Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review

Ultrasound-guided anterior quadratus lumborum block at the L2 level for postsurgical analgesia in patients undergoing laparoscopic gynaecological surgery: a single-centre, randomised, double-blinded trial at a university-affiliated hospital in China

OBJECTIVE

This study aimed to investigate the analgesic effect of an ultrasound-guided anterior quadratus lumborum block (QLB) at the L2 level on postoperative pain after laparoscopic gynaecological surgery.

DESIGN

Prospective single-centre randomised double-blind trial.

SETTING

University-affiliated hospital.

PARTICIPANTS

Sixty patients aged between 18 and 65 years scheduled for laparoscopic gynaecological surgery.

INTERVENTIONS

Before surgery, bilateral anterior QLB was performed with 20 mL of 0.375% ropivacaine injected on each side in the QLB group, whereas equal amount of saline was administered in the placebo group.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary endpoint was the cumulative morphine dose in the first 24 hours, and the secondary endpoints were morphine consumption at each time interval, area under the curve (AUC) of the numeric rating scale (NRS) for pain, maximum pain intensity, incidence of moderate-to-severe pain (NRS>3), sedation score, adverse events, and time to home-readiness.

RESULTS

Cumulative morphine consumption in the first 24 hours after surgery was significantly lower in the QLB group than in the placebo group (mean difference, 14.2; 95% CI 6.3 to 22.1; p<0.001). The AUCs of NRS pain intensity scores, including visceral and incisional pain at rest and on movement, were significantly lower in the QLB group than in the placebo group (all p<0.001). The time to home-readiness was significantly shorter in the QLB group than in the placebo group (p<0.05).

CONCLUSION

Ultrasound-guided anterior QLB at the L2 level significantly reduced morphine consumption and relieved visceral and incision pain intensity after laparoscopic gynaecological surgery, which was beneficial for enhanced recovery.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry (ChiCTR-IOR-17011960).

Alternative statistical modeling for radical prostatectomy data

Several statistical models have been proposed in recent years, among them is the semiparametric regression. In medicine, there are several situations in which it is impracticable to consider a linear regression for statistical modeling, especially when the data contain explanatory variables that present a nonlinear relationship with the response variable. Another common situation is when the response variable does not have a unimodal shape, and it is not possible to adopt distributions belonging to the symmetric or asymmetric classes. In this context, a semiparametric heteroskedastic regression is proposed based on an extension of the normal distribution. Then, we show the usefulness of this model to analyze the cost of prostate cancer surgery. The predictor variables refer to two groups of patients such that one group receives a multimodal local anesthetic solution (Preemptive Target Anesthetic Solution) and the second group is treated with neuraxial blockade (spinal anesthesia/traditional standard). The other relevant predictor variables are also evaluated, thus allowing for the in-depth interpretation of the predictor variables with a nonlinear effect on the dependent variable cost. The penalized maximum likelihood method is adopted to estimate the model parameters. The new regression is a useful statistical tool for analyzing medical data.

Implementation of enhanced recovery in cardiac surgery: An experimental study with the control group

INTRODUCTION

The Enhanced Recovery After Cardiac Surgery protocol is the most recent addition to cardiac treatment. In this paper, we aimed to test the safety and viability of this protocol in our hospital to improve our standard of care.

METHODS

This study was conducted as an experimental study with a historical control at the Maritime Heart Center, Halifax, Nova Scotia, Canada. In order to quantify the success of this protocol, we measured the postoperative Length of Hospital Stay and three intensive care unit variables: time to extubation, time to ambulation, and opioid consumption. In the study, 100 patients were in the Enhanced Recovery After Cardiac Surgery group, and 103 patients were used as historic controls-selected by strenuous chart review and selection criteria.

RESULTS

The primary outcome (Length of Hospital Stay) was reduced from a mean of 8.88 ± 3.50 days in the control group to a mean of 5.13 ± 1.34 days in the Enhanced Recovery After Cardiac Surgery group (p < 0.001). Likewise, we observed a significant reduction in intensive care unit variables: time to extubation was reduced from 10.54 ± 7.83 h in the control group to 6.69 ± 1.63 in the Enhanced Recovery After Cardiac Surgery group (p < 0.01), and time to ambulation was reduced from 36.27 ± 35.21 h in the control group to 9.78 ± 2.03 in the Enhanced Recovery After Cardiac Surgery group (p < 0.01) and opioid consumption was reduced from 50.58 ± 11.93 milligram morphine equivalent in the control group to 11.58 ± 4.43 milligram morphine equivalent in the Enhanced Recovery After Cardiac Surgery group (p < 0.01).

CONCLUSION

Enhanced Recovery After Cardiac Surgery protocols were seamlessly integrated into selected cardiac surgical patients, contingent on a high level of interprofessional communication and collaboration.

Pre-incisional infiltration with ropivacaine plus dexamethasone palmitate emulsion for postoperative pain in patients undergoing craniotomy: study protocol for a prospective, randomized controlled trial

BACKGROUND

Post-craniotomy pain is a common occurrence which is associated with poor outcomes. Pre-emptive scalp infiltration with dexamethasone and ropivacaine has been proven effective in previous studies but with limited clinical significance. Dexamethasone palmitate emulsion (D-PAL) is a pro-drug incorporating dexamethasone into lipid microspheres with greater anti-inflammatory activity and fewer side effects than free dexamethasone. However, its effects in post-craniotomy pain management remain unknown. This study hypothesizes that pre-emptive scalp infiltration with ropivacaine plus D-PAL emulsion can achieve superior analgesic effects to ropivacaine alone in adult patients undergoing craniotomy.

METHODS/DESIGN

This is a single center, randomized controlled trial enrolling 130 patients scheduled for supratentorial craniotomy, which is expected to last longer than 4 h. We compare the efficacy and safety for postoperative pain relief of ropivacaine plus D-PAL group and ropivacaine alone group following pre-emptive scalp infiltration. Primary outcome will be pain Numerical Rating Scale at 24 h postoperatively. Secondary outcomes will include further analgesia evaluations and drug-related complications within a follow-up period of 3 months.

