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Zeeni CA, Kaddoum RN, Aouad MT, Shebbo FM, Ramadan JG, Habli YA, Hassani JR, Siddik-Sayyid SM. The effect of the addition of nefopam to intraoperative ketoprofen and acetaminophen on postoperative morphine requirements after laparoscopic cholecystectomy: a randomized controlled trial. Minerva Anestesiol 2024; 90:31-40. [PMID: 37987989 DOI: 10.23736/s0375-9393.23.17542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Few studies investigated the use of nefopam for pain control after laparoscopic cholecystectomy in the context of multimodal analgesia. The aim of this study was to evaluate the effect of adding nefopam to ketoprofen and acetaminophen given before the end of laparoscopic cholecystectomy. METHODS In this double-blind, controlled study, 90 patients undergoing laparoscopic cholecystectomy during sevoflurane-dexmedetomidine-based anesthesia were randomized to receive either ketoprofen and acetaminophen or nefopam, ketoprofen, and acetaminophen for postoperative pain control before the end of surgery. The primary outcome was total morphine consumption in the Postanesthesia Care Unit (PACU). RESULTS PACU morphine consumption was significantly lower in the experimental group compared to the control group (0.9±1.8 mg vs. 2.3±2.4 mg, respectively; P=0.004, Cohen's d=0.63). In the experimental group, a smaller proportion of patients received morphine in PACU (24% vs. 60%, respectively; P=0.001), morphine during the first 24 hours after surgery (47% vs. 77%, respectively; P=0.004), and acetaminophen on the floor (76% vs. 93%, respectively; P=0.039) compared with the control group. The average pain score during PACU stay was also significantly lower in the experimental group (1.7±2.0 vs. 2.7±2.0, P=0.01). Median time to first morphine requirement (44.0 minutes, 95% CI [(31.96 to, 52.21)] was shorter in the control group than in the experimental group (higher than the 90 minutes-last time point taken in PACU). CONCLUSIONS Adding nefopam to ketoprofen and acetaminophen before the end of laparoscopic cholecystectomy provides a reduction in morphine consumption with superior analgesia in PACU.
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Affiliation(s)
- Carine A Zeeni
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roland N Kaddoum
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marie T Aouad
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jowana G Ramadan
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasmine A Habli
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana R Hassani
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar M Siddik-Sayyid
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon -
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Ge Z, Li M, Chen Y, Sun Y, Zhang R, Zhang J, Bai X, Zhang Y, Chen Q. The Efficacy and Safety of Parecoxib Multimodal Preemptive Analgesia in Artificial Joint Replacement: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Ther 2023; 12:1065-1078. [PMID: 37284928 PMCID: PMC10290003 DOI: 10.1007/s40122-023-00500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Postoperative pain after artificial joint replacement is intense and remains an unsolved problem. Some studies have shown that parecoxib can provide better analgesia in postoperative multimodal analgesia, however, doubts arise about whether its multimodal preemptive analgesia can reduce postoperative pain. OBJECTIVES The purpose of this systematic review and meta-analysis was to evaluate the impact of preoperative injection of parecoxib on postoperative pain in patients undergoing artificial joint replacement. STUDY DESIGN Systematic review and meta-analysis. SETTING Embase, PubMed, Cochrane Library, CNKI, VIP, Wangfang databases were searched to identify relevant randomized controlled trials. The last search was in May 2022. METHODS Randomized controlled trials of efficacy and adverse reactions of intra-operative and postoperative injection of parecoxib in artificial joint replacement were collected. The primary outcome was postoperative visual analog scale scores and the secondary outcomes included cumulative postoperative opioid consumption and incidence of adverse reactions. Using the Cochrane systematic review method to screen the studies, evaluate the quality of the included studies, and extract feature information, RevMan 5.4 software performs a meta-analysis of the corresponding research indicators. RESULTS In total, nine studies were involved in the meta-analysis with 667 patients. The trial and control group were given the same dose of parecoxib or placebo at the same time point before and after surgery. The results showed that compared with the control group, the trial group is associated with substantially reduced visual analog scale scores in 24, 48 h at rest (P < 0.05), visual analog scale scores in 24, 48, 72 h at movement (P < 0.05), dose of opioid need in trial group is notably lower than that in control group (P < 0.05), but shows no obvious effect on visual analog scale scores in 72 h at rest, and adverse events (P > 0.05). LIMITATIONS The major limitation of this meta-analysis relates to some low-quality studies. CONCLUSIONS Our results support parecoxib multimodal preemptive analgesia in reducing postoperative acute pain in hip and knee replacement patients, and reduces cumulative opioid consumption without increasing the risk of adverse drug events. Its multimodal preemptive analgesia is safe and effective in hip and knee replacement. PROSPERO REGISTRATION CRD42022379672.
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Affiliation(s)
- Zhuoqi Ge
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China
- College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China
| | - Mingnian Li
- College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China
| | - Yu Chen
- College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China
| | - Yufeng Sun
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, China
| | - Rui Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Jiaxing Zhang
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Xue Bai
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yanyan Zhang
- College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China.
| | - Qi Chen
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
- College of Pharmacy, Guizhou Medical University, Guiyang, 550025, China.
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, China.
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Weraarchakul S, Sae-Jung S. Etoricoxib Can Reduce Post-Operative Morphine Consumption and Pain Score in Patients Undergoing Lumbar Laminectomy Compare to Acetaminophen: A Randomized Trial. Global Spine J 2023; 13:1433-1440. [PMID: 34325539 PMCID: PMC10448096 DOI: 10.1177/21925682211035719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES This prospective trial aimed to compare the effectiveness of etoricoxib and acetaminophen in terms of post-operative morphine consumption and pain score in patients undergoing lumbar laminectomy. METHODS Forty lumbar-laminectomy patients aged between 18 and 50 years were enrolled, randomized, and allocated into either the etoricoxib group or the acetaminophen group. The measures assessed were the amount of morphine consumed and pain visual analog score (VAS) at 12, 24, and 48 hours after surgery. Adverse events were recorded. RESULTS Patients in the etoricoxib group had statistically significantly lower morphine consumption than those in the acetaminophen group at 12 hours (P-value = .006), 24 hours (P-value = .006) and 48 hours (P-value = .011). Patients in the etoricoxib group had lower VAS scores than those in the acetaminophen group at 0, 12, 24, 48 hours, the difference being statistically significant at 48 hours (P < .001). CONCLUSIONS Compared to acetaminophen, etoricoxib can significantly reduce post-operative morphine consumption and improve the pain score at 12, 24, and 48 hours.
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Affiliation(s)
- Supanut Weraarchakul
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Surachai Sae-Jung
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Elghazaly A, Alsahali S, Farooqui M, Ibrahim N, Alshammari M, Almutairi A, Almutairi M, Almutairi W. A Cross-Sectional Study to Investigate the Prevalence of Self-Medication of Non-Opioid Analgesics Among Medical Students at Qassim University, Saudi Arabia. Patient Prefer Adherence 2023; 17:1371-1379. [PMID: 37309455 PMCID: PMC10257911 DOI: 10.2147/ppa.s407693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023] Open
Abstract
Purpose Self-medication (SM) using non-opioid analgesics (NOA) is contentious and increasingly recognized as a major public health concern with severe consequences, including masking of malignant and fatal diseases, risk of misdiagnosis, problems relating to over- and under-dosing, drug interactions, incorrect dosage, and choice of therapy. Herein, we aim to determine the prevalence of SM with NOA among pharmacy and medical students at Unaizah College, Qassim University, Saudi Arabia. Patients and Methods A cross-sectional study using a validated self-administered questionnaire was conducted on 709 pharmacy and medicine students belonging to an age group of 21-24 years from Unaizah Colleges. Data were statistically analyzed using SPSS version 21. Results Of 709 participants, 635 responded to the questionnaire. Our results showed a prevalence percentage of 89.6% using self-medicated NOA for pain management. The most common factor leading to SM in NOA was the mild nature of the illness (50.6%), and headache/migraine (66.8%) was the dominant health problem. Paracetamol (acetaminophen, 73.7%) was the most commonly used analgesic, followed by ibuprofen (16.5%). The most common and reliable sources of drug information were pharmacists (51.5%). Conclusion We observed a high rate of SM for NOA among undergraduate students. We believe that the adverse consequences of SM could be controlled through educational, regulatory, and administrative strategies by providing appropriate awareness sessions, and the role of pharmacists should be highlighted in preventing SM from NOA.
