Topical anaesthetic patches for postoperative wound pain in laparoscopic gynaecological surgery: a prospective, blinded and randomised trial

Topic anaesthesia with a eutectic mixture of lidocaine/prilocaine cream after elective caesarean section: a randomised, placebo-controlled trial

PURPOSE

Aim of the study was to investigate the topical application of a eutectic mixture of lidocaine/prilocaine (EMLA^®) cream after caesarean section (CS) and its effect on postoperative pain, time to mobilisation, and time to discharge.

MATERIALS AND METHODS

A total of 189 pregnant women were enrolled; full data sets were available for 139 of them, who were prospectively randomised to receive either placebo (control group) or EMLA^® cream (study group) on the CS lesion directly as well as 24 h after surgery. Postoperative pain was assessed 24 and 48 h after surgery using the short form of the McGill Pain Questionnaire (SF-MPQ). Additional analgesic pain medication on demand was assessed in both groups.

RESULTS

A total of 62 women were allocated randomly to the study and 77 patients to the control group before primary CS. There were no statistically significant differences regarding demographic and surgical parameters comparing both collectives. In addition, the postoperative total pain scores after 24 h [McGill total: 38.5 (0-102) vs. 50 (0-120) p = 0.0889] as well as after 48 h [24 (0-79) vs. 30.5 (0-92); p = 0.1455] showed no significant differences. Furthermore, time to mobilisation (hours) [9.68 (2.18-51.38) vs. 9.47 (4.18-41.77); p = 0.5919] and time to discharge (hours) [98.6 (54.08-170.15) vs. 98.2 (43.45-195.87); p = 0.5331] were comparable.

CONCLUSION

The postoperative application of EMLA^® cream after CS did not reduce postoperative pain or time to mobilisation or discharge, so that its use in this context has to be seen critically.

EFFECT OF BROMFENAC ON PAIN RELATED TO INTRAVITREAL INJECTIONS: A Randomized Crossover Study

PURPOSE

To evaluate the analgesic effect of bromfenac, a topically administered nonsteroidal antiinflammatory agent, in patients undergoing intravitreal injections (IVIs) of anti-vascular endothelial growth factor agents.

METHODS

A single center, prospective, randomized, double-blind, placebo-controlled, cross over interventional study. Patients scheduled to undergo IVI of anti-vascular endothelial growth factor were randomized to receive topical bromfenac or placebo before IVI. Pain perception was assessed using the short form of the McGill Pain Questionnaire. Pain intensity was evaluated with the visual analog scale, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity scores immediately and 6 hours postinjection.

RESULTS

Sixty-five patients (65 eyes) were enrolled in the study. Immediately after IVI, pain perception was statistically significant lower in patients treated with bromfenac compared with placebo as assessed by the visual analog scale pain score and the main component of the short form of the McGill Pain Questionnaire (P = 0.002 and 0.001, respectively). At 6 hours postIVI, pain was statistically significant lower in patients treated with bromfenac, according to the visual analog scale pain score, the main component of the short form of the McGill Pain Questionnaire, and the Present Pain Intensity score (P < 0.001, <0.001, and P = 0.001, respectively). Multivariable regression analysis revealed that pain perception, as evaluated with the visual analog scale pain score immediately after IVI, was significantly lower in patients of older age, female patients and those with higher number of previous injections. Immediately after IVI, bromfenac seemed to be more effective in younger patients and in those who had already undergone an amount of injections.

CONCLUSION

Topical instillation of bromfenac significantly reduced the IVI-related pain immediately after and 6 hours postinjection.