levels were measured at admission, 1, 6, 12, 24, and 48 h postoperatively. Pain severity and adverse effects were evaluated too. RESULTS The fentanyl level peaked 1 h after operation in the TFP group (3.27 ± 0.34 ng/mL) and 24 h postoperatively in the IV group (2.9 ± 0.42 ng/mL). Pain scores and the use of rescue analgesics were not significantly different between 2 groups. Respiratory depression was not happened in both groups. CONCLUSIONS The TFP (25 μg/h) affixed 14 h before surgery reached a higher constant concentration than the same dose setting of a constant IV infusion of fentanyl after surgery. Although the concentration of fentanyl was higher than those of previous researches, there was no respiratory depression. But, there was no advantage of reducing pain score and the use of rescue analgesics. CLINICAL TRIAL REGISTRATION (available at: http://cris.nih.go.kr, KCT0002221).
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Affiliation(s)
- Ji Su Jang
- Department of Anesthesiology and Pain medicine, Hallym University Chuncheon Sacred Heart Hospital
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain medicine, Hallym University Chuncheon Sacred Heart Hospital
| | - Youngsuk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University
| | - Hyunjin Tark
- Department of Anesthesiology and Pain medicine, Hallym University Chuncheon Sacred Heart Hospital
| | - Young Joon Kim
- Department of Anesthesiology and Pain medicine, Hallym University Chuncheon Sacred Heart Hospital
| | - Byoung Yoon Ryu
- Department of General Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Jae Jun Lee
- Department of Anesthesiology and Pain medicine, Hallym University Chuncheon Sacred Heart Hospital
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Assouline B, Tramèr MR, Kreienbühl L, Elia N. Benefit and harm of adding ketamine to an opioid in a patient-controlled analgesia device for the control of postoperative pain: systematic review and meta-analyses of randomized controlled trials with trial sequential analyses. Pain 2016; 157:2854-64. [PMID: 27780181 DOI: 10.1097/j.pain.0000000000000705] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ketamine is often added to opioids in patient-controlled analgesia devices. We tested whether in surgical patients, ketamine added to an opioid patient-controlled analgesia decreased pain intensity by ≥25%, cumulative opioid consumption by ≥30%, the risk of postoperative nausea and vomiting by ≥30%, the risk of respiratory adverse effects by ≥50%, and increased the risk of hallucination not more than 2-fold. In addition, we searched for evidence of dose-responsiveness. Nineteen randomized trials (1349 adults, 104 children) testing different ketamine regimens added to various opioids were identified through searches in databases and bibliographies (to 04.2016). In 9 trials (595 patients), pain intensity at rest at 24 hours was decreased by 32% with ketamine (weighted mean difference -1.1 cm on the 0-10 cm visual analog scale [98% CI, -1.8 to -0.39], P < 0.001). In 7 trials (495 patients), cumulative 24 hours morphine consumption was decreased by 28% with ketamine (weighted mean difference -12.9 mg [-22.4 to -3.35], P = 0.002). In 7 trials (435 patients), the incidence of postoperative nausea and vomiting was decreased by 44% with ketamine (risk ratio 0.56 [0.40 to 0.78], P < 0.001). There was no evidence of a difference in the incidence of respiratory adverse events (9 trials, 871 patients; risk ratio 0.31 [0.06 to 1.51], P = 0.08) or hallucination (7 trials, 690 patients; odds ratio 1.16 [0.47 to 2.79], P = 0.70). Trial sequential analyses confirmed the significant benefit of ketamine on pain intensity, cumulative morphine consumption, and postoperative nausea and vomiting and its inability to double the risk of hallucination. The available data did not allow us to make a conclusion on respiratory adverse events or to establish dose-responsiveness.