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Affiliation(s)
- Abir Elghazaly
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Saud Alsahali
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Nada Ibrahim
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Mohammed Alshammari
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Asma Almutairi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Manar Almutairi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | - Wafa Almutairi
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
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Stessel B, Lambrechts M, Evers S, Vanderstappen C, Callebaut I, Ory JP, Herbots J, Dreesen I, Vaninbroukx M, Van de Velde M. Additive or synergistic analgesic effect of metamizole on standard pain treatment at home after arthroscopic shoulder surgery: A randomised controlled superiority trial. Eur J Anaesthesiol 2023; 40:171-178. [PMID: 36632758 PMCID: PMC9894134 DOI: 10.1097/eja.0000000000001792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is growing evidence that the analgesic effect of metamizole is mediated at least partly by central mechanisms, including the endocannabinoid/endovanilloid system. Consequently, metamizole may have additive or even synergistic analgesic effects with paracetamol and nonsteroidal anti-inflammatory drugs (NSAID). OBJECTIVE This study aimed to assess if triple therapy with metamizole, ibuprofen and paracetamol (MIP) is superior to double therapy with ibuprofen and paracetamol (i.p.) in treating pain at home after ambulatory arthroscopic shoulder surgery. DESIGN/SETTING/PATIENTS/INTERVENTION In this double-blind, controlled, high-volume single centre, superiority trial, 110 patients undergoing elective ambulatory arthroscopic shoulder surgery were randomised to receive either MIP ( n = 55) or i.p. ( n = 55) orally for 4 days between December 2019 and November 2021. Pain intensity at movement and rest, using a numeric rating scale (NRS), perceived pain relief, use of rescue medication and adverse effects of study medication were recorded at the post-anaesthesia care unit (PACU) and on postoperative day (POD) 1 to 4 and 7. Quality of Recovery (QoR) and satisfaction with study medication were measured at POD 7 with telephone follow-up. MAIN OUTCOME MEASURE The primary outcome measure was postoperative pain intensity on movement measured by an 11-point NRS (where 0 = no pain and 10 = worst pain imaginable) on POD 1. RESULTS For the primary outcome, superiority of MIP in reducing postoperative pain at movement on POD 1 was not confirmed: mean difference NRS [95% confidence interval (CI), -0.08 (-1.00 to 0.84)]. For pain on movement and at rest, no significant differences were found between groups in the PACU nor on POD 1 to 4 or day 7. Nausea was reported significantly more frequently in the metamizole group (22.6 vs. 58.5; P < 0.001). Other adverse effects of study medication, rescue opioid consumption, perceived pain relief, QoR at POD 7, and overall patient satisfaction were similar in both groups. CONCLUSION Clinically, triple oral treatment with metamizole, paracetamol and ibuprofen is not superior to oral paracetamol and ibuprofen in multimodal pain treatment at home after ambulatory arthroscopic shoulder surgery. TRIAL REGISTRATION European Union Clinical Trials Register 2019-002801-23 and Clinicaltrials.gov NCT04082728.
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Affiliation(s)
- Björn Stessel
- From the Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt (BS, ML, SE, CV, IC, J-PO, JH), Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Diepenbeek (BS, IC), Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven (ML, MVdV), Department of Orthopaedic Surgery, Jessa Hospital, Hasselt (CV, MV) and Department of Pharmacy, Jessa Hospital, Hasselt, Belgium (ID)
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Toleska M, Dimitrovski A, Shosholcheva M, Kartalov A, Kuzmanovska B, Dimitrovska NT. Pain and Multimodal Analgesia in Laparoscopic Cholecystectomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:41-49. [PMID: 35843915 DOI: 10.2478/prilozi-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. Results: The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. Conclusion: Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.
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Affiliation(s)
- Marija Toleska
- University Clinical Center "Mother Teresa" Skopje, University Clinic for TOARILUC -Department for Anesthesiology, Reanimation and Intensive Care (KARIL), Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
| | - Aleksandar Dimitrovski
- University Clinical Center "Mother Teresa" Skopje, University Clinic for TOARILUC -Department for Anesthesiology, Reanimation and Intensive Care (KARIL), Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
| | - Mirjana Shosholcheva
- University Clinic "St. Naum Ohridski" Skopje, Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
| | - Andrijan Kartalov
- University Clinical Center "Mother Teresa" Skopje, University Clinic for TOARILUC -Department for Anesthesiology, Reanimation and Intensive Care (KARIL), Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
| | - Biljana Kuzmanovska
- University Clinical Center "Mother Teresa" Skopje, University Clinic for TOARILUC -Department for Anesthesiology, Reanimation and Intensive Care (KARIL), Medical Faculty - Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
| | - Natasha Toleska Dimitrovska
- University Clinical Center "Mother Teresa" Skopje, University Clinic for Thoracic and Vascular Surgery, Medical Faculty -Skopje, University ″Ss. Cyril and Methodius″ Skopje, RN Macedonia
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Use of Intravenous Paracetamol Preoperatively Favors Lower Risk of Delirium and Functional Recovery in Elderly Patients with Hip Fracture: A Propensity Score-Matched Analysis. Pain Res Manag 2022; 2022:1582727. [PMID: 35463628 PMCID: PMC9020999 DOI: 10.1155/2022/1582727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
We aimed to investigate whether the use of intravenous paracetamol (IVP) preoperatively in intertrochanteric fracture (IF) patients aged 65 years or over receiving intramedullary fixation had significantly benefits on the pain score at discharge, delirium incidence, length of hospital stay (LOS), functional outcomes, and mortality. A retrospective analysis of all surgically treated patients presenting with IF was conducted at a single Level I trauma center in China between Jan. 2016 and Jan. 2020. The data concerning patients' demographics, injury-related data, surgery-related data, operation-related data, in-hospital data, and postoperative outcomes were extracted. To minimize potential confounding and selection bias, the propensity score matching (PSM) method was performed via the caliper matching method by using a 1 : 1 ratio. After PSM, McNemar's chi-square tests were used to examine the association of using IVP with outcome analyses. The Spearman correlations of IVP using, pain scores, and the factors which may influence them were also computed. After screening 2963 consecutive patients, 2166 were included finally, including 1576 in the non-IVP group and 590 in the IVP group. After PSM, 531 remained in each group. The pain scores at discharge were significantly between the two groups before and after matching (all p < 0.001). The differences of delirium rate and functional outcomes became significant after propensity score-based matching (p=0.001 and 0.033, respectively), although they were not significant before matching. No significant difference was observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month before and after PSM. In conclusion, this study highlights the need for preoperative IVP use to optimize pain control, postoperative functional recovery, and minimize pain-related comorbidities such as delirium in elderly patients with hip fracture.
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Lynch DJ, Lin JS, Goyal KS. Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery. J Hand Microsurg 2022; 14:85-91. [PMID: 35256832 PMCID: PMC8898152 DOI: 10.1055/s-0040-1715917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery ( n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone ( n = 66) or soft tissue ( n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t -tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients' postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.
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Affiliation(s)
- Daniel J. Lynch
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, Ohio, United States
| | - James S. Lin
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, Ohio, United States
| | - Kanu S. Goyal
- Department of Orthopaedics, The Ohio State University Medical Center, Columbus, Ohio, United States
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Al-metwalli R, Khidr A, Fallata S, A. Elsayed H. Effect of preemptive intramuscular diclofenac on minimal effective-dose bupivacaine saddle block for minor perianal surgeries. Saudi J Anaesth 2022; 16:156-160. [PMID: 35431752 PMCID: PMC9009573 DOI: 10.4103/sja.sja_722_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Preemptive analgesics are commonly used to increase analgesic efficacy and patient satisfaction. The aim of this study was to evaluate the preemptive analgesic effect of intramuscular diclofenac on minimal effective dose spinal anesthesia for perianal surgeries. Materials and Methods: Fifty patients ASA I&II were divided randomly into two groups, control group (GC N = 25) and Diclofenac group (GD N = 25), both groups received saddle block with 5% hyperbaric bupivacaine 0.5 mL (2.5 mg). Thirty minutes before the saddle block, patients in GD received 75 mg (3 mL) diclofenac intramuscularly, whereas patients in GC received 3 mL saline intramuscularly. The differences in the time for the first analgesic request, postoperative analgesic consumption as well as, visual analog scale, were our primary outcomes. Results: Fifty patients (25 in each group) undergoing perianal surgery completed the study successfully. The time to the first request of analgesia was significantly longer in GD 511.8 (108.07) min. compared to the GC 179.56 (49.24) min with P = 0.00001, as well as the total consumption of rescue analgesic (tramadol hydrochloride) was significantly less in GD 66 (23.8) mg compared to 104 (28.5) mg in the GC with P = 0.00001. Conclusion: Preemptive intramuscular diclofenac sodium with minimal dose bupivacaine saddle block significantly minimized the postoperative analgesic consumption and delayed the first analgesia request after perianal surgery.
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Alptekin A, Ergul Z, Sonmez ME, Ugurlu C, Gumus H, Kulacoglu H. Can the preemptive use of lornoxicam or paracetamol prevent pain after inguinal hernia repair? A randomized prospective double-blind placebo controlled trial. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2022. [DOI: 10.4103/ijawhs.ijawhs_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Leech J, Oswalt K, Tucci MA, Alam Mendez OA, Hierlmeier BJ. Opioid Sparing Anesthesia and Enhanced Recovery After Surgery Protocol for Pancreaticoduodenectomy. Cureus 2021; 13:e19558. [PMID: 34917438 PMCID: PMC8669974 DOI: 10.7759/cureus.19558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background Opioid sparing anesthesia and enhanced recovery after surgery protocols are not innovative ideas. However, the utilization of pancreaticoduodenectomy is limited. With the rise in awareness of the opioid epidemic in the United States, we have created a multimodal approach to anesthesia and postoperative care to limit adverse effects of opioids and curb the use of opioids postoperatively. Methods We conducted a retrospective cohort study performed by chart review of an opioid-sparing anesthetic and enhanced recovery after surgery (ERAS) protocol initiated jointly by the anesthesiology departments and transplant surgery for pancreaticoduodenectomy from January 2017 to October 2019. Results Demographic data was found to be comparable between the control and protocol groups. Hospital length of stay, ICU length of stay, and opioid requirements significantly decreased in the protocol group. Hospital length of stay decreased from 8.92 to 5.72 days, ICU days decreased from 1.52 to 0.42 days, and narcotics for the first five hospital days were significantly decreased from 130.13 to 71.2 morphine milligram equivalents. Conclusion Proper postoperative pain management can improve patient satisfaction and decrease complication rates. Pancreaticoduodenectomy is a complicated procedure with relatively limited data regarding enhanced recovery after surgery protocols. Likewise, there is limited data regarding opioid-sparing anesthesia techniques. Our protocol produced promising hospital length of stay and reduced opioid administration during the first five hospital days without increasing 30-day readmission rates.
