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Girotra C, Padhye M, Mahajan P, Savla S, Nair A, Pardeshi P, Tomar G, Kini Y. Is Paracetamol Better than Diclofenac Sodium in Management of Postoperative Pain and Edema Following Major Maxillofacial Surgeries? J Maxillofac Oral Surg 2023; 22:187-195. [PMID: 36703676 PMCID: PMC9871110 DOI: 10.1007/s12663-022-01806-2] [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: 05/15/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Paracetamol is an optimal non-opioid analgesic and holds considerable advantages over NSAIDs in managing post-operative pain. Literature to date doesn't provide substantial documentation of it's efficacy and safety in major oral and maxillofacial surgeries. The study is designed to compare the effectiveness of intravenous paracetamol with diclofenac sodium for controlling post-operative pain and edema in major oral and maxillofacial surgeries. Method The double-blind randomised prospective study includes 140 healthy patients with ASA grades I and II. Patients were divided into Group A (1gm paracetamol) and B (75 mg diclofenac sodium), 70 patients each, undergoing similar surgical procedures. VAS and VRS were assessed for pain and thread method for measuring swelling. Mouth opening in space infections was measured with calliper and scale. Results Independent samples t-test and chi-square test showed longer pain-free interval, more interval between first and second dose, lesser number of doses required in Group A than Group B (p-value < 0.05). Independent samples t-test and Mann-Whitney test showed faster resolution of swelling in Group A (p-value < 0.05). Independent samples t-test showed lesser time taken for resolution of trismus in space infections in Group A (p-value < 0.05). Discussion Paracetamol 1 g was found to be an effective analgesic with less adverse effects. It is superior non-opioid analgesic in reducing the intensity of post-operative pain and swelling, also requires less number of doses than diclofenac sodium in major surgeries. Patients treated with paracetamol had better quality of life during post-operative period.
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Affiliation(s)
- Charu Girotra
- Department of Oral and Maxillofacial Surgery, School of Dentistry, D. Y. Patil University, Nerul, Navi Mumbai, India
| | - Mukul Padhye
- Department of Oral and Maxillofacial Surgery, School of Dentistry, D. Y. Patil University, Nerul, Navi Mumbai, India
| | - Pratibha Mahajan
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Siddhi Savla
- D. Y. Patil University School of Dentistry, Sector 7 Nerul, Navi Mumbai, 400706 India
| | - Aishwarya Nair
- Department of Oral and Maxillofacial Surgery, School of Dentistry, D. Y. Patil University, Nerul, Navi Mumbai, India
| | | | - Gaurav Tomar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, D. Y. Patil University, Nerul, Navi Mumbai, India
| | - Yogesh Kini
- Department of Oral and Maxillofacial Surgery, School of Dentistry, D. Y. Patil University, Nerul, Navi Mumbai, India
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Muacevic A, Adler JR, Kandru M, Dendukuri NK, Gandla G, Vemuri SSS, Peri H, Linga S. Effect of Parecoxib on Postoperative Pain Management After Total Knee/Hip Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e32339. [PMID: 36628043 PMCID: PMC9826532 DOI: 10.7759/cureus.32339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) or total hip arthroplasty (THA) are frequent procedures used to relieve the symptoms of hip or knee joint dysfunction, enhance disease recovery, and boost patients' quality of life. Nevertheless, postoperative pain has been a significant disadvantage since it strongly impacts patients' postoperative recovery. Parecoxib has been demonstrated to be useful in the management of postoperative pain in a variety of surgical procedures. While parecoxib can help with postoperative pain, its analgesic and unfavourable effects in TKA/THA patients have not been well studied. METHODS A systematic search of peer-reviewed articles was conducted through the PubMed database, Google Scholar, and Cochrane library to retrieve related studies published in the English language that met inclusion and exclusion criteria. The publication date was restricted to the past 10 years (2012-2022). Results were analyzed using Review Manager software (RevMan version 5.4.1, The Cochrane Collaboration, 2020). The quality of the studies included was assessed using Jadad scores. Risk ratios (RR) standard mean difference (SMD) and 95% confidence intervals (CI) were calculated to analyze the primary and secondary endpoints. RESULTS Eleven randomized controlled trials covering 1911 patients who underwent TKA/THA were selected. The pooled results indicated that the parecoxib group has lower visual analogue scale (VAS) scores than the placebo group. However, there was no significant difference in the secondary endpoint. The Jadad scores ranged from 3 to 5 and most of the studies were of high quality. CONCLUSION The results of our meta-analysis indicate that parecoxib has a better analgesic effect compared to placebo. It alleviates postoperative orthopaedic pain without raising the risk of adverse events.
