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Campsen J, Call T, Thiesset HF, Rosales A, Kim RD. TORPEDO: Prospective, double blind, randomized clinical trial comparing the use of Ketorolac verse placebo during live donor nephrectomy for kidney transplant. TRANSPLANTATION REPORTS 2017. [DOI: 10.1016/j.tpr.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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52
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Pain after single-incision versus conventional laparoscopic appendectomy: a propensity-matched analysis. J Surg Res 2017; 212:122-129. [PMID: 28550898 DOI: 10.1016/j.jss.2017.01.023] [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: 11/08/2016] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to compare postoperative pain outcomes between single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) using a propensity score matching analysis. MATERIALS AND METHODS Adult patients who underwent SILA or CLA for acute appendicitis between January 2010 and December 2015 at a single center were identified retrospectively from a prospectively collected database. All patients had used an intravenous patient-controlled analgesia (PCA) device for postoperative pain control. As potential confounding variables, patient characteristics and surgery-related, anesthesia-related, and PCA-related factors were collected from the database. The primary outcome was the postoperative pain score, and secondary outcomes were nausea, vomiting, rescue analgesic use, rescue antiemetic use, and PCA-related complications. These outcomes were compared between the SILA and CLA groups before and after 1:1 propensity score matching. RESULTS From a total of 915 patients, 753 were selected: 116 in the SILA group and 637 in the CLA group. After propensity score matching, two comparable groups with 111 patients each were obtained. Pain score (P = 0.007) and rescue analgesic use (P = 0.043) on the day of surgery were significantly lower in the SILA group than in the CLA group. The other outcomes were similar between the two groups. CONCLUSIONS SILA is a beneficial surgical procedure for postoperative pain management.
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Meyr AJ, Mirmiran R, Naldo J, Sachs BD, Shibuya N. American College of Foot and Ankle Surgeons ® Clinical Consensus Statement: Perioperative Management. J Foot Ankle Surg 2017; 56:336-356. [PMID: 28231966 DOI: 10.1053/j.jfas.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 02/07/2023]
Abstract
A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.
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Affiliation(s)
- Andrew J Meyr
- Committee Chairperson and Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | | | - Jason Naldo
- Assistant Professor, Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Brett D Sachs
- Private Practice, Rocky Mountain Foot & Ankle Center, Wheat Ridge, CO; Faculty, Podiatric Medicine and Surgery Program, Highlands-Presbyterian St. Luke's Medical Center, Denver, CO
| | - Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M, College of Medicine, Temple, TX
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Abstract
One third of operations are performed on an outpatient basis in Germany, but methods of postoperative pain therapy are less studied. We observed 126 patients with ambulatory and planned surgery in the field of orthopedics and trauma surgery. They were treated with the analgesic metamizole intra- and postoperatively and completed the patients' questionnaire QUIPS on the first postoperative day. In all, 79 patients (61.7%) reported current pain ≥4 on the numerical rating scale (NRS); 84 (66.6%) had restrictions in mobility, 48 (38.1%) described sleep disorders, and 26 (20.6%) wished for more or stronger analgesics. However, 91 (72.2%) of our patients were satisfied with the their pain therapy. Chances are that the treatment of nociceptive pain during movement with NSAID or COX-2-inhibitors is more successful. Further investigations should follow.
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Affiliation(s)
- E A Lux
- Klinik für Schmerz- und Palliativmedizin, Katholisches Klinikum Lünen-Werne GmbH, Altstadtstr. 23, 44534, Lünen, Deutschland. .,Fakultät für Gesundheit, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.
| | - E Neugebauer
- Fakultät für Gesundheit, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland
| | - M Zimmermann
- Klinik für Orthopädie und Unfallchirurgie, Katholisches Klinikum Lünen-Werne, Lünen, Deutschland
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Serum Bupivacaine Concentration After Periarticular Injection With a Mixture of Liposomal Bupivacaine and Bupivacaine HCl During Total Knee Arthroplasty. Reg Anesth Pain Med 2017; 42:582-587. [DOI: 10.1097/aap.0000000000000636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lidocaine Reduces Acute Postoperative Pain After Supratentorial Tumor Surgery in the PACU: A Secondary Finding From a Randomized, Controlled Trial. J Neurosurg Anesthesiol 2016; 28:309-15. [DOI: 10.1097/ana.0000000000000230] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tuncel A, Balci M, Postaci A, Aslan Y, Atan A. Comparıson of different postoperative paın managements in patients submitted to transperitoneal laparoscopic renal and adrenal surgery. Int Braz J Urol 2016; 41:669-75. [PMID: 26401858 PMCID: PMC4756994 DOI: 10.1590/s1677-5538.ibju.2013.0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/30/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose: We compared the effects of local levobupivacaine infiltration, intravenous paracetamol, intravenous lornoxicam treatments on postoperative analgesia in patients submitted to transperitoneal laparoscopic renal and adrenal surgery. Materials and Methods: Sixty adult patients 26 and 70 years who underwent laparoscopic renal and adrenal surgery were randomized into three groups with 20 patients each: Group 1 received local 20mL of levobupivacaine 0.25% infiltration to the trocar incisions before skin closure. In group 2, 1g paracetamol was given to the patients intravenously 30 minutes before extubation and 5g paracetamol was given intravenoulsy in the 24 postoperative period. In group 3, 8mg lornoxicam i.v. was given 30 minutes before extubation and 8mg lornoxicam i.v. was given in the 24 postoperative period. In the postoperative period, pain scores, cumulative tramadol, and additional pethidine consumption were evaluated. Results: Postoperative pain scores significantly reduced in each group (p < 0.05). Although pain levels of the groups were not significantly different at 1, 2, 4, 8, 12 and 24 hours postoperatively, cumulative tramadol consumptions were higher in group 1 than the others. (Group 1 = 370.6 ± 121.6mg, Group 2: 220.9 ± 92.5mg, Group 3 = 240.7 ± 100.4mg.) (p < 0.005). The average dose of pethidine administered was significantly lower in groups 2 and 3 compared with group 1 (Group 1: 145mg, Group 2: 100mg, Group 3: 100mg) (p = 0.024). Conclusions: Levobupivacaine treated group required significantly more intravenous tramadol when compared with paracetamol and lornoxicam groups in patients submitted to transperitoneal laparoscopic renal and adrenal surgery.
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Affiliation(s)
- Altug Tuncel
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Melih Balci
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Aysun Postaci
- Second Department of Anaesthesiology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Ali Atan
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
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Vasigh A, Jaafarpour M, Khajavikhan J, Khani A. The Effect of Gabapentin Plus Celecoxib on Pain and Associated Complications After Laminectomy. J Clin Diagn Res 2016; 10:UC04-8. [PMID: 27134973 DOI: 10.7860/jcdr/2016/17923.7346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 01/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prevention and treatment of postoperative pain is a major challenge in postoperative care and well-being of the surgical patient. The multimodal analgesic method has been recommended as an alternative treatment for the management of postoperative pain. AIM To assess the comparative effect of gabapentin versus gabapentin plus celecoxib on pain and associated complications after laminectomy. MATERIALS AND METHODS In this randomized double- blind clinical trial, 114 patients scheduled for elective laminectomy received gabapentin (n=38, 900 mg daily), gabapentin plus celecoxib (n=38, 200 mg celecoxib plus 300mg gabapentin twice a day), and placebo (n=38, capsule containing starch). Visual Analog Scale (VAS) was used to determine the severity of pain. Complications after surgery, anxiety scores before surgery and patient's satisfaction 24 hour after surgery were recorded. RESULTS The mean pain sevenity score and morphine consumption in the gabapentin plus celecoxib group were less compared to the placebo and gabapentin group respectively at various intervals (p < 0.001). The mean anxiety score, shivering, nausea, vomiting and pruritus in the gabapentin group were significantly lower compared to the placebo and gabapentin plus celecoxib groups respectively (p < 0.001, p < 0.05). The frequencies of drowsiness (42.1%) in the gabapentin group were significantly high compared to the placebo and gabapentin plus celecoxib group respectively (p <0.001, p< 0.05). In the gabapentin plus celecoxib group patient satisfaction was significantly higher compared to the placebo and gabapentin group (p< 0.05). CONCLUSION Combination of 300 mg gabapentin plus 200 mg celecoxib twice a day is a good alternative in multimodal analgesia, effective in pain control with lesser side effects seen with gabapentin alone.