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Chi X, Li M, Mei W, Liao M. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia - a prospective, randomized, double-blind, controlled study. J Pain Res 2017; 10:1521-1527. [PMID: 28740418 PMCID: PMC5505163 DOI: 10.2147/jpr.s137799] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Acute pain is a common complication following cesarean section under general anesthesia. Post–cesarean section pain management is important for both the mother and the newborn. This study compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia. Methods Primiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol. Movement-evoked and rest-pain intensity were assessed by the Numerical Rating Scale (NRS) postoperatively. The number of PCIA attempts, amount of drug consumed, initiation time of lactation, and Quality of Recovery Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively. Pre- and postoperative serum prolactin levels were recorded. Results No between-group difference existed in the NRS at rest at any time point postoperatively. Patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 was higher in the tramadol group compared with the sufentanil group. No significant between-group differences were present in patient satisfaction and nausea/vomiting scores. Postpartum prolactin levels were significantly higher in the tramadol group versus the sufentanil group, corresponding with a significant delay in initiation of lactation in the latter. Conclusion PCIA with tramadol may be preferred due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients following cesarean section under general anesthesia.
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Affiliation(s)
- Xiaohui Chi
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Man Li
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Mingfeng Liao
- Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Subramanian B, Shastri N, Aziz L, Gopinath R, Karlekar A, Mehta Y, Sharma A, Bapat JS, Jain P, Jayant A, Samra T, Perera A, Agarwal A, Shetty V, Bhatnagar S, Pandya ST, Jain P. ASSIST - Patient satisfaction survey in postoperative pain management from Indian subcontinent. J Anaesthesiol Clin Pharmacol 2017; 33:40-47. [PMID: 28413271 PMCID: PMC5374829 DOI: 10.4103/joacp.joacp_245_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To compare pain scores at rest and ambulation and to assess patient satisfaction between the different modalities of pain management at different time points after surgery. SETTINGS AND DESIGN The ASSIST (Patient Satisfaction Survey: Pain Management) was an investigator-initiated, prospective, multicenter survey conducted among 1046 postoperative patients from India. MATERIAL AND METHODS Pain scores, patient's and caregiver's satisfaction toward postoperative pain treatment, and overall pain management at the hospital were captured at three different time points through a specially designed questionnaire. The survey assessed if the presence of acute pain services (APSs) leads to better pain scores and patient satisfaction scores. STATISTICAL ANALYSIS One-way ANOVA was used to evaluate the statistical significance between different modalities of pain management, and paired t-test was used to compare pain and patient satisfaction scores between the APS and non-APS groups. RESULTS The results indicated that about 88.4% of patients reported postoperative pain during the first 24 h after surgery. The mean pain score at rest on a scale of 1-10 was 2.3 ± 1.8 during the first 24 h after surgery and 1.1 ± 1.5 at 72 h; the patient satisfaction was 7.9/10. Significant pain relief from all pain treatment was reported by patients in the non-APS group (81.6%) compared with those in the APS (77.8%) group (P < 0.0016). CONCLUSION This investigator-initiated survey from the Indian subcontinent demonstrates that current standards of care in postoperative pain management remain suboptimal and that APS service, wherever it exists, is yet to reach its full potential.
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Affiliation(s)
- Balavenkata Subramanian
- Department of Anaesthesia, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - Naman Shastri
- Department of Anaesthesia, SAL Hospital, Ahmedabad, Gujarat, India
| | - Lutful Aziz
- Department of Anesthesiology, Apollo Hospitals, Dhaka, Bangladesh
| | | | - Anil Karlekar
- Department of Anaesthesiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Anand Sharma
- Department of Critical Care and Anaesthesiology, Medanta, The Medicity, Gurgaon, Haryana, India
| | | | - Pradeep Jain
- Department Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Aveek Jayant
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajantha Perera
- Department of Anaesthesia, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Anil Agarwal
- Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vijay Shetty
- Department of Anaesthesiology, Fortis Hospital, Mumbai, Maharashtra, India
| | - Sushma Bhatnagar
- Department of Unit of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil T Pandya
- Department of Anaesthesia, Pain and Surgical Intensive Care and High Risk Obstetric Unit, Century Super Specialty Hospital, Hyderabad, Telangana, India
| | - Paramanand Jain
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Onaka H, Ishikawa M, Mizuguchi Y, Uchida E, Sakamoto A. Evaluation of Postoperative Pain Control and Quality of Recovery in Patients Using Intravenous Patient-Controlled Analgesia with Fentanyl: A Prospective Randomized Study. J NIPPON MED SCH 2016; 83:158-66. [DOI: 10.1272/jnms.83.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hiroe Onaka
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Masashi Ishikawa
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yoshiaki Mizuguchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
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Demirel I, Ozer AB, Atilgan R, Kavak BS, Unlu S, Bayar MK, Sapmaz E. Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-cesarean section pain management. J Obstet Gynaecol Res 2013; 40:392-8. [PMID: 24147822 DOI: 10.1111/jog.12205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022]
Abstract
AIM To evaluate and compare analgesic efficacy, drug consumption and patient satisfaction with the i.v. patient-controlled and continuous infusion modes of administration of tramadol. METHODS A total of 40 pregnant women in American Society of Anesthesiologists physical status classification system risk classes I-II scheduled for cesarean section were randomized into two groups to receive treatment in single-blind fashion. Patients in both groups received tramadol as an i.v. infusion 15 min before the end of surgery under general anesthesia for cesarean section. In the post-anesthesia care unit, the 20 patients allocated to group I were given i.v. tramadol in patient-controlled anesthesia (PCA), while the 20 other patients assigned to group II received it as a continuous infusion. Pain visual analog scores (VAS), mean arterial pressure (MAP), heart rate, total tramadol consumption, sedation scores, side-effects (nausea/vomiting) and patient satisfaction were evaluated seven times in the course of the first postoperative 24 h. The Mann-Whitney U-test and Friedman's anova were used for the statistical treatment of data. RESULTS VAS, sedation scores and nausea/vomiting scores were similar in both groups (P > 0.05). The 24-h tramadol consumption was significantly lower in group I (420.15 ± 66.58 mg) than in group II (494.00 ± 29.45 mg), while patient satisfaction was significantly higher in group I (P < 0.05). CONCLUSION While tramadol administration by either of the methods used may ensure efficient early postoperative anesthesia in cesarean section patients, i.v. PCA may be preferred because of the lower drug consumption and higher patient satisfaction associated with it.
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Affiliation(s)
- Ismail Demirel
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Firat University, Elazig, Turkey
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Fyneface-Ogan S, Gogo Job O, Enyindah CE. Comparative Effects of Single Shot Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine with Fentanyl on Labor Outcome. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/816984] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background. Effective intrapartum analgesia attenuates pain, stress, and anxiety which cause release of stress hormones as well as beta-endorphins. Aim. The purpose of this study was to determine the effect of adding dexmedetomidine to hyperbaric bupivacaine for neuraxial analgesia for labor. Methods. Ninety laboring multiparous women were allocated to have single shot intrathecal bupivacaine alone (B), bupivacaine with fentanyl (BF), or bupivacaine with dexmedetomidine (BD). Sensory and motor block characteristics; time from injection to two dermatome sensory regression, sensory regression to S1 dermatome, and motor block regression to Bromage 1 were recorded. Labor pain was assessed with a 10 cm verbal pain scale. Results. Peak sensory block levels in the three groups were essentially the same (). The time for sensory and motor blocks to reach T10 dermatome and Bromage 1, respectively, was faster in group BD than in the other groups (). The time for sensory regression to S1 was significantly prolonged in the group BD (). Motor block regression time to Bromage 1 was also prolonged in the group BD (). Neonatal outcome was normal in all groups. Conclusion. Single shot intrathecal bupivacaine/dexmedetomidine significantly prolonged sensory block in laboring women.