DISCUSSION

This is the first randomized controlled trial aiming to assess the possible benefits or disadvantages of D-PAL emulsion for incisional pain in craniotomy. It may provide an alternative to optimize pain outcome for neurosurgical patients.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT04488315). Registered on 19 July 2020.

Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p < 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p < 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Enhanced recovery open radical prostatectomy: costs and length of hospital stay

PURPOSE

To evaluate factors related to the length of hospital stay and costs in patients undergoing local multimodal anesthetic solution compared to neuraxial block, both in association with general anesthesia.

METHODS

This is a retrospective cohort study of 77 consecutive patients submitted to open radical prostatectomies: 42 under general anesthesia plus neuraxial block, and 35 under enhanced recovery multimodal general anesthesia associated with preemptive target anesthetic solution (3 phases-P.T.A.S). Mann-Whitney, Chi-square, and Spearman correlation were applied with a 5% significance level.

RESULTS

There were no statistically significant differences between the two groups. The cost was positively and significantly related to the pathological report (PR), anesthetic time, use of crystalloid, and total drain volume. Length of hospital stay was positively and significantly related to the use of crystalloids and total drain volume, with a strong correlation with the latter.

CONCLUSION

There was no statistically significant difference between the studied groups; however, there was a tendency to reduce the length of stay in the multimodal anesthetic solution group that may be better evidenced in studies with greater sampling power.

Lidocaine and bupivacaine as part of multimodal pain management in a C57BL/6J laparotomy mouse model

While the use of local anesthesia as part of multimodal pain management is common practice in human and veterinarian surgery, these drugs are not applied routinely in rodent surgery. Several recommendations on the use of local anesthesia exist, but systematic studies on their efficacy and side effects are lacking. In the present study, male and female C57BL/6J mice were subjected to a sham vasectomy or a sham embryo transfer, respectively. We tested whether a mixture of subcutaneously injected Lidocaine and Bupivacaine in combination with systemic Paracetamol applied via drinking water results in superior pain relief when compared to treatment with local anesthesia or Paracetamol alone. We applied a combination of methods to assess behavioral, emotional, and physiological changes indicative of pain. Voluntary Paracetamol intake via drinking water reached the target dosage of 200 mg/kg in most animals. Local anesthesia did not lead to obvious side effects such as irregular wound healing or systemic disorders. No relevant sex differences were detected in our study. Sevoflurane anesthesia and surgery affected physiological and behavioral measurements. Surprisingly, Paracetamol treatment alone significantly increased the Mouse Grimace Scale. Taken together, mice treated with a combination of local anesthesia and systemic analgesia did not show fewer signs of post-surgical pain or improved recovery compared to animals treated with either local anesthesia or Paracetamol.

Case Report: Ultrasound Sciatic and Saphenous Nerve Blocks for Tibial Malunion Surgical Correction in a Pediatric African Leopard (Panthera pardus)

Little information is available regarding ultrasound-guided locoregional anesthesia in non-domestic species. Locoregional techniques have been shown to reduce intraoperative anesthetic requirements and provide postoperative pain relief. Decreasing dosage of general anesthetics allows more stable cardiopulmonary function during anesthesia and reduces the probability of side effects. An 11-week-old African leopard (Panthera pardus) was referred for treatment of a malunion angular limb deformity secondary to a tibial and fibular fracture. The animal was scheduled to undergo angular correction of the tibia via closing wedge osteotomy and fixation with a locking plate system. Following preanesthetic medication and induction of general anesthesia, a saphenous nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed under ultrasound guidance and a sciatic nerve block (ropivacaine 0.5%; 0.15 ml/kg) was performed using ultrasound and a peripheral nerve stimulator. Intraoperative anesthetic plane was considered light, yet no abrupt cardiocirculatory changes were seen, nor was rescue analgesia required. This case report suggests that sciatic and saphenous blockade could therefore be recommended as part of a multimodal plan of analgesia for orthopedic surgeries in pediatric exotic felids.

A Historical Review of Indian Perspectives on Techniques of Tympanoplasty

Reconstructive surgery of the conductive hearing mechanism is collectively called as tympanoplasty, which has gradually evolved over time with the contributions from all over the word. The aim of the present historical review is to summarize the Indian contributions in the development of the technique of tympanoplasty. The literature review was conducted using only the “Medline” search using keywords “tympanoplasty” and “ossiculoplasty” in “India” on 15^th June 2016. A total of 195 articles and abstracts were found dated from the year 1998 onwards. Articles describing work on technique were included, and those describing only experimentation with graft material were excluded. All articles were fully read and analysed. It was found that there had been experiments regarding the choice of anaesthesia and the use of combinations of different chemical agents for this purpose. There were suggestions in favour of monitored anaesthesia care for the surgery in select patients. Surgeons expressed their perspectives on the time and conditions for the surgery, laterality of surgery, different types of incisions, use of endoscopes, graft placement techniques, ossicular replacements with autologous or allogenic grafts, and the timing of prophylactic antibiotic therapy given after or during the surgery. The range of work is wide and covers most of the aspects of surgery; however, the incorporation of a uniform methodology and standards reporting results were lacking in the articles reviewed.

Intra-operative effect of interscalene brachial plexus block to arthroscopic rotator cuff repair surgery

INTRODUCTION

To determine whether the placement of an interscalene brachial plexus block (IBPB) with general anaesthesia before shoulder arthroscopy would be effective in establishing a clear visual field and in shortening the surgical procedure.

METHOD

This prospective randomized control trial study included 152 patients who had undergone arthroscopic rotator cuff repair. Group A received IBPB and group B did not receive IBPB. A visual clarity scale (VCS) was determined by arthroscopic visualization. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), duration of surgical procedure, VCS, and medication that was administered for haemodynamic stability were recorded.

