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Pharmacological Methods of Postoperative Pain Management After Laparoscopic Cholecystectomy: A Review of Meta-analyses. Surg Laparosc Endosc Percutan Tech 2020; 30:534-541. [DOI: 10.1097/sle.0000000000000824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eiamcharoenwit J, Chotisukarat H, Tainil K, Attanath N, Akavipat P. Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial. F1000Res 2020; 9:516. [PMID: 32934804 PMCID: PMC7477643 DOI: 10.12688/f1000research.22909.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 03/30/2024] Open
Abstract
Background: The incidence of moderate to severe pain is high among patients undergoing spinal surgery. Nefopam can be used as an adjuvant analgesic postoperatively after spine surgery. The study aimed to assess the analgesic efficacy and side effects of nefopam on 24-hour postoperative morphine consumption after spine surgery. Methods: The study is a randomized, double-blinded, placebo-controlled trial. A total of 96 patients were randomized into 4 treatment groups, 24 each. In group 1, patients received normal saline before surgical incision and before the end of surgery. In group 2, patients received 30 mg nefopam before surgical incision and normal saline before the end of surgery. In group 3, patients received normal saline before surgical incision and 30 mg of nefopam before the end of surgery. In group 4, patients received 30 mg of nefopam in both timings. Patient-controlled analgesia morphine was used for the postoperative period. Outcomes were to determine 24-hour morphine consumption and incidence of side effects. Results: Of 96 patients enrolled, 21 in placebo-placebo, 22 in nefopam-placebo, 22 in placebo-nefopam and 21 in nefopam-nefopam groups completed the study. Analysis of the Kruskal-Wallis test on the intention-to-treat basis shows no significant difference in 24-hour postoperative morphine consumption between four groups, which were 18 [IQR 13.5-29], 20 [IQR 11-28.3], 17 [IQR 11.5-28.5], 13 [IQR 8.5-18.5] mg., respectively (p = 0.223). Incidence of side effects, including tachycardia, sedation, sweating and nausea/ vomiting, did not differ. Conclusions: Adding perioperative nefopam to opioid analgesic does not improve analgesic efficacy in patients who underwent spine surgery. Registration: Thai Clinical Trials Registry ID TCTR20171115001; registered on 15 November 2017.
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Affiliation(s)
- Jatuporn Eiamcharoenwit
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Haruthai Chotisukarat
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Kanjana Tainil
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nalinrat Attanath
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Phuping Akavipat
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
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Eiamcharoenwit J, Chotisukarat H, Tainil K, Attanath N, Akavipat P. Analgesic efficacy of intravenous nefopam after spine surgery: a randomized, double-blind, placebo-controlled trial. F1000Res 2020; 9:516. [PMID: 32934804 PMCID: PMC7477643 DOI: 10.12688/f1000research.22909.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The incidence of moderate to severe pain is high among patients undergoing spinal surgery. Nefopam can be used as an adjuvant analgesic postoperatively after spine surgery. The study aimed to assess the analgesic efficacy and side effects of nefopam on 24-hour postoperative morphine consumption after spine surgery. Methods: The study is a randomized, double-blinded, placebo-controlled trial. A total of 96 patients were randomized into 4 treatment groups, 24 each. In group 1, patients received normal saline before surgical incision and before the end of surgery. In group 2, patients received 30 mg nefopam before surgical incision and normal saline before the end of surgery. In group 3, patients received normal saline before surgical incision and 30 mg of nefopam before the end of surgery. In group 4, patients received 30 mg of nefopam in both timings. Patient-controlled analgesia morphine was used for the postoperative period. Outcomes were to determine 24-hour morphine consumption and incidence of side effects. Results: Of 96 patients enrolled, 21 in placebo-placebo, 22 in nefopam-placebo, 22 in placebo-nefopam and 21 in nefopam-nefopam groups completed the study. Analysis of the Kruskal-Wallis test shows no significant difference in 24-hour postoperative morphine consumption between four groups, which were 18 [IQR 13.5-29], 20 [IQR 11-28.3], 17 [IQR 11.5-28.5], 13 [IQR 8.5-18.5] mg., respectively (p = 0.223). Incidence of side effects, including tachycardia, sedation, sweating and nausea/ vomiting, did not differ. Conclusions: Adding perioperative nefopam to opioid analgesic does not improve analgesic efficacy in patients who underwent spine surgery. Registration: Thai Clinical Trials Registry ID TCTR20171115001; registered on 15 November 2017.
