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Al-Touny SA, Abd Elnasser AG, Al-Taher EM, El-Lilly AA. Analgesic effect of ketorolac as an adjuvant to bupivacaine in ultrasound-guided pectoral nerve block (I + II) for patients undergoing modified radical mastectomy: A randomized controlled clinical trial. J Anaesthesiol Clin Pharmacol 2023; 39:61-66. [PMID: 37250239 PMCID: PMC10220180 DOI: 10.4103/joacp.joacp_149_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Many drugs have been tried as adjuvant to local anesthetic in different nerve blocks. Ketorolac is one of them, but it has never been used in pectoral nerve block. In this study, we evaluated its adjuvant effect with local anesthetic on postoperative analgesia in ultrasound (US)-guided pectoral nerve (PECS) blocks. The aim was to assess the quality and the duration of analgesia by the addition of ketorolac in the PECS block. Material and Methods 46 patients who underwent modified radical mastectomies under general anesthesia were randomized into two groups: control group, where pectoral nerve block was given with bupivacaine 0.25% only; and ketorolac group, where the block was given with bupivacaine 0.25% and ketorolac 30 mg. Results Patients who needed postoperative supplemental analgesia were significantly less in the ketorolac group (9 vs 21 patients, P = 0.00) and that first-time analgesic requirement was significantly later in the ketorolac group (14 hrs) postoperatively compared to the control group (9 hrs) postoperatively. Conclusion Adding ketorolac to bupivacaine in pectoral nerve block safely increases postoperative duration of analgesia.
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Affiliation(s)
- Shimaa A Al-Touny
- Department of Anesthesia, Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Amira G Abd Elnasser
- Department of Anesthesia, Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ezzat M Al-Taher
- Department of Anesthesia, Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed A El-Lilly
- Department of Anesthesia, Intensive Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Nestor CC, Ng C, Sepulveda P, Irwin MG. Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review. Anaesthesia 2021; 77:339-350. [PMID: 34904711 DOI: 10.1111/anae.15641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 12/19/2022]
Abstract
Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long- and short-acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non-steroidal anti-inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non-steroidal anti-inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose-dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.
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Affiliation(s)
- C C Nestor
- Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
| | - C Ng
- Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
| | | | - M G Irwin
- Department of Anaesthesia and Pain Medicine, Hospital Base San Jose, Los Lagos, Chile
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Yan R, Fu X, Ren YF, Liu H, You FM, Shi W, Jiang YF. The Analgesic Benefits of Ketorolac to Local Anesthetic Wound Infiltration Is Statistically Significant But Clinically Unimportant: A Comprehensive Systematic Review and Meta-Analysis. Adv Wound Care (New Rochelle) 2021; 10:583-595. [PMID: 34074155 DOI: 10.1089/wound.2021.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: Even though ketorolac-infiltration is said to provide superior postoperative analgesic benefits in different surgical procedures, its safety and efficacy remain to be validated because of the lack of high-quality evidence. We aimed to summarize the efficacy and safety of ketorolac-infiltration based on published randomized-controlled trials (RCTs). Approach: This work followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, assessing the methodological quality of systematic reviews and the Cochrane Collaboration recommendations. We searched for RCTs evaluating the efficacy of ketorolac-infiltration in adults in the PubMed, Web of Science, Embase, Cochrane Library, Chinese databases, and Google Scholar. The two co-primary outcomes of this meta-analysis were rescue analgesic consumption in the 24-h postoperative period and rest pain scores. Results: Twelve trials (761 patients) were analyzed. Ketorolac-infiltration provided a clinically unimportant benefit in morphine consumption (mean difference, -2.81 mg; 95% confidence interval [CI], -5.11 to -0.50; p = 0.02; moderate-quality evidence). Low-to-moderate quality evidence supported a brief (2-6 h), clinically subtle, but statistically consistent effect of surgical site ketorolac-infiltration in reducing wound pain at rest. High-quality evidence supported shorter hospital stays for surgical patients receiving local ketorolac-infiltration when compared to controls (mean difference, -0.12 days; 95% CI, -0.17 to -0.08; p < 0.00001). Further, ketorolac-infiltration does not improve any opioid-related side effects. Innovation: Ketorolac-infiltration provides statistically significant but clinically unimportant benefits for improving postoperative wound pain. Conclusion: Overall, despite the fact that current moderate-to-high quality of evidence does not support routine using of ketorolac as an adjuvant to local anesthetic for wound infiltration, these findings underscore the importance of optimizing agents and sustained delivery parameters in postoperative local anesthetic practice. Clinical Trials.gov ID: CRD42021229095.