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Affiliation(s)
- Joseph Leech
- Anesthesiology, University of Mississippi Medical Center, Jackson, USA
| | - Kenneth Oswalt
- Anesthesiology, University of Mississippi Medical Center, Jackson, USA
| | - Michelle A Tucci
- Anesthesiology, University of Mississippi Medical Center, Jackson, USA
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Perineural Local Anesthetic Treatments for Osteoarthritic Pain. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021; 7:262-282. [DOI: 10.1007/s40883-021-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lee JK, Kang C, Hwang DS, Lee GS, Hwang JM, Park EJJ, Ga IH. An Innovative Pain Control Method Using Peripheral Nerve Block and Patient-Controlled Analgesia With Ketorolac After Bone Surgery in the Ankle Area: A Prospective Study. J Foot Ankle Surg 2021; 59:698-703. [PMID: 32057624 DOI: 10.1053/j.jfas.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/10/2019] [Accepted: 12/04/2019] [Indexed: 02/03/2023]
Abstract
Although postoperative pain is inevitable after bone surgery, there is no general consensus regarding its ideal management. We hypothesized that the combination of ultrasound-guided peripheral nerve block (PNB) and patient-controlled analgesia (PCA) with ketorolac would be useful for pain control and reducing opioid usage. This prospective study aimed to evaluate the effectiveness of this method. This study included 95 patients aged >18 years who underwent bone surgery in the ankle area from June to December 2018. All operations were performed under anesthetic PNB, and additional PNB was given for pain control ∼11 hours after preoperative PNB. An additional PCA with ketorolac, started before rebound pain was experienced, was used for pain control in group A (49 patients) but not group B (46 patients). We used intramuscular injection with pethidine or ketorolac as rescue analgesics if pain persisted. A visual analogue scale (VAS) for pain was used to quantify pain at 6, 12, 18, 24, 36, 48, and 72 hours postoperatively. Patient satisfaction was assessed, along with side effects in both groups. VAS pain scores differed significantly between the groups at 24 hours after the operation (p = .013). All patients in group A were satisfied with the pain control method; however, 5 patients in group B were dissatisfied (p = .001), 3 owing to severe postoperative pain and 2 owing to postoperative nausea and vomiting. An average of 0.75 and 11.40 mg pethidine per patient was used in groups A and B, respectively, for 3 days. We concluded that the combined use of ultrasound-guided PNB and PCA with ketorolac can be an effective postoperative method of pain control that can reduce opioid usage.
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Affiliation(s)
- Jeong-Kil Lee
- Fellow, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Chan Kang
- Associate Professor, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea.
| | - Deuk-Soo Hwang
- Professor, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Gi-Soo Lee
- Associate Professor, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Jung-Mo Hwang
- Associate Professor, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Eugene Jae-Jin Park
- Associate Professor, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - In-Ho Ga
- Resident, Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
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INFLUENCE OF DIFFERENT TYPES OF ANESTHESIA FOR LAPAROSCOPIC HYSTERECTOMY ON THE DYNAMICS OF STRESS HORMONES. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the study – to evaluate the influence of different variants of anesthesia, including low-opioid (LOA) and opioid-free anesthesia (OFA), on the dynamics of the stress response during laparoscopic hysterectomy.
Materials and methods: 102 patients were randomly allocated into 3 groups: 37 women assigned to receive a standard opioid-based anesthesia (OBA group), 33 women – LOA group and 32 patients OFA group.
Results: The patients of OFA group after induction and intubation of the trachea showed a significant (p<0.05) increase in cortisol level by 155.4 % and 160.9 % compared with the OBA group and LOA group. After completion of the hysterectomy, regardless of the variant of anesthesia, the level of cortisol exceeded the preoperative one (pOBA=0.116, pLOA=0.049, pOFA=0.043). Two hours after surgery with standard anesthesia (OBA group) there was a further increase in the concentration of cortisol in the blood, exceeding the initial values by 142.9 % (p=0.043). Patients in the LOA group and OFA group tended to decrease cortisolemia. The changes in adrenaline & glucose levels were somewhat similar.
Conclusion: Use of OFA is accompanied by an aggravation of the stress response at the stage of hysterectomy, which is manifested by an increase in the level of adrenaline and cortisol. The most adequate perioperative protection is inherent in low-opioid anesthesia, which is accompanied by a lower release of stress hormones during hysterectomy and in the postoperative period. Opioid-based anesthesia provides adequate intraoperative protection, but is accompanied by insufficient postoperative analgesia.
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Chen C, Pang Q, Tu A, Wang J, Tu F. Effect of low-dose ketamine on MAC BAR of sevoflurane in laparoscopic cholecystectomy: A randomized controlled trial. J Clin Pharm Ther 2020; 46:121-127. [PMID: 32981056 DOI: 10.1111/jcpt.13263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Low-dose ketamine can reduce the minimum alveolar concentration of sevoflurane necessary to block the adrenergic response (MACBAR ) in animals. However, the effects of low-dose ketamine on the sevoflurane MACBAR in patients undergoing laparoscopic surgery are unclear. The aim of this study was to investigate the effects of three different low doses of ketamine on the MACBAR of sevoflurane in patients undergoing laparoscopic cholecystectomy. METHODS One hundred patients who underwent laparoscopic cholecystectomy were enrolled. After general anaesthesia induction and tracheal intubation, patients received sevoflurane anaesthesia in combination with a loading dose of saline followed by infusion or a loading dose of 0.5 mg/kg ketamine followed by a continuous infusion of 5 (K1 group), 10 (K2 group) and 20 μg/kg/min (K3 group). The target concentration of end-tidal sevoflurane was maintained for at least 20 minutes before carbon dioxide pneumoperitoneum stimulus. The MACBAR of sevoflurane in each group was determined by using an up-and-down sequential allocation technique. RESULTS AND DISCUSSION Seventy-one patients completed the study. The values of MACBAR for sevoflurane were 5.3% in the K0 , 4.8% in K1 , 3.3% in K2 and 3.2% in K3 groups. The use of ketamine significantly reduced the MACBAR of sevoflurane compared to sevoflurane alone. The K2 and K3 groups showed significantly lower values of MACBAR than that in the K1 group. However, a higher dose of ketamine in the K3 group did not further reduce the sevoflurane MACBAR . The mean arterial blood pressure (MAP) values before pneumoperitoneum in the K2 and the K3 groups were significantly higher compared to those in the K0 and K1 groups. Compared with the values before pneumoperitoneum, the heart rate and MAP after pneumoperitoneum were significantly increased. Overall, the haemodynamics remained stable during the study period in all groups. WHAT IS NEW AND CONCLUSION A loading dose of 0.5 mg/kg ketamine followed by a continuous infusion of 10.0 μg/kg/min led to a significant decrease in the MACBAR of sevoflurane in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Changchun Chen
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qiying Pang
- Department of Anesthesiology, Tongji Hospital of Tongji University, Shanghai, China
| | - Ailing Tu
- Department of Clinical Medicine, Grade 2017, North Sichuan Medical College, Nanchong, China
| | - Ji Wang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Faping Tu
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Morita S, Oizumi N, Suenaga N, Yoshioka C, Yamane S, Tanaka Y. Dexamethasone added to levobupivacaine prolongs the duration of interscalene brachial plexus block and decreases rebound pain after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2020; 29:1751-1757. [PMID: 32815804 DOI: 10.1016/j.jse.2020.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 04/02/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND It has been reported that the addition of dexamethasone to interscalene brachial plexus block (ISBPB) prolongs the duration of the block effect. However, there have been no studies focusing on the effects of dexamethasone on rebound pain after the block effect has worn off. The aim of this study was to investigate the effect on postoperative pain when dexamethasone was added to ISBPB for arthroscopic rotator cuff repair (ARCR). METHODS In this multicenter, single-blinded, and randomized controlled study, 54 patients (33 males, 21 females) who received ARCR were randomly assigned to group L (ISBPB with 20 cc of 0.25% levobupivacaine; 21 patients) or group LD (ISBPB with 20 cc of 0.25% levobupivacaine + 3.3 mg dexamethasone; 33 patients). The primary outcome was the visual analog scale (VAS) for pain after the block effect had worn off. Secondary outcomes were the duration of analgesia, the time to the first request for additional analgesic, the number of additional doses of analgesic, and complications. RESULTS The VAS scores on postoperative days 0 and 1 were significantly lower in group LD than group L (P = .005, .035). This indicated that the rebound pain was relieved in group LD. After postoperative day 1, there was no significant difference in VAS score (P = .43 and .19 for days 2 and 3, respectively). The duration of analgesia was significantly longer in group LD than group L (P < .001). The time to the first request for additional analgesic was significantly longer in group LD than group L (P < .001). The number of additional doses of analgesic was significantly lower in group LD (P < .001). CONCLUSION In ARCR, the addition of dexamethasone to levobupivacaine not only prolongs the duration of ISBPB but also relieves rebound pain after the block effect wears off.
