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Batko I, Kościelniak-Merak B, Tomasik PJ, Kobylarz K, Wordliczek J. Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study. Pharmacol Rep 2020; 72:744-755. [PMID: 32297162 PMCID: PMC7329801 DOI: 10.1007/s43440-020-00100-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
Background Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery. Materials and methods Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients. Measurements: morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey). Results Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery. Conclusions Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.
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Affiliation(s)
- Ilona Batko
- Department of Anesthesiology and Intensive Care, University Children's Hospital, 265 Wielicka St, 30-663, Cracow, Poland.
| | - Barbara Kościelniak-Merak
- Department of Clinical Biochemistry, University Children's Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Przemysław J Tomasik
- Department of Clinical Biochemistry, University Children's Hospital, Jagiellonian University Medical College, Cracow, Poland
| | - Krzysztof Kobylarz
- Department of Anesthesiology and Intensive Care, University Children's Hospital, 265 Wielicka St, 30-663, Cracow, Poland.,Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland
| | - Jerzy Wordliczek
- Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland.,Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Cracow, Poland
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Decreasing Opioid Prescriptions in Women Undergoing Mastectomy and Breast Reconstruction. Pain Manag Nurs 2020; 21:339-344. [PMID: 32280011 DOI: 10.1016/j.pmn.2020.02.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Florida enacted legislation limiting opioid prescriptions and affecting the management of acute pain in the postoperative patient. Patients in a reconstructive surgery practice were receiving prescriptions for opioids as their primary method of pain management. Clinic providers identified a need to limit opioid prescriptions. AIM The aim of this quality improvement initiative was to decrease the number of opioids prescribed while effectively managing pain in women undergoing mastectomy and breast tissue expander placement. DESIGN This is a quality improvement project. METHODS The Model for Improvement was used as a framework for this project. An evidence-based pain management plan was developed after a review of the breast reconstruction surgery literature. The plan incorporated preoperative patient and family education and the standard use of preemptive analgesia, intraoperative nerve blocks, and postoperative multimodal analgesia in all patients undergoing mastectomy with breast tissue expander placement. Patient and family education and perioperative pain management were provided to patients, and the number of opioid tablets prescribed was tracked. RESULTS Between January 2018 and August 2019, the average number of opioid tablets prescribed per patient decreased from 84.7 to 8.4. CONCLUSIONS Opioid prescriptions can be decreased in women undergoing breast reconstruction with the use of patient education and multimodal analgesia.
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Shin HJ, Do SH, Lee JS, Kim TK, Na HS. Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial. Anesth Analg 2019; 129:1512-1518. [PMID: 31743170 DOI: 10.1213/ane.0000000000003315] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol. METHODS Forty-eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1-0.5 μg·kg·hour, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5-2.0 μg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified observer's assessment of alertness/sedation score of 3 or 4. The cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia were recorded at 24 and 48 hours postoperatively (primary outcome). The postoperative numerical rating scale for pain was assessed at 6, 12, 24, and 48 hours (secondary outcome). The postoperative use of additional rescue analgesic (ketoprofen) and antiemetic drugs was also compared between the 2 groups at 24 and 48 hours. RESULTS Dexmedetomidine significantly reduced postoperative fentanyl consumption (median [interquartile range]) during 0-24 hours (45 [30-71] vs 150 [49-248] μg, P = .004; median difference = -105 μg [99.98% CI, 210-7.5]), 24-48 hours (90 [45-143] vs 188 [75-266] μg, P = .005; median difference = -98 μg [99.98% CI, 195-45]), and 0-48 hours (135 [68-195] vs 360 [146-480] μg, P = .003; median difference = -225 μg [99.98% CI, 405-7.5]). The numerical rating scale (median [interquartile range]) was lower at 6 hours (1 [0-2] vs 2 [1-3], P = .003), 12 hours (1 [1-2] vs 3 [2-3], P < .001), 24 hours (1 [1-2] vs 3 [2-3], P < .001), and 48 hours (2 [2-3] vs 3 [3-4], P < .001) after surgery in the dexmedetomidine group compared to the propofol group. No significant intergroup differences were observed in the amount of rescue analgesics and antiemetics at 24 hours (P = .155 and P = .482) and 48 hours (P = .082 and P = .153) after surgery. CONCLUSIONS Intraoperative dexmedetomidine sedation was associated with a small but clinically important reduction in postoperative opioid use after total knee arthroplasty.