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Hong C, Xie HY, Ge WK, Yu M, Lin SN, Liu CJ. The efficacy of parecoxib in improving pain after total knee or total hip arthroplasty: Systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30748. [PMID: 36197263 PMCID: PMC9509050 DOI: 10.1097/md.0000000000030748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The cyclooxygenase-2 (COX-2) selective inhibitor parecoxib is widely used in the treatment of pain and inflammation. Parecoxib has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and dental surgery). Total knee or total hip arthroplasty (THA) surgery is mostly done in older patients, so postoperative analgesics need to be used more carefully, and the safety and efficacy of parecoxib in this type of surgery need to be further verified. The aim of this study was to investigate the effects of parecoxib on patient safety, cumulative morphine consumption and was at 24 and 48 hours in the analgesic treatment of total knee or THA for meta-analysis and systematic review, with few studies in this area so far. METHODS We searched the Online Database Cochrane Library, PubMed, Web of Science, EMBASE, and CBM (SinoMed), CNKI, VIP, WANFANG up to January 2021. According to the value of I2, the random-effect model or fixed-effect model was supposed to combine data from studies, respectively. Publication bias was assessed through funneling plot and Beggs test. Review Manager 5.3 and Stata 16.0 software were applied to perform the statistical analyses. RESULTS Eleven RCTs which involved 1690 participants were included in this study. The meta-analysis indicated parecoxib sodium could not significantly reduce the incidence of adverse events after total knee or THA compared with placebo. There was no statistical significance in incidence of nausea and vomiting. 24 hours resting VAS score was statistically significant between the group. The 48-hour resting VAS scores did not indicate a significant difference between the groups. CONCLUSION Parecoxib can reduce the incidence of adverse events after total knee or total hip surgery to some extent but cannot reduce the incidence of nausea and vomiting. Twenty-four hour postoperative analgesia is better than placebo, but 48 hours after operation analgesia is the same as placebo.
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Affiliation(s)
- Chuan Hong
- Department of Orthopedics, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Hai-Yan Xie
- Department of Pharmacy, The Third Hospital of Quzhou, Zhejiang, China
| | - Wu-Kun Ge
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
- * Correspondence: Wu-Kun Ge, Department of Pharmacy, Ninghai First Hospital, No. 142, Taoyuan Middle Road, Ninghai County, Ningbo City, Zhejiang Province, China (e-mail: )
| | - Min Yu
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Shuai-nan Lin
- Department of Pharmacy, Ninghai First Hospital, Ningbo, Zhejiang, China
| | - Cheng-Jiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anhui, China
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Intravenous Parecoxib for Pain Relief after Orthopedic Surgery: A Systematic Review and Meta-analysis. Pain Ther 2022; 11:771-787. [PMID: 35705843 PMCID: PMC9314469 DOI: 10.1007/s40122-022-00400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Orthopedic procedures have been associated with increased pain, making perioperative analgesia a major clinical concern. We assessed the efficacy and safety of intravenous parecoxib administration during the perioperative period for postoperative pain relief after orthopedic surgery in adults. METHODS PubMed, Cochrane Library, EMBASE, and clinicaltrial.gov were searched from inception to 23 August 2021 without language restrictions. Randomized controlled trials comparing intravenous parecoxib with placebo or another active treatment for acute postoperative pain in adults after orthopedic surgery were included. The primary outcomes were the pain scores and cumulative morphine consumption. The secondary outcomes included the proportion of patients requiring rescue analgesics and the incidence of adverse events. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered on the International Prospective Register of Systematic Reviews Registration (PROSPERO). RESULTS Twenty-seven trials (n = 2840) from more than 20 countries involving six types of orthopedic surgery met the inclusion criteria. Compared with placebo, intravenous parecoxib administration led to reductions in postoperative resting pain scores at 6, 12, 24, and 48 h [mean difference (MD) -0.87, 95% confidence interval [CI] -1.71 to -0.03; MD -0.86, 95% CI -1.26 to -0.46; MD -0.57, 95% CI -0.84 to -0.31; MD -0.40, 95% CI -0.69 to -0.11, respectively], postoperative movement pain scores at 24 and 48 h (MD -0.66, 95% CI -1.14 to -0.19; MD -0.78, 95% CI -1.16 to -0.39, respectively), cumulative morphine consumption (MD -11.30 mg, 95% CI -14.79 to -7.81 mg), and the proportion of patients requiring rescue analgesia (relative risk 0.83, 95% CI 0.77-0.89). There was no difference in the incidence of adverse events between groups. CONCLUSION Low to moderate evidence indicates that parecoxib might be an effective and safe analgesic in perioperative orthopedic settings. It relieves postoperative orthopedic pain while sparing opioid analgesic consumption without increasing the incidence of adverse events. PROSPERO REGISTRATION CRD42021274939.