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Affiliation(s)
- Shuzo Morita
- Department of Orthopedic Surgery, Otemae Hospital, Osaka, Japan.
| | - Naomi Oizumi
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopedic Hospital, Sapporo, Hokkaido, Japan
| | - Naoki Suenaga
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Orthopedic Hospital, Sapporo, Hokkaido, Japan
| | - Chika Yoshioka
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Higashi Orthopedic Hospital, Sapporo, Hokkaido, Japan
| | - Shintaro Yamane
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Higashi Orthopedic Hospital, Sapporo, Hokkaido, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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Eidan A, Ratsch A, Burmeister EA, Griffiths G. Comparison of Opioid-Free Anesthesia Versus Opioid-Containing Anesthesia for Elective Laparoscopic Surgery (COFA: LAP): A Protocol Measuring Recovery Outcomes. Methods Protoc 2020; 3:mps3030058. [PMID: 32823720 PMCID: PMC7565777 DOI: 10.3390/mps3030058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022] Open
Abstract
The administration of opioids is a central element in contemporary anesthetic techniques in Australia; however, opioids have a range of side effects. As an alternative, opioid-free anesthesia (OFA) is an emerging mode of anesthesia intended to avoid these side effects. This study is the first to publish the use of OFA in Australia and is conducted in a regional Queensland Health Service. The design will utilize a randomized clinical trial (RCT) to investigate the impact of OFA for patients having an elective laparoscopic cholecystectomy (n = 40) or tubal ligation (n = 40). Participant outcomes to be measured include: Quality of Recovery (QoR-15); Oral Morphine Equivalent Daily Dose (OMEDD) at 24-h post-operatively; time to first opioid (TTFO) dose; post-operative nausea and vomiting (PONV); Post Anesthetic Care Unit length of stay (PACU-LOS); and hospital length of stay (LOS). The findings may challenge the essentiality of opioids in the peri-operative period, which in turn would influence the future intra-operative management of surgical patients. Ultimately, a reduction in anesthesia-associated opioid use will support a more general decline in opioid use.
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Affiliation(s)
- Anthony Eidan
- Anesthetic Department, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia;
- School of Medicine, The University of Queensland, Brisbane 4072, Australia
| | - Angela Ratsch
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
- Correspondence:
| | - Elizabeth A. Burmeister
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
| | - Geraldine Griffiths
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
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Joseph WJ, Cuccolo NG, Chow I, Moroni EA, Beers EH. Opioid-Prescribing Practices in Plastic Surgery: A Juxtaposition of Attendings and Trainees. Aesthetic Plast Surg 2020; 44:595-603. [PMID: 31907588 DOI: 10.1007/s00266-019-01588-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The rates of opioid abuse and overdose in America have risen in parallel with the rates of opioid prescribing by physicians. As such, we sought to examine the prescribing practices among plastic surgery attendings and trainees to determine the need for more thorough education. METHODS A survey was distributed to all ACGME-accredited plastic surgery residency programs and included questions regarding opioid-prescribing practices and self-rated ability pertaining to opioid management. Trends in prescribing practices based on prescriber position were analyzed using cumulative odds ordinal logistic regression with proportional odds and Chi-squared tests for ordinal and nominal variables, respectively. RESULTS We received 78 responses with a wide geographical representation from plastic surgery residency programs: 59% of respondents were male and 39.7% female, 29.5% were attendings, 26.9% senior residents, 29.5% junior residents, and 14.1% interns. Compared with attendings, interns prescribe fewer pills (p < 0.05) and were significantly more likely to prescribe oxycodone (p < 0.03). Junior residents were 4.49 times more likely (p = 0.012) and senior residents 3.65 times more likely (p = 0.029) to prescribe additional opioids to avoid phone calls and follow-up visits. Interns and senior residents were significantly less comfortable than attendings in managing patients requesting additional opioids (p < 0.02). CONCLUSIONS The results of this survey demonstrate that knowledge deficits do exist among trainees, and that trainees are significantly less comfortable than their attending counterparts with opioid prescribing and patient management. Therefore, the implementation of a thorough postoperative pain management education in residency may be a cogent strategy in mitigating the opioid crisis. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Walter J Joseph
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA.
| | - Nicholas G Cuccolo
- Division of Plastic Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ian Chow
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
| | - Elizabeth A Moroni
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
| | - Emily H Beers
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA
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Dastan F, Langari ZM, Salamzadeh J, Khalili A, Aqajani S, Jahangirifard A. A comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video-assisted thoracoscopic surgery: A double-blind, active-controlled, randomized clinical trial. Ann Card Anaesth 2020; 23:177-182. [PMID: 32275032 PMCID: PMC7336963 DOI: 10.4103/aca.aca_239_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/20/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022] Open
Abstract
Background Opioids are traditionally used as the drug of choice for the management of postoperative pain. However, their use is limited in patients undergoing Video-assisted thoracic surgery (VATS), due to their side effects, such as respiratory depression, nausea, and vomiting. Aim In this double-blind active-controlled randomized study, we have compared the analgesic effects of ketorolac and paracetamol to morphine. Methods Patients were randomly chosen from a pool of candidates who were undergoing VATS and were divided into three groups. During the first 24 h postsurgery, patients in the control group received a cumulative dose of morphine 20 mg, while patients in two treatment groups received ketorolac 120 mg and paracetamol 4 g in total. Doses were administered as bolus immediately after surgery and infusion during the first 24 h. Patients' pain severity was evaluated by visual analogue scale rating (VAS) at rest and during coughing episodes. Results The average pain score at recovery time was 2.29 ± 2.13 and 2.26 ± 2.16 for ketorolac and paracetamol, respectively, and it was significantly lower than the morphine group with an average pain score of 3.87 (P = 0.003). Additionally, the VAS score during cough episodes was significantly higher in the control group throughout the study period compared to study groups. Comparison of mean morphine dose utilized as liberation analgesic (in case of patients had VAS >3) between three groups was not significantly different (P = 0.17). Conclusion Our study demonstrates the non-inferiority of ketorolac and paracetamol to morphine in controlling post-VATS pain without causing any significant side effects. We also show that ketorolac and paracetamol are superior to morphine in controlling pain during 2 h postsurgery.
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Affiliation(s)
- Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra M. Langari
- Department of Pharmacovigilance, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Food Safety Research Center, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khalili
- Anesthesiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Aqajani
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Jahangirifard
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Is Opioid-Free General Anesthesia More Superior for Postoperative Pain Versus Opioid General Anesthesia in Laparoscopic Cholecystectomy? ACTA ACUST UNITED AC 2020; 40:81-87. [PMID: 31605587 DOI: 10.2478/prilozi-2019-0018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Opioid-free anesthesia (OFA) is a new anesthesiological technique, where the giving of opioids (fentanyl) is avoided in the intra- and post-operative period. This leads to reduction in the opioid-related side effects and lower pain scores in the postoperative period. MATERIALS AND METHODS In this randomized, single-blind clinical study, 60 patients scheduled for elective laparoscopic cholecystectomy were enrolled. Half of them (30 patients) received general balanced anesthesia with fentanyl (F group-FG), and the half received opioid-free general anesthesia (OFA group-OFAG). In the post-operative period, Visual Analogue Scale (VAS) scores were followed at rest and when coughing 1 hour, 4 hrs, 8 hrs, 12 and 24 hrs after surgery. Both groups were followed by opioid requirements in the postoperative period. RESULTS In the postoperative period, patients in the fentanyl group (FG) have higher pain scores at rest and on coughing in all analyzed timeframes compared to patients from the OFA group, but statistically significant difference was approved 1 and 24 hours after surgery. In the OFA group 24 hours after surgery none of the patients reported pain at rest and when coughing number 7, 8, 9 and 10 according to the VAS pain score. The total opioid requirement in the postoperative period was significantly higher in the fentanyl group (FG) at rest and when coughing, compared to the OFA group. CONCLUSION Opioid-free anesthesia as a part of multimodal analgesia and a new anesthesiology technique is a safe procedure, where opioid-related negative effects in patients undergoing elective laparoscopic cholecystectomy are avoided..