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MESH Headings
- Acute Pain/diagnosis
- Acute Pain/etiology
- Acute Pain/prevention & control
- Adrenergic alpha-2 Receptor Agonists/administration & dosage
- Adrenergic alpha-2 Receptor Agonists/adverse effects
- Adult
- Aged
- Aged, 80 and over
- Analgesia, Patient-Controlled
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/adverse effects
- Analgesics, Opioid/administration & dosage
- Anesthesia, Spinal/adverse effects
- Anesthetics, Intravenous/administration & dosage
- Anesthetics, Intravenous/adverse effects
- Arthroplasty, Replacement, Knee/adverse effects
- Dexmedetomidine/administration & dosage
- Dexmedetomidine/adverse effects
- Female
- Fentanyl/administration & dosage
- Humans
- Hypnotics and Sedatives/administration & dosage
- Hypnotics and Sedatives/adverse effects
- Male
- Middle Aged
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Propofol/administration & dosage
- Propofol/adverse effects
- Republic of Korea
- Time Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Sang-Hwan Do
- From the Department of Anesthesiology and Pain Medicine
| | - Jae-Sung Lee
- From the Department of Anesthesiology and Pain Medicine
| | - Tae-Kyun Kim
- Joint Reconstruction Center, Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Hyo-Seok Na
- From the Department of Anesthesiology and Pain Medicine
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Ioffe O, Stetsenko O, Kryvopustov M, Tarasiuk T, Tsiura Y. Using the principles of multimodal analgesia as a component of Fast-Track surgery in practice. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v4i3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aim. To evaluate the effectiveness of reducing postoperative pain in the first days after surgery in accelerating postoperative recovery of patients and reducing the length of stay in hospital.
Materials and methods. In the period from September 2011 to May 2019 we performed 569 scheduled surgeries using the Fasttrack surgery principles, including MMA. Depending on the type of surgery, we defined VAS pain impulses indicators and the average stay in hospital.
Results. Analyzing the impulses of pain after laparoscopic cholecystectomy in the first postoperative day (POD) VAS level was 2.87 ± 0.74, the second POD – 2.01 ± 0.50 (p < 0.001). The average hospital stay was 1.72 days. In laparoscopic hernioplasty, the results of the study of the level of pain according to VAS were as follows: the first POD – 3.44 ± 0.67, the second POD – 2.06 ± 0.51 (p < 0.001). The average hospital stay was 1.43 days after surgery. Analyzing laparoscopic bariatric interventions and interventions on the large intestine the first POD level according to VAS was 4.24 ± 0.75 and 4.39 ± 0.84 respectively; the second POD – 3.48 ± 0.57 and 3.48 ± 0.77, the third POD – 2.79 ± 0.67 and 2.84 ± 0.69. When comparing the first and second PODs after bariatric interventions, the level of pain impulsion decreased to 3.48 ± 0.57 (p < 0.001), and to the third POD – to 2.79 ± 0.67 (p < 0.001). A similar tendency was observed after laparoscopic interventions on the large intestine: the second POD – the level of pain impulsion decreased 3.48 ± 0.77 (p < 0.001), the third POD – 2.84 ± 0.69 (p < 0.001). The average hospital stay was 4.99 ± 0.45 and 4.10 ± 0.60, respectively.
Conclusions. The effectiveness of reducing postoperative pain in the first days after surgery directly affects the rate of recovery of the patient and the length of stay in hospital.
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The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain After Lumbar Fusion Surgery: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2019; 44:1333-1338. [PMID: 31095117 DOI: 10.1097/brs.0000000000003096] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery. OBJECTIVE Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery. SUMMARY OF BACKGROUND DATA Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied. METHODS Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected. RESULTS In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R. CONCLUSION The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects. LEVEL OF EVIDENCE 2.