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Affiliation(s)
- Aminolah Vasigh
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Molouk Jaafarpour
- Faculty, Department of Midwifery, Nursing & Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Javaher Khajavikhan
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Ali Khani
- Faculty, Department of Nursing, Nursing & Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
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Vasigh A, Najafi F, Khajavikhan J, Jaafarpour M, Khani A. Comparing Gabapentin and Celecoxib in Pain Management and Complications After Laminectomy: A Randomized Double-Blind Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e34559. [PMID: 27195145 PMCID: PMC4867363 DOI: 10.5812/ircmj.34559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/05/2015] [Accepted: 01/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complications and postoperative pain are major care problems that can affect the quality of health care plan. OBJECTIVES According to the use of multimodal therapy the current study aimed to compare the efficacy of gabapentin and celecoxib in pain management and complications after laminectomy at Ilam University of Medical Sciences, Ilam, Iran, in 2015. PATIENTS AND METHODS In this randomized double-blind clinical trial, 114 patients scheduled for elective laminectomy with simple random sampling design received gabapentin (n = 38, 900 mg/day), celecoxib (n = 38, 600 mg/day) and placebo (n = 38, capsule contain starch). Visual analog scale (VAS) was used to determine the intensity of pain. Complications after surgery, anxiety scores before surgery and patient's satisfaction 24 hours after the surgery were recorded. RESULTS The mean pain intensity in the gabapentin group was lower compared to those of the placebo and celecoxib groups respectively at different time durations (P < 0.001). The means of morphine consumption were 11.9 mg, 22.8 mg and 30.1 mg in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). The prevalence of shivering, nausea, vomiting and pruritus were 10.5%, 12.8%, 10.3% and 18.4% in the gabapentin group vs 31.5%, 29.8%, 32.4% and 28.9% in the celecoxib group and 42.1%, 44.7%, 39.5% and 44.7% in the placebo group (P < 0.001). The mean anxiety score in the gabapentin group was 2.4 vs those of the celecoxib group 3 and placebo group 3.6 (P < 0.001). The frequencies of drowsiness were 42.1%, 13.2% and 5.3% in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). In the gabapentin group, patient satisfaction was significantly higher compared to those of the placebo and celecoxib groups (P < 0.05). CONCLUSIONS According to the effect of gabapentin on pain management, complications after laminectomy and increased patients satisfaction, it can be regarded as an alter native in multimodal analgesia.
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Affiliation(s)
- Aminolah Vasigh
- Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Fatemeh Najafi
- Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Javaher Khajavikhan
- Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Sciences, Ilam, IR Iran
- Corresponding Author: Javaher Khajavikhan, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Sciences, Ilam, IR Iran. Tel: +98-9186158582, Fax: +98-8433337259, E-mail:
| | - Molouk Jaafarpour
- Department of Midwifery, Nursing and Midwifery Faculty, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Ali Khani
- Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Sciences, Ilam, IR Iran
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60
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Bali C, Ergenoglu P, Ozmete O, Akin S, Ozyilkan NB, Cok OY, Aribogan A. [Comparison of the postoperative analgesic effects of naproxen sodium and naproxen sodium-codeine phosphate for arthroscopic meniscus surgery]. Rev Bras Anestesiol 2016; 66:151-6. [PMID: 26832827 DOI: 10.1016/j.bjan.2016.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/07/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid "codeine" to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. METHODS Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. RESULTS The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18(th) hour on movement (p<0.05). The median time to the first demand of PCA was shorter in Group N compared with Group NC (p<0.001). Meperidine consumption was higher in Group N compared with Group NC (p<0.001). There was no difference between groups with respect to side effects (p>0.05). CONCLUSIONS The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.
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Affiliation(s)
- Cagla Bali
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia.
| | - Pinar Ergenoglu
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
| | - Ozlem Ozmete
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
| | - Sule Akin
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
| | - Nesrin Bozdogan Ozyilkan
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
| | - Oya Yalcin Cok
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
| | - Anis Aribogan
- Baskent University School of Medicine, Departamento de Anestesiologia e Reanimação, Adana, Turquia
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Beaussier M, Sciard D, Sautet A. New modalities of pain treatment after outpatient orthopaedic surgery. Orthop Traumatol Surg Res 2016; 102:S121-4. [PMID: 26803223 DOI: 10.1016/j.otsr.2015.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/22/2015] [Accepted: 05/14/2015] [Indexed: 02/02/2023]
Abstract
Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored.
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Affiliation(s)
- M Beaussier
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France.
| | - D Sciard
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France
| | - A Sautet
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France
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Reddy VSK, Brown JD, Ku B, Gilchrist BF, Farkas DT. Effect of Pain Medication Choice on Emergency Room Visits for Pain after Ambulatory Laparoscopic Cholecystectomy. Am Surg 2015. [DOI: 10.1177/000313481508100824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inadequate pain control after ambulatory surgery can lead to unexpected return visits to the hospital. The purpose of this study was to compare patients based on which medications they were prescribed and to see whether this affected the rate of return to the hospital. A retrospective chart review of patients who underwent ambulatory laparoscopic cholecystectomy between January 2009 and December 2013 was performed. Patients were divided into two groups based on the pain medication prescribed after surgery: Opioids and nonopioids. Patients returning to the Emergency room (ER) within seven days were evaluated. If no complication or other diagnosis was identified, the patient was considered to have returned for inadequate pain control. The two groups were statistically compared with each other using Fisher's exact chi-squared test. A total of 749 patients underwent laparoscopic cholecystectomy during the study period: 180 (25.2%) were prescribed opioids, whereas, 560 (74.8%) were prescribed nonopioids. In the nonopioid group, 14 (1.9%) returned to the ER for pain, whereas no patient in the opioid group returned for pain. This difference was statistically significant ( P = 0.027). In conclusion, patients who were given opioid pain medications after ambulatory laparoscopic cholecystectomy were less likely to return to the ER for pain. This implied that opioids were better at pain control and helped avoid the costs of unnecessary ER visits. Future research should be aimed at more direct measures of pain control, as well as the role of opioids after inpatient surgery.
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Affiliation(s)
- Vemuru Sunil K. Reddy
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York
| | - Joshua D. Brown
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York
| | - Benson Ku
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York
| | - Brian F. Gilchrist
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel T. Farkas
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York
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Heo BH, Park JH, Choi JI, Kim WM, Lee HG, Cho SY, Yoon MH. A Comparative Efficacy of Propacetamol and Ketorolac in Postoperative Patient Controlled Analgesia. Korean J Pain 2015; 28:203-9. [PMID: 26175881 PMCID: PMC4500785 DOI: 10.3344/kjp.2015.28.3.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Bong Ha Heo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Hun Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyoung Gon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Young Cho
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Myoung Ha Yoon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
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Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. Can J Hosp Pharm 2015; 68:238-47. [PMID: 26157186 DOI: 10.4212/cjhp.v68i3.1458] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravenous (IV) acetaminophen is increasingly used around the world for pain control for a variety of indications. However, it is unclear whether IV administration offers advantages over oral administration. OBJECTIVE To identify, summarize, and critically evaluate the literature comparing analgesic efficacy, safety, and pharmacokinetics for IV and oral dosage forms of acetaminophen. DATA SOURCES A literature search of the PubMed, Embase, and International Pharmaceutical Abstracts databases was supplemented with keyword searches of Science Direct, Wiley Library Online, and Springer Link databases for the period 1948 to November 2014. The reference lists of identified studies were searched manually. STUDY SELECTION AND DATA EXTRACTION Randomized controlled trials comparing IV and oral dosage forms of acetaminophen were included if they assessed an efficacy, safety, or pharmacokinetic outcome. For each study, 2 investigators independently extracted data (study design, population, interventions, follow-up, efficacy outcomes, safety outcomes, pharmacokinetic outcomes, and any other pertinent information) and completed risk-of-bias assessments. DATA SYNTHESIS Six randomized clinical trials were included. Three of the studies reported outcomes pertaining to efficacy, 4 to safety, and 4 to pharmacokinetics. No clinically significant differences in efficacy were found between the 2 dosage forms. Safety outcomes were not reported consistently enough to allow adequate assessment. No evidence was found to suggest that increased bioavailability of the IV formulation enhances efficacy outcomes. For studies reporting clinical outcomes, the results of risk-of-bias assessments were largely unclear. CONCLUSIONS For patients who can take an oral dosage form, no clear indication exists for preferential prescribing of IV acetaminophen. Decision-making must take into account the known adverse effects of each dosage form and other considerations such as convenience and cost. Future studies should assess multiple-dose regimens over longer periods for patients with common pain indications such as cancer, trauma, and surgery.