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Affiliation(s)
- Jatuporn Eiamcharoenwit
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Haruthai Chotisukarat
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Kanjana Tainil
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Nalinrat Attanath
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
| | - Phuping Akavipat
- Department of Anesthesiology, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand
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Choi E, Karm MH, So E, Choi YJ, Park S, Oh Y, Yun HJ, Kim HJ, Seo KS. Effects on postoperative nausea and vomiting of nefopam versus fentanyl following bimaxillary orthognathic surgery: a prospective double-blind randomized controlled trial. J Dent Anesth Pain Med 2019; 19:55-66. [PMID: 30859134 PMCID: PMC6405349 DOI: 10.17245/jdapm.2019.19.1.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. Methods Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. Results Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. Conclusion Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.
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Affiliation(s)
- Eunhye Choi
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Eunsun So
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sookyung Park
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Yul Oh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye Joo Yun
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Jesus RRD, Leite AM, Leite SS, Vieira MC, Villela NR. Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review. Rev Col Bras Cir 2018; 45:e1885. [PMID: 30066738 DOI: 10.1590/0100-6991e-20181885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/17/2018] [Indexed: 11/22/2022] Open
Abstract
Inappropriate therapy of postoperative pain in laparoscopic cholecystectomy may lead to late mobilization, patient dissatisfaction, delayed hospital discharge, and chronic pain development. Our objective was to identify the best therapeutic strategy available to the anesthesiologist for the acute postoperative pain of patients submitted to elective laparoscopic cholecystectomy. This is a systematic review that included 36 complete articles indexed in the Medline, Scopus, Web of Science and LILACS databases, with a five-year time cut (2012 to 2016), resulting from controlled and randomized studies that were submitted to qualitative analysis. In a proposal for multimodal analgesia, it is important to consider the contraindications, adverse effects, dose and optimal timing of interventions. Non-opioid drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase-2 (COX-2) inhibitors, gabapentin/pregabalin, N-methyl-D-aspartate (NMDA) receptor antagonists, and others. Opioids may be used at low doses associated with multimodal therapy or are restricted to cases where non-opioid multimodal analgesia is insufficient. We conclude that there is no consensus as to the best analgesic strategy to be implemented in the acute postoperative pain of laparoscopic cholecystectomy, which requires its applicability in an individualized way, based on the scientific evidence found in the literature. As contribution to medical learning and practice, we point out the theoretical enrichment of the analgesic drug options available for the therapy of postoperative pain in patients submitted to elective laparoscopic cholecystectomy, and alert the team to consider the adverse effects of the interventions implemented.
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Affiliation(s)
- Renato Ribeiro de Jesus
- Universidade Federal do Rio de Janeiro, Departamento de Cirurgia, Serviço de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Adebaldo Maia Leite
- Universidade Federal do Rio de Janeiro, Departamento de Cirurgia, Serviço de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Simone Soares Leite
- Universidade Federal do Rio de Janeiro, Departamento de Cirurgia, Serviço de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Márcio Carneiro Vieira
- Universidade Federal do Rio de Janeiro, Departamento de Cirurgia, Serviço de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Nivaldo Ribeiro Villela
- Universidade Federal do Rio de Janeiro, Departamento de Cirurgia, Serviço de Anestesiologia, Rio de Janeiro, RJ, Brasil.,Universidade do Estado do Rio de Janeiro, Departamento de Cirurgia Geral, Serviço de Anestesiologia, Centro de Ensino e Treinamento em Dor, Rio de Janeiro, RJ, Brasil
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Zhao T, Shen Z, Sheng S. The efficacy and safety of nefopam for pain relief during laparoscopic cholecystectomy: A meta-analysis. Medicine (Baltimore) 2018; 97:e0089. [PMID: 29517677 PMCID: PMC5882431 DOI: 10.1097/md.0000000000010089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pain control after laparoscopic cholecystectomy (LC) has become an important topic. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of nefopam for pain management after LC. METHODS PubMed, Medline, Embase, ScienceDirect, and the Cochrane Library were searched up to November 2017 for comparative articles involving nefopam and placebo for reducing postoperative pain after LC. Primary outcomes were postoperative pain scores and opioid consumption. Secondary outcomes were length of hospital stay, opioid-related adverse effects, and postoperative complications. We assessed statistical heterogeneity for each RCT by using a standard Chi test and the I statistic. The meta-analysis was undertaken using Stata 12.0. RESULTS A total of 215 patients were analyzed across 4 RCTs. We found that there were significant differences between nefopam and placebo groups regarding the postoperative pain scores and opioid requirements at 6, 12, and 24 hours. Moreover, there was a decreased risk of opioid-related adverse effects in the nefopam groups. No significant differences were identified in terms of the incidence of postoperative complications. CONCLUSION Intravenous nefopam infusion resulted in significant reduction in postoperative pain scores and opioid requirements while decreasing opioid-related adverse effects. Additionally, no increased risk of venous thromboembolism was found. The current evidence suggests that more RCTs will be needed in further investigations.