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An Y, Zhao L, Wang T, Huang J, Xiao W, Wang P, Li L, Li Z, Chen X. Preemptive oxycodone is superior to equal dose of sufentanil to reduce visceral pain and inflammatory markers after surgery: a randomized controlled trail. BMC Anesthesiol 2019; 19:96. [PMID: 31185942 PMCID: PMC6560747 DOI: 10.1186/s12871-019-0775-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/31/2019] [Indexed: 01/27/2023] Open
Abstract
Background Postoperative visceral pain is common after surgery and previous studies have demonstrated that oxycodone is an effective treatment. In this study, we compared the effects of preemptive oxycodone to equal dose of sufentanil on postoperative pain and serum level of inflammatory factors (TNF-α, IL-6, IL-10) after laparoscopic cholecystectomy. Methods Forty patients undergoing laparoscopic cholecystectomy were randomized into preemptive oxycodone group or preemptive sufentanil group. Patients were given either oxycodone 0.1 mg/kg (oxycodone group, n = 20) or sufentanil 0.1 μg/kg (sufentanil group, n = 20) for preemptive analgesia. We evaluated pain/sedation scores at 0 h, 0.5 h, 2 h, 4 h, 6 h, 8 h and 24 h after surgery and measured serum concentrations of TNF-α, IL-6 and IL-10 before surgery and at 0 h, 6 h and 24 h after surgery. Results Twenty patients were recruited in each group. Numerical rating scale (NRS) of visceral pain in the oxycodone group at 2 h when resting (0.5(0,2.75) vs 3(2,4), P = 0.008) and moving (0.5(0,3) vs 3(2.25,4), P = 0.015) and 4 h when moving (2(0,3) vs 3(0,4.75), P = 0.043) after surgery were significantly lower than the sufentanil group. Serum concentrations of TNF-α at 6 h (38.68 ± 10.49 vs 73.02 ± 16.27, P<0.001) and 24 h (43.12 ± 8.40 vs 74.00 ± 21.30, P<0.001) in the oxycodone group were lower than the sufentanil group. Conclusions Preemptive oxycodone 0.1 mg/kg administration could effectively suppress visceral pain at 2 h and 4 h after surgery and had lower inflammatory marker, serum TNF-α, level when compared to equal dose of sufentanil. Trial registration Clinical trials registration number: ChiCTR-IOR-17013738http://www.chictr.org.cn/showproj.aspx?proj=17346. Date of registration: 6th December 2017.
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Affiliation(s)
- Yi An
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lei Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China.
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology, Jewish Hospital and Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Wei Xiao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Ping Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lixia Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Zhongjia Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Xiaoxu Chen
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
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Stokes SM, Wakeam E, Antonoff MB, Backhus LM, Meguid RA, Odell D, Varghese TK. Optimizing health before elective thoracic surgery: systematic review of modifiable risk factors and opportunities for health services research. J Thorac Dis 2019; 11:S537-S554. [PMID: 31032072 PMCID: PMC6465421 DOI: 10.21037/jtd.2019.01.06] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/31/2018] [Indexed: 12/20/2022]
Abstract
Despite progress in many different domains of surgical care, we are still striving toward practices which will consistently lead to the best care for an increasingly complex surgical population. Thoracic surgical patients, as a group, have multiple medical co-morbidities and are at increased risk for developing complications after surgical intervention. Our healthcare systems have been focused on treating complications as they occur in the hopes of minimizing their impact, as well as aiding in recovery. In recent years there has emerged a body of evidence outlining opportunities to optimize patients and likely prevent or decrease the impact of many complications. The purpose of this review article is to summarize four major domains-optimal pain control, nutritional status, functional fitness, and smoking cessation-all of which can have a substantial impact on the thoracic surgical patient's course in the hospital-as well as to describe opportunities for improvement, and areas for future research efforts.
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Affiliation(s)
- Sean M. Stokes
- Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Elliot Wakeam
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson, Cancer Center, Houston, TX, USA
| | - Leah M. Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO, USA
| | - David Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Thomas K. Varghese
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Abstract
Lack of physician familiarity with alternative pain control strategies is a major reason why opioids remain the most commonly used first-line treatment for pain after surgery. This is perhaps most problematic in abdominal wall reconstruction, where opioids may delay ambulation and return of bowel function, while negatively affecting mental status. In this article, we discuss multimodal strategies for optimal pain control in abdominal wall reconstruction. These strategies are straightforward and are proven to improve pain control while minimizing opioid-associated side effects.