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Affiliation(s)
- Ran Yan
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Fu
- Teaching and Research Office of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi-Feng Ren
- Teaching and Research Office of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hong Liu
- Teaching and Research Office of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng-Ming You
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Shi
- Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Yi-Fang Jiang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Perioperative Pain Management after Ambulatory Abdominal Surgery: An American College of Surgeons Systematic Review. J Am Coll Surg 2020; 231:572-601.e27. [DOI: 10.1016/j.jamcollsurg.2020.07.755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023]
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Effects of Bupivacaine Versus Bupivacaine Plus Dexamethasone-Soaked Nasal Packing After Endoscopic Nasal Surgery. J Craniofac Surg 2019; 30:1174-1177. [DOI: 10.1097/scs.0000000000005227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Godbole MR, Karhade SS, Parihar PP. A Prospective Study of Comparison of Analgesic Efficacy of Dexamethasone as an Adjuvant in Supraclavicular Block with Intravenous Dexamethasone after Supraclavicular Block in Patients Undergoing Forearm Surgeries. Anesth Essays Res 2019; 13:31-35. [PMID: 31031476 PMCID: PMC6444946 DOI: 10.4103/aer.aer_11_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Context: Brachial plexus block is a preferred anesthesia technique for upper limb surgeries below the shoulder joint. Drugs used as adjuvants in block enhance the postoperative analgesia significantly. Aim: We aimed to evaluate the analgesic efficacy, of perineural dexamethasone used as an adjuvant to supraclavicular block as against systemic dexamethasone after supraclavicular block. Time for rescue analgesia was also noted in both groups. Subjects and Methods: In our randomized study, 60 patients belonging to the American Society of Anesthesiologist physical status Classes I and II were randomly allocated in two groups of thirty. Group BD received supraclavicular block with local anesthetic and dexamethasone 0.05 mg/kg as an adjuvant. Group BI received supraclavicular block with local anesthetic and intravenous (IV) dexamethasone 0.05 mg/kg after the block. In both groups, the comparison of postoperative analgesia and time for first rescue analgesic was noted. Statistical Analysis Used: Data analysis was done using SPSS version 20.0. Demographic data and continuous variables were analyzed by independent sample t-test. Categorical data were analyzed by unpaired t-test. Results: Group BD showed significantly prolonged postoperative analgesia as compared to Group BI. Time for rescue analgesic in Group BD was (15.8 ± 2.6) H as compared to Group BI (10.3 ± 1.07) H. Conclusions: Dexamethasone, when used in supraclavicular block significantly, prolongs the duration of analgesia as against IV dexamethasone after supraclavicular block.
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Affiliation(s)
- Madhavi Rahul Godbole
- Department of Anaesthesia, Smt. Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India
| | - Seema Shreepad Karhade
- Department of Anaesthesia, Smt. Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India
| | - Priya P Parihar
- Department of Anaesthesia, Smt. Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India
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Beaussier M, Sciard D, Sautet A. New modalities of pain treatment after outpatient orthopaedic surgery. Orthop Traumatol Surg Res 2016; 102:S121-4. [PMID: 26803223 DOI: 10.1016/j.otsr.2015.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/22/2015] [Accepted: 05/14/2015] [Indexed: 02/02/2023]
Abstract
Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored.