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Yin F, Ma W, Liu Q, Xiong LL, Wang TH, Li Q, Liu F. Efficacy and safety of intravenous acetaminophen (2 g/day) for reducing opioid consumption in Chinese adults after elective orthopedic surgery: A multicenter randomized controlled trial. Front Pharmacol 2022; 13:909572. [PMID: 35935863 PMCID: PMC9355325 DOI: 10.3389/fphar.2022.909572] [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: 03/31/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Acetaminophen is an important component of a multimodal analgesia strategy to reduce opioid consumption and pain intensity after an orthopedic surgery. The opioid-sparing efficacy of intravenous acetaminophen has been established at a daily dose of 4 g. However, it is still unclear for the daily dose of 2 g of acetaminophen, which is recommended by the China Food and Drug Administration Center for Drug Evaluation, in terms of its efficacy and safety.Objectives: This study aimed to evaluate the efficacy and safety of intravenous acetaminophen at a daily dose of 2 g for reducing opioid consumption and pain intensity after orthopedic surgery.Methods: In this multicenter, randomized, double-blind, placebo-controlled phase III trial, 235 patients who underwent orthopedic surgery were randomly assigned to receive intravenous acetaminophen 500 mg every 6 h or placebo. Postoperative morphine consumption, pain intensity at rest and during movement, and adverse events were analysed.Results: For the mean (standard deviation) morphine consumption within 24 h after surgery, intravenous acetaminophen was superior to placebo both in the modified intention-to-treat analysis [8.7 (7.7) mg vs. 11.2 (9.2) mg] in the acetaminophen group and the placebo group, respectively. Difference in means: 2.5 mg; 95% confidence interval, 0.25 to 4.61; p = 0.030), and in the per-protocol analysis (8.3 (7.0) mg and 11.7 (9.9) mg in the acetaminophen group and the placebo group, respectively. Difference in means: 3.4 mg; 95% confidence interval: 1.05 to 5.77; p = 0.005). The two groups did not differ significantly in terms of pain intensity and adverse events.Conclusion: Our results suggest that intravenous acetaminophen at a daily dose of 2 g can reduce morphine consumption by Chinese adults within the first 24 h after orthopedic surgery, but the extent of reduction is not clinically relevant.Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT02811991].
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Affiliation(s)
- Feng Yin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Ma
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiao Liu
- Department of Anesthesiology, Chenzhou No. 1 People’s Hospital, Chenzhou, Hunan, China
| | - Liu-Lin Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting-Hua Wang
- Institute of Neurological Disease, Translational Neuroscience Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Qian Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Li, ; Fei Liu,
| | - Fei Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Qian Li, ; Fei Liu,
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Lee HM, Park JH, Park SJ, Choi H, Lee JR. Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial. Anesth Analg 2021; 133:168-175. [PMID: 33181557 DOI: 10.1213/ane.0000000000005284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Extensive efforts have been made toward reducing postoperative opioid use in children. In this study, we assessed whether propacetamol, or a nonsteroidal anti-inflammatory drug (NSAID), or their combination could effectively reduce opioid use in children after laparoscopic inguinal hernia repair. METHODS This randomized, double-blind clinical trial included 159 children aged 6 months to 6 years. Children were allocated into 1 of the following 3 groups: group I was treated with 10 mg·kg-1 ibuprofen, group P was treated with 30 mg·kg-1 propacetamol, and group I + P was treated with both drugs in their respective concentrations. If the face-legs-activity-crying-consolability (FLACC) score was ≥4 during the postanesthesia care unit stay, 1.0 µg·kg-1 fentanyl was administered as a rescue analgesic. The number of patients who received rescue fentanyl in the postanesthesia care unit was defined as the primary outcome; this was analyzed using the χ2 test. The secondary outcomes included the FLACC and the parents' postoperative pain measure (PPPM) scores until the 24-hour postoperative period. RESULTS Among the 144 enrolled patients, 28.6% in group I, 66.7% in group P, and 12.8% in group I + P received rescue fentanyl in the postanesthesia care unit (P < .001). The highest FLACC score was lower in group I + P than in either group I or P (P = .007 and P < .001, respectively). Group I + P presented significantly lower PPPM scores than group P at 4 and 12 hours postoperative (P = .03 and .01, respectively). CONCLUSIONS The use of ibuprofen plus propacetamol immediately following laparoscopic hernia repair surgery in children resulted in the reduced use of an opioid drug compared with the use of propacetamol alone.
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Affiliation(s)
- Hye-Mi Lee
- From the Department of Anesthesiology and Pain Medicine.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Su-Jung Park
- From the Department of Anesthesiology and Pain Medicine.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Haegi Choi
- From the Department of Anesthesiology and Pain Medicine.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Rim Lee
- From the Department of Anesthesiology and Pain Medicine.,Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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[Perioperative analgesia with nonopioid analgesics : Joint interdisciplinary consensus-based recommendations of the German Pain Society, the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery]. Schmerz 2021; 35:265-281. [PMID: 34076782 DOI: 10.1007/s00482-021-00566-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. METHODS An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process. RESULTS The panel agreed that nonopioid analgesics shall be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake shall be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain shall be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anesthesia. Nonopioid analgesics or combinations of analgesics shall be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery-specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician shall be informed of analgesics given and those necessary after discharge. Patients shall be informed of possible side effects and symptoms and timely discontinuation of analgesic drugs. CONCLUSION The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
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Stamer UM, Erlenwein J, Freys SM, Stammschulte T, Stichtenoth D, Wirz S. [Perioperative analgesia with nonopioid analgesics : Joint interdisciplinary consensus-based recommendations of the German Pain Society, the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery]. Anaesthesist 2021; 70:689-705. [PMID: 34282481 DOI: 10.1007/s00101-021-01010-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. METHODS An expert panel representing the German national societies of pain, anaesthesiology and intensive care medicine and surgery developed recommendations for the perioperative use of nonopioid analgesics within a formal, structured consensus process. RESULTS The panel agreed that nonopioid analgesics shall be part of a multimodal analgesia concept and that patients have to be informed preoperatively about possible complications and alternative treatment options. Patients' history of pain and analgesic intake shall be evaluated. Patients at risk of severe postoperative pain and possible chronification of postsurgical pain shall be identified. Depending on the duration of surgery, nonopioid analgesics can already be administered preoperatively or intraoperatively so that plasma concentrations are sufficient after emergence from anesthesia. Nonopioid analgesics or combinations of analgesics shall be administered for a limited time only. An interdisciplinary written standard of care, comprising the nonopioid analgesic of choice, possible alternatives, adequate dosing and timing of administration as well as surgery-specific policies, have to be agreed upon by all departments involved. At discharge, the patient's physician shall be informed of analgesics given and those necessary after discharge. Patients shall be informed of possible side effects and symptoms and timely discontinuation of analgesic drugs. CONCLUSION The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
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Affiliation(s)
- Ulrike M Stamer
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz.
- Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland.
| | - Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V., Nürnberg, Deutschland
| | - Stephan M Freys
- Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland
- Chirurgische Arbeitsgemeinschaft Akutschmerz, Deutsche Gesellschaft für Chirurgie e.V., Berlin, Deutschland
| | - Thomas Stammschulte
- , Bern, Schweiz
- ehemalige Institution Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
| | - Dirk Stichtenoth
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefan Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA - GFO-Kliniken Bonn, Bad Honnef, Deutschland
- Arbeitskreis Tumorschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland
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Stamer UM, Erlenwein J, Freys SM, Stammschulte T, Stichtenoth D, Wirz S. [Perioperative analgesia with nonopioid analgesics : Joint interdisciplinary consensus-based recommendations of the German Pain Society, the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery]. Chirurg 2021; 92:647-663. [PMID: 34037807 PMCID: PMC8241738 DOI: 10.1007/s00104-021-01421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
Hintergrund Nichtopioidanalgetika werden bei vielen Patienten zur perioperativen Analgesie eingesetzt. Zu einigen praktischen Fragen beim Einsatz von Nichtopioidanalgetika liegen z. T. nur wenig Informationen aus Studien vor, und in Krankenhäusern existieren häufig keine Konzepte zum Vorgehen, z. B. zur Patientenaufklärung und zum Zeitpunkt der perioperativen Gabe. Methodik Eine Expertengruppe der beteiligten Fachgesellschaften hat konsensbasierte Empfehlungen zum perioperativen Einsatz von Nichtopioidanalgetika erarbeitet und in einem strukturierten formalen Konsensusprozess verabschiedet. Ergebnisse Die Arbeitsgruppe stimmt überein, dass Nichtopioidanalgetika Bestandteil eines perioperativen multimodalen Analgesiekonzepts sein sollen und Patienten präoperativ über Nutzen, Risiken und alternative Behandlungsmöglichkeiten aufgeklärt werden sollen. Die präoperative Patienteninformation und -edukation soll auch eine Schmerz- und Analgetikaanamnese umfassen und Patienten mit Risikofaktoren für starke Schmerzen und eine Schmerzchronifizierung sollen identifiziert werden. Unter Berücksichtigung von Kontraindikationen können Nichtopioidanalgetika abhängig von der Operationsdauer auch schon prä- oder intraoperativ gegeben werden, um nach Beendigung der Anästhesie ausreichende Plasmakonzentrationen zu erzielen. Nichtopioidanalgetika oder Kombinationen von (Nichtopioid‑)Analgetika sollen nur für einen begrenzten Zeitraum gegeben werden. Ein gemeinsam erarbeiteter abteilungsübergreifender Behandlungsstandard mit dem Nichtopioidanalgetikum erster Wahl, weiteren Therapieoptionen sowie adäquaten Dosierungen, ergänzt durch eingriffsspezifische Konzepte, soll schriftlich hinterlegt werden. Bei Entlassung aus dem Krankenhaus soll der nachbehandelnde Arzt zu perioperativ gegebenen und aktuell noch eingenommenen Analgetika schriftliche Informationen erhalten. Patienten sollen zu möglichen Nebenwirkungen der Analgetika und ihrer Symptome, die auch nach Krankenhausentlassung auftreten können, und die befristete Einnahmedauer informiert werden. Schlussfolgerung Die Anwendung von Nichtopioidanalgetika soll als Bestandteil eines perioperativen multimodalen Analgesiekonzepts mit klaren Vorgaben zu Indikationen, Kontraindikationen, Dosierungen und Behandlungsdauer in einem abteilungsübergreifenden Behandlungsstandard schriftlich hinterlegt werden. Zusatzmaterial online Die Offenlegung von Interessen ist in der Online-Version dieses Artikels (10.1007/s00104-021-01421-w) enthalten.