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Affiliation(s)
- Farah Jibril
- BSc(Pharm), PharmD, is a Clinical Pharmacist at the National Center for Cancer Care and Research, Doha, Qatar
| | - Sherif Sharaby
- Sherif Sharaby, BSc(Pharm), is a Pharmacist with the San Joaquin Valley Rehabilitation Hospital, Fresno, California
| | - Ahmed Mohamed
- BSc(Pharm), PhD, is an Assistant Professor with the College of Pharmacy, Qatar University, Doha, Qatar
| | - Kyle J Wilby
- BSP, ACPR, PharmD, is an Assistant Professor - Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, Qatar
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Affiliation(s)
- Paul F White
- White Mountain Institute, The Sea Ranch, CA, USA
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Loxoprofen sodium and celecoxib for postoperative pain in patients after spinal surgery: a randomized comparative study. J Orthop Sci 2015; 20:617-23. [PMID: 25911562 DOI: 10.1007/s00776-015-0726-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/07/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to treat inflammation, pain, and fever, but no criterion standard exists for the management of postoperative pain following spinal surgery. In the present study, we compared the analgesic efficacy of loxoprofen sodium (loxoprofen) and celecoxib for the management of postoperative pain following spinal surgery. METHODS One-hundred forty-one patients (mean age 62.2 years) were randomly assigned to two groups before spinal surgery: a loxoprofen group (n = 73, 180 mg/day) and a celecoxib group (n = 68, 200 mg/day). The drugs were administered from 1 day until 7 days after surgery. A numeric rating scale (NRS) was used to evaluate pain at nine predefined times every day and the findings were compared between the two groups. Laboratory data and adverse events were also recorded. RESULTS There was no significant difference in the maximum and mean NRS scores on each day between loxoprofen and celecoxib, suggesting a comparable analgesic effect for these two NSAIDs. Greater improvement in the NRS score between preadministration (baseline) and 30 min or 2 h after administration was obtained for loxoprofen. This tendency was shown for both slight (NRS score <5 at baseline) and severe pain (NRS score ≥ 5 at baseline). Loxoprofen was discontinued in one patient on day 4 because of renal dysfunction. Celecoxib was discontinued in one patient on day 2 at the patient's request. CONCLUSIONS Both loxoprofen sodium and celecoxib were well tolerated for the relief of acute postoperative pain after spinal surgery. A single administration of loxoprofen showed superior and rapid effectiveness compared with celecoxib for both slight and severe postoperative pain.
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Aynehchi BB, Cerrati EW, Rosenberg DB. The efficacy of oral celecoxib for acute postoperative pain in face-lift surgery. JAMA FACIAL PLAST SU 2015; 16:306-9. [PMID: 25010711 DOI: 10.1001/jamafacial.2014.351] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Exploring methods of potentially improving patient comfort and pain control in cosmetic facial surgery. OBJECTIVE To examine the effects of celecoxib in reducing pain and possible opioid consumption following face-lift surgery. DESIGN, SETTING, AND PARTICIPANTS We reviewed the medical records of 100 patients: 50 consecutive patients who underwent a face-lift without receiving perioperative celecoxib and 50 patients who underwent face-lift and received immediate preoperative and standing postoperative celecoxib. MAIN OUTCOMES AND MEASURES In addition to demographic information, the following outcome measures were recorded for each group: visual analog scale patient-reported pain, acetaminophen and/or opioid consumption rates, and related analgesic adverse effects. RESULTS The participants in the noncelecoxib vs celecoxib groups had similar demographic characteristics: mean age, 59.6 vs 57.9 years; mean BMI, 23.3 vs 22.3; history of chronic pain or opioid use, 7 (14%) vs 6 (12%); and 94% of both groups were women. Postoperative pain scores were higher in the noncelecoxib vs celecoxib groups; mean (SD) overall pain score was 3.88 (2.20) vs 2.31 (2.36) (P < .001). The noncelecoxib group had a higher number of postoperative opioid doses than did the celecoxib group: 9.40 (4.30) vs 5.18 (4.58) (P < .05). The noncelecoxib group had a higher incidence of postoperative nausea and vomiting: 12 (24%) vs 0 in the celecoxib group. CONCLUSIONS AND RELEVANCE Preemptive treatment with oral celecoxib appears to be effective in decreasing acute postoperative pain and opioid consumption in patients undergoing face-lift. Given the well-documented adverse effects of opioids, celecoxib is a desirable alternative. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Behrad B Aynehchi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, New York, New York
| | - Eric W Cerrati
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, New York, New York
| | - David B Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, New York, New York
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Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia. Clin Ther 2015; 37:1354-71. [DOI: 10.1016/j.clinthera.2015.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 02/09/2015] [Accepted: 03/11/2015] [Indexed: 11/20/2022]
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Kang JE, Park SK, Song IK, Lee JH, Kim JT, Kim HS. Comparison of the Efficacy and Safety of Different Doses of Propacetamol for Postoperative Pain Control after Breast Surgery. Pain Manag Nurs 2015; 16:367-71. [DOI: 10.1016/j.pmn.2014.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 11/28/2022]
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Blair HA, Plosker GL. Diclofenac sodium injection (akis(®), dicloin (®)): a review of its use in the management of pain. Clin Drug Investig 2015; 35:397-404. [PMID: 25989733 DOI: 10.1007/s40261-015-0294-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A novel formulation of diclofenac sodium suitable for subcutaneous or intramuscular injection (Akis(®), Dicloin(®)) has been developed using the complexing agent hydroxypropyl-β-cyclodextrin (HPβCD) as a solubility enhancer. Diclofenac HPβCD is available in several European countries, where it is indicated for use in adults with acute forms of pain, including postoperative pain. Clinical trials have demonstrated the analgesic efficacy of diclofenac HPβCD in terms of relieving moderate to severe postoperative pain in patients undergoing dental surgery or minor orthopaedic surgery. Subcutaneous diclofenac HPβCD also effectively relieved moderate to severe neuropathic pain, related to cancer or not. Diclofenac HPβCD was generally well tolerated in clinical trials, with injection-site reactions among the most commonly reported adverse events. The local tolerability of diclofenac HPβCD was consistently rated as 'good' or 'excellent' across all studies. Subcutaneous administration of diclofenac is a valid alternative to intramuscular delivery, with the advantages of easier administration, the availability of additional body sites suitable for injection and the potential for self-administration. Thus, diclofenac HPβCD 25, 50 or 75 mg/mL solution for subcutaneous or intramuscular injection extends the treatment options available for use in the management of pain in adults.
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Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Abstract
Acute and chronic pain control is a significant clinical challenge that has been largely unmet. Local anesthetics are widely used for the control of post-operative pain and in the therapy of acute and chronic pain. While a variety of approaches are currently used to prolong the duration of action of local anesthetics, an optimal strategy to achieve neural blockage for several hours to days with minimal toxicity has yet to be identified. Several drug delivery systems such as liposomes, microparticles and nanoparticles have been investigated as local anesthetic delivery vehicles to achieve prolonged anesthesia. Recently, injectable responsive hydrogels raise significant interest for the localized delivery of anesthetic molecules. This paper discusses the potential of injectable hydrogels to prolong the action of local anesthetics.