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Affiliation(s)
- M Beaussier
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France.
| | - D Sciard
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France
| | - A Sautet
- Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Est-Parisien, Sorbonne Universités, UPMC Université Paris, Hôpital St-Antoine, Orthopaedic and Trauma Surgery Department, Surgical Anesthesia and Intensive Care Unit, Paris, France
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Kumar S, Palaria U, Sinha AK, Punera DC, Pandey V. Comparative evaluation of ropivacaine and ropivacaine with dexamethasone in supraclavicular brachial plexus block for postoperative analgesia. Anesth Essays Res 2015; 8:202-8. [PMID: 25886227 PMCID: PMC4173629 DOI: 10.4103/0259-1162.134506] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mixing of various adjuvants has been tried with local anesthetics in an attempt to prolong anesthesia from peripheral nerve blocks but have met with inconclusive success. More recent studies indicate that 8 mg dexamethasone added to perineural local anesthetic injections augment the duration of peripheral nerve block analgesia. AIMS Evaluating the hypothesis that adding dexamethasone to ropivacaine significantly prolongs the duration of analgesia in supraclavicular brachial plexus block compared with ropivacaine alone. PATIENTS AND METHODS It was a randomized, prospective, and double-blind clinical trial. Eighty patients of ASA I and II of either sex, aged 16-60 years, undergoing elective upper limb surgeries were equally divided into two groups and given supraclavicular nerve block. Group R patients (n = 40) received 30 ml of 0.5% ropivacaine with distilled water (2 ml)-control group whereas Group D patients (n = 40) received 30 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml)-study group. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The secondary outcome included maximum visual analogue scale (VAS), total analgesia consumption, surgeon satisfaction, and side effects. RESULTS Group R patients required first rescue analgesia earlier (557 ± 58.99 min) than those of Group D patients (1179.4 ± 108.60 min), which was found statistically significant in Group D (P < 0.000). The total dose of rescue analgesia was higher in Group R as compared to Group D, which was statistically significant (P < 0.00). CONCLUSION Addition of dexamethasone (8 mg) to ropivacaine in supraclavicular brachial plexus approach significantly and safely prolongs motor blockade and postoperative analgesia (sensory) that lasted much longer than that produced by local anesthetic alone.
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Affiliation(s)
- Santosh Kumar
- Department of Anaesthesiology and Critical Care, TBCD, GMC, Haldwani, Nainital, Uttarakhand, India
| | - Urmila Palaria
- Department of Anaesthesiology and Critical Care, TBCD, GMC, Haldwani, Nainital, Uttarakhand, India
| | - Ajay K Sinha
- Department of Anaesthesiology and Critical Care, TBCD, GMC, Haldwani, Nainital, Uttarakhand, India
| | - D C Punera
- TBCD, GMC, Haldwani, Nainital, Uttarakhand, India
| | - Vijita Pandey
- Department of Anaesthesiology and Critical Care, TBCD, GMC, Haldwani, Nainital, Uttarakhand, India
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Opperer M, Gerner P, Memtsoudis SG. Additives to local anesthetics for peripheral nerve blocks or local anesthesia: a review of the literature. Pain Manag 2015; 5:117-28. [DOI: 10.2217/pmt.15.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
SUMMARY A multitude of studies have focused on individual additives to local anesthetics and their effect on quality, onset, duration, spread and selectivity, as well as the potential toxic effects of their use. This review aims to give a broad overview of the current evidence in this developing field, based on beneficial and adverse effects of these drugs. We discuss the limitations of the available data and hope to convey implications and future perspectives for clinicians and researchers alike.