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Factors Associated With Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks. Clin J Pain 2020; 36:296-301. [PMID: 31977369 DOI: 10.1097/ajp.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the correlations between the minimum effective volume (MEV) of lidocaine 1.5% for an ultrasound-guided popliteal sciatic nerve block and individual factors including the cross-sectional nerve area, sex, age, body mass index, and the depth of the sciatic nerve and to evaluate the safety of combined femoral and sciatic nerve blocks by monitoring the plasma concentration of local anesthetics. METHODS Forty patients received combined single-shot femoral and continuous sciatic nerve blocks. The femoral nerve block was performed with an in-plane technique and 15 mL of lidocaine 1.5%. A continuous peripheral nerve block annular tube was positioned between the tibial and peroneal nerves inside the paraneural sheath. Thirty minutes after the femoral nerve block, a loading dose of 5 mL of lidocaine 1.5% was given to block the sciatic nerve after obtaining the maximum compound muscle action potential (CMAP) amplitude using nerve conduction studies. Additional lidocaine 1.5% was pumped at a rate of 30 mL/h through the indwelling annular tube if, after 8 minutes, the CMAP amplitude was still present. The CMAP amplitude monitored by the nerve conduction studies and pinprick tests were recorded every 2 minutes after the administration of lidocaine 1.5%. When the CMAP amplitude decreased to nearly 0 mV, this MEV was recorded. The influences of the cross-sectional area of the sciatic nerve, sex, age, body mass index, and the depth of the sciatic nerve on the MEV were analyzed using stepwise multiple linear regression. Blood samples were collected from 10 patients to evaluate the safety of combined femoral and sciatic nerve blocks by ultra-performance liquid chromatography-tandem mass spectrometry. Blood was drawn at 0 minutes before femoral nerve injection; 0 minutes before sciatic nerve injection; 8 minutes after sciatic nerve injection; and 0, 10, 20, 30, 45, 60, 75, 90, and 120 minutes after the pumping of lidocaine 1.5% stopped. RESULTS A significant correlation was found between the MEV of lidocaine 1.5% and the cross-sectional area of the sciatic nerve (r=0.459), with a regression equation of the MEV (mL)=5.969+0.095×(the cross-sectional area of the sciatic nerve). The coefficient of determination was 0.211 (P<0.05). The MEV of lidocaine 1.5% for complete sciatic nerve blocks ranged from 7 to 15 mL. The maximum concentrations of lidocaine, monoethylglycinexylidide, and glycinexylidide were 1672.9 (227.6), 265.7 (32.7), and 42.2 (22.4) ng/mL, respectively. CONCLUSIONS There is a positive correlation between the cross-sectional area of the sciatic nerve and the MEV. The regression equation can help to predict the MEV of lidocaine 1.5% for popliteal sciatic nerve blocks. The maximum concentrations of lidocaine and its metabolites did not approach toxic threshold limits in this study.
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Bajracharya JL, Subedi A, Pokharel K, Bhattarai B. The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial. BMC Anesthesiol 2019; 19:198. [PMID: 31684867 PMCID: PMC6829809 DOI: 10.1186/s12871-019-0874-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/23/2019] [Indexed: 01/08/2023] Open
Abstract
Background As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. Methods In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively. Results Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later. Conclusion Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol. Trial registration ClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.
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Affiliation(s)
| | - Asish Subedi
- Department of Anesthesiology & Critical Care Medicine, BP Koirala Institute of Health Sciences, BPKIHS, Dharan, Nepal.
| | - Krishna Pokharel
- Department of Anesthesiology & Critical Care Medicine, BPKIHS, Dharan, Nepal
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Dmytriiev D, Lysak Y, Glazov Y, Geranin S, Zaletska O. Mini-invasive methods of treatment of diabetic foot pain. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v4i3.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuropathic pain occurs with diabetic polyneuropathy more often than with all polyneuropathies of another etiology. Because the cause of pain can rarely be cured, treatment is usually symptomatic. Neuropathic pain is usually poorly controlled by analgesics. Management of neuropathic pain is started with conservative pharmacotherapy before invasive pain management is applied. Although there are many drugs that can be used in patients with diabetic pain syndrome, pain syndrome can not be surely stoped with monotherapy. In addition, the patient may not tolerate the full therapeutic dose of the drug.
All this dictates the need for combination therapy. It is believed that regional anesthesia as an independent type of analgesia or a component of combined anesthesia is the method of choice for the elderly and senile patients. The main reasons for this choice, when comparing regional anesthesia with narcosis, are less stressful response of the organism, absence of depression of the central nervous system, stable reliable analgesia with complete blockade of nociceptive reflexes with the provision of adequate muscle relaxation, prevention of neurovegetative reactions, which ultimately helps to reduce the incidence of postoperative complications and mortality. Clinicians have accumulated considerable experience demonstrating the need for regional analgesia in the management of diabetic foot pain.
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Goswami D, Sardar A, Baidya DK, Yadav R, Bhutia O, Roychoudhury A. Comparative Evaluation of Two Doses of Etoricoxib (90 mg and 120 mg) as Pre-Emptive Analgesic for Post-Operative Pain Relief in Mandibular Fracture Surgery Under General Anaesthesia: A Prospective, Randomised, Double-Blinded, Placebo-Controlled Trial. Turk J Anaesthesiol Reanim 2019; 48:24-30. [PMID: 32076676 PMCID: PMC7001814 DOI: 10.5152/tjar.2019.54614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective This trial investigated the post operative analgesic efficacy of oarl etoricoxib 90 mg and 120 mg and a placebo in mandibular fracture pain model. Methods A total of 63 adult patients with mandibular fractures who were scheduled to undergo maxillofacial surgery were randomly allocated to receive etoricoxib 90 mg, etoricoxib 120 mg and a placebo 1 hour before the surgery. Patients were followed-up till 24 hours after the surgery. Duration of analgesia, intra-operative and post-operative analgesic requirement, pain score, post-operative patient satisfaction and adverse effects were measured. Results The baseline demographic parameters were similar in all the groups. Duration of analgesia was longer in both the E120 (6.00±0.816 hours) and E90 (4.37±1.008 hours) groups (p<0.05) as compared to the placebo group (2.60±0.821 hours). Mean difference of duration of analgesia between E120 and E90 was 1.62 (95% confidence interval: 0.234–3.484; p>0.05). Post-operative pain intensity was significantly lower in both the E120 and E90 groups as compared to the C group. Both the etoricoxib groups required less intra-operative (p=0.002) and post-operative (p=0.001) analgesic supplementation as compared to the placebo group. The patient satisfaction score and rate of occurrence of significant adverse effects were similar among all the three groups. Conclusion Etoricoxib 90 mg is equally efficacious to etoricoxib120 mg with a similar side effect profile in a severely acute setting.
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Affiliation(s)
- Devalina Goswami
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arijit Sardar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
BACKGROUND Post-craniotomy pain can be severe and is often undermanaged. Opioids can interfere with neurological monitoring and are associated with adverse effects. This systematic review aimed to identify measures of opioid-free analgesia and compare their effectiveness with opioid analgesia for post-craniotomy pain in patients with supratentorial tumors. METHODS EMBASE, MEDLINE, and Cochrane databases were searched from their inception to February 14, 2017, for randomized controlled trials (RCTs) evaluating opioid versus non-opioid analgesia post-supratentorial craniotomy. Two reviewers independently carried out study selection and data extraction. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Outcomes were pain control (changes to pain scores or use of rescue analgesia) and adverse effects. Considering the number of studies and heterogeneity, a narrative synthesis was done without pooling and results were summarized using tables. Non-opioids were assessed for the potential to be equivalent to opioid-based analgesics for pain relief and adverse effects. RESULTS Of 467 RCTs, 4 met our inclusion criteria (n = 186 patients). Patients with scalp blocks (2 RCTs) had less post-operative nausea and vomiting (PONV), but scalp block was not superior to morphine for analgesia. Acetaminophen (1 RCT) was less likely to induce PONV but provided inadequate pain relief compared to morphine and sufentanil. Dexmedetomidine (1 RCT) was not superior to remifentanil for analgesia although it delayed time to rescue analgesia. CONCLUSIONS Limited evidence suggests that scalp blocks and dexmedetomidine have the potential to eliminate the need for opioid analgesia. Multimodal analgesia should be considered as significant opioid-sparing effects have been shown.
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Abstract
Outpatient surgery has become a national policy priority set by health care authorities (targets for more than 70% of outpatient procedures by 2022), making ambulatory hospitalization the new standard of care. This practice introduces new risks along the patient's course. Even though these risks are low and although the literature and data from insurance databases is reassuring, the risks in outpatient surgery remain poorly understood. Risks can be organizational in view of the many stages of the patient journey that must be formalized-medical, anesthetic or surgical-in view of planned discharge the same evening as the procedure, and medico-legal because of the importance of the discharge authorization and the information provided to the patient. A risk management approach (a priori or a posteriori) has become a mandatory part of a policy of continuous quality improvement and safety of care. The coordination of all the team members (surgeon, anesthesiologist, nursing and administrative staff and the patient's accompanying person) as well as the patient's active participation are essential to minimize risks and prevent complications.