RESULTS

The VCS was improved in group A at stages 2 and 3 of the surgical procedures (p < 0.05), but there were no significant difference at stages 1 (p = 0.288) and 4 (p = 0.062). SBP, DBP, and HR were higher in group B during surgery (p < 0.05). The administered analgesics were higher in group B (p = 0.003), but there were no differences in hypotensive agents (p = 0.287). No significant difference was observed for the duration of surgery (p = 0.704).

CONCLUSIONS

Pre-operative IBPB with general anaesthesia for arthroscopic rotator cuff repair was beneficial in maintaining haemodynamic stability and improving the VCS during surgery.

Randomised, masked study of local anaesthesia administered prior to external dacryocystorhinostomy under general anaesthesia

OBJECTIVES

To determine whether administration of local anaesthetic at the site of skin incision during open lacrimal drainage surgery under general anaesthesia alters the total dosage of anaesthetic drugs required during total intravenous anaesthesia (TIVA), and whether it alters postoperative pain and recovery.

STUDY DESIGN

Masked comparison of a randomized, two-group interventional study.

PATIENTS AND METHODS

Patients undergoing unilateral external dacryocystorhinostomy under total intravenous general anaesthesia were recruited from the lacrimal service at Moorfields Eye Hospital between September 2012 and February 2014. The patients were randomised to receive, after induction and stabilisation of general anaesthesia, infiltration of the ipsilateral paranasal tissues with 2.5 ml of 0.5% bupivacaine with 1:100000 epinephrine ("treatment" group), or a sham injection ("control" group); the infiltration was performed about 7 min prior to the skin incision. The infusion rates for propofol and remifentanil were adjusted to maintain a steady intra-operative mean blood pressure of 55-70 mmHg and BIS score of 40-60%. The time taken for extubation of the patient after cessation of TIVA was recorded, and postoperative pain scores (on a Likert scale from 0-10) were taken at regular intervals after extubation. The average intra-operative mean blood pressures, total drug usage, extubation time and pain scores for each of the two groups were compared using two-tail Student's t-testing and Wilcoxon rank sum testing.

RESULTS

There were 12 patients (7 female; 58%) in the treatment group and 11 (7 female; 64%) in the control group, with similar average age at surgery (59 years treatment, 53 years control; p = 0.38) The average operative time was 45 min in the treatment group (median 42, range 30-55) and 47 min (median 45; range 37-61) in the control group (p = 0.52). The mean dosage of propofol required to maintain satisfactory GA was significantly less in the "treatment" group (89.8 mcg/kg/min) as compared to the "control" group (mean 126 mcg/kg/min) (p = 0.0007). Likewise, remifentanil dosage was significantly less in the "treatment" group (100 ng/kg/min) as compared to controls (259 ng/kg/min) (p = 0.00007). The mean non-invasive blood pressure was consistently lower during surgery in the "treated" group, and showed less intra-operative variation. After surgery, the patients receiving LA had a significantly shorter extubation time (mean time 6.0 min in "treated" group, 12.1 min in "controls"; P < 0.0002) and also significantly lower pain scores at 10, 30, 60, 120 and 180 min after extubation (p < 0.01, p < 0.01, p < 0.01, p < 0.01 and p < 0.05, respectively).

CONCLUSIONS

Ipsilateral infiltration of local anaesthesia containing epinephrine in the paranasal tissues just prior to open dacryocystorhinostomy under total intravenous anaesthesia is associated with a 28% reduction in mean propofol usage, and a 61% reduction in remifentanil usage. LA usage during GA also produces improved and less variable intra-operative mean blood pressures, a significantly shorter extubation time and significantly lower postoperative pain scores.

Does Pre-Emptive Administration of Intravenous Ibuprofen (Caldolor) or Intravenous Acetaminophen (Ofirmev) Reduce Postoperative Pain and Subsequent Narcotic Consumption After Third Molar Surgery?

PURPOSE

Pre-emptive analgesia is known to reduce postoperative pain after third molar removal. The purpose of this study was to compare postoperative pain in patients receiving either preoperative intravenous (IV) ibuprofen or preoperative IV acetaminophen for third molar surgery.

PATIENTS AND METHODS

This study was a randomized, single-blinded clinical study conducted in patients undergoing surgical extraction of 2 or more impacted third molars under deep sedation. This study compared 2 interventions: 800 mg of IV ibuprofen (Caldolor; Cumberland Pharmaceuticals, Nashville, TN) and 1,000 mg of IV acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom). The primary outcome variable was postoperative pain measured on a visual analog scale at different time points. The secondary outcome variable was the amount of postoperative analgesic (narcotic and over-the-counter) medication taken in both groups. The Mann-Whitney U test was used to compare groups in terms of outcomes, the χ² test was used to assess associations between nominal variables, and Spearman correlations were used to assess associations between continuous variables. Significance was set at P < .05.

RESULTS

The study sample consisted of 58 patients (39 female and 19 male patients). A total of 41 patients (IV ibuprofen, n = 19; IV acetaminophen, n = 22) completed the study. Equal distributions of age, gender, and number of impacted teeth were noted between the groups. At 4 hours postoperatively, the pain level in the ibuprofen group was significantly lower than that in the acetaminophen group (P = .004). This trend continued at 24 hours (P = .019) and 48 hours (P = .017). The average amount of narcotic medication taken in the ibuprofen group (2.68 ± 2.26 doses) was lower than that in the acetaminophen group (7.32 ± 6.68 doses), and the result was statistically significant (P = .005).

CONCLUSIONS

Pre-emptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.

Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis

The aim of the present study was to assess the effectiveness of preemptive dexamethasone in surgery of the lower third molars and to compare it with other oral anti-inflammatories. An electronic search was conducted for preemptive effects related to lower third-molar surgery in 3 separate databases. The variables pain, swelling, and trismus were assessed. Meta-analysis was used to calculate the pooled effect measures for mean and standard deviation values (95% confidence interval [CI]). Seven split-mouth clinical trials were selected. Two studies were included in the meta-analysis. Three studies showed a low risk of bias; 2 studies exhibited a moderate risk and 2 a high risk of bias. Dexamethasone was better than nonsteroidal anti-inflammatories for preemptive effectiveness. Meta-analysis for swelling confirmed better results for dexamethasone than for methylprednisolone after 2 days (95% CI = -1.28 to -0.38), 4 days (95% CI = -1.65 to -0.71), 7 days (95% CI = -1.42 to -0.71), and overall (95% CI = -1.25 to -0.72). Dexamethasone was better than methylprednisolone for mouth opening after 4 days (95% CI = 0.18 to 1.07). There is insufficient evidence through meta-analysis to conclude that dexamethasone is better than other nonsteroidal anti-inflammatories or methylprednisolone as a preemptive analgesic. The results of this meta-analysis suggest that dexamethasone is more effective than methylprednisolone for swelling and trismus.

Effect of intravenous paracetamol as pre-emptive compared to preventive analgesia in a pediatric dental setting: a prospective randomized study

BACKGROUND

Efficacy of pre-emptive analgesia compared to preventive regimen, managing postoperative pain is still controversial.

AIM

Evaluating the efficacy of intravenous (IV) paracetamol as pre-emptive analgesia compared to preventive post-treatment administration in pediatric dental setting.

DESIGN

In a prospective trial, 60 noncooperative children of ASA I, II aged 3-10 years who underwent dental rehabilitation under general anesthesia were randomly divided into two groups. Pre-emptive group (n = 30) received 15 mg/kg of IV paracetamol before the start of treatment. Preventive group (n = 30) received 15 mg/kg of paracetamol at the end of treatment. Analgesic efficacy was measured by visual analog scale of faces (VASOF), percentage of children received postoperative analgesia.

RESULTS

The VASOF results in the pre-emptive group were significantly lower compared to the preventive group at 4, 8, 12, and 24 h (0.0146, 0.0188, 0.0085, and 0.0001, respectively). Less children in the pre-emptive group received supplemental fentanyl postoperatively compared to the preventive group (27.6%, 58.6%, respectively, P = 0.0170). Time to first rescue dose of fentanyl postoperatively in the pre-emptive group was later than in the preventive group (P = 0.0432).

CONCLUSIONS

Administration of IV paracetamol pre-emptively provides lower pain scores, and a decreased percentage of children required pain relief and less amount of postoperative opioids, compared to preventive administration.

Reprint of: Efficacy and safety of different doses of dezocine for preemptive analgesia in gynecological laparoscopic surgeries: A prospective, double blind and randomized controlled clinical trial

BACKGROUND

The incidence of reproductive system tumors in Chinese females is increasing year by year, with the trend of younger onset ages. Laparoscopic surgery has been recognized by the majority of medical staff and patients, but the postoperative pain still exists. Therefore, it has become the focus of attention of medical workers to take effective analgesia measures to alleviate postoperative pain as well as to improve the degree of comfort and satisfaction for the patients.

OBJECTIVES

The research objective was to study the effect of different doses of dezocine preemptive analgesia on the safety and the pain post laparoscopic surgeries, in order to explore the best dose of dezocine for postoperative analgesia in gynecological laparoscopic surgeries.

METHODS

Gynecological laparoscopic surgery patients conformed to the criteria (n = 390) were randomly divided into three groups (group A, B and C) by the methods of randomized, double-blind studies. 0.1 mg/kg, 0.15 mg/kg or 0.2 mg/kg dezocine was intravenously injected 15 min before surgeries for preemptive analgesia. VAS score, Ramsay score and MMSE score were used to evaluate the efficacy and safety of dezocine in preemptive analgesia and sedation, and the use of adjuvant analgesic drugs and the incidence of adverse reactions were also observed.

RESULTS

The VAS scores of the 0.15 mg/kg and 0.2 mg/kg dezocine groups were significantly lower than that of the 0.1 mg/kg group at 2h, 4h, 6h, 8h, 12h and 24h post-surgery, and the difference was statistically significant (p < 0.05). There was no statistically significant difference between the 0.15 mg/kg and 0.2 mg/kg groups (p > 0.05) except for the 12h time point. The MMSE scores 12h post-surgery of the three groups were compared with those 12h prior-to-surgery, and the differences were not statistically significant (p > 0.05) and no increase in the incidence of cognitive impairment was observed. The use rate of analgesic drugs in the 0.1 mg/kg group was significantly higher than those in the 0.15 mg/kg and 0.2 mg/kg groups, and the difference was statistically significant (p < 0.05). There were no significant differences in the incidence of adverse events between the three groups (P > 0.05).

CONCLUSIONS

The analgesia and sedation effects of dezocine were enhanced with the increase of usage dose, which suggested that the effects of dezocine were dose-dependent. Intravenous injection of 0.15 mg/kg dezocine 15 min before gynecological laparoscopic surgery showed better analgesic and sedative effects as well as less adverse reactions, and should be the appropriate dose to be used in the preemptive analgesia in gynecological laparoscopic surgeries.

Efficacy and safety of different doses of dezocine for preemptive analgesia in gynecological laparoscopic surgeries: A prospective, double blind and randomized controlled clinical trial

BACKGROUND

The incidence of reproductive system tumors in Chinese females is increasing year by year, with the trend of younger onset ages. Laparoscopic surgery has been recognized by the majority of medical staff and patients, but the postoperative pain still exists. Therefore, it has become the focus of attention of medical workers to take effective analgesia measures to alleviate postoperative pain as well as to improve the degree of comfort and satisfaction for the patients.

OBJECTIVES

The research objective was to study the effect of different doses of dezocine preemptive analgesia on the safety and the pain post laparoscopic surgeries, in order to explore the best dose of dezocine for postoperative analgesia in gynecological laparoscopic surgeries.