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Affiliation(s)
- Mathias Opperer
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
| | - Peter Gerner
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Department of Anesthesiology, Paracelsus Medical University, Müllnerhauptstraße 48, 5020 Salzburg, Austria
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Lashgarinia M, Naghibi K, Honarmand A, Safavi M, Khazaei M. Effect of ketamine as an adjuvant in ultrasound-guided supraclavicular brachial plexus block: A double-blind randomized clinical trial study. Adv Biomed Res 2014; 3:232. [PMID: 25538918 PMCID: PMC4260270 DOI: 10.4103/2277-9175.145730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/31/2014] [Indexed: 12/14/2022] Open
Abstract
Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. Ketamine has been reported to enhance the analgesic effects of local anesthetics. We have conducted this study to assess whether coadministration of ketamine can prolong the local analgesic effect of lidocaine in the supraclavicular brachial plexus block for patients undergoing elective upper extremity surgery. Materials and Methods: Sixty adult patients undergoing elective surgery of the elbow, forearm, wrist or hand were randomly allocated in two groups of 30 patients each. Group 1 (ketamine group) received 5 mg/kg lidocaine 1.5% plus 2 mg/kg ketamine, Group 2 (control group) received 5 mg/kg lidocaine 1.5% and saline. The outcome measures included severity of pain by using visual analog scale (VAS, 0 = no pain 10 cm = the most severe pain), time of first request for analgesia, and total dose of postoperative opioid administration. The data was analyzed using the χ2 test, student's t-test, Kaplan-Meier survival analysis, and Multivariate analysis tests. Results: Patients in the control group had a higher VAS than patients who received ketamine, at all time points during the first 24 hours after surgery (all P < 0.05). The time of first request for analgesia in the ketamine group was significantly more than in the control group (8.93 ± 1.0 vs. 7.30 ± 1.9, respectively, P < 0.001). Conclusion: The addition of ketamine to lidocaine in the ultrasound-guided brachial plexus block could decrease the postoperative pain and need for analgesic. Therefore, it could be considered as an option in the brachial plexus block to enhance the analgesic action of lidocaine.
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Affiliation(s)
- Mohammadreza Lashgarinia
- Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khosro Naghibi
- Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Safavi
- Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Khazaei
- Departments of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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INTERSCALENE BRACHIAL PLEXUS BLOCK: COMPARISON OF EFFICACY OF VARYING DOSES OF DEXAMETHASONE COMBINED WITH LEVOBUPIVACAINE: A DOUBLE-BLIND RANDOMISED TRAIL. ACTA ACUST UNITED AC 2014. [DOI: 10.14260/jemds/2014/2836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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12
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Joshi GP, Rawal N, Kehlet H. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg 2011; 99:168-85. [DOI: 10.1002/bjs.7660] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 01/31/2023]
Abstract
Abstract
Background
Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery.
Methods
Randomized studies, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases. In addition to published evidence, clinical practice was taken into account to ensure that the recommendations had clinical validity.
Results
Of the 334 randomized studies identified, 79 were included. Quantitative analysis suggested that regional anaesthesia was superior to general anaesthesia for reducing postoperative pain. Spinal anaesthesia was associated with a higher incidence of urinary retention and increased time to home-readiness compared with regional anaesthesia.
Conclusion
Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion of a surgical wound provides a longer duration of analgesia. Conventional non-steroidal anti-inflammatory drugs or cyclo-oxygenase 2-selective inhibitors in combination with paracetamol, administered in time to provide sufficient analgesia in the early recovery phase, are optimal. In addition, weak opioids are recommended for moderate pain, and strong opioids for severe pain, on request.