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Groppetti D, Di Cesare F, Pecile A, Cagnardi P, Merlanti R, D'Urso ES, Gioeni D, Boracchi P, Ravasio G. Maternal and neonatal wellbeing during elective C-section induced with a combination of propofol and dexmedetomidine: How effective is the placental barrier in dogs? Theriogenology 2019; 129:90-98. [PMID: 30826722 DOI: 10.1016/j.theriogenology.2019.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 01/05/2023]
Abstract
Anaesthetics administered during C-section (CS) can cross the placenta and the foetal blood-brain barrier contributing to distress up to neonatal mortality. Therefore, to prevent neonatal risks, sedatives and analgesics are not commonly administered to the bitch until all pups are delivered. This study aims to evaluate the effect of a new anaesthetic and analgesic protocol for elective CS in dogs, focused on both maternal and neonatal wellbeing. General anaesthesia was induced by a combination of propofol (PPF) and dexmedetomidine (DEX) and maintained with isoflurane. DEX was added to PPF in order to provide analgesia and to reduce PPF dose. Propofol and DEX concentrations in maternal blood, amniotic fluid, and placenta were correlated to maternal and neonatal parameters. Maternal pain score was assessed with Glasgow Composite Measure Pain Scale short-form. Nine healthy purebred dogs scheduled for elective CS delivered 54 pups. The 77.8% of pups were vigorous at birth and assigned to the highest Apgar score (AS). The lowest AS was recorded in pups from mothers receiving additional doses of PPF (p < 0.001). Apgar scores improved with the increase in time between induction and pups' extraction, starting from 30 min after induction (p < 0.01). This study could contribute to clarify the controversy about the optimal extraction's time of pups after induction i.e. the best time between PPF administration and birth. No bitch showed post-operative pain or required additional analgesic doses based on their pain score. Maternal blood PPF and DEX, as well as placental PPF concentrations, decreased over time (p < 0.01). Conversely, placental DEX was fair uniformly detected in littermate pups. Both PPF and DEX were not detectable in amniotic fluid. Placenta resulted an effective barrier against foetal DEX exposure, making this protocol safe, analgesic and advisable for elective CS in dogs.
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Affiliation(s)
- Debora Groppetti
- Department of Veterinary Medicine, Università degli Studi di Milano, via Celoria 10, 20133, Milan, Italy.
| | - Federica Di Cesare
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Via Celoria 10, 20133, Milan, Italy
| | - Alessandro Pecile
- Department of Veterinary Medicine, Università degli Studi di Milano, via Celoria 10, 20133, Milan, Italy
| | - Petra Cagnardi
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Via Celoria 10, 20133, Milan, Italy
| | - Roberta Merlanti
- Department of Comparative Biomedicine and Food Science, Università degli Studi di Padova, Viale dell'Università 16, 35020, Legnaro, Padova, Italy
| | - Elisa S D'Urso
- Department of Veterinary Medicine, Università degli Studi di Milano, via Celoria 10, 20133, Milan, Italy
| | - Daniela Gioeni
- Department of Veterinary Medicine, Università degli Studi di Milano, via Celoria 10, 20133, Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health, Università; degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - Giuliano Ravasio
- Department of Veterinary Medicine, Università degli Studi di Milano, via Celoria 10, 20133, Milan, Italy
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Qiao XF, Jia WD, Li YQ, Lv JG, Zhou H. Effectiveness of Parecoxib Sodium Combined with Transversus Abdominis Plane Block for Pain Management After Hepatectomy for Hepatocellular Carcinoma: A Prospective Controlled Study. Med Sci Monit 2019; 25:1053-1060. [PMID: 30730866 PMCID: PMC6375540 DOI: 10.12659/msm.912843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effectiveness of perioperative parecoxib sodium combined with transversus abdominis plane (TAP) block on postoperative pain management following hepatectomy in patients with hepatocellular carcinoma (HCC). MATERIAL AND METHODS One hundred patients with HCC who underwent hepatectomy were randomized into a study group (n=51) and a control group (n=49). The study group received 40 mg of parecoxib sodium 30 minutes before anesthetic induction, and 150 mg of 0.375% ropivacaine with 5 mg dexamethasone as TAP inhibitors, before closing the abdominal incision. The control group received 40 mg of placebo 30 minutes before anesthetic induction, without TAP block. Postoperatively, all patients received patient-controlled intravenous analgesia (PCIA) and evaluation with subjective visual analog scale (VAS) pain scores. Data on adverse events, postoperative ambulation (>6 hours/day), time of flatus and defecation, and hospitalization duration were recorded. RESULTS Pain scores of the study group were significantly lower compared with the control group on the first three postoperative days. No significant differences were found between the two groups in terms of adverse events. In the study group, the number of cases of postoperative ambulation was significantly more than the control group. The onset of flatus and defecation and duration of hospital stay in the study group were significantly shorter in the study group compared with the control group. CONCLUSIONS Parecoxib sodium combined with TAP block effectively reduced postoperative pain, improved ambulation, improved gastrointestinal function, and shortened hospitalization time following hepatectomy in patients with HCC without adverse effects.