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Gupta K, Rastogi B, Gupta PK, Sharma D, Agarwal S, Rastogi A. Clinical evaluation of intravenous paracetamol versus Parecoxib for postoperative analgesia after general anaesthesia. Anesth Essays Res 2015; 6:42-6. [PMID: 25885501 PMCID: PMC4173417 DOI: 10.4103/0259-1162.103372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postoperative pain has a significant impact on patient's recovery and optimal nonopioid analgesia would reduce postoperative pain and pain-related complications. This study was aimed to evaluate the analgesic efficacy and safety of intravenous paracetamol versus parecoxib for postoperative analgesia after surgery. MATERIALS AND METHODS Sixty-eight adult consented patients belonging to ASA I and II, scheduled for surgery, were randomly allocated in two treatment groups receiving either infusion of paracetamol (1 gm) or parecoxib (40 mg). The surgical and anesthetic techniques were standardized. Postoperative pain was assessed using visual analog score (VAS) at rest, during coughing and movement. The primary variables were the differences between the mean values of postoperative pain scores, time of first dose of rescue analgesic (tramadol) required, and patient satisfaction throughout the first 12 postoperatively. RESULTS There was no significant difference among groups to first request for tramadol. The VAS score was significantly less in parecoxib group at rest compared to paracetamol group (P<0.05), but the same did not differ for pain score while coughing and movement. Patients in the parecoxib group were more satisfied regarding the postoperative pain management at 12 h postoperatively. The incidence of adverse side effects was infrequent in both the groups. CONCLUSION Postoperative nonopioid intravenous analgesia with paracetamol and parecoxib is comparable in the early postoperative period with no adverse effects.
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Affiliation(s)
- Kumkum Gupta
- Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
| | - Bhawna Rastogi
- Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
| | - Prashant K Gupta
- Department of Radio-diagnosis, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
| | - Deepak Sharma
- Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
| | - Salony Agarwal
- Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
| | - Avinash Rastogi
- Orthopaedics, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India
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Siribumrungwong K, Cheewakidakarn J, Tangtrakulwanich B, Nimmaanrat S. Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial. BMC Musculoskelet Disord 2015; 16:59. [PMID: 25886746 PMCID: PMC4369094 DOI: 10.1186/s12891-015-0522-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background Poor postoperative pain control is frequently associated with complications and delayed discharge from a hospital. Preemptive analgesia is one of the methods suggested for reducing postoperative pain. Opioids are effective for pain control, but there known addictive properties make physicians cautious about using them. Parecoxib and ketorolac are potent non-opioid NSAIDs that are attractive alternative drugs to opioids to avoid opioid-related side effects. However, there are no good head-to-head comparisons between these two drugs in the aspect of preemptive analgesic effects in lumbar spinal fusion surgery. This study aimed to compare the efficacy in terms of postoperative pain control and safety of parecoxib with ketorolac as preemptive analgesia in posterior lumbar spinal fusion patients. Methods A prospective, double-blinded randomized controlled trial was carried out in patients undergoing posterior lumbar spinal fusion, who were randomized into 3 groups (n = 32). Parecoxib, ketorolac or a placebo was given to each patient via injection around 30 minutes prior to incision. The efficacy of postoperative pain control was assessed by a verbal numerical rating score (0–10). And various postoperative things were monitored for analysis, such as total opioid consumption, complications, and estimated blood loss. Results Both the ketorolac and parecoxib groups showed significantly better early postoperative pain reduction at the postanesthesia care unit (PACU) than the control group (p < 0.05). There were no differences between the pain scores of ketorolac and parecoxib at any time points. Complications and bleeding were not significantly different between all three groups. Conclusions Preemptive analgesia using both ketorolac and parecoxib showed a significantly better early postoperative pain control in the PACU than the control group in patients undergoing lumbar spinal fusion. Trial registration ClinicalTrials.gov NCT01859585. Registered 15 May 2013.
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Affiliation(s)
- Koopong Siribumrungwong
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand.
| | - Julin Cheewakidakarn
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand.
| | - Boonsin Tangtrakulwanich
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand.
| | - Sasikaan Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkla, Hat Yai, 90110, Thailand.
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Willens JS, Bucior I, Bujanover S, Mehta N. Assessment of rescue opioid use in patients with post-bunionectomy pain treated with diclofenac potassium liquid-filled capsules. J Pain Res 2015; 8:53-62. [PMID: 25678812 PMCID: PMC4322883 DOI: 10.2147/jpr.s75234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
When used in multimodal analgesia for acute pain, nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the requirement for opioids during the perioperative period. To provide more insight into pain treatment during the outpatient period, we examined the use of opioid rescue medication (RM) and described the relationship between pain intensity and RM use in patients with acute pain after bunionectomy. Patients received placebo or 25 mg of a liquid-filled capsule version of the NSAID diclofenac potassium (DPLFC; n=188 patients/group) every 6 hours during the 48-hour inpatient period through the end of outpatient dosing on day 4. Opioid RM (hydrocodone/acetaminophen tablets, 5 mg/500 mg) was available as needed, but taken at least 1 hour post-study medication. Fewer patients taking DPLFC versus placebo requested opioid RM during the inpatient period (4.8%-44.7% versus 25.0%-90.4%) and also during the outpatient period (3.7%-16.0% versus 13.1%-46.4%). Moderate or severe pain after surgery (P=0.0307 and P=0.0002, respectively) or at second dose (P=0.0006 and P=0.0002, respectively) was predictive of RM use. Patients taking RM (placebo/DPLFC) reported more adverse events (RM 55.7%/40.6%; no RM 29.4%/26.0%). Most adverse events in the RM group were opioid-related. In summary, this study shows that DPLFC lowers the requirement for opioids, which is associated with a reduction in the occurrence of treatment side effects, while maintaining adequate analgesia for patients with moderate acute pain in both the outpatient and outpatient periods. Patients with more severe pain are more likely to use RM, but they still use fewer opioids when treated with DPLFC. This suggests that multimodal treatment using DPLFC and an opioid may offer an important clinical benefit in the treatment of acute pain, including in the home environment.
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Affiliation(s)
| | | | | | - Neel Mehta
- Weill-Cornell Pain Medicine Center, New York, NY, USA
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Bali C, Ergenoglu P, Ozmete O, Akin S, Ozyilkan NB, Cok OY, Aribogan A. Comparison of the postoperative analgesic effects of naproxen sodium and naproxen sodium-codeine phosphate for arthroscopic meniscus surgery. Braz J Anesthesiol 2014; 66:151-6. [PMID: 26952223 DOI: 10.1016/j.bjane.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to control arthroscopic pain. Addition of oral effective opioid "codeine" to NSAIDs may be more effective and decrease parenteral opioid consumption in the postoperative period. The aim of this study was to compare the efficacy and side effects of naproxen sodium and a new preparation naproxen sodium-codeine phosphate when administered preemptively for arthroscopic meniscectomy. METHODS Sixty-one patients were randomized into two groups to receive either oral naproxen sodium (Group N) or naproxen sodium-codeine phosphate (Group NC) before surgery. The surgery was carried out under general anesthesia. Intravenous meperidine was initiated by patient-controlled analgesia (PCA) for all patients. The primary outcome measure was pain score at the first postoperative hour assessed by the Visual Analogue Scale (VAS). Sedation assessed by Ramsey Sedation Scale, first demand time of PCA, postoperative meperidine consumption, side effects and hemodynamic data were also recorded. RESULTS The groups were demographically comparable. Median VAS scores both at rest and on movement were significantly lower in Group NC compared with Group N, except 18(th) hour on movement (p<0.05). The median time to the first demand of PCA was shorter in Group N compared with Group NC (p<0.001). Meperidine consumption was higher in Group N compared with Group NC (p<0.001). There was no difference between groups with respect to side effects (p>0.05). CONCLUSIONS The combination of naproxen sodium-codeine phosphate provided more effective analgesia than naproxen sodium and did not increase side effects.