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Affiliation(s)
- Ulrike M Stamer
- Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Universität Bern, Freiburgstrasse, 3010, Bern, Schweiz. .,Arbeitskreis Akutschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland.
| | - Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.,Wissenschaftlicher Arbeitskreis Schmerzmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V., Nürnberg, Deutschland
| | - Stephan M Freys
- Chirurgische Klinik, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Deutschland.,Chirurgische Arbeitsgemeinschaft Akutschmerz, Deutsche Gesellschaft für Chirurgie e.V., Berlin, Deutschland
| | - Thomas Stammschulte
- , Bern, Schweiz.,ehemalige Institution Arzneimittelkommission der deutschen Ärzteschaft, Berlin, Deutschland
| | - Dirk Stichtenoth
- Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefan Wirz
- Abteilung für Anästhesie, Interdisziplinäre Intensivmedizin, Schmerzmedizin/Palliativmedizin, Zentrum für Schmerzmedizin, Weaningzentrum, CURA - GFO-Kliniken Bonn, Bad Honnef, Deutschland.,Arbeitskreis Tumorschmerz, Deutsche Schmerzgesellschaft e.V., Berlin, Deutschland
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Anger M, Valovska T, Beloeil H, Lirk P, Joshi GP, Van de Velde M, Raeder J. PROSPECT guideline for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 76:1082-1097. [PMID: 34015859 DOI: 10.1111/anae.15498] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2021] [Indexed: 12/11/2022]
Abstract
The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intra-operative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.
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Affiliation(s)
- M Anger
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - T Valovska
- Service d'Anesthésie Réanimation et Médecine Péri-opératoire, CHU Rennes, Université Rennes, Rennes, France
| | - H Beloeil
- Department of Anesthesiology, Henry Ford Health Systems, Wayne State School of Medicine, Detroit, MI, USA
| | - P Lirk
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Van de Velde
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Anaesthesiology, UZLeuven, Leuven, Belgium
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.,Division of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
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Fillingham YA, Hannon CP, Erens GA, Hamilton WG, Della Valle CJ. Acetaminophen in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty 2020; 35:2697-2699. [PMID: 32571591 DOI: 10.1016/j.arth.2020.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Greg A Erens
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | | | | | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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12
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The Efficacy and Safety of Acetaminophen in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis. J Arthroplasty 2020; 35:2715-2729. [PMID: 32563592 DOI: 10.1016/j.arth.2020.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management. METHODS We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of acetaminophen. RESULTS In total, 1287 publications were critically appraised yielding 17 publications representing the best available evidence for analysis. Oral and IV acetaminophen demonstrates the ability to safely reduce postoperative pain and opioid consumption during the inpatient hospital stay. No evidence was available to assess the efficacy and safety of oral acetaminophen after discharge. CONCLUSION Moderate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct for pain management during the inpatient hospitalization. Strong evidence supports the safety of oral and IV acetaminophen when appropriately administered to patients undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen following discharge, it remains a low-cost and low-risk option as part of a multimodal pain regimen.
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Essex MN, Camu F, Borgeat A, Salomon PA, Pan S, Cheung R. The relationship between postoperative opioid consumption and the incidence of hypoxemic events following total hip arthroplasty: a post hoc analysis. Can J Surg 2020; 63:E250-E253. [PMID: 32386476 DOI: 10.1503/cjs.010519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Postoperative opioid analgesia may cause respiratory depression. We assessed whether following total hip arthroplasty, placebo-adjusted reductions in morphine consumption at 48 hours with parecoxib (47.0%), propacetamol (35.1%) or parecoxib plus propacetamol (67.9%) translated into a reduction in hypoxemic events. Methods This was a post hoc analysis of a randomized, placebo-controlled, noninferiority study. Patients were randomly assigned to receive intravenous parecoxib (40 mg twice daily), propacetamol (2 g 4 times daily), parecoxib plus propacetamol (40 mg twice daily + 2 g 4 times daily) or placebo. Dose, date and time of morphine administration via patient-controlled analgesia were monitored throughout the study. In patients not receiving supplemental oxygen, peripheral blood oxygenation was assessed continuously for 48 hours after surgery. Hypoxemia was defined as peripheral oxygen saturation less than 90%. The times and oximeter readings of hypoxemic events were recorded. Pearson correlation coefficient was used to assess for correlations between cumulative morphine consumption at 48 hours and mean number of hypoxemic events. Results A significantly smaller proportion of patients who received the combined treatment with parecoxib and propacetamol had hypoxemia versus placebo (2.8% v. 13.2%, p < 0.05), and the mean number of hypoxemic events was significantly smaller for parecoxib (0.12), propacetamol (0.06) and parecoxib plus propacetamol (0.03) versus placebo (0.36; all p < 0.05). There was no correlation between the reduction in cumulative morphine consumption at 48 hours and the mean number of hypoxemic events in any treatment group (all p > 0.1). Conclusion Following total hip arthroplasty, a greater than 70% reduction in morphine consumption may be necessary to translate into a corresponding reduction in hypoxemic events.