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Preoperative use of gabapentin decreases the anesthetic and analgesic requirements in patients undergoing radical mastectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2010.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Preoperative gabapentin augments intraoperative hypotension and reduces postoperative opioid requirements with functional endoscopic sinus surgery. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gao X, Zhu P, Yu L, Yang L, Chen Y. Ultrasound/Acidity-Triggered and Nanoparticle-Enabled Analgesia. Adv Healthc Mater 2019; 8:e1801350. [PMID: 30901164 DOI: 10.1002/adhm.201801350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/25/2019] [Indexed: 11/10/2022]
Abstract
Local anesthetics have been extensively employed to treat postoperative pain, but they generally suffer from short acting duration and potential neurotoxicity under high local concentrations, which require the controlled and sustained releasing patterns of treatment drugs. In this work, it is reported, for the first time, the construction of hollow mesoporous organosilica nanoparticles (HMONs)-based nanoplatforms for localized delivery and controlled/sustained release of loaded ropivacaine for local anesthetics, which can be repeatedly triggered by either external ultrasound irradiation or acidity triggering to release the payload, causing on-demand and long-lasting analgesia. Based on the in vivo mouse model of incision pain, the controlled and sustained release of ropivacaine achieves more than six hours of continuous analgesia, which is almost three times longer as compared to single free ropivacaine injection. The low neurotoxicity and high biocompatibility of HMONs for nanoparticle-enabled analgesia are also demonstrated both in vitro and in vivo. This designed/constructed HMONs-based nanoplatform provides a potential methodology for clinical pain management via on-demand and long-lasting pain relief.
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Affiliation(s)
- Xiong Gao
- Department of AnesthesiologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong University Shanghai 200127 P. R. China
| | - Piao Zhu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
- University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Luodan Yu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
| | - Liqun Yang
- Department of AnesthesiologyRen Ji HospitalSchool of MedicineShanghai Jiao Tong University Shanghai 200127 P. R. China
| | - Yu Chen
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of Sciences Shanghai 200050 P. R. China
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Seyedhejazi M, Motarabbesoun S, Eslampoor Y, Taghizadieh N, Hazhir N. Appendectomy Pain Control by Transversus Abdominis Plane (TAP) Block in Children. Anesth Pain Med 2019; 9:e83975. [PMID: 30881907 PMCID: PMC6412316 DOI: 10.5812/aapm.83975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/23/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background Pain control after surgery in children is very important. Despite having good analgesic effects, the use of opioids is, however, limited due to side effects. Objectives This study was aimed to investigate the effect of transverse abdominis plane (TAP) block on the intensity and frequency of pain after appendectomy in children. Methods In a single-blinded clinical trial, 40 children aged from 4 to 16 years, candidates for the appendectomy, were divided randomly to intervention and control groups. The intervention group received ultrasound-guided TAP block using 0.25 mL/kg of 0.25% bupivacaine in the Petit triangle after general anesthesia. Postoperative pain was assessed within the first 24 hours after surgery based on the Wong-Baker FACES Pain Rating Scale (WBFP). Results There was a reduction in WBFP scores at 2 hours after appendectomy in the intervention group compared with the control group (5.05 ± 2.83 vs 6.30 ± 2.2063). Also, the pain intensity within 24 hours after surgery in the intervention and control groups was 3.10 ± 1.33, and 3.60 ± 1.63 respectively according to WBFP scale (P > 0.05). Conclusions The TAP block was effective to reduce pain after appendectomy in children, however, there was no significant difference between intervention and control groups. Further studies with larger sample sizes are needed to be done in this area of research.
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Affiliation(s)
- Mahin Seyedhejazi
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Motarabbesoun
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yashar Eslampoor
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Taghizadieh
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Hazhir
- Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Anesthesiology Department, Children's Hospital, Tabriz University of Medical Sciences, Sheshgelan st., Tabriz, Iran. Tel: +98-9146303383,
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Tsai HL, Chang TK, Su WC, Yeh YS, Huang CW, Ma CJ, Wang JY. Comparing efficacy and safety between Naldebain ® and intravenous patient-controlled analgesia with fentanyl for pain management post-laparotomy: study protocol for a randomized controlled, non-inferior trial. Trials 2019; 20:173. [PMID: 30885242 PMCID: PMC6423831 DOI: 10.1186/s13063-019-3260-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 02/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background A long-acting prodrug of nalbuphine, nalbuphine sebacate, has been developed for meeting the unmet medical need of long-acting analgesics. Naldebain® (nalbuphine sebacate) has been developed as a new premedication for postoperative pain management. The primary objective of this study is to determine the efficacy and safety of a single dose of intramuscular Naldebain® in patients scheduled to undergo elective laparotomy. Methods/design A total of 110 patients will be recruited and randomized into two treatment groups. Group 1 receives a single dose of Naldebain® intramuscularly 24 ± 12 h prior to surgery. Group 2 receives intravenous patient-controlled analgesia (PCA) with fentanyl through 48 h postsurgery. Both groups will have follow-up observations until the final visit (day of discharge, day 6–30). The primary efficacy endpoint is to assess time-specific pain intensity calculated as the area under the curve (AUC) of a visual analog scale at individual time points and by using total AUC. Safety endpoints—including incidence of treatment, emergent adverse events, and percentage of abnormality from baseline to final visit—in vital signs, laboratory tests, and injection site evaluations will also be analyzed. Statistical analyses will be performed on the data to compare the two groups. Discussion Post-laparotomy pain can have a harmful effect on patient recovery; therefore, a slow-release formulation that can cover at least 7 days of analgesic effect is required. This study will demonstrate whether a single use of Naldebain® is not less efficacious than PCA with fentanyl for pain management as a non-inferior trial. Trial registration NCT03296488. Electronic supplementary material The online version of this article (10.1186/s13063-019-3260-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Trauma and Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, San-Ming District, Kaohsiung, 807, Taiwan. .,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Koniuch KL, Buys MJ, Campbell B, Gililland JM, Pelt CE, Pace NL, Johnson KB. Serum ropivacaine levels after local infiltration analgesia during total knee arthroplasty with and without adductor canal block. Reg Anesth Pain Med 2019; 44:rapm-2018-100043. [PMID: 30635510 DOI: 10.1136/rapm-2018-100043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding the maximum dosage when adding a peripheral nerve block. Little research exists that addresses serum ropivacaine concentrations following LIA combined with peripheral nerve block. We hypothesized that after combining LIA and adductor canal blockade (ACB), serum ropivacaine concentrations would remain below levels associated with local anesthetic toxicity. METHODS This was a prospective observational study that included 14 subjects undergoing TKA with intraoperative LIA containing 270 mg ropivacaine with epinephrine. Patients weighing less than 80 kg were excluded due to standardized dosing by our pharmacy. Seven patients were assigned consecutively to receive LIA alone (Group LIA) and seven were assigned to receive LIA plus ACB with 100 mg ropivacaine with epinephrine (Group LIA+ACB). Venous serum ropivacaine concentrations were measured over 24 hours. RESULTS Peak serum concentrations (Cmax) in Group LIA ranged from 0.23 to 0.75 µg/mL and occurred at times from 4 to 24 hours. Cmax in Group LIA+ACB ranged from 0.46 to 1.00 µg/mL and occurred at times from 4 to 8 hours. No participants demonstrated signs or symptoms of local anesthetic toxicity. CONCLUSIONS Total serum concentration of ropivacaine after LIA using 270 mg ropivacaine with and without an additional 100 mg perineural ropivacaine remained well below the toxicity threshold of 3.0 µg/mL at all time points. Additional studies are needed to ascertain the safety of combining LIA with peripheral nerve blockade.
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Affiliation(s)
- Katherine L Koniuch
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Michael Jay Buys
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Blake Campbell
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Jeremy M Gililland
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Ken B Johnson
- Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA
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Hakim KYK, Wahba WZB. Opioid-Free Total Intravenous Anesthesia Improves Postoperative Quality of Recovery after Ambulatory Gynecologic Laparoscopy. Anesth Essays Res 2019; 13:199-203. [PMID: 31198230 PMCID: PMC6545966 DOI: 10.4103/aer.aer_74_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Gynecological laparoscopic surgery is commonly performed on an ambulatory basis under general anesthesia. The postoperative quality of recovery (QOR) should be considered one of the principal endpoints after ambulatory surgery. Total intravenous anesthesia (TIVA) with opioids is known to improve postoperative QOR after ambulatory surgery. However, opioids can be associated with an increased incidence of postoperative complications, which can affect postoperative QOR. The primary aim of this study was to compare the patient recovery using the QOR-40 at 24 h postoperative in ambulatory gynecological laparoscopy between opioid-free (OF) TIVA and opioid-based TIVA. Settings and Design: A prospective, randomized, controlled, comparative study was conducted at the day surgery center. Patients and Methods: Eighty females were included in the study. They were randomized into two equal groups: OF TIVA group with dexmedetomidine and propofol or opioid-based TIVA (O) group with fentanyl and propofol. The primary outcome was QOR-40 at 24 h postoperative, and the secondary outcomes were postoperative numerical rating scale (NRS), time to first rescue analgesia, number of rescue tramadol analgesia, and the incidence of postoperative nausea and vomiting. Results: A statistically significant difference in total QOR-40 score at 24 h postoperative was observed between the groups (median [range] QOR-40 of 182.0 [164.0–192.0] in the OF TIVA group and 170.0 [156.0–185.0] in the O group; P = 0.03). OF group had significantly lower time to first rescue analgesia, maximum NRS pain scores, number of rescue tramadol analgesia, and ondansetron use. Conclusions: OF TIVA significantly improves postoperative QOR in patients undergoing ambulatory gynecological laparoscopic surgery.
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Rhon DI, Snodgrass SJ, Cleland JA, Sissel CD, Cook CE. Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule. Perioper Med (Lond) 2018; 7:25. [PMID: 30479746 PMCID: PMC6249901 DOI: 10.1186/s13741-018-0105-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
Abstract
Background Prescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery. Methods Individuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables. Results There were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present. Conclusion A combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.