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Affiliation(s)
| | - Zhen Shen
- Department of Gastrointestinal Surgery, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Shihou Sheng
- Department of Gastrointestinal Surgery, China–Japan Union Hospital of Jilin University, Jilin, China
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A Comparison of Oxycodone and Alfentanil in Intravenous Patient-Controlled Analgesia with a Time-Scheduled Decremental Infusion after Laparoscopic Cholecystectomy. Pain Res Manag 2016; 2016:7868152. [PMID: 27725791 PMCID: PMC5048092 DOI: 10.1155/2016/7868152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022]
Abstract
Background. Oxycodone, a semisynthetic opioid, has been widely used for acute and chronic pain. Objectives. The aim of this study was to compare the analgesic and adverse effects of oxycodone and alfentanil on postoperative pain after laparoscopic cholecystectomy. Methods. This was a prospective, randomized, double-blind study. A total of 82 patients undergoing laparoscopic cholecystectomy were randomly assigned to receive either oxycodone or alfentanil using intravenous patient-controlled analgesia (PCA). PCA was administered as a time-scheduled decremental continuous infusion based on lean body mass for 48 hours postoperatively. Patients were assessed for pain with a visual analogue scale (VAS), the cumulative PCA dose, adverse effects, sedation level at 1, 4, 8, 16, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. Results. There were no significant differences (p < 0.05) between the two groups in VAS score, cumulative PCA dose, adverse effects, sedation level at 1, 4, 8, 16, 24, and 48 hours postoperatively, and satisfaction during the postoperative 48 hours. Conclusions. Our data showed that the analgesic and adverse effects of oxycodone and alfentanil were similar. Therefore, oxycodone may be a good alternative to alfentanil for pain management using intravenous PCA after laparoscopic cholecystectomy when used at a conversion ratio of 10 : 1. This trial is registered with KCT0001962.
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Gokara M, Narayana VV, Sadarangani V, Chowdhury SR, Varkala S, Ramachary DB, Subramanyam R. Unravelling the binding mechanism and protein stability of human serum albumin while interacting with nefopam analogues: a biophysical and insilico approach. J Biomol Struct Dyn 2016; 35:2280-2292. [PMID: 27453381 DOI: 10.1080/07391102.2016.1216895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In this study, molecular binding affinity was investigated for Nefopam analogues (NFs), a functionalized benzoxazocine, with human serum albumin (HSA), a major transport protein in the blood. Its binding affinity and concomitant changes in its conformation, binding site and simulations were also studied. Fluorescence data revealed that the fluorescence quenching of HSA upon binding of NFs analogues is based on a static mechanism. The three analogues of NFs binding constants (KA) are in the order of NF3 > NF2 > NF1 with values of 1.53 ± .057 × 104, 2.16 ± .071 × 104 and 3.6 ± .102 × 105 M-1, respectively. Concurrently, thermodynamic parameters indicate that the binding process was spontaneous, and the complexes were stabilized mostly by hydrophobic interactions, except for NF2 has one hydrogen bond stabilizes it along with hydrophobic interactions. Circular dichroism (CD) studies revealed that there is a decrease in α-helix with an increase in β-sheets and random coils signifying partial unfolding of the protein upon binding of NFs, which might be due to the formation of NFs-HSA complexes. Further, molecular docking studies showed that NF1, NF2 and NF3 bound to subdomains IIIA, IB and IIA through hydrophobic interactions. However, NF1 have additionally formed a single hydrogen bond with LYS 413. Furthermore, molecular simulations unveiled that NFs binding was in support with the structural perturbation observed in CD, which is evident from the root mean square deviation and Rg fluctuations. We hope our insights will provide ample scope for engineering new drugs based on the resemblances with NFs for enhanced efficacy with HSA.