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Affiliation(s)
- Xiao-Fei Qiao
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Wei-Dong Jia
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Yue-Qing Li
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Jian-Guo Lv
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
| | - Hong Zhou
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, P.R. China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, P.R. China
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Nguyen THC, Lombana NF, Zavlin D, Moliver CL. Transition to Nonopioid Analgesia Does Not Impair Pain Control After Major Aesthetic Plastic Surgery. Aesthet Surg J 2018; 38:1139-1144. [PMID: 29608639 DOI: 10.1093/asj/sjy050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Multimodal analgesic protocols are increasingly favored over traditional opioid regimens due to decreased adverse side effects and reduced opioid consumption. Concomitant use of selective cyclooxygenase (COX)-2 inhibitor celecoxib and anticonvulsant gabapentin have been proposed to adequately control acute postoperative pain. OBJECTIVES To determine efficacy of postoperative pain control using nonopioid pain regimen vs traditional opioids for all aesthetic plastic surgery procedures. METHODS A retrospective chart review was performed on 462 consecutive outpatient plastic surgery procedures by a single surgeon between November 2015 and July 2017. Procedures in the historical control group (n = 275) received traditional postoperative narcotic, hydrocodone-acetaminophen. Patients in the more recent nonopioid study group (n = 187) received a pre-, peri-, and postoperative regimen of celecoxib and gabapentin. RESULTS Similar demographic characteristics between the control and study groups were observed: mean age, 39.7 vs 39.5 years; BMI, 24.6 vs 24.4 kg/m2; and ratio of female patients 92.7% vs 92.4%. A significant reduction in rescue analgesia (meperidine 44.6% vs 14.9%, P < 0.001) and antiemetic use (ondansetron 24.2% vs 16.3%, P < 0.05; promethazine 17.0% vs 4.7%, P < 0.001) in postanesthesia recovery unit (PACU) was noted in the nonopioid group compared to the control. The average stay in PACU also decreased in the study group (82 ± 39 min vs 70 ± 22 min, P < 0.001). Both groups reported low numbers of adverse events and need for additional pain prescriptions. These findings were reproducible in the breast subgroup. CONCLUSIONS This nonopioid regimen is as effective as traditional opioid use for acute postoperative pain control and decreased recovery time for outpatient aesthetic plastic breast surgeries. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Thu-Hoai C Nguyen
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Nicholas F Lombana
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Clayton L Moliver
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, TX
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Abstract
Osteoarthritis (OA) is the most common articular disease. The condition results in bone-on-bone contact, stiffness, pain, and decreased mobility. By the year 2050, 40 million individuals will be severely disabled because of OA, and there will be over 130 million individuals suffering from OA worldwide.
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Affiliation(s)
- Scott J Saccomano
- Scott J. Saccomano is an assistant professor at the University of North Carolina, Wilmington College of Health and Human Services School of Nursing, Wilmington, N.C
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Role of Multimodal Analgesia in the Evolving Enhanced Recovery after Surgery Pathways. ACTA ACUST UNITED AC 2018; 54:medicina54020020. [PMID: 30344251 PMCID: PMC6037254 DOI: 10.3390/medicina54020020] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Abstract
Enhanced recovery after surgery (ERAS) are specially designed multimodal perioperative care pathways which are intended to attain and improve rapid recovery after surgical interventions by supporting preoperative organ function and attenuating the stress response caused by surgical trauma, allowing patients to get back to normal activities as soon as possible. Evidence-based protocols are prepared and published to implement the conception of ERAS. Although they vary amongst health care institutions, the main three elements (preoperative, perioperative, and postoperative components) remain the cornerstones. Postoperative pain influences the quality and length of the postoperative recovery period, and later, the quality of life. Therefore, the optimal postoperative pain management (PPM) applying multimodal analgesia (MA) is one of the most important components of ERAS. The main purpose of this article is to discuss the concept of MA in PPM, particularly reviewing the use of opioid-sparing measures such as paracetamol, nonsteroid anti-inflammatory drugs (NSAIDs), other adjuvants, and regional techniques.