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Affiliation(s)
- Margaret Noyes Essex
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
| | - Frederic Camu
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
| | - Alain Borgeat
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
| | - P Arline Salomon
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
| | - Sharon Pan
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
| | - Raymond Cheung
- From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon)
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Jiang M, Deng H, Chen X, Lin Y, Xie X, Bo Z. The efficacy and safety of selective COX-2 inhibitors for postoperative pain management in patients after total knee/hip arthroplasty: a meta-analysis. J Orthop Surg Res 2020; 15:39. [PMID: 32024535 PMCID: PMC7003344 DOI: 10.1186/s13018-020-1569-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many selective cyclooxygenase (COX-2) inhibitors are currently used in clinical practice. COX-2 inhibitors have good anti-inflammatory, analgesic, antipyretic effects, and gastrointestinal safety. However, the analgesic effects and adverse reactions of COX-2 after total knee/hip arthroplasty (TKA/THA) are not fully known. OBJECTIVE To evaluate the efficacy and safety of selective COX-2 inhibitors in postoperative pain management in patients receiving TKA/THA. METHODS Randomized controlled trials (RCTs) were retrieved from medical literature databases. Risk ratios (RR) Std mean difference (SMD) and 95% confidence intervals (CI) were calculated to analyze the primary and safety endpoints. RESULTS In total, 18 articles (23 trial comparisons) were retrieved comprising 3104 patients. Among them, 1910 patients (61.5%) were randomized to the experimental group whereas 1194 patients (38.5%) were randomized to the control group. The primary endpoints were the patients' VAS score at rest or on ambulation (within 3 days). We found that VAS score in patients that received selective COX-2 inhibitor was significantly lower compared to those of the control group. CONCLUSION This meta-analysis shows that selective COX-2 inhibitor therapy is effective, safe, and reliable in relieving postoperative pain of THA/TKA.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/trends
- Cyclooxygenase 2 Inhibitors/adverse effects
- Cyclooxygenase 2 Inhibitors/therapeutic use
- Humans
- Pain Management/methods
- Pain, Postoperative/drug therapy
- Pain, Postoperative/etiology
- Randomized Controlled Trials as Topic/methods
- Treatment Outcome
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Affiliation(s)
- Mingyang Jiang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huachu Deng
- Guangxi Medical University, Nanning, Guangxi, China
| | - Xuxu Chen
- Guangxi Medical University, Nanning, Guangxi, China
| | - Yunni Lin
- Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoyong Xie
- Guangxi Medical University, Nanning, Guangxi, China
| | - Zhandong Bo
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Du X, Song F, Zhang X, Ma S. Protective efficacy of combined use of parecoxib and dexmedetomidine on postoperative hyperalgesia and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. Acta Cir Bras 2019; 34:e201900905. [PMID: 31800679 PMCID: PMC6889861 DOI: 10.1590/s0102-865020190090000005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/06/2019] [Accepted: 08/04/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate efficacy of combined use of parecoxib and dexmedetomidine on postoperative pain and early cognitive dysfunction after laparoscopic cholecystectomy for elderly patients. METHODS The present prospective randomized controlled study included a total of 80 patients who underwent laparoscopic cholecystectomy surgery during January 2016 to November 2017 in our hospital. All patients were randomly divided into 4 groups, the parecoxib group, the dexmedetomidine group, the parecoxib and dexmedetomidine combined group, and the control group. Demographic data and clinical data were collected. Indexes of heart rate (HR), mean arterial pressure (MAP), levels of jugular venous oxygen saturation (SjvO2) and jugular venous oxygen pressure (PjvO2) were recorded at different time points before and during the surgery. The mini-mental state examination (MMSE) score, Ramsay score and Visual Analogue Score (VAS) were measured. RESULTS Levels of both SjvO2 and PjvO2 were significantly higher in parecoxib group, dexmedetomidine group and the combined group than the control group. Meanwhile, levels of both SjvO2 and PjvO2 in the combined group were the highest. VAS scores were significantly lower in the combined group than all other groups, and total patient controlled intravenous analgesia (PCIA) pressing times within 48 h after surgery were the lowest in the combined group. Both Ramsay and MMSE scores were the highest in the combined group compared with other groups, while were the lowest in the control group. CONCLUSION The combined use of parecoxib and dexmedetomidine could reduce the postoperative pain and improve the postoperative sedation and cognitive conditions of patients after laparoscopic cholecystectomy.
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Affiliation(s)
- Xiaoxuan Du
- MD, Department of Anesthesiology, the Sixth Affiliated Hospital
of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan
District, Urumqi, XinJiang, China. Design of the study, technical procedures,
manuscript writing
| | - Feng Song
- MD, Department of Anesthesiology, the Sixth Affiliated Hospital
of the Sixth Clinical Medical School, Xinjiang Medical University, Tianshan
District, Urumqi, XinJiang, China. Technical procedures, analysis of data,
critical revision
| | - Xueqiang Zhang
- MM, Department of Anesthesiology, the Sixth Affiliated
Hospital of the Sixth Clinical Medical School, Xinjiang Medical University,
Tianshan District, Urumqi, XinJiang, China. Technical procedures, analysis of
data, critical revision
| | - Shanshan Ma