METHODS

Gynecological laparoscopic surgery patients conformed to the criteria (n = 390) were randomly divided into three groups (group A, B and C) by the methods of randomized, double-blind studies. 0.1 mg/kg, 0.15 mg/kg or 0.2 mg/kg dezocine was intravenously injected 15 min before surgeries for preemptive analgesia. VAS score, Ramsay score and MMSE score were used to evaluate the efficacy and safety of dezocine in preemptive analgesia and sedation, and the use of adjuvant analgesic drugs and the incidence of adverse reactions were also observed.

RESULTS

The VAS scores of the 0.15 mg/kg and 0.2 mg/kg dezocine groups were significantly lower than that of the 0.1 mg/kg group at 2h, 4h, 6h, 8h, 12h and 24h post-surgery, and the difference was statistically significant (p < 0.05). There was no statistically significant difference between the 0.15 mg/kg and 0.2 mg/kg groups (p > 0.05) except for the 12h time point. The MMSE scores 12h post-surgery of the three groups were compared with those 12h prior-to-surgery, and the differences were not statistically significant (p > 0.05) and no increase in the incidence of cognitive impairment was observed. The use rate of analgesic drugs in the 0.1 mg/kg group was significantly higher than those in the 0.15 mg/kg and 0.2 mg/kg groups, and the difference was statistically significant (p < 0.05). There were no significant differences in the incidence of adverse events between the three groups (P > 0.05).

CONCLUSIONS

The analgesia and sedation effects of dezocine were enhanced with the increase of usage dose, which suggested that the effects of dezocine were dose-dependent. Intravenous injection of 0.15 mg/kg dezocine 15 min before gynecological laparoscopic surgery showed better analgesic and sedative effects as well as less adverse reactions, and should be the appropriate dose to be used in the preemptive analgesia in gynecological laparoscopic surgeries.

The efficacy and safety of early initiation of preoperative analgesia with celecoxib in patients underwent arthroscopic knee surgery: A randomized, controlled study

This study aimed to investigate the efficacy and safety of celecoxib 24 hours preoperative, 1 hour preoperative, and 4 hours postoperative administration in patients with arthroscopic knee surgery (AKS).In all, 206 patients who underwent AKS were consecutively recruited and randomized into 3 groups: (1) early preoperative analgesia group (EPEA), celecoxib 400 mg 24 hours preoperative administration; (2) preoperative analgesia group (PEA), celecoxib 400 mg 1 hour preoperative administration; (3) postoperative analgesia group (POA), celecoxib 400 mg 4 hours postoperative administration. Pain visual analog scale (VAS) scores (at rest and at 90 flexion) and patient global assessment (PGA) score were evaluated before and after operation, and also pethidine consumption and adverse events (AEs).The pain-rest VAS score, percentage of patients with moderate-severe pain at rest, and PGA score in the EPEA and PEA groups were decreased compared with POA group at 8 and 12 hours postoperation. Besides, pain-flexion to 90 VAS score in EPEA and PEA groups were also reduced compared with POA group at 8 hours postsurgery. Interestingly, the percentage of patients with moderate-severe pain at 90 flexion at 8 hours postsurgery in PEA group was fewer compared with POA group, whereas at 4 hours postoperation it was reduced in EPEA group compared with PEA and POA groups. As to consumption of pethidine, it was numerically decreased in EPEA and PEA groups compared with POA group. No difference between each 2 groups was found in AEs.Celecoxib was effective and safe as pre-emptive analgesia in AKS, and 1 hour administration before operation might be an optimal choice.

Clinical Analysis of Analgesics and Steroids Use for Extraction of Teeth in Patients with Intellectual Disability Under General Anesthesia

Background:

The extraction of lower wisdom teeth is often performed under general anesthesia in patients with intellectual disabilities. However, the choice of analgesics has not yet been investigated.

Objective:

To analyze the use of analgesics during general anesthesia for extraction including lower wisdom teeth in patients with intellectual disabilities.

Methods:

This research is a retrospective observational study. The study population was composed of all patients presenting for extraction of lower wisdom teeth under ambulatory general anesthesia in the clinic of Special Needs Dentistry in Okayama University Hospital from April 2011 to March 2016. The distribution of the combination of analgesics and the relationship between the use of analgesics and the type of extraction were investigated.

Results:

One hundred and twelve cases were enrolled in this study. Intravenous injections of flurbiprofen, acetaminophen and betamethasone were used in 96 (85.7%), 12 (10.7%) and 26 cases (23.2%), respectively. Flurbiprofen is a non-steroid anti-inflammatory drugs (NSAIDs). Acetaminophen is an old analgesic, but an injection of acetaminophen is new, which was released in 2013 in Japan. And betamethasone is not an analgesic, but a steroid. Betamethasone was used in combination with other analgesics, and was used at a higher dose in a case in which four wisdom teeth were extracted.

Conclusion:

Flurbiprofen was the main analgesic used for extraction of wisdom teeth under general anesthesia in patients with intellectual disabilities. Betamethasone was used to support flurbiprofen or acetaminophen for extractions of multiple wisdom teeth, with the aim of controlling swelling rather than relieving pain.

Protective multimodal analgesia with etoricoxib and spinal anesthesia in inguinal hernia repair: a randomized controlled trial

BACKGROUND

Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established.

PURPOSE

To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair.

METHODS

Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center. The intervention group (n = 30) received 120 mg of oral etoricoxib 1 h preoperatively, and 10-12 mg bupivacaine with 25 μg fentanyl as spinal anesthesia. The control group (n = 30) received oral placebo 1 h preoperatively, and spinal anesthesia as above. Postoperative Visual Analog Scale pain scores at rest and on active straight leg raise were recorded and analyzed.

RESULTS

Resting pain scores were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.00 vs. 4.35; 1.57 vs. 4.00; 1.24 vs. 3.76, respectively; p < 0.05). Pain scores on active straight leg raise were significantly lower in the intervention than the control group at 16 h, 24 h, and on discharge (3.85 vs. 5.59, p < 0.01; 2.84 vs. 4.90, p < 0.05; 3.55 vs. 5.32, p < 0.05, respectively).