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Cardinale JP, Gilly G. Opiate-Free Tricuspid Valve Replacement: Case Report. Semin Cardiothorac Vasc Anesth 2018; 22:407-413. [PMID: 29676223 DOI: 10.1177/1089253218771342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The utility of opioid pain medications for perioperative analgesia is well described. However, opioids have many dangerous side effects including respiratory depression, acute tolerance, hyperalgesia, and chronic opioid dependence. Multimodal approaches continue to be used in more invasive and complex surgical procedures for enhanced recovery and decreased postoperative complications from opioid administration. The current case report centers on a 30-year-old male recovering from opioid addiction presenting with severe tricuspid regurgitation scheduled to undergo a tricuspid valve replacement. The patient requested an opioid-free procedure, and a multimodal plan was developed for intraoperative and postprocedure management. This case represents a completely opioid-free valve replacement surgery and recovery.
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Moro ET, Bloomstone JA, Navarro LHC. Response letter (Dr. Mion's Letter to the Editor). Acta Anaesthesiol Scand 2017; 61:1379-1380. [PMID: 28921492 DOI: 10.1111/aas.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. T. Moro
- Department of Surgery; School of Medical and Health Sciences; Pontifical Catholic; University of São Paulo; São Paulo Brazil
| | - J. A. Bloomstone
- Department of Anesthesiology and Perioperative Medicine; Arizona State University; Glendale AZ USA
| | - L. H. C. Navarro
- Department of Anesthesiology; Botucatu Medical School; São Paulo State University, UNESP; São Paulo Brazil
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Transversus Abdominis Plane Blocks with Single-Dose Liposomal Bupivacaine in Conjunction with a Nonnarcotic Pain Regimen Help Reduce Length of Stay following Abdominally Based Microsurgical Breast Reconstruction. Plast Reconstr Surg 2017; 140:240-251. [DOI: 10.1097/prs.0000000000003508] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pain Management in Abdominal Wall Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1400. [PMID: 28740797 PMCID: PMC5505858 DOI: 10.1097/gox.0000000000001400] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/09/2017] [Indexed: 01/31/2023]
Abstract
Background: In abdominal wall reconstruction, adequate pain control and minimization of narcotic consumption are essential to improving patient outcomes and satisfaction. Previous studies have examined the role of individual strategies, such as neuraxial analgesia and multimodal analgesia. However, there has not been a study that examined all potential determinants of postoperative narcotic requirements, including intraoperative strategies. Methods: Consecutive patients who underwent abdominal wall reconstruction were reviewed. Preoperative factors (chronic preoperative narcotic usage, indication for abdominal wall reconstruction, administration of neuraxial analgesia), intraoperative factors (intraoperative narcotics administered, method of mesh fixation), and postoperative factors (multimodal analgesia, complications) were collected. The main outcomes were daily amount of opioids used and length of hospital stay. Results: Ninety-three patients were included in the study. Patients who had an epidural required lower doses of opioids postoperatively, while those on chronic preoperative opioids, those whose mesh was fixated using transfascial sutures, and those who received large doses of opioids intraoperatively required higher doses of postoperative opioids. Hospital length of stay was longer in patients who received transfascially sutured mesh and those on chronic opioids preoperatively. Conclusions: This study provides potential strategies to improve pain control and minimize narcotic consumption postoperatively in patients undergoing abdominal wall reconstruction. Intraoperative administration of opioids should be minimized to avoid the development of tolerance. Epidural analgesia reduces postoperative narcotic requirement and may be especially beneficial in patients at highest risk for postoperative pain, including those on chronic opioids, and those in whom transfascial sutures are used for mesh fixation.