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Affiliation(s)
- S. Fyneface-Ogan
- Obstetric Anesthesia Unit, Department of Anesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - O. Gogo Job
- Obstetric Anesthesia Unit, Department of Anesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - C. E. Enyindah
- Department Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Lee SH, Kim KH, Cheong SM, Kim S, Kooh M, Chin DK. A comparison of the effect of epidural patient-controlled analgesia with intravenous patient-controlled analgesia on pain control after posterior lumbar instrumented fusion. J Korean Neurosurg Soc 2011; 50:205-8. [PMID: 22102950 DOI: 10.3340/jkns.2011.50.3.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/20/2011] [Accepted: 09/08/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Retrospective analysis to compare the effect and complication of epidural patient-controlled analgesia (epidural PCA) with intravenous patient-controlled analgesia (IV PCA) for the treatment of the post-operative pain after posterior lumbar instrumented fusion. METHODS Sixty patients who underwent posterior lumbar instrumented fusion for degenerative lumbar disease at our institution from September 2007 to January 2008 were enrolled in this study. Out of sixty patients, thirty patients received IV PCA group and thirty patients received epidural PCA group. The pain scale was measured by the visual analogue scale (VAS) score. RESULTS There were no significant difference between IV PCA group and epidural PCA group on the PCA related complications (p=0.7168). Ten patients in IV PCA group and six patients in epidural PCA group showed PCA related complications. Also, there were no significant differences in reduction of VAS score between two groups on postoperative 2 hours (p=0.9618) and 6 hours (p=0.0744). However, postoperative 12 hours, 24 hours and 48 hours showed the significant differences as mean of reduction of VAS score (p=0.0069, 0.0165, 0.0058 respectively). CONCLUSION The epidural PCA is more effective method to control the post-operative pain than IV PCA after 12 hours of spinal fusion operation. However, during the first twelve hours after operation, there were no differences between IV PCA and epidural PCA.
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Affiliation(s)
- Sang Hoon Lee
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
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Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, Zdeblick TA, Resnick DK. Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery. ACTA ACUST UNITED AC 2010; 23:139-45. [PMID: 20375829 DOI: 10.1097/BSD.0b013e3181cf07ee] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A preintervention and postintervention design was used to examine a total of 200 patients. OBJECTIVE After successful implementation at our institution of a perioperative oral multimodal analgesia protocol in major joint arthroplasty, a modified regimen was provided to patients undergoing spine procedures. SUMMARY OF BACKGROUND DATA A proactive, multimodal approach is currently recommended for the management of acute postoperative pain. Inadequate postoperative analgesia can negatively influence surgical outcome and duration of rehabilitation. Routine use of intravenous patient controlled analgesia (IV PCA) after surgery can result in substantial functional interference, side effects, and lead to untoward events as a result of programming errors. METHODS A preintervention and postintervention design was used to compare a historical control group of spine surgery patients who received conventional IV PCA (N=100) with a prospective group who received some form of perioperative oral multimodal analgesia (N=100). The new regimen included preoperative and postoperative scheduled extended-release oxycodone, gabapentin, and acetaminophen, intraoperative dolasetron and as-needed postoperative short-acting oral oxycodone. Patient surveys and chart audits were used to measure pain intensity, functional interference from pain, opioid consumption, analgesic-related side effects, and patient satisfaction over the first 24 hours postoperatively. RESULTS Patients who received the new perioperative multimodal oral regimen had significantly less opioid consumption (P<0.001), lower ratings of Least Pain (P<0.01), and experienced less nausea (P<.001), drowsiness (P<0.05), interference with walking (P=0.05), and coughing and deep breathing (P<0.05) compared with the IV PCA group. CONCLUSIONS This quality improvement study shows some safety and significant advantages of a multimodal perioperative oral analgesic regimen compared with standard IV PCA after spine surgery.
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Schein JR, Hicks RW, Nelson WW, Sikirica V, Doyle DJ. Patient-controlled analgesia-related medication errors in the postoperative period: causes and prevention. Drug Saf 2009; 32:549-59. [PMID: 19530742 DOI: 10.2165/00002018-200932070-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patient-controlled analgesia (PCA) is a common and effective means of managing postoperative pain. Unfortunately, the complex processes and equipment associated with the setup, programming and administration of intravenous or epidural PCA have allowed it to become a significant source of preventable medication errors. These errors can be classified into two major categories: human (operator) errors and equipment errors (malfunctions). Such errors are potentially harmful to patients, time-consuming for hospital staff and costly for healthcare providers. The objective of this article is to describe PCA medication errors and examine systems and modalities that may help reduce the incidence of system-related errors. Data from the US FDA's Manufacturer and User Facility Device Experience (MAUDE) database indicate that 6.5% of intravenous PCA-related events were due to operator error. Most (81%) of these errors were due to pump misprogramming, of which almost half were associated with patient harm; 76.4% of adverse events were attributed to device malfunction (e.g. due to frayed wires or a crack in the drug cartridge), although only 0.5% of these were associated with harm to patients. In a report based on data from MEDMARX, a voluntary database that captures reports on medication errors, 7.9% of the PCA-related errors captured over a 5-year period were described as causing harm to patients. Technological advances, such as improved PCA pump designs based on ergonomic and cognitive engineering principles, the use of barcode technology and other 'smart pump' safety features, and new postoperative pain management modalities, may play a significant role in reducing the future incidence and severity of PCA medication errors.