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Affiliation(s)
- Daniel I Rhon
- 1Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam, Houston, TX 78234 USA.,2Doctoral Program in Physical Therapy, Baylor University, San Antonio, TX USA.,3School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW Australia
| | - Suzanne J Snodgrass
- 3School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW Australia
| | - Joshua A Cleland
- 4Department of Physical Therapy, Franklin Pierce University, Manchester, NH USA
| | - Charles D Sissel
- 5Program Analysis and Evaluation Division, US Army Medical Command, Joint Base San Antonio - Fort Sam Houston, San Antonio, TX 78234 USA
| | - Chad E Cook
- 6Division of Physical Therapy, Department of Orthopedics, Duke University, Duke MSK, Duke Clinical Research Institute, Durham, NC USA
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Dixon J, Ashton F, Baker P, Charlton K, Bates C, Eardley W. Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol. Geriatr Orthop Surg Rehabil 2018; 9:2151459318806443. [PMID: 30377550 PMCID: PMC6202735 DOI: 10.1177/2151459318806443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/06/2018] [Accepted: 09/19/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented. Materials and Methods Systematic review of preoperative IVP administration in patients presenting with a hip fracture. Results Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia. Discussion The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.
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Affiliation(s)
- Ján Dixon
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
| | - Fiona Ashton
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
| | - Paul Baker
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
| | - Karl Charlton
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
| | - Charlotte Bates
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
| | - William Eardley
- Department of Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, England
- William Eardley, Department of Trauma & Orthopaedics, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, England, United Kingdom.
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Zhang Z, Shen B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res 2018; 46:4874-4884. [PMID: 30318966 PMCID: PMC6300945 DOI: 10.1177/0300060518799616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Local infiltration analgesia has been widely used for pain relief in patients undergoing total knee arthroplasty. However, the effectiveness and major weakness of this technique have not been clarified; therefore, improvements in the technique have been limited. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and conducted a meta-analysis of randomized controlled trials comparing local infiltration analgesia with placebo infiltration in patients undergoing total knee arthroplasty. Fourteen trials involving 1305 knees were eligible. The results showed that local infiltration analgesia significantly reduced early perioperative pain and total narcotic consumption. However, postoperative functional outcomes were not significantly different between local infiltration analgesia and placebo. The pain-relieving effect of local infiltration analgesia was found to be strong but short in duration. In the future, modified delivery methods and formulas with longer durations of action and analgesia may provide a better environment for patients and therefore improve their function outcomes.
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Affiliation(s)
- Zihao Zhang
- 1 Chinese PLA General Hospital, Beijing, China
| | - Bin Shen
- 2 West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Dai H, Tilley DM, Mercedes G, Doherty C, Gulati A, Mehta N, Khalil A, Holzhaus K, Reynolds FM. Opiate-Free Pain Therapy Using Carbamazepine-Loaded Microparticles Provides Up to 2 Weeks of Pain Relief in a Neuropathic Pain Model. Pain Pract 2018; 18:1024-1035. [PMID: 29723917 DOI: 10.1111/papr.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Opioids remain a mainstay in the treatment of acute and chronic pain, despite numerous and potentially dangerous side effects. There is a great unmet medical need for alternative treatments for patients suffering from pain that do not result in addiction or adverse side effects. Anticonvulsants have been shown to be effective in managing pain, though high systemic levels and subsequent side effects limit their widespread usage. Our goal was to determine if the incorporation of an anticonvulsant, carbamazepine, into a biodegradable microparticle for local sustained perineural release would be an efficacious analgesic following a peripheral injury. METHODS Following induction of the chronic constriction injury model in Sprague-Dawley rats, mechanical allodynia testing was performed using von Frey filaments and thermal allodynia was evaluated using the Hargreaves method. Histology and blood work were performed to evaluate toxicity as well as to monitor drug and metabolite presence over time. RESULTS A 2-fold increase in hindpaw withdrawal thresholds in animals receiving carbamazepine-loaded microparticles relative to controls was observed for up to 14 days after treatment. Drug and metabolite had a peak blood concentration of 54.7 ng/mL and dropped off exponentially to < 5 ng/mL over a few days. CONCLUSION This formulation reduced systemic exposure to carbamazepine over 1,000-fold relative to traditional analgesic dosing regimens. This 2-component drug delivery system has been specifically engineered to release a controlled amount of carbamazepine over a 14-day period, providing significant pain relief with no toxicological or observable adverse events via behavioral or histochemical analysis.
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Affiliation(s)
- Haining Dai
- PixarBio Corporation, Salem, New Hampshire, U.S.A
| | | | | | | | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, New York, U.S.A
| | - Neel Mehta
- Department of Anesthesiology, Weill Cornell Medical College, New York City, New York, U.S.A
| | - Amer Khalil
- PixarBio Corporation, Salem, New Hampshire, U.S.A.,Department of Neurosurgery, University of California Irvine, Irvine, California, U.S.A
| | | | - Francis M Reynolds
- PixarBio Corporation, Salem, New Hampshire, U.S.A.,Frank Reynolds Corporation, Salem, New Hampshire, U.S.A
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E C, M S, M K, I Y, A A. Comparison of the effects of intravenous Dexketoprofen Trometamol versus Paracetamol on postoperative analgesia in patients undergoing Septoplasty: A randomised double-blind clinical trial. Pak J Med Sci 2018; 34:546-552. [PMID: 30034413 PMCID: PMC6041512 DOI: 10.12669/pjms.343.13804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Septoplasty operations are associated with moderate to severe postoperative pain which has unfavourable effects on patient’s recovery and postoperative outcome. The aim of this study was to compare effects of intravenous paracetamol and dexketoprofen on postoperative analgesia, tramadol consumption and side effects after septoplasty. Methods: In total 72 patients (aged 18–65 years) who had undergone an elective septoplasty from August 2013 to January 2015 in Baskent University Faculty of Medicine, in the Department of Anesthesiology and Reanimation Clinics were included in this study. The patients were randomised into one of two groups: those who received intravenous paracetamol; and those who received intravenous dexketoprofen. All patients were treated with tramadol for 24 hour postoperatively. The primary endpoint was pain intensity as measured by a visual analogue scale (VAS). Tramadol consumption and drug related side effects were also recorded. Results: The pain scores in the dexketoprofen group were significantly lower at recovery, 15 and 30 minutes and two hour (p< 0.05). The pain scores had no difference at other time points. Tramadol consumption in the recovery period was significantly lower in the dexketoprofen group, but cumulative tramadol consumption did not differ between the groups. The incidence of nausea was lower but not statistically significant in the dexketoprofen group at 15 and 30 minutes and two hour. Conclusions: Compared with paracetamol, preemptive dexketoprofen is associated with lower VAS scores and tramadol consumption in the early postoperative period after septoplasty. However, the cumulative tramadol consumption did not significantly differ between the groups.
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Affiliation(s)
- Caliskan E
- Caliskan E. Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Sener M
- Sener M. Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Kipri M
- Kipri M. Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Yilmaz I
- Yilmaz I. Department of Otolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Aribogan A
- Aribogan A. Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Ankara, Turkey
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Post-operative Weaning of Opioids After Ambulatory Surgery: the Importance of Physician Stewardship. Curr Pain Headache Rep 2018; 22:40. [DOI: 10.1007/s11916-018-0694-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hanzawa A, Handa T, Kohkita Y, Ichinohe T, Fukuda KI. A Comparative Study of Oral Analgesics for Postoperative Pain After Minor Oral Surgery. Anesth Prog 2018; 65:24-29. [PMID: 29509516 DOI: 10.2344/anpr-65-01-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We compared the effects of preoperative administration of diclofenac sodium, celecoxib, and acetaminophen on postoperative pain in patients undergoing minor oral surgery under general anesthesia. One hundred twenty-eight patients were randomly divided into 4 groups preoperatively treated with diclofenac sodium 50 mg, celecoxib 400 mg, acetaminophen 1000 mg, or placebo. Postoperative pain was managed using intravenous patient-controlled infusion of fentanyl. Assessments included levels of postoperative pain by using visual analog scale (VAS) scores at 4, 5, and 6 hours after administration of the test drug; consumption of fentanyl up to each time point; and time to first requirement for fentanyl. Our study demonstrated that, for diclofenac sodium and celecoxib in comparison with placebo, there were significantly lower VAS scores at 4, 5, and 6 hours after oral administration of the study drug; a longer period of time to first requirement for fentanyl after surgery; and less consumption of postoperative fentanyl. A similar analgesic effect versus placebo was noted for acetaminophen but only at the 5- and 6-hour time points. In contrast, no significant differences in VAS scores at 4 hours after administration or time to first requirement for fentanyl were observed between acetaminophen and placebo. Furthermore, no significant differences in measurements were observed between the study drugs at any time point. These findings suggest that oral administration of celecoxib 400 mg is suitable for controlling postoperative pain, and as effective as diclofenac sodium 50 mg. Acetaminophen 1000 mg also exerts analgesic effect with slower onset for postoperative pain.