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Affiliation(s)
- G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - N Rawal
- Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden
| | - H Kehlet
- Section for Surgical Pathophysiology 4074, The Juliane Marie Centre, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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Cummings K, Napierkowski D, Parra-Sanchez I, Kurz A, Dalton J, Brems J, Sessler D. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth 2011; 107:446-53. [DOI: 10.1093/bja/aer159] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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An Investigation Into the Hypoalgesic Effects of High- and Low-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally-Induced Blunt Pressure Pain in Healthy Human Participants. THE JOURNAL OF PAIN 2010; 11:53-61. [DOI: 10.1016/j.jpain.2009.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 05/01/2009] [Accepted: 05/29/2009] [Indexed: 11/19/2022]
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Infiltrations cicatricielles en injections uniques. Neurochirurgie, chirurgie ORL, thoracique, abdominale et périnéale. ACTA ACUST UNITED AC 2009; 28:e163-73. [DOI: 10.1016/j.annfar.2009.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rezaii J, Esfandiari K, Tavakoli H, Haji-Mahmoodi M, Pouya JK, Malakian F, Rashidi A, Abouzari M. Effect of wound infiltration with 0.5% bupivacaine on post-herniorrhaphy pain. ANZ J Surg 2008; 78:107-8. [DOI: 10.1111/j.1445-2197.2007.04374.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Jaffer U, Elmghrbee A, Wilding R, Cameron AEP. Audit of patient experience of day-case inguinal hernia repair. Hernia 2007; 12:79-82. [DOI: 10.1007/s10029-007-0291-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/24/2007] [Indexed: 11/24/2022]
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Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother 2006; 60:341-8. [PMID: 16854557 DOI: 10.1016/j.biopha.2006.06.021] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 06/12/2006] [Indexed: 01/21/2023] Open
Abstract
Ketamine is a dissociative anaesthetic; its mechanism of action is primarily an antagonism of the N-methyl-D-aspartate (NMDA) receptor. The role of ketamine, in particular in lower sub-anaesthetic doses, has recently gained increasing interest in pain management. It has been studied in a considerable number of trials and analysed in meta-analyses and systematic reviews. Based on these data, the primary role of ketamine in such low doses is as an 'anti-hyperalgesic', 'anti-allodynic' or 'tolerance-protective' agent. It therefore has a role in the treatment of opioid resistant or 'pathological' pain (central sensitisation with hyperalgesia or allodynia, opioid induced hyperalgesia, neuropathic pain) rather than as an 'analgesic' in its own right. Low dose ketamine also has 'preventive analgesia' properties. Furthermore, in higher doses it provides effective and safe sedation and analgesia for painful procedures. The place of ketamine in the treatment of chronic pain and the effects of long-term medicinal use remain unclear.
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Affiliation(s)
- E Visser
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, and University of Western Australia, School of Medicine and Pharmacology, Perth, WA 6847, Australia
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Koç M, Tez M, Yoldaş O, Dizen H, Göçmen E. Cooling for the reduction of postoperative pain: prospective randomized study. Hernia 2006; 10:184-6. [PMID: 16432641 DOI: 10.1007/s10029-005-0062-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Accepted: 12/06/2005] [Indexed: 11/26/2022]
Abstract
Hernia surgery has been associated with severe pain within the first 24 h postoperatively. The application of cold or cryotherapy has been in use since at least the time of Hippocrates. The physiological and biological effects from the reduction of temperature in various tissues include local analgesia, inhibited oedema formation and reduced blood circulation. Our hypothesis was that cold therapy, applied by means of ice packs, following inguinal hernia surgery, controlled pain postoperatively. Forty patients scheduled for inguinal hernia repair were enrolled in a double-blind, randomized study. Postoperatively, chipped ice in a plastic bag (cold group), and a plastic bag containing only room temperature water (control) were placed over the incision for 20 min. Postoperative pain data were collected at 2, 6 and 24 h after operation according to the well validated visual analogue scale (VAS). The highest pain levels were recorded 2 h postoperatively for both groups. Pain levels then gradually decreased for both the trial groups during the first 24 h postoperatively. There were significant differences in the VAS scores between the groups at 2, 6 and 24 h. We conclude that local cooling is a safe and effective technique for providing analgesia following inguinal hernia repair.
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Affiliation(s)
- M Koç
- Fifth Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey
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