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Likar R, Jaksch W, Aigmüller T, Brunner M, Cohnert T, Dieber J, Eisner W, Geyrhofer S, Grögl G, Herbst F, Hetterle R, Javorsky F, Kress HG, Kwasny O, Madersbacher S, Mächler H, Mittermair R, Osterbrink J, Stöckl B, Sulzbacher M, Taxer B, Todoroff B, Tuchmann A, Wicker A, Sandner-Kiesling A. Interdisziplinäres Positionspapier „Perioperatives Schmerzmanagement“. Schmerz 2017; 31:463-482. [DOI: 10.1007/s00482-017-0217-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cabedo N, Valero R, Alcón A, Gomar C. Prevalence and characterization of postoperative pain in the Postanaesthesia Care Unit. ACTA ACUST UNITED AC 2017; 64:375-383. [PMID: 28363327 DOI: 10.1016/j.redar.2016.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Immediate postoperative pain occurs initially after surgery, while the patient is in the Post-Anaesthesia Recovery Unit. Very few studies assess this pain in this most immediate phase. OBJECTIVE Cross-sectional study of the prevalence and characteristics of immediate postoperative pain in patients after surgery. MATERIAL AND METHODS Between August 2014 and February 2015, a sample of 503 patients from the Post-Anaesthesia Recovery Unit was followed. Immediate postoperative pain was assessed (by the patient and the researcher) using the visual analogue scale (VAS; range 0-10) on 5 occasions after surgery. The impact of numerous factors (age, gender, type of surgery, type of anaesthesia and analgesic) on the pain, as well as variation in vital signs and the presence of side effects, were analysed. RESULTS Assessment of the pain showed overall VAS values of 2.2±2.8 on all occasions. Pain was reported to be of greatest intensity 20min after the patients' arrival in the Post-Anaesthesia Recovery Unit (P<.001). The VAS values reported by the researcher (1.4±2.0) were lower than those reported by the patients. Although there was a very strong correlation (R2=0.82; P<.001) and they followed a parallel distribution, there was moderate concordance (kappa=0.4). Plastic surgery and neurosurgery were the specialties with the highest percentages of VAS values in the strong intensity range (8-10). Patients with regional block techniques (with or without general anaesthesia) had lower VAS values than other general anaesthesia groups. Male patients and older patients displayed less pain than female and young patients, respectively (P<.001). CONCLUSIONS Studying the characteristics of postoperative pain at such an early stage allows for improved management. It helps to predict, according to the type of surgery and the anaesthesia used, those patients in which higher VAS values may be seen and to better adapt analgesic therapy.
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Affiliation(s)
- N Cabedo
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - R Valero
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
| | - A Alcón
- Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - C Gomar
- Departament de Cirurgia i Especialitats Quirúrgiques, Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Departamento de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
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Wang N, Wang L, Gao Y, Zhou H, Wang J. Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy. Cureus 2016; 8:e948. [PMID: 28168126 PMCID: PMC5289897 DOI: 10.7759/cureus.948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To assess whether preoperative pentazocine can reduce intraoperative hemodynamic changes and postoperative pain. Methods: Fifty patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group P received intravenous 0.5 mg/kg pentazocine 10 min before surgery, and Group C received normal saline as a placebo. A standardized general anesthesia was conducted in all patients. Mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) scores at various time points were recorded. The tramadol consumption during the study period was recorded. Results: Group P had lower VAS scores at two, four, and eight hours postoperatively compared with Group C. MBP and HR rose significantly because of pneumoperitoneum within Group C, and no significant changes were detected in MBP and HR within Group P. Tramadol doses given were statistically fewer in Group P. Conclusion: Preoperative intravenous pentazocine can decrease intraoperative hemodynamic changes and postoperative pain.
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Affiliation(s)
- Na Wang
- Department of Anesthesiology, The First Hospital of Jilin University
| | - Lei Wang
- Department of Cardiovascular Surgery, The First Hospital of Jilin University
| | - Yang Gao
- Department of Anesthesiology, The First Hospital of Jilin University
| | - Honglan Zhou
- Department of Urology, The First Hospital of Jilin University
| | - Jinguo Wang
- Department of Urology, The First Hospital of Jilin University
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Wang J, Pang L, Han W, Li G, Wang N. Effect of preemptive intravenous oxycodone on low-dose bupivacaine spinal anesthesia with intrathecal sufentanil. Saudi Med J 2016; 36:437-41. [PMID: 25828280 PMCID: PMC4404477 DOI: 10.15537/smj.2015.4.10706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the efficacy of preemptive intravenous oxycodone on low-dose bupivacaine spinal anesthesia with intrathecal sufentanil in patients undergoing transurethral resection of the prostate (TURP). Methods: In this randomized, double-blinded, placebo-controlled trial, 60 patients undergoing TURP were allocated into 2 groups: oxycodone group (group O, n=30) and a normal saline group (group N, n=30). Oxycodone 0.1 mg/kg, or normal saline 0.1 ml/kg was administered intravenously 10 minutes before surgical procedures in group O, or in group N. All patients received sufentanil 5 µg + bupivacaine 0.5% (0.8 ml) + normal saline 0.7 ml - in total, bupivacaine 0.25% (1.6 ml) intrathecally. Spinal block characteristics, hemodynamic values, the perioperative analgesic requirements, visual analogue scale (VAS) scores, Ramsay sedation scale, and side effects were assessed. The study was carried out at the First Hospital of Jilin University, Jilin, China between March and September 2014. Results: The time to 2-segment regression of sensory block, full recovery of sensory block, and first analgesic request was longer in group O. Fewer patients required postoperative analgesics, and the VAS pain scores at 4, 8, 16, and 24 hour after operation were significantly lower in group O. Conclusion: Preemptive intravenous oxycodone was an efficient and safe method to decrease postoperative pain and reduce tramadol analgesia in patients under low-dose dilute bupivacaine spinal anesthesia combined with intrathecal sufentanil.