CONCLUSION

The addition of etoricoxib to spinal anesthesia as a multimodal protective regimen can improve pain control after inguinal hernia repair. The optimal dose and applicability to other operations remains to be established.

The effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypasses surgery

Background and Objective:

Pain control during surgery in order to cause analgesia and reduce the somatic and autonomic response may decrease the morbidity. Intrapleural catheter embedding during surgery under direct vision of surgeon is safe and easy and without potential risk of thoracic epidural block. The aim of this study was to investigate the effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypass surgery.

Methods:

In this prospective randomized double blind clinical trial,130 adult patients undergoing elective CABG with age range of 20 to 60 years were divided into two groups receiving either lidocaine and fentanyl (group A) or lidocaine (group B). The analgesia was evaluated every two hours in all intubated and non-intubated patients using Visual analog scale (VAS) and data were analyzed using SPSS software package.

Results:

Of all patients, 67 (51.5%) were males and 63 (48.5%) were females. The average age of subjects was 53.49 ± 5.099 years. Mean pain score six hours after the surgery was statistically different between the groups at all times.

Conclusion:

The pain in patients receiving combination of lidocaine and fentanyl is less than patients receiving only lidocaine.

Effect of skin infiltration with ropivacaine on postoperative pain in patients undergoing craniotomy

BACKGROUND

Local anesthetic infiltration has been used to manage postoperative pain in various surgeries. The present study was aimed to investigate the effect of skin infiltration with 0.5 % ropivacaine on postoperative pain in patients undergoing craniotomy.

METHODS

One hundred and six patients with ASA I/II scheduled to undergo elective craniotomy were enrolled during March to November in 2015 in this prospective, randomized, placebo-controlled, double-blind study. After the anesthesia induction, skin along the incision was infiltrated with 0.5 % ropicavaine (group R, n = 53) or 0.9 % normal saline (group C, n = 53), respectively. Morphine was used as rescue analgesic postoperatively. Morphine consumption during the first 24 postoperative hours was recorded as the primary outcome, and the time to first rescue requirement was also recorded. Pain was assessed at 2, 4, 8, 24 h, 7 days, 3 months after surgery by visual analog scale (VAS). Heart rate and mean arterial pressure were recorded before anesthesia induction (T1), after anesthesia induction (T2), after scalp infiltration (T3), during skull drilling (T4), mater cutting (T5) and skin closure (T6).

RESULTS

Morphine consumption during the first 24 postoperative hours was significantly higher in group C than in group R (13.36 [6.5, 20] vs. 6.3 [0, 10] mg, P < 0.05). The first time of patients needed rescue analgesic was prolonged in group R as compared with group C (6.16 [3.4, 8.0] vs. 3.87 [2.3, 4] h, P < 0.05). Postoperative VAS and hemodynamic signs during the first 24 h showed no significant difference in two groups. The incidence of persistent pain on 7 days and 3 months postoperatively had no significant differences between two groups. Besides one patient (2 %) enduring moderate pain (VAS 4-7) in group C, the number of patients suffering from mild pain (VAS 1-3) was 17 (33.3 %) in group R and 17 (34 %) in group C 3 months after surgery.

CONCLUSION

The results suggest 0.5 % ropivacaine scalp infiltration before skin incision has favorable analgesic effect in reducing morphine consumption and prolong the time of first rescue analgesic requirement after surgery. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn/) registration number: ChiCTR-IPR-14005717.

B. K, Kannan R, Rajaram K, Rajendra Sharma A. 'Plain lignocaine' vs 'Lignocaine with vasoconstrictor'-Comparative evaluation of pain during administration and post-extraction wound healing by a double blinded randomized controlled clinical trial

OBJECTIVES

The aim of this double blinded randomized controlled clinical trial was to evaluate the efficacy of two local anaesthetic solutions, 'Plain lignocaine' and 'Lignocaine with vasoconstrictor', on pain during administration and post-extraction wound healing in patients undergoing therapeutic extractions.

MATERIALS AND METHODS

Fifty patients indicated for therapeutic extraction of upper and lower premolars for orthodontic purpose were recruited for the study. Using a split-mouth study design, anaesthesia was achieved using lignocaine with adrenaline on the control side and plain lignocaine on the study side. Pain perception was measured by modified visual analogue scale and wound healing was assessed by Landry's Wound Healing Index. Sample allocation was done by simple randomization. The outcome parameters compared were (1) pain during administration of LA and (2) post-operative healing after extraction. Data analysis involved Chi-square test to compare proportions between treatment groups and independent sample t-test to compare mean values between treatment groups. SPSS version 22.0 was used to analyse the data.

RESULTS

The study group demonstrated a statistically significant wound healing on day1 and day 3 between the study and control group with p < 0.001. In the control group 68% had severe pain, whereas only 2% had severe pain in the study group. The proportions between the two groups were statistically significant (p < 0.001).

CONCLUSION

The patients who received Plain Lignocaine perceived less pain during injection of local anaesthetic solution when compared to patients who received lignocaine with vasoconstrictor. The early post-operative wound healing was better in patients anaesthetized by Plain Lignocaine.

Options for perioperative pain management in neurosurgery

Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients. Neurosurgical patients may have difficulty or be incapable of communicating their need for analgesics due to neurologic deficits, which poses an additional challenge. Postoperative pain control should be a priority, because pain adversely affects recovery and patient outcomes. Inconsistent practices and the quality of current analgesic strategies for neurosurgical patients still leave room for improvement. Given the complexity of postoperative pain management for these patients, multimodal strategies are often required to optimize pain control and at the same time limit undesired side effects.