- MM, Department of Anesthesiology, the Sixth Affiliated
Hospital of the Sixth Clinical Medical School, Xinjiang Medical University,
Tianshan District, Urumqi, XinJiang, China. Technical procedures, analysis of
data, critical revision
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冯 金, 李 卡, 冯 缓, 韩 蔷, 高 敏, 许 瑞. [Efficacy of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative analgesia in patients undergoing pancreaticoduodenectomy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:830-835. [PMID: 31340917 PMCID: PMC6765552 DOI: 10.12122/j.issn.1673-4254.2019.07.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the effect of local infiltration of ropivacaine combined with multimodal analgesia with parecoxib for perioperative pain management in patients undergoing pancreaticoduodenectomy. METHODS This randomized controlled trial was conducted among 98 patients undergoing pancreaticoduodenectomy in the Department of Biliary Surgery of West China Hospital between March, 2017 and August, 2018. The patients were randomized to receive perioperative analgesia with local infiltration anesthesia with ropivacaine combined with multimodal analgesia with parecoxib (experimental group, n=50) or postoperative analgesia with dizosin (control group, n=48). The regimens for intraoperative anesthesia and postoperative pain relief were identical in the two groups. The differences in NRS pain score, use of pain relief agents, the incidences of adverse reactions to analgesia and wound infection, and the time to first ambulation and first flatus passage after the operation were compared between the two groups. RESULTS At 12, 24 h, 48 h, 72 h and 7 days after the operation, the patients in the experimental group had significantly lower NRS scores (P < 0.05) than those in the control group. The rate of use of rescue analgesics was significantly lower in the experimental group than in the control group (32% vs 66.67%, P < 0.05); the rate of tramadol hydrochloride use was also significantly lower in the experimental group (P < 0.05). Compared with those in the control group, the patients in the experimental group showed a significantly lower total incidence of adverse reactions (22% vs 54.17%, P < 0.05) as well as a lower incidence of nausea and vomiting (P < 0.05), an earlier time of first ambulation and first flatus passage after the operation (P < 0.05), and a shorter postoperative hospital stay (P < 0.05). CONCLUSIONS In patients undergoing pancreaticoduodenectomy, local infiltration of ropivacaine combined with multimodal analgesia with ropivacaine can effectively relieve perioperative pain, reduce the use of relief analgesics, lower the incidence of adverse reactions, and promote the recovery after the surgery.
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Affiliation(s)
- 金华 冯
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卡 李
- 四川大学 华西护理学院,四川 成都 610041West China Nursing College, Sichuan University, Chengdu 610041, China
| | - 缓 冯
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 蔷 韩
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 敏 高
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
| | - 瑞华 许
- 四川大学 华西医院胆道外科,四川 成都 610041Department of Bilary Surgery of West China Hospital, Sichuan University, Chengdu 610041, China
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17
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Xu BP, Yao M, Tian ZR, Zhou LY, Yang L, Li ZJ, Zhu S, Wang XT, Lan JH, Wang YJ, Cui XJ. Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomized, double-blind, parallel positive controlled, multi-center clinical trial. Trials 2019; 20:377. [PMID: 31234919 PMCID: PMC6591844 DOI: 10.1186/s13063-019-3481-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common chronic musculoskeletal disorder that seriously affects quality of life. Patients with KOA frequently develop one or more of the following typical symptoms: joint pain, stiffness, joint friction noise and impaired functionality. Traditional Chinese medicine (TCM) has been shown to have a superior effect and a particular advantage in the treatment of KOA; among TCM, the Tong-luo Qu-tong plaster is the convenient and most commonly used method in China to improve symptoms including pain, stiffness and limited mobility in patients with KOA, as it causes few adverse effects. But there is a lack of high-quality clinical evidences to support the therapeutic effect that Chinese adhesive plaster can have in relieving pain and stiffness. The purpose of this study will be to evaluate the efficacy and safety of Tong-luo Qu-tong plaster in patients with KOA. METHODS/DESIGN This study will be a randomized, double-blind, parallel positive controlled, multi-center clinical trial, a non-inferiority trial design was adopted. A total of 2000 participants older than 40 years, with KOA, will be randomly allocated into an experimental group (n = 1500) and a control group (n = 500). All participants will receive a conventional conservative treatment lasting for 14 days as two courses, once daily. Tong-luo Qu-tong plaster will be administered externally to participants in the experimental group, while the control group will receive a Qi-zheng Xiao-tong plaster. The outcome of the total Western Ontario and McMaster Universities Arthritis Index scores, TCM syndrome quantitative score and visual analog scale scores will be measured during the assessment visits (baseline and 1-week and 2-week follow up). In addition, adverse events related to clinical symptoms and signs and results of laboratory tests will be documented during the clinical trials. DISCUSSION This study will provide reliable evidence of the effectiveness and safety of Tong-luo Qutong plaster in patients with KOA. If the results are favorable, it is expected that the patients with KOA will benefit from this study, many patients may have a good alternative treatment for KOA. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03309501 . Registered on 8 November 2017.