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Affiliation(s)
- Atsushi Hanzawa
- Department of Oral Health and Clinical Science, Division of Special Needs Dentistry and Orofacial Pain, Tokyo Dental College, Tokyo, Japan
| | - Toshiyuki Handa
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Yoshihiko Kohkita
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Tatsuya Ichinohe
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Ken-Ichi Fukuda
- Department of Oral Health and Clinical Science, Division of Special Needs Dentistry and Orofacial Pain, Tokyo Dental College, Tokyo, Japan
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Ho MLJ, Kerr SJ, Stevens J. Intravenous lidocaine infusions for 48 hours in open colorectal surgery: a prospective, randomized, double-blinded, placebo-controlled trial. Korean J Anesthesiol 2018; 71:57-65. [PMID: 29441176 PMCID: PMC5809709 DOI: 10.4097/kjae.2018.71.1.57] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background Although intravenous (i.v.) lidocaine is used as a perioperative analgesic in abdominal surgery, evidence of efficacy is limited. The infusion dose and duration remain unclear. This study aimed to investigate the effect of a longer low-dose 48-hour infusion regimen on these outcomes. Methods Fifty-eight adults undergoing elective open colorectal surgery were randomized into the lidocaine group (1.5 mg/kg bolus followed by 1 mg/kg/h infusion for 48 hours) and control group. After surgery, patients were given a fentanyl patient-controlled analgesia machine and time to first bowel movement (primary outcome) and flatus were recorded. Postoperative pain scores and fentanyl consumption were assessed for 72 hours. Results There was no significant difference in time to first bowel movement (80.1 ± 42.2 vs. 82.5 ± 40.4 hours; P = 0.830), time to first flatus (64.7 ± 38.5 vs. 70.0 ± 31.2 hours; P = 0.568), length of hospital stay (9 [8–13] vs. 11 [9–14) days; P = 0.531], nor postoperative pain scores in the lidocaine vs. control groups. Cumulative opioid consumption was significantly lower in the lidocaine vs. the control group from 24 hours onwards. At 72 hours, cumulative opioid consumption (µg fentanyl) in the lidocaine group (1,570 [825–3,587]) was over 40% lower than in the placebo group (2,730 [1,778–5,327]; P = 0.039). Conclusions A 48-hour low-dose i.v. lidocaine infusion does not significantly speed the return of bowel function in patients undergoing elective open colorectal surgery. It was associated with reduced postoperative opioid consumption, but not with earlier hospital discharge, or lower pain scores.
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Affiliation(s)
- Matthew Liang Jinn Ho
- Department of Anaesthesia, Concord Repatriation General Hospital, Camperdown NSW, Sydney, Australia
| | - Stephen John Kerr
- The Kirby Institute, University of New South Wales, Kensington NSW, Sydney, Australia
| | - Jennifer Stevens
- Department of Anaesthesia, St Vincent's Hospital, Darlinghurst NSW, Sydney, Australia
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Patel MK, Ekka M, Ekka S, Dalai H, Pujahari PS. A COMPARATIVE STUDY OF PREEMPTIVE ANALGESIC PROPERTY OF INTRAVENOUS PARACETAMOL AND DICLOFENAC SODIUM. ACTA ACUST UNITED AC 2018. [DOI: 10.18410/jebmh/2018/97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mavrogenis AF, Igoumenou VG, Kostroglou A, Kostopanagiotou K, Saranteas T. The ABC and pain in trauma. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:545-550. [PMID: 29362976 DOI: 10.1007/s00590-018-2123-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/04/2018] [Indexed: 12/28/2022]
Abstract
Musculoskeletal trauma in the emergency setting is a challenge for orthopaedic surgeons. Life- and limb-threatening injuries of the extremities should be treated as soon as possible, since major musculoskeletal trauma can be the cause of significant bleeding. However, musculoskeletal trauma is often related to thoracic trauma. Management of the former should be performed only after patient's airway is maintained and breathing is secured with appropriate pain monitoring and management by expert anesthesiologists. This article discusses the association of musculoskeletal with thoracic trauma care and emphasizes on pain as a vital sign in trauma.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece.
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Kostis Kostopanagiotou
- Department of Thoracic Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Theodosis Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Lin CC, Wu YH, Wu CT, Lin CF, Chen WH, Huang SS, Wu LH. Efficacy of parecoxib for reducing pyelovenous backflow pain during retrograde intrarenal surgery. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chiu AS, Healy JM, DeWane MP, Longo WE, Yoo PS. Trainees as Agents of Change in the Opioid Epidemic: Optimizing the Opioid Prescription Practices of Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:65-71. [PMID: 28705485 DOI: 10.1016/j.jsurg.2017.06.020] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/12/2017] [Accepted: 06/17/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Opioid abuse has become an epidemic in the United States, causing nearly 50,000 deaths a year. Postoperative pain is an unavoidable consequence of most surgery, and surgeons must balance the need for sufficient analgesia with the risks of overprescribing. Prescribing narcotics is often the responsibility of surgical residents, yet little is known about their opioid-prescribing habits, influences, and training experience. DESIGN Anonymous online survey that assessed the amounts of postoperative opioid prescribed by residents, including type of analgesia, dosage, and number of pills, for a series of common general surgery procedures. Additional questions investigated influences on opioid prescription, use of nonnarcotic analgesia, degree of engagement in patient education on opioids, and degree of training received on analgesia and opioid prescription. SETTING Accreditation Council for Graduate Medical Education accredited general surgery program at a university-based tertiary hospital. PARTICIPANTS Categorical and preliminary general surgery residents of all postgraduate years. RESULTS The percentage of residents prescribing opioids postprocedure ranged from 75.5% for incision and drainage to 100% for open hernia repair. Residents report prescribing 166.3 morphine milligram equivalents of opioid for a laparoscopic cholecystectomy, yet believe patients will only need an average of 113.9 morphine milligram equivalents. The most commonly reported influences on opioid-prescribing habits include attending preference (95.2%), concern for patient satisfaction (59.5%), and fear of potential opioid abuse (59.5%). Only 35.8% of residents routinely perform a narcotic risk assessment before prescribing and 6.2% instruct patients how to properly dispose of excess opioids. More than 90% of residents have not had formal training in best practices of pain management or opioid prescription. CONCLUSION AND RELEVANCE Surgical trainees are relying almost exclusively on opioids for postoperative analgesia, often in excessive amounts. Residents are heavily influenced by their superiors, but are not receiving formal opioid-prescribing education, pointing to a great need for increased resident education on postoperative pain and opioid management to help change prescribing habits.
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Affiliation(s)
- Alexander S Chiu
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James M Healy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael P DeWane
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Walter E Longo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Peter S Yoo
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
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Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks. Best Pract Res Clin Anaesthesiol 2017; 31:533-545. [DOI: 10.1016/j.bpa.2017.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/08/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022]
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Forogh B, Aslanpour H, Fallah E, Babaei-Ghazani A, Ebadi S. Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial. Disabil Rehabil 2017; 41:514-522. [DOI: 10.1080/09638288.2017.1399294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Aslanpour
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Fallah
- Department of Orthopedics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Safoora Ebadi
- Neuromusculoskeletal Research center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Clinical Efficacy of Intravenous Lidocaine for Thyroidectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. World J Surg 2017; 40:2941-2947. [PMID: 27379388 DOI: 10.1007/s00268-016-3619-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Systemic lidocaine has analgesic and anti-inflammatory effects. The purpose of this prospective, randomized, double-blind study was to evaluate the effects of intravenous lidocaine on pain following thyroidectomy. METHODS Fifty-eight adult patients scheduled for total thyroidectomy were randomly allocated to receive a 1.5 mg/kg lidocaine bolus followed by a 2 mg/kg/h infusion during surgery, or the same volume of normal saline (control). After thyroidectomy, we evaluated postoperative pain, nausea, fentanyl consumption, frequency of pushing the button (FPB) for patient-controlled analgesia (PCA), High-sensitivity C-reactive protein (hs-CRP) in serum, and patient satisfaction scores regarding the recovery process. RESULTS Postoperative pain and nausea scores were significantly lower in the lidocaine group for the first 4 h following thyroidectomy, compared to the control group. Fentanyl consumption and FPB for the PCA were also significantly reduced in the lidocaine group for 4 h following thyroidectomy, and hs-CRP was significantly less in the lidocaine group at postoperative days 1 and 3. Furthermore, satisfaction scores were significantly higher in the lidocaine group compared to the control group. CONCLUSIONS Intravenous lidocaine effectively reduced postoperative pain and nausea following thyroidectomy as well as improved the quality of recovery. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT01608360.
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Egede JO, Ajah LO, Umeora OU, Ozumba BC, Onoh RC, Obuna JA, Ekem N. Pentazocine Alone Versus Pentazocine Plus Diclofenac for Pain Relief in the First 24 Hours after Caesarean Section: A Randomized Controlled Study. J Clin Diagn Res 2017; 11:QC01-QC05. [PMID: 28571211 DOI: 10.7860/jcdr/2017/25294.9519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. AIM To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. MATERIALS AND METHODS This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05. RESULTS The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05). CONCLUSION The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.
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Affiliation(s)
- John Okafor Egede
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Leonard Ogbonna Ajah
- Senior Lecturer, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Odidika Ugochukwu Umeora
- Professor, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Benjamin Chukwuma Ozumba
- Professor, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Robinson Chukwudi Onoh
- Lecturer, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Johnson Akuma Obuna
- Senior Lecturer, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Napoleon Ekem
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
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