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Affiliation(s)
- Jinguo Wang
- Department of Urology, the First Hospital of Jilin University, Changchun, Jilin, China. E-mail.
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Woo KJ, Kang BY, Min JJ, Park JW, Kim A, Oh KS. Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: A randomized controlled trial. J Plast Reconstr Aesthet Surg 2016; 69:1203-10. [DOI: 10.1016/j.bjps.2016.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/06/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
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Eidy M, Fazel MR, Janzamini M, Haji Rezaei M, Moravveji AR. Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35050. [PMID: 27275401 PMCID: PMC4893426 DOI: 10.5812/ircmj.35050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/29/2016] [Accepted: 02/21/2016] [Indexed: 11/17/2022]
Abstract
Background Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. Objectives The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. Patients and Methods This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. Results The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. Conclusions TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.
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Affiliation(s)
- Mohammad Eidy
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Monir Janzamini
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Monir Janzamini, Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155540021; +98-9123976157, Fax: +98-3155540111, E-mail:
| | - Mostafa Haji Rezaei
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Ali Reza Moravveji
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Na HS, Oh AY, Koo BW, Lim DJ, Ryu JH, Han JW. Preventive Analgesic Efficacy of Nefopam in Acute and Chronic Pain After Breast Cancer Surgery: A Prospective, Double-Blind, and Randomized Trial. Medicine (Baltimore) 2016; 95:e3705. [PMID: 27196485 PMCID: PMC4902427 DOI: 10.1097/md.0000000000003705] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain.Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated.The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P < 0.001), and at postoperative 24 h (3.1 ± 1.1 vs 3.8 ± 1.5, respectively; P = 0.01) with reduced use of rescue analgesic drugs. Significantly fewer patients suffered from chronic postoperative pain in the nefopam than in the control group at postoperative 3 months (36.6% vs 59.5%, P = 0.04). Considering only the cohort without postoperative adjuvant RT, the difference in the proportion of patients reporting chronic pain increased (23.5% in the nefopam group vs 61.5% in the control group, P = 0.04).Preventive nefopam was helpful in reducing the acute postoperative pain, with reduced use of rescue analgesic drugs, and it contributed to reduced occurrence of chronic pain at postoperative 3 months after breast cancer surgery.
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Affiliation(s)
- Hyo-Seok Na
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (H-SN, A-YO, B-WK, J-HR, J-WH); Department of Anesthesiology and Pain Medicine, Yonsei Barun Orthopedic Clinic, Yongin (D-JL), Gyeonggi; and Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul (A-YO, J-HR), Republic of Korea
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Acute pain management in dermatology. J Am Acad Dermatol 2015; 73:543-60; quiz 561-2. [DOI: 10.1016/j.jaad.2015.04.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/02/2023]
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Walters TL, Mariano ER, Clark JD. Perioperative Surgical Home and the Integral Role of Pain Medicine. PAIN MEDICINE 2015; 16:1666-72. [DOI: 10.1111/pme.12796] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Webb CAJ, Mariano ER. Best multimodal analgesic protocol for total knee arthroplasty. Pain Manag 2015; 5:185-96. [DOI: 10.2217/pmt.15.8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Do Postoperative Pain Management Techniques Influence Postoperative Delirium? CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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