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Affiliation(s)
- Cagla Bali
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
| | - Pinar Ergenoglu
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Ozlem Ozmete
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Sule Akin
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
| | | | - Oya Yalcin Cok
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
| | - Anis Aribogan
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
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Kodaka M, Tsukakoshi M, Miyao H, Tsuzaki K, Ichikawa J, Komori M. The fentanyl concentration required for immobility under propofol anesthesia is reduced by pre-treatment with flurbiprofen axetil. Can J Anaesth 2014; 60:1204-11. [PMID: 24078554 DOI: 10.1007/s12630-013-0040-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE We hypothesized that nonsteroidal anti-inflammatory drugs decrease the plasma fentanyl concentration required to produce immobility in 50% of patients in response to skin incision (Cp50incision) compared with placebo under target-controlled infusion (TCI) propofol anesthesia. METHODS Sixty-two unpremedicated patients scheduled to undergo gynecologic laparoscopy were randomly assigned to receive placebo (control group) or flurbiprofen axetil 1 mg·kg(-1) (flurbiprofen group) preoperatively. General anesthesia was induced with fentanyl and propofol, and intubation was performed after succinylcholine 1 mg·kg(-1). Propofol was administered via a target-controlled infusion (TCI) system (Diprifusor™) set at an effect-site concentration of 5 μg·mL(-1). Fentanyl was given by a TCI system using the STANPUMP software (Schafer model). The concentration for the first patient was set at 3 ng·mL(-1) and modified in each group according to the up-down method. Skin incision was performed after more than ten minutes equilibration time. Serum fentanyl concentration, bispectral index (BIS), and hemodynamic parameters were measured two minutes before and after skin incision. The Cp50incision of fentanyl was derived from the mean of the crossovers (i.e., the serum fentanyl concentrations of successive participants who responded and those who did not or vice versa). RESULTS Ten and 11 independent crossover pairs were collected in the control and flurbiprofen groups, respectively, representing 42 of 62 enrolled patients. The mean (SD) fentanyl Cp50incision was less in the flurbiprofen group [0.84 (0.63) ng·mL(-1)] than in the control group [1.65 (1.15) ng·mL(-1)]; P = 0.007; however, there were no differences in BIS, blood pressure, or heart rate, between groups. CONCLUSION Preoperative flurbiprofen axetil decreased the Cp50incision of fentanyl by 49% during propofol anesthesia without changing the BIS or hemodynamic variables.
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COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF ETORICOXIB VS PLACEBO AS PREEMPTIVE ANALGESIA FOR ACUTE POSTOPERATIVE PAIN RELIEF IN ORTHOPEDIC SURGERIES. ACTA ACUST UNITED AC 2014. [DOI: 10.14260/jemds/2014/3051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Vadivelu N, Gowda AM, Urman RD, Jolly S, Kodumudi V, Maria M, Taylor R, Pergolizzi JV. Ketorolac tromethamine - routes and clinical implications. Pain Pract 2014; 15:175-93. [PMID: 24738596 DOI: 10.1111/papr.12198] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
Opioids have long been used for analgesic purposes for a wide range of procedures. However, the binding of these drugs to opiate receptors has created various challenges to the clinician due to unfavorable side effect profiles and the potential for tolerance and abuse. In 1989, ketorolac became an approved nonsteroidal inflammatory drug (NSAID) for injectable use as an analgesic. Over the last 20 years, numerous studies have been conducted involving ketorolac. These studies have provided additional information about various routes of administration and their effect on the efficacy and the side effect profile of ketorolac. Moreover, ketorolac has been compared with several widely used analgesics. This review evaluates both the potential benefits and potential drawbacks of ketorolac generally, and specifically discusses routes of administration, including their advantages and disadvantages when compared to several traditional analgesics in both inpatient and outpatient settings.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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Sener M, Ozgur Pektas Z, Yilmaz I, Turkoz A, Uckan S, Donmez A, Arslan G. Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind studyin Turkish patients. Curr Ther Res Clin Exp 2014; 66:541-51. [PMID: 24678075 DOI: 10.1016/j.curtheres.2005.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preemptive analgesia used for postsurgical pain management has been shown to reduce the requirements of postoperative analgesics. OBJECTIVE The aim of this study was to compare the preemptive analgesic effects of diflunisal, naproxen sodium, meloxicam, acetaminophen, and rofecoxin (no longer available in some markets) in patients undergoing ambulatory dental surgery and the need for postoperative pain management in these patients. METHODS This prospective, randomized, single-blind study was conducted at the Departments of Anesthesiology and Reanimation and Oral and Maxillofacial Surgery, Baskent University, Adana Teaching and Medical Research Center, Adana, Turkey. Turkish outpatients aged ≥ 16 years with American Society of Anesthesiologists physical status 1 (ie, healthy) and scheduled to undergo surgical extraction of an impacted third molar were enrolled. Patients were randomly assigned to receive diflunisal 500 mg, naproxen sodium 550 mg, meloxicam 7.5 mg, acetaminophen 500 mg, or rofecoxib 12.5 mg. All medications were administered orally 1 hour before surgery as preemptive analgesia and after surgery if needed, up to the maximum recommended dose. Surgery was performed with the patient under local anesthesia (articaine hydrochloride). Pain intensity was assessed using a 100-mm visual analog scale (VAS) (0 = none to 100 = worst possible pain) at 2, 4, 6, and 12 hours after ambulatory surgery. The use of additional analgesics was recorded for 24 hours using patient diaries. Postoperative adverse events were recorded using the diaries. RESULTS One hundred fifty patients (108 women, 42 men; mean [SE] age, 26.8 [0.6] years; 30 patients per group) had data available for analysis. Demographic data were similar between the 5 groups. No significant differences in mean VAS scores were found between the 5 groups at any time point. All mean VAS scores indicated minor pain. The rate of additional postoperative analgesics required was significantly lower in the diflunisal group compared with groups receiving naproxen sodium, meloxicam, acetaminophen, and rofecoxib (3 [10%] patients vs 11 [37%], 15 [50%], 15 [50%], and 14 [47%] patients, respectively; all, P < 0.05). Bleeding at the surgical site was reported in 2 patients each in the diflunisal, naproxen sodium, meloxicam, and acetaminophen groups, and in 1 patient in the rofecoxib group; the between-group differences were not significant. No significant differences in the prevalences of other adverse effects (eg, nausea, vomiting, allergy, gastrointestinal symptoms) were found between the 5 treatment groups. CONCLUSIONS In the present study in patients undergoing third molar extraction, adequate preemptive analgesia, based on VAS scores, was found with all of the nonopioid analgesic agents used. Fewer patients required rescue medication with diflunisal. All 5 study drugs were similarly well tolerated.