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Affiliation(s)
- Jeff R Schein
- Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, New Jersey, USA.
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Viscusi ER. Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies. Reg Anesth Pain Med 2008; 33:146-58. [DOI: 10.1097/00115550-200803000-00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hicks RW, Sikirica V, Nelson W, Schein JR, Cousins DD. Medication errors involving patient-controlled analgesia. Am J Health Syst Pharm 2008; 65:429-40. [DOI: 10.2146/ajhp070194] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rodney W. Hicks
- System Hospital Endowed Chair for Patient Safety and Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock; at the time of writing he was Manager, Patient Safety Research and Practice, United States Pharmacopeia (USP), Rockville, MD
| | - Vanja Sikirica
- Outcomes Research, Internal Medicine, Ortho–McNeil Janssen Scientific Affairs, LLC (OMJSA), Raritan, NJ
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Grond S, Hall J, Spacek A, Hoppenbrouwers M, Richarz U, Bonnet F. Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management †. Br J Anaesth 2007; 98:806-15. [PMID: 17519263 DOI: 10.1093/bja/aem102] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The fentanyl iontophoretic transdermal system (fentanyl ITS) enables needle-free, patient-controlled analgesia for postoperative pain management. This study compared the efficacy, safety, and ease of care of fentanyl ITS with patient-controlled, i.v. analgesia (PCIA) with morphine for postoperative pain management. METHODS A prospective, randomized, multicentre trial enrolled patients in Europe after abdominal or orthopaedic surgery. Patients received fentanyl ITS (n = 325; 40.0 microg fentanyl over 10 min) or morphine PCIA [n = 335; bolus doses (standard at each hospital)] for < or =72 h. Supplemental i.v. morphine was available during the first 3 h. The primary efficacy measure was the patient global assessment (PGA) of the pain control method during the first 24 h. RESULTS PGA ratings of 'good' or 'excellent' were reported by 86.2 and 87.5% of patients using fentanyl ITS or morphine PCIA, respectively (95% CI, -6.5 to 3.9%). Mean (sd) last pain intensity scores (numerical rating scale, 0-10) were 1.8 (1.77) and 1.9 (1.86) in the fentanyl ITS and morphine PCIA groups, respectively (95% CI, -0.38 to 0.18). More patients reported a system-related problem for fentanyl ITS than morphine PCIA (51.1 vs 17.9%, respectively). However, fewer of these problems interrupted pain control (4.4 vs 41.3%, respectively). Patients, nurses, and physiotherapists reported more favourable overall ease-of-care ratings for fentanyl ITS than morphine PCIA. Study termination rates and opioid-related side-effects were similar between groups. CONCLUSION Fentanyl ITS and morphine PCIA were comparably effective and safe.
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Affiliation(s)
- S Grond
- Klinik für Anästhesiologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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Abstract
The fentanyl HCl iontophoretic transdermal system (ITS) is a compact, needle-free, pre-programmed patient-controlled analgesic system that was developed to address limitations to existing therapies for postoperative pain management. A randomized, controlled trial was conducted in 11 European countries to evaluate the efficacy and safety of postoperative pain control using fentanyl ITS compared with a standard regimen of morphine provided by an intravenous patient-controlled analgesia (IV PCA) pump. This article summarizes results from Nurse Ease-of-Care Questionnaires which were completed to assess the convenience and ease of use of each pain management modality from the perspective of the nurse. Nurses' ratings of patient-care tasks associated with each pain management system were significantly more favourable for fentanyl ITS than for morphine IV PCA. These findings suggest that nurses consider fentanyl ITS to be easier to use than morphine IV PCA.
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Affiliation(s)
- P van Raders
- East and North Hertfordshire NHS Trust, Stevenage
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