An integrated safety analysis of intravenous ibuprofen (Caldolor(®)) in adults

Intravenous (IV) nonsteroidal anti-inflammatory drugs such as IV ibuprofen are increasingly used as a component of multimodal pain management in the inpatient and outpatient settings. The safety of IV ibuprofen as assessed in ten sponsored clinical studies is presented in this analysis. Overall, 1,752 adult patients have been included in safety and efficacy trials over 11 years; 1,220 of these patients have received IV ibuprofen and 532 received either placebo or comparator medication. The incidence of adverse events (AEs), serious AEs, and changes in vital signs and clinically significant laboratory parameters have been summarized and compared to patients receiving placebo or active comparator drug. Overall, IV ibuprofen has been well tolerated by hospitalized and outpatient patients when administered both prior to surgery and postoperatively as well as for nonsurgical pain or fever. The overall incidence of AEs is lower in patients receiving IV ibuprofen as compared to those receiving placebo in this integrated analysis. Specific analysis of hematological and renal effects showed no increased risk for patients receiving IV ibuprofen. A subset analysis of elderly patients suggests that no dose adjustment is needed in this higher risk population. This integrated safety analysis demonstrates that IV ibuprofen can be safely administered prior to surgery and continued in the postoperative period as a component of multimodal pain management.

Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine reduces postoperative pain after craniotomy

BACKGROUND

In order to reduce the consequences of narcotic-related side effects and provide effective analgesia after craniotomy, we conducted a randomized trial to compare the analgesic efficacy of preemptive scalp infiltrations with 1% lidocaine and 0.5% ropivacaine on the postoperative pain.

METHODS

Sixty adult patients scheduled for craniotomy were enrolled. A solution contained 0.5% ropivacaine and 1% lidocaine (40 ml) was prepared. In group A, local anesthetic was injected throughout the entire thickness of the scalp before skin incision. In group B, it was injected before skin closure. Additional intravenous injection and patient-controlled analgesia with morphine was used to control postoperative pain if the verbal numerical rating scale > 4. Cumulative morphine consumption; numerical rating scale of pain at 1, 2, 4, 6, 8, 12, and 24 h; postoperative nausea, vomiting, and respiratory depression, were recorded for 24 h after the operation.

RESULTS

Postoperative pain scores were lower in group A than in group B within the first 6 h after surgery. Mean time to demand for postoperative analgesic was statistically (p < 0.001) delayed in group A 300 (240, 360) min compared to group B 150 (105, 200) min. Ten patients in group A received morphine analgesia was half less than 21 patients in group B (p < 0.006). The median morphine consumption in 24 h after operation in group A 10.5 (8, 15) mg was less than that in group B 28 (22.5, 30.5) mg (p < 0.001).

CONCLUSIONS

Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine provides effective postoperative analgesia after craniotomy.

Preemptive Submucosal Infiltration with Ropivacaine for Uvulopalatopharyngoplasty

Objective

To evaluate the preemptive analgesic effect of submucosal infiltration of ropivacaine for uvulopalatopharyngoplasty.

Study Design

Randomized controlled trial.

Setting

Comprehensive clinical center and academic hospital.

Subjects and Methods

Fifty consecutive male patients scheduled for uvulopalatopharyngoplasty were divided randomly into group A and group B. In group A, 4 mL of 0.33% ropivacaine and normal saline with epinephrine was preincisionally injected under the mucosa on both sides of the tonsillar fossa, soft palate, and the lower part of palatoglossal arch, whereas the upper and middle parts of the palatoglossal arch and the upper part of the palatopharyngeal arch were infiltrated with 2 mL of the same mixture. In group B, an identical volume of normal saline with epinephrine was administered. In both groups, postoperative pain was initially controlled by intravenous morphine titration until patient-controlled analgesia with morphine could be used. Cumulative patient-controlled analgesic morphine consumption; visual analog scale scores at 4, 8, 12, 24, and 48 hours postoperatively at rest and during swallowing; and opioid-related adverse effects were recorded.

Results

The visual analog score was lower at rest during the 48-hour postoperative period and during swallowing within the first 12 hours for group A versus group B ( P < .05). Patients in group A required 44.1%, 38.2%, and 41.1% less morphine during the first 24 hours, 24 hours to 48 hours, and 48 hours postoperatively, respectively, and fewer patients experienced nausea, vomiting, and pruritus ( P < .05).

Conclusion

Preemptive submucosal infiltration with 0.33% ropivacaine effectively controlled pain after uvulopalato-pharyngoplasty.

Preemptive subcutaneous tramadol for post-operative pain in lower abdomen surgeries: A randomized double blinded placebo-control study

Background:

Recently, the preemptive analgesic effects of subcutaneous infiltration of tramadol (T) in the site of incision have not been extensively studied. In this study, we investigated the effect of subcutaneous T infiltration before the incision of surgery on post-operative pain, in lower abdomen surgeries.

Materials and Methods:

This double-blind study was carried out on 90 patients (18-65 years) of American Society Anesthesiologists physical status I and II who were candidates for a lower abdomen surgery during 2011. They were randomly assigned to receive preemptive subcutaneous T or normal saline (NS). The visual analogue scale for pain (VAS) in rest and cough position and opium total dose consumption were compared between two groups in times 0, 15, 30, 60 min and 2, 4, 6, 12, 24 h after the surgery.

Results:

The VAS in cough and rest position in the first 24 h following the surgery was lower in group T (P < 0.05). Opium consumption was lower in group T (P < 0.05).

Conclusion:

Subcutaneous preemptive infiltration of T before surgical incision reduces post-operative opioid consumption.

A randomized, double-blind, placebo-controlled trial of preemptive analgesia with bupivacaine in patients undergoing mastectomy for carcinoma of the breast

Background

In this prospective, randomized, placebo-controlled, double-blinded clinical trial we tested the hypothesis that preemptive analgesia with bupivacaine applied in the area of the surgical incision in patients undergoing mastectomy for breast cancer would reduce post-operative acute pain and would reduce the amount of analgesics used during surgery and in the post-operative period.

Material/Methods

Participants were assigned into 1 of 2 groups – with bupivacaine applied in the area of surgical incision or with placebo. We assessed the intraoperative consumption of fentanyl, the postoperative consumption of morphine delivered using a PCA method, and the subjective pain intensity according to VAS score reported by patients in the early post-operative period.