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Affiliation(s)
- Mesut Sener
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Zafer Ozgur Pektas
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, easkent University, Ankara, Turkey
| | - Ismail Yilmaz
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, easkent University, Ankara, Turkey
| | - Ayda Turkoz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Sina Uckan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Asli Donmez
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Gulnaz Arslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey
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Sedighinejad A, Haghighi M, Naderi Nabi B, Rahimzadeh P, Mirbolook A, Mardani-Kivi M, Nekufard M, Biazar G. Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery. Anesth Pain Med 2014; 4:e11334. [PMID: 24660152 PMCID: PMC3961029 DOI: 10.5812/aapm.11334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/22/2013] [Accepted: 09/22/2013] [Indexed: 01/09/2023] Open
Abstract
Background: Postoperative analgesia is one of the concerns of anesthesiologists and patients. Systemic opioid administration is the gold standard in reducing the severe pain after the surgery but some side effects prevent the use of adequate dosage of opioids. Objectives: The aim of this study was to evaluate the result of adding magnesium sulphate to sufentanil in patient-controlled intravenous analgesia (PCIA) system. Patients and Methods: In this randomized clinical trial, 60 patients candidate for lower limb orthopedic surgery were recruited in Poursina Medical Center for six months. They were randomly classified in two group of patient-controlled intravenous analgesia for postoperative pain control, one was group S [(sufentanil) (n = 30)] and the other was group S + M [(magnesium sulphate/sufentanil) (n = 30)]. The drug infusion rate was 5 mL/h. Each mL of solution in group S contained 1 mcg of sufentanil and in group M + S, 1 mcg of sufentanil and 200 mcg magnesium sulphate, respectively. Pain score, sedation score, satisfaction score, nausea and vomiting score were evaluated 6, 12, 24, 36 and 48 hours after surgery. Results: The demographic data between two groups were not significantly different. The pain scores after 6, 12 and 24 hours in S and S + M groups were significantly different. But the comparison of Visual Analogue Scale (VAS) scores after 36 and 48 hours didn’t show significant differences (P < 0.001). Comparison of the sedation, nausea and vomiting scores between two groups did not show any difference. But the number of patient’s satisfaction in S + M group was more than S group which suggests significant differences (P < 0.05). Conclusions: This study showed that magnesium sulphate added to sufentanil through PCIA is an effective method to alleviate pain in patients undergoing lower limb orthopedic surgery. Moreover, we found fewer side effects on magnesium-sufentanil regimen in terms of in nausea, vomiting, and sedation; and patients’ satisfaction in this regimen was more rather than that in the regiment of sufentanil alone.
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Affiliation(s)
- Abass Sedighinejad
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Haghighi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author: Bahram Naderi Nabi, Guilan Pain Clinic, Guilan Building, Ansari High Way, Golbagh Namaz Blv., Rasht, Iran. Tel/Fax +98-1317731634. E-mail:
| | - Poupak Rahimzadeh
- Anesthesiology Department, Rasoul-e-Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Mirbolook
- Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohsen Mardani-Kivi
- Orthopedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Majid Nekufard
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
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81
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High frequency TENS as a complement for pain relief in postoperative transition from epidural to general analgesia after pancreatic resection. Complement Ther Clin Pract 2014; 20:5-10. [DOI: 10.1016/j.ctcp.2013.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/12/2013] [Indexed: 11/15/2022]
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Arun O, Oc B, Duman A, Yildirim S, Simsek M, Farsak B, Oc M. Endovenous Laser Ablation under General Anesthesia for Day Surgery: Feasibility and Outcomes of the 300 Patients. Ann Thorac Cardiovasc Surg 2014; 20:55-60. [DOI: 10.5761/atcs.oa.13-00222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lee SK, Lee JW, Choy WS. Is multimodal analgesia as effective as postoperative patient-controlled analgesia following upper extremity surgery? Orthop Traumatol Surg Res 2013; 99:895-901. [PMID: 24183743 DOI: 10.1016/j.otsr.2013.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/13/2013] [Accepted: 09/06/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The present prospective study compared the clinical outcomes between a multimodal analgesia group and a patient-controlled analgesia (PCA) group for postoperative pain control in upper extremities surgery. HYPOTHESIS Multimodal analgesia including pre-emptive analgesic can provide similar or superior analgesic effects and a lower incidence of adverse reactions than PCA following upper extremity surgery. PATIENTS AND METHODS Sixty-one patients undergoing upper extremity surgery were randomized to 2 perioperative analgesic groups (multimodal analgesia and PCA). We compared the clinical outcomes: use of additional pain rescue, opioid-related complication rate, and patient's satisfaction between the 2 groups. RESULTS No significant differences on the resting and exercise pain scores between the two groups. Also, there were no differences regarding additional pain rescue during postoperative day (POD) 1, 2 and achievement of rehabilitation protocol in both groups. However, use of additional pain rescue in PCA group was increased significantly after PCA removal. Moreover, there was significant difference in the incidence of opioid-related complications on operation day and at POD 1. At discharge, multimodal analgesia group showed significantly greater satisfaction than PCA group. DISCUSSION Perioperative pain management following upper extremity surgery through the multimodal analgesia could be an acceptable alternative method that can provide good results.
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Affiliation(s)
- S K Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, 1306 Dunsan-dong, Seo-gu, Daejeon 302-799, Republic of Korea.
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84
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Iorno V, Landi L, Di Pasquale R, Cicenia S, Moschini V. Comparison of intravenous ketorolac with or without paracetamol in postoperative pain control following ambulatory surgery. Curr Med Res Opin 2013; 29:1685-90. [PMID: 23998433 DOI: 10.1185/03007995.2013.835256] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this randomized, patient-blinded study was to compare efficacy and safety of oral paracetamol plus intra-venous (i.v.) ketorolac with i.v. ketorolac alone after ambulatory uterine evacuation. RESEARCH DESIGN AND METHODS Women were randomly assigned to receive either oral paracetamol (1 g), in a melt-in-the mouth, without-water formulation plus ketorolac (30 mg i.v. once daily (o.d.)) or ketorolac (30 mg i.v. o.d.) as monotherapy. The mean duration of uterine evacuation was 11 minutes in the paracetamol + ketorolac group and 13 minutes in the ketorolac-only group. Paracetamol was administered 15 minutes before surgery, on discharge from hospital (mean 6 hours after surgery) and in the morning the day after surgery, while ketorolac was administered at the end of the surgical intervention. MAIN OUTCOME MEASURES The numeric rating scale (NRS) was used by patients to rate their pain on an 11 point scale. RESULTS Overall, 60 women received paracetamol plus ketorolac (group 1) and 60 ketorolac alone (group 2). There were significant differences in pain levels (NRS 0.92 and 2.08; p < 0.01) at T0 (when patients left the operating room 30 minutes after the end of surgery). At T1 (before discharge from hospital but before the next administration of paracetamol) there were no significant differences between NRS scores in the two groups (3.7 vs. 3.5, respectively, p = 0.3453). At T2 (in the morning after surgery; data collected by phone interview), following administration of the next dose of paracetamol, significant differences in pain scores were recorded (1.58 vs. 1.98; p = 0.01). Only a case of dizziness was reported in the paracetamol + ketorolac group, and no other unexpected adverse events were recorded. CONCLUSION Despite the small sample size and the monocentric nature of the study being taken into account, this study suggests, for the first time to our knowledge, that oral paracetamol t.i.d. in combination with i.v. ketorolac o.d. is effective and well tolerated in the control of postoperative pain after ambulatory uterine evacuation.
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Affiliation(s)
- Vittorio Iorno
- U.O Anestesia and Rianimazione Pediatrica, IRCCS Fondazione Ca' Granda Ospedale Maggiore, Policlinico di Milano , Milano , Italy
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85
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Chiarello E, Bernasconi S, Gugliotta B, Giannini S. Subcutaneous injection of diclofenac for the treatment of pain following minor orthopedic surgery (DIRECT study): a randomized trial. Pain Pract 2013; 15:31-9. [PMID: 24279691 DOI: 10.1111/papr.12140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/15/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Parenteral diclofenac is frequently used for analgesia following minor orthopedic interventions. Currently available diclofenac formulations are for intramuscular (IM) or intravenous injection. A new 1 mL volume formulation of diclofenac containing hydroxypropyl-β-cyclodextrin (HPβCD) allows both SC and IM administration. The objective of this open-label, randomized, parallel group, active-controlled study was to assess the safety and efficacy of 75 mg diclofenac HPβCD, administered SC or IM, compared with IM Voltaren® 75 mg in inpatients undergoing minor orthopedic surgeries with moderate-to-severe postoperative pain. METHODS A total of 325 patients were randomized to treatment. Surgery-related pain was comparable between groups before treatment and rapidly declined in all patients following diclofenac injection. The primary endpoint was investigator-assessed local tolerability up to 18 hours postinjection (redness, swelling, and hardening at the injection site each scored on a 4-point scale where 0 = none, 1 = mild, 2 = moderate, and 3 = severe). RESULTS Local tolerability was found to be optimal for all the injected formulations, with mean overall scores (0 to 9) of 0.57, 0.31, and 0.26, for diclofenac HPβCD SC, diclofenac HPβCD IM, and Voltaren® IM, respectively. Consistently, the overall tolerability as judged by the patients and investigators was reported as good or excellent in more than 90% of cases in all groups. CONCLUSIONS Overall, the study results indicate that safety and efficacy were similar irrespective of the diclofenac formulation used; thus, the new SC diclofenac HPβCD has an acceptable tolerability profile and may be considered a valid alternative to IM-delivered diclofenac formulations.