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Affiliation(s)
- Bao-ping Xu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Lu’an Hospital of Traditional Chinese Medicine, 76 Renmin Road, Anhui, 237000 Lu’an China
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), 725 South Wanping Road, Shanghai, 200032 China
| | - Zi-rui Tian
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), 725 South Wanping Road, Shanghai, 200032 China
| | - Long-yun Zhou
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), 725 South Wanping Road, Shanghai, 200032 China
| | - Long Yang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, 540 Xinhua Road, Shanghai, 200052 China
| | - Zhen-jun Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Gansu Provincial Hospital of Traditional Chinese Medicine, 418 Guazhou Road, Qi lihe District, Gansu, 730050 Lanzhou China
| | - Sen Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Department of Orthopaedic, Shanghai Pudong Gongli Hospital, Second Military Medical University, 219 Miaopu Road, Shanghai, 200013 China
| | - Xiao-tao Wang
- Ehu Branch of Xishan People’s Hospital, No. 1 Xuehai East Road, Xishan District, Wuxi, 214116 Jiangsu China
| | - Jia-hui Lan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
| | - Yong-jun Wang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), 725 South Wanping Road, Shanghai, 200032 China
| | - Xue-jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032 China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), 725 South Wanping Road, Shanghai, 200032 China
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Guo H, Wang C, He Y. A meta-analysis evaluates the efficacy of intravenous acetaminophen for pain management in knee or hip arthroplasty. J Orthop Sci 2018; 23:793-800. [PMID: 29910098 DOI: 10.1016/j.jos.2018.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/28/2018] [Accepted: 04/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management. METHOD Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events. RESULTS Among 832 records identified, six randomized controlled trials (RCTs) and five non-RCTs were eligible for data extraction and meta-analysis. According to the outcomes, the patients receive intravenous acetaminophen had less total opioid consumption after knee or hip artroplasty (SMD = -0.66; 95%CI, -1.13 to -0.20), but they did not obtain statistical improvement of postoperative pain control at postoperative day 0 (POD0, SMD = -0,15; 95%CI, -0.36 to 0.07), POD1(SMD = 0,12; 95%CI, -0.13 to 0.36), POD2 (SMD = -0,29; 95%CI, -0.70 to 0.12) and POD3 (SMD = -0,04; 95%CI, -0.49 to 0.41). Meanwhile, there were similar outcomes about the length of hospital stays in patients whether or not receiving intravenous acetaminophen (SMD = -0,05; 95%CI, -0.26 to 0.15). And, the total adverse effects occurrence also didn't show any significant difference between the acetaminophen group and control group (OR = 0.87; 95%CI, 0.57 to 1.33). CONCLUSIONS Perioperative intravenous acetaminophen use in multimodal analgesia could significantly reduce of total opioid consumption, but it did not contribute to decrease the average pain scores and shorten the length of hospital stays in total hip or knee arthroplasty.
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Affiliation(s)
- Hongzhang Guo
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, 418# GuaZhou Road, Qi Li He Zone, Lanzhou, 730050, People's Republic of China.
| | - Changde Wang
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, 418# GuaZhou Road, Qi Li He Zone, Lanzhou, 730050, People's Republic of China.
| | - Yufang He
- The Third Hospital of Gansu Province, 736# Duan Jia Tan, Cheng Guan Zone, Lanzhou, 730030, People's Republic of China.
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Sah AP, Liang K, Sclafani JA. Optimal Multimodal Analgesia Treatment Recommendations for Total Joint Arthroplasty. JBJS Rev 2018; 6:e7. [DOI: 10.2106/jbjs.rvw.17.00137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Li X, Sun Z, Han C, He L, Wang B. A systematic review and meta-analysis of intravenous glucocorticoids for acute pain following total hip arthroplasty. Medicine (Baltimore) 2017; 96:e6872. [PMID: 28489787 PMCID: PMC5428621 DOI: 10.1097/md.0000000000006872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/31/2017] [Accepted: 04/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Glucocorticoids are increasingly used perioperatively, principally to prevent postoperative nausea and vomiting (PONV), and acute postoperative pain following total hip arthroplasty (THA). The authors hypothesized that preoperative intravenous glucocorticoids is associated with less pain scores and PONV without increasing the complications after THA. METHODS Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science) were searched with the limitations of randomized controlled trials (RCTs). The search cutoff date was set at November 6, 2016. Participants were patients who were prepared for primary THA. Intervention was preoperative intravenous glucocorticoids for postoperative pain control. Outcomes including the visual analog scale (VAS) scores at the postanesthesia care unit (PACU) and at 24 and 48 hours post operation, the occurrence of PONV and total morphine consumption were recorded. We calculated risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes, and the weighted mean difference (WMD) with a 95% CI for continuous outcomes. RESULTS A total of 6 studies were evaluated, which included 297 patients who underwent hip surgery with intravenous glucocorticoid treatment and control patients who underwent hip surgery without glucocorticoid treatment. Pooled results indicated that intravenous glucocorticoid treatment was associated with a reduction of VAS scores at the PACU (WMD = -9.06, 95% CI -12.67 to -5.45, P = .000) and total morphine consumption by 15.68 mg (WMD = -15.68, 95% CI -24.60 to -6.75, P = .001). No significant difference was observed in the VAS scores at 24 and 48 hours between the intravenous glucocorticoid and placebo treatments. Intravenous steroids can decrease the occurrence of PONV (RR = 0.46, 95% CI 0.26-0.82, P = .029). CONCLUSION Intravenous glucocorticoid treatment can decrease early pain intensity and PONV after THA. However, the evidence for the use of glucocorticoids is limited by the low number of studies and variation in dosing regimens. Thus, additional high-quality RCTs are needed to identify the optimal drug protocol and determine the safety of intravenous glucocorticoids.
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Affiliation(s)
- Xiuhua Li
- Department of Anesthesiology, Weifang Medical University
| | - Zheng Sun
- Department of Pathology, Affiliated Hospital of Weifang Medical University
| | - Chengbing Han
- Department of Oral and Maxillofacial Surgery, Weifang People's Hospital, Weifang
| | | | - Baoguo Wang
- Department of Anesthesiology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
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