Results

Out of 121 consecutive cases qualified for mastectomy, 112 women were allocated randomly to 1 of 2 groups – group A (bupivacaine) and group B (placebo). The final study group comprised 106 breast cancer cases. Between the groups, a statistically significant difference was observed with respect to: lower fentanyl consumption during surgery (p=0.011), lower morphine (delivered by means of a PCA) consumption between the 4–12^th postoperative hours (p=0.02) and significantly lower pain intensity assessed according to VAS score at the 4^th and 12^th hours after surgery (p=0.004 and p=0.02 respectively) for the group A patients.

Conclusions

Preemptive analgesia application in the form of infiltration of the area of planned surgical incisions with bupivacaine in breast cancer patients undergoing mastectomy decreases post-operative pain sensation, limits the amount of fentanyl used during surgery, and reduces the demand for opiates in the hours soon after surgery.

Is Lidocaine Infiltration Really Necessary in Micro Ear Surgeries performed Under General Anaesthesia?

To study the role of infiltrating 2% Lidocaine in Micro ear surgeries performed under general anaesthesia. To measure the impact of infiltration of 2% Lidocaine in post operative pain relief and per operative bleeding. A Double blinded, Prospective randomized comparative study was conducted in a tertiary care referral centre. A total of 30 patients planned for micro ear surgeries under general anaesthesia (Tympanoplasty and Cortical mastoidectomy) for CSOM tubotympanic disease were selected and divided into two groups randomly by the chief senior consultant. Group A patients received local infiltration of 2% Lidocaine with one in 200,000 adrenaline and Group B patients received infiltration of one in 200,000 adrenaline in distilled water alone. Operating surgeon assessed the bleeding in the surgical field using Boezaart's grading system. Post operative pain was assessed using a visual analog scale. Pain scores of these patients were assessed in the 1st, 4 and 24th h post operatively and recorded. The mean post operative pain score in the 1st h for the patients in Group A was 0.93 and for patients in Group B was two. The difference in the pain scores between the two groups was significant (P < 0.02).The difference in the mean post operative pain scores between the two groups in the 4 and 24th h were not significant (P < 0.1).Per operatively, grade III bleeding was present in 73% of patients in group B and only 33% of patients had grade III bleeding in group A. Infiltration of 2% Lidocaine has a significant impact over the grade of bleeding in the operative field and also on 1st h post operative pain relief. It did not have a significant influence on the pain relief in the 4 and 24th h post operatively.

Randomized controlled trial of bilateral intrapleural block in cardiac surgery

The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). Evaluation of the severity of pain was performed using the visual analog scale at 12 and 24 h after entering the intensive care unit and again during chest tube removal. Pain scores at 12 and 24 h after intensive care unit admission were significantly lower in the bupivacaine group. There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.

Parasternal Intercostal Block With Ropivacaine for Pain Management After Cardiac Surgery: A Double-Blind, Randomized, Controlled Trial

OBJECTIVE

The purpose of this study was to test the hypothesis that administration of a parasternal intercostal block using ropivacaine 0.75% improved analgesia in postoperative cardiac surgical patients.

DESIGN

Randomized, controlled, double-blinded trial.

SETTING

Teaching hospital.

PARTICIPANTS

Eighty-eight cardiac surgery patients.

INTERVENTIONS

Ropivacaine 0.75% with 5 doses each side, total dosage 40 mL (300 mg), via parasternal intercostal injection or saline before insertion of the sternal wires and closure of the sternal wound.

MEASUREMENTS AND MAIN RESULTS

At extubation, patients who had a parasternal intercostal block with ropivacaine had visual analog and numerical rating pain scores approximately 50% less than those in the saline group (29.5 [standard deviation (SD) = 24.3] v 53.2 [SD = 24.1], ropivacaine v saline, respectively, p < 0.001). Patients who received ropivacaine used approximately 50% less PCA morphine (12.0 [SD = 5.4] v 23.2 [SD = 8.3] total morphine equivalents in milligrams, ropivacaine v saline, respectively; p < 0.001) in the first 12 hours postoperatively, with a continued reduction in dosages for the ensuing 12 to 24 hours (18.8 [SD = 9.6] v 23.7 [SD = 10.0] total morphine equivalents in milligrams, ropivacaine v saline; p = 0.028).

CONCLUSIONS

A ropivacaine parasternal intercostal block is a safe, simple, and effective adjunct for optimizing of pain control and reducing opioid analgesics after adult cardiac surgery. This study provides clinicians with an effective treatment for sternal wound pain.

Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management

OBJECTIVE

To evaluate the impact of preemptive local analgesia at the incision site in reducing pain in women undergoing abdominal hysterectomy for a benign myomatous uterus.

STUDY DESIGN

In this prospective, randomized, double-blinded, placebo-controlled study, 20 mL of 1% lidocaine or 0.9% saline was injected at the abdominal incision site prior to the performance of the hysterectomy. Thirty-two women were enrolled in the study, 16 received preemptive analgesia while 14 were treated by placebo; 2 were excluded. All operations were performed under general anesthesia. The standard postoperative pain treatment consisted of oral analgesia with ibuprofen (400 mg) in liquid-filled capsules. Morphine (10 mg) was used for rescue analgesia. Pain intensity was self-evaluated with the use of a 100 mm visual analog scale.

RESULTS

Compared to the placebo group, women who received preemptive analgesia with lidocaine 1% perceived a significant reduction in postoperative pain in the first hours after surgery (2 h: 50.1+/-27.9 versus 70.6+/-22.6, p=0.043; 5 h: 42.5+/-25.2 versus 64.6+/-28.3, p=0.043; 8 h: 31.2+/-22.4 versus 53.3+/-30.3, p=0.031).

CONCLUSION

Preemptive analgesia with lidocaine 1% is a simple, cheap and efficient mode to reduce pain in the first hours after hysterectomy.