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Affiliation(s)
- Eugenio Chiarello
- Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
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86
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Addition of ketamine to propofol-alfentanil anesthesia may reduce postoperative pain in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2013; 23:197-202. [PMID: 23579518 DOI: 10.1097/sle.0b013e3182827f09] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether intravenous anesthesia supplemented with ketamine reduces postoperative pain after elective laparoscopic cholecystectomy. MATERIALS AND METHODS Forty patients were enrolled and randomized 1:1 into one of 2 groups: the propofol group (received propofol and alfentanil supplemented with saline) and the ketamine group (received propofol and alfentanil with ketamine). The study was double-blind. The number and amount of the intraoperative additional alfentanil doses were recorded. Pain assessments and cumulative analgesic consumption at postanesthesia care unit (PACU) admission, PACU discharge, postoperative 24th hour, and hospital discharge were recorded. RESULTS The visual analog scale scores at PACU admission, PACU discharge, postoperative 24th hour, and hospital discharge were significantly lower in the ketamine group than the propofol group. The pain visual analog scale ≥ 75 at the postoperative 24th hour for the propofol group was also significantly lower (P<0.035) than that of the ketamine group. The difference in analgesic consumption between groups was statistically significant (P<0.001). CONCLUSIONS Our study showed that ketamine supplemented with propofol and alfentanil produced better analgesia intraoperatively and postoperatively and decreased analgesic consumption compared with the propofol group after laparoscopic cholecystectomy.
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87
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Mardani-Kivi M, Karimi Mobarakeh M, Haghighi M, Naderi-Nabi B, Sedighi-Nejad A, Hashemi-Motlagh K, Saheb-Ekhtiari K. Celecoxib as a pre-emptive analgesia after arthroscopic knee surgery; a triple-blinded randomized controlled trial. Arch Orthop Trauma Surg 2013; 133:1561-6. [PMID: 24043481 DOI: 10.1007/s00402-013-1852-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pre-emptive analgesia not only controls pain but also may result in the reduction of opioid consumption and related side effects following orthopedic surgeries. The purpose of the present study was to examine the therapeutic effects of celecoxib in reducing pain following the arthroscopic knee surgeries: anterior cruciate ligament (ACL) reconstruction and partial meniscectomy. MATERIALS AND METHODS In this triple-blinded, randomized, placebo-controlled clinical trial, celecoxib 400 mg and identical placebo were administered, 2 h prior to operation, to 130 patient candidates for undergoing knee arthroscopic surgery of either isolated meniscectomy or ACL reconstruction. Pain intensity, 24 h opioid consumption and the related side effects were measured at 6 and 24 h post operation. RESULTS The patients in both groups were similar with regards to demographic characteristics such as age, gender and body mass index. The results of the study indicated that the pain intensity and opioid consumption were lower in both subgroups (meniscectomy and ACL-R) in celecoxib group at 6 and 24 h post operation (P < 0.0001). The side effects of analgesics such as nausea and vomiting, sedation, and dizziness were not significantly different between the two groups (P > 0.05). CONCLUSION It seems that celecoxib as a pre-emptive analgesia agent is effective in decreasing acute postoperative pain and 24 h opioid consumption in patients undergoing arthroscopic knee surgery.
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88
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Maghsoudi R, Tabatabai M, Radfar MH, Movasagi G, Etemadian M, Shati M, Amjadi M. Opioid-sparing effect of intravenous paracetamol after percutaneous nephrolithotomy: a double-blind randomized controlled trial. J Endourol 2013; 28:23-7. [PMID: 23952097 DOI: 10.1089/end.2013.0267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS One hundred patients who underwent PCNL were randomized to paracetamol (n=50) and placebo (n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded. RESULTS The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group (P<0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively (P<0.001). CONCLUSION In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL.
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Affiliation(s)
- Robab Maghsoudi
- 1 Hasheminejad Clinical Research Development Center, Hasheminejad Kidney Center, Iran University of Medical Sciences , Tehran, Iran
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Gerstein NS, Gerstein WH, Carey MC, Kong Lam NC, Ram H, Spassil NR, Schulman PM. The thrombotic and arrhythmogenic risks of perioperative NSAIDs. J Cardiothorac Vasc Anesth 2013; 28:369-78. [PMID: 24125630 DOI: 10.1053/j.jvca.2013.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Indexed: 01/12/2023]
Affiliation(s)
| | - Wendy Hawks Gerstein
- Department of Internal Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | | | | | - Harish Ram
- Department of Anesthesiology, University of New Mexico, Albuquerque, NM
| | | | - Peter Mark Schulman
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR
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Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. J Res Pharm Pract 2013; 2:99-104. [PMID: 24991614 PMCID: PMC4076920 DOI: 10.4103/2279-042x.122370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Any operation leads to body stress and tissue injury that causes pain and its complications. Glucocorticoids such as Dexamethasone are strong anti-inflammatory agents, which can be used for a short time post-operative pain control in various surgeries. Main purpose of this study is to evaluate the effect of administration of intravenous (IV) Dexamethasone on reducing the pain after cesarean. METHODS A double-blind prospective randomized clinical trial was performed on 60 patients candidate for elective caesarean section. Patients were randomly assigned into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were recorded in different time points during first 24 h after operation. Statistical methods using repeated measure analysis of variances and t-test, Mann-Whitney and Chi-square tests were used for analyzing data. FINDINGS The results indicated that within-group comparisons including severity of pain, MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study period. Between group comparisons indicated significant differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in case group were lower than the control group. CONCLUSION IV Dexamethasone could efficiently reduce post-operative pain severity and the need for analgesic consumption and improve vital signs after cesarean section.
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Affiliation(s)
- Azar Danesh Shahraki
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan
| | - Mitra Jabalameli
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan
| | - Shadi Nouri
- School of Medicine, Isfahan University of Medical Sciences, Isfahan
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91
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Comparison of continuous local anaesthetic and systemic pain treatment after axillary lymphadenectomy in breast carcinoma patients - a prospective randomized study. Radiol Oncol 2013; 47:145-53. [PMID: 23801911 PMCID: PMC3691083 DOI: 10.2478/raon-2013-0018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 12/22/2012] [Indexed: 11/20/2022] Open
Abstract
Background Acute pain after axillary lymphadenectomy is often related mainly to axillary surgery. The aim of the prospective randomized study was to find out if continuous wound infusion of local anaesthetic reduces postoperative pain, consumption of opioids and the incidence of chronic pain compared to the standard intravenous piritramide analgesia after axillary lymphadenectomy in breast carcinoma patients. Methods Altogether 60 patients were enrolled in the prospective randomized study; half in wound infusion of local anaesthetic and half in the standard (piritramide) group. Results In the recovery room and on the first day after surgical procedure, the wound infusion of local anaesthetic group reported less acute and chronic pain, a lower consumption of piritramide and metoclopramide, but their alertness after the surgical procedure was higher compared to the standard group. Conclusions After axillary lymphadenectomy in breast carcinoma patients, wound infusion of local anaesthetic reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and a reduced need for antiemetic drugs. After wound infusion of local anaesthetic there is a statistical trend for reduction of chronic pain.
