Comparison of the postoperative analgesic effects of paracetamol–codeine phosphate and naproxen sodium–codeine phosphate for lumbar disk surgery

The Effects of Locally Administered Morphine Over the Dura on Postoperative Morphine Consumption and Pain After Lumbar Disc Surgery: A Prospective, Randomised, Double-Blind and Placebo-Controlled Study

Objective

Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h.

Methods

The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively.

Results

Morphine consumption, pain scores and opioid-related side effects were similar among the groups.

Conclusion

Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects.

Comparison of tramadol/acetaminophen fixed-dose combination, tramadol, and acetaminophen in patients undergoing ambulatory arthroscopic meniscectomy

OBJECTIVES

Preemptive analgesia is a technique in which analgesics are administered before a surgery to provide better postoperative pain relief with fewer side effects. In this study, we aimed to compare the preemptive efficacy of tramadol/acetaminophen fixed-dose combination, tramadol, and acetaminophen in patients undergoing ambulatory arthroscopic partial meniscectomy.

METHODS

We evaluated the patient records of 75 patients who underwent ambulatory arthroscopic partial meniscectomy. We divided the patients into three groups consisting of 20 patients each to equalize the groups. Group A comprised patients who were administered 37.5 mg tramadol/325 mg acetaminophen fixed-dose combination, Group B comprised patients who were administered 50 mg tramadol, and Group C comprised patients who were administered 500 mg acetaminophen. Premedication was not used in any group.

RESULTS

There were no significant differences between the groups in terms of age, sex, BMI, and duration of surgery and anesthesia. All patients in Group B and Group C and 17 patients in Group A required rescue analgesics in the first 6 h. Visual analog scale (VAS) was 4.75 ± 3.05 in Group B at time 0 and was 6.10 ± 1.86 in Group C in the first hour and was higher than the other groups with a statistically significance (p = 0.030 and 0.020, respectively). VAS at 24 h postoperatively was ≤3 (1.60 ± 1.63, 1.55 ± 1.84 and 1.70 ± 0.65 respectively in each group), and none of the patients in any group required rescue analgesics. No major side effects, except for slight nausea in one patient requiring no medication, were noted in any group.

CONCLUSION

The fixed-dose combination of tramadol/acetaminophen or tramadol alone is better than acetaminophen alone as a preemptive analgesic in patients undergoing ambulatory arthroscopic meniscectomy.

LEVEL OF EVIDENCE

Level III, therapeutic study.

SGEF is a potential prognostic and therapeutic target for lung adenocarcinoma

Background

SH3-containing guanine nucleotide exchange factor (SGEF), a RhoG-specific guanine nucleotide exchange factor (GEF), was consider as a key signal that determines cancer cell invasion. Although SGEF has been considered to highly express in glioma and prostate cancer. However, it is not well illustrated in LAC.

Methods

In this experiment, expression of SGEF was detected in 92 LAC and corresponding normal tissue samples by immunohistochemistry. In addition, we evaluated the invasion and migration of lung adenocarcinoma cells by the gain and loss of SGEF expression. Furthermore, RhoG activity was measured by GST pull-down assay.

Results

SGEF is highly expressed in LAC tissues than in normal lung tissues and was associated with the TNM stage. Lung adenocarcinoma patients with low SGEF subgroup had longer overall survival compared to those with high expression. Furthermore, univariate analysis showed that SGEF expression was an independent prognostic factor for overall survival in lung adenocarcinoma. Silencing of SGEF effectively suppressed the invasion and migration of human lung adenocarcinoma cells in vitro by inhibiting RhoG activity, and over-expression of SGEF could reverse this phenomena.

Conclusion

SGEF is a novel prognostic target in human lung adenocarcinoma.

Electronic supplementary material

The online version of this article (10.1186/s12957-018-1331-8) contains supplementary material, which is available to authorized users.