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92
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Leese PT, Recker DP, Kent JD. The COX-2 Selective Inhibitor, Valdecoxib, Does Not Impair Platelet Function in the Elderly: Results of a Randomized Controlled Trial. J Clin Pharmacol 2013. [DOI: 10.1177/0091270003252234] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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He A, Hersh EV. A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level. Curr Med Res Opin 2012; 28:1873-80. [PMID: 23098098 DOI: 10.1185/03007995.2012.744302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An intranasal (IN) formulation of ketorolac was recently FDA approved in adult patients for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level. SCOPE The aim of this paper is to provide an overview of the clinical pharmacology, pharmacokinetics, efficacy, and tolerability of IN ketorolac. Databases used for this literature search include PubMed, International Pharmaceutical Abstracts, Cochrane Library and ClinicalTrials.gov from January 1980 to January 2012. All primary papers on IN ketorolac were eligible, including pharmacologic, pharmacokinetic, clinical, outcomes, and meta-analyses. The approved product labeling was a source of information, as well as the bibliographies of published articles which were reviewed for additional pertinent literature. FINDINGS The search yielded six relevant studies all of which were selected for this review and included efficacy and safety trials, one pharmacokinetics study, and one preclinical study. IN ketorolac is a non-steroidal inflammatory drug that exhibits its effect mainly by inhibiting cyclo-oxygenase (COX) 1 and 2 with high affinity for COX-1. Absorption of IN ketorolac displays a median t(max) of 0.50-0.75 hours and has a t(½) of approximately 5-6 hours. Primary analyses included evaluation of morphine use and summed pain intensity difference (SPID) which was assessed using a visual analog scale. In one of the two phase III studies, the mean SPID6 score was 83.3 in the IN ketorolac group versus 37.2 in the placebo group, p = 0.007. In another phase III study, the mean SPID6 score was 117.4 in the IN ketorolac group versus 89.9 in the placebo group, p = 0.032. IN ketorolac was well-tolerated with most adverse events associated with the route of administration. CONCLUSION Based on the clinical trials reviewed, IN ketorolac was associated with significant pain reduction in patients with various post-operative procedures, with good tolerability.
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Affiliation(s)
- Andy He
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
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94
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Preemptive use of diclofenac in combination with ketamine in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Laparosc Endosc Percutan Tech 2012; 22:232-8. [PMID: 22678319 DOI: 10.1097/sle.0b013e31824f8ae4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To examine the combined preemptive effects of low-dose ketamine, diclofenac, and their combination on postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS A total of 80 consecutive patients, American Society of Anesthesiologists physical status I or II, were recruited to the study. Patients were randomized to one of the following groups: group 1 received 100-mL isotonic saline intravenously (i.v.) 20 minutes before the induction of anesthesia and 5-mL isotonic saline i.v. before skin incision as a placebo; group 2 received 100-mL isotonic saline i.v. 20 minutes before the induction of anesthesia and 0.15-mg/kg ketamine diluted in 5-mL isotonic saline i.v. before skin incision; group 3 received diclofenac 1 mg/kg diluted in 100-mL isotonic saline i.v. 20 minutes before the induction of anesthesia and 5-mL isotonic saline i.v. before skin incision; and group 4 received a combination of the same diclofenac sodium and ketamine doses at the same time. Abdominal and shoulder pain intensity was assessed using the visual analog scale and verbal rating scale during 24 hours postoperatively. RESULTS Patients receiving diclofenac had a significantly lower pain score between 2 and 6 hours after surgery compared with patients receiving placebo. One hour after surgery, patients receiving a combination of diclofenac and ketamine had a significantly lower pain score compared with patients receiving placebo and ketamine alone. Patients from all the 4 study groups required postoperative analgesic; however, the time to diclofenac sodium request was longer in patients receiving a combination of diclofenac and ketamine compared with patients receiving placebo (p<0.001), ketamine (p<0.001), or diclofenac (p=0.03) alone. CONCLUSIONS The preemptive administration of a combination of low-dose ketamine plus diclofenac sodium improved postoperative analgesia after laparoscopic cholecystectomy, whereas ketamine at a dose of 0.15 mg/kg did not elicit a preemptive analgesic effect.
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Ogboli-Nwasor E, Sule ST, Yusufu LM. Pattern of postoperative pain management among adult surgical patients in a low-resource setting. J Pain Res 2012; 5:117-20. [PMID: 22791999 PMCID: PMC3392713 DOI: 10.2147/jpr.s28198] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria). Methods Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package. Results One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7%) of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%). Intermittent intramuscular injections of opioids/opiates were prescribed for 126 patients (91.3%), while nine patients (6.5%) received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%), while three patients (2.1%) received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%), and 90 patients (65.2%) had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%]), than males (42 patients [29.7%]) suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients), dry mouth (21.7%), vomiting (13.0%), and urinary retention (6.5%), with 32.6% of patients experiencing no side effects. The three patients who received no analgesics experienced vomiting as a side effect. Despite the high incidence of pain and other side effects, 108 patients (78.2%) still reported that the methods of postoperative pain management were satisfactory. Conclusion Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.
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Rago R, Forfori F, Materazzi G, Abramo A, Collareta M, Miccoli P, Giunta F. Evaluation of a Preoperative Pain Score in Response to Pressure as a Marker of Postoperative Pain and Drugs Consumption in Surgical Thyroidectomy. Clin J Pain 2012; 28:382-6. [DOI: 10.1097/ajp.0b013e3182326495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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97
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Choi SJ, Kim MH, Jeong HY, Lee JJ. Effect of intraoperative lidocaine on anesthetic consumption, and bowel function, pain intensity, analgesic consumption and hospital stay after breast surgery. Korean J Anesthesiol 2012; 62:429-34. [PMID: 22679539 PMCID: PMC3366309 DOI: 10.4097/kjae.2012.62.5.429] [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: 08/25/2011] [Revised: 09/30/2011] [Accepted: 10/11/2011] [Indexed: 12/11/2022] Open
Abstract
Background Perioperative lidocaine infusion improves postoperative outcomes, mostly after abdominal and urologic surgeries. Knowledge of the effect of lidocaine on peripheral surgeries is limited. Presently, we investigated whether intraoperative lidocaine infusion reduced anesthetic consumption, duration of ileus, pain intensity, analgesic consumption and hospital stay after breast plastic surgeries. Methods Sixty female patients, aged 20-60 years, enrolled in this prospective study were randomly and equally divided to two groups. One group (n = 30) received a 1.5 mg/kg bolus of lidocaine approximately 30 min before incision followed by continuous infusion of lidocaine (1.5 mg/kg/h) until skin closure (lidocaine group). The other group (n = 30) was untreated (control group). Balanced inhalation (sevoflurane) anesthesia and multimodal postoperative analgesia were standardized. End tidal sevoflurane concentration during surgery, time to the first flatus and defecation, visual analog pain scale (0-10), analgesic consumption and associated side effects at 24, 48, and 72 h after surgery, hospital stay, and patient's general satisfaction were assessed. Results Compared to the control group, intraoperative lidocaine infusion reduced by 5% the amount of sevoflurane required at similar bispectral index (P = 0.014). However, there were no significant effects of lidocaine regarding the return of bowel function, postoperative pain intensity, analgesic sparing and side effects at all time points, hospital stay, and level of patient's satisfaction for pain control. Conclusions Low dose intraoperative lidocaine infusion offered no beneficial effects on return of bowel function, opioid sparing, pain intensity and hospital stay after various breast plastic surgeries.
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Affiliation(s)
- Soo Joo Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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White PF, White LM, Monk T, Jakobsson J, Raeder J, Mulroy MF, Bertini L, Torri G, Solca M, Pittoni G, Bettelli G. Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg 2012; 114:1190-215. [PMID: 22467899 DOI: 10.1213/ane.0b013e31824f19b8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.
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Affiliation(s)
- Paul F White
- Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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The Pharmacokinetics and Pharmacodynamics of Liposome Bupivacaine Administered Via a Single Epidural Injection to Healthy Volunteers. Reg Anesth Pain Med 2012; 37:616-22. [DOI: 10.1097/aap.0b013e318269d29e] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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100
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Anesthesia and Pain Relief for Procedures Performed to Manage Urolithiasis. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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