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Affiliation(s)
- Mahesh Gokara
- a Department of Biochemistry , School of Life Sciences, University of Hyderabad , Hyderabad 500046 , India
| | | | - Vineet Sadarangani
- a Department of Biochemistry , School of Life Sciences, University of Hyderabad , Hyderabad 500046 , India
| | - Shatabdi Roy Chowdhury
- a Department of Biochemistry , School of Life Sciences, University of Hyderabad , Hyderabad 500046 , India
| | - Sreelaxmi Varkala
- a Department of Biochemistry , School of Life Sciences, University of Hyderabad , Hyderabad 500046 , India
| | | | - Rajagopal Subramanyam
- c Department of Plant Sciences , School of Life Sciences, University of Hyderabad , Hyderabad 500046 , India
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Choi JI. Use of Nefopam in Perioperative Pain Management; Keeping Nefopam in between. Korean J Pain 2016; 29:71-2. [PMID: 27103960 PMCID: PMC4837121 DOI: 10.3344/kjp.2016.29.2.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jeong Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School and Hospital, Gwangju, Korea
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Moon JY, Choi SS, Lee SY, Lee MK, Kim JE, Lee JE, Lee SH. The Effect of Nefopam on Postoperative Fentanyl Consumption: A Randomized, Double-blind Study. Korean J Pain 2016; 29:110-8. [PMID: 27103966 PMCID: PMC4837116 DOI: 10.3344/kjp.2016.29.2.110] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 01/23/2023] Open
Abstract
Background Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug. The concomitant use of opioids and nefopam is believed to have many advantages over the administration of opioids alone for postoperative pain management. We conducted a randomized, double-blind study to determine the fentanyl-sparing effect of co-administration of nefopam with fentanyl for postoperative pain management via patient
controlled analgesia (PCA). Methods Ninety female patients who underwent laparoscopic total hysterectomy under general anesthesia were randomized into 3 groups, Group A, fentanyl 1,000 µg; Group B, fentanyl 500 µg + nefopam 200 mg; and Group C, fentanyl 500 µg + nefopam 400 mg, in a total volume of 100 ml PCA to be administered over the first 48 h postoperatively without basal infusion. The primary outcome was total fentanyl consumption during 48 h; secondary outcomes included pain scores and incidence of side effects. Results Eighty-one patients were included in the analysis. The overall fentanyl-sparing effects of PCA with concomitant administration of nefopam during the first 48 h postoperatively were 54.5% in Group B and 48.9% group C. Fentanyl use was not significantly different between Groups B and C despite the difference in the nefopam dose. There were no differences among the three groups in terms of PCA-related side effects, although the overall sedation score of Group B was significantly lower than that of Group A. Conclusions The concomitant administration of nefopam with fentanyl for postoperative pain management may allow reduction of fentanyl dose, thereby reducing the risk of opioid-related adverse effects.
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shin Young Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Mi Kyung Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Eun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Hyun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Koh JC, Lee J, Kim SY, Choi S, Han DW. Postoperative Pain and Intravenous Patient-Controlled Analgesia-Related Adverse Effects in Young and Elderly Patients: A Retrospective Analysis of 10,575 Patients. Medicine (Baltimore) 2015; 94:e2008. [PMID: 26559296 PMCID: PMC4912290 DOI: 10.1097/md.0000000000002008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this retrospective analysis of 10,575 patients who used fentanyl-based intravenous patient-controlled analgesia (IV-PCA) after surgery, we evaluated difference between young and elderly patients on their characteristic of adverse effects.We reviewed the data collected from the patients who were provided IV-PCA for pain control following elective surgery under either general or spinal anesthesia between September 2010 and March 2014. Postoperative pain, incidence of PCA-related adverse effects, and risk factors for the need of rescue analgesics and antiemetics for postoperative 48 hours were analyzed.Pain intensity (numerical rating scale [NRS]) at postoperative 6 to 12 hours (4.68 vs 4.58, P < 0.01) and incidence of nausea or vomiting (23.8% vs 20.6%, P < 0.001) were higher in young patients, while incidence of PCA discontinuation (9.9% vs 11.5%, P < 0.01) and sedation (0.1% vs 0.7%, P < 0.001) was higher in elderly patients. Despite larger fentanyl dose used, a greater proportion of young patients required rescue analgesics (53.8% vs 47.9%, P < 0.001) while addition of ketorolac was effective in reducing postoperative pain. Despite lower incidence of postoperative nausea and vomiting (PONV), a larger proportion of elderly patients required rescue antiemetics (10.1% vs 12.2%, P < 0.001) while addition of ramosetron was effective in reducing PONV.In conclusion, when fentanyl-based IV-PCA is used for postoperative pain control, a larger proportion of young patients may require rescue analgesics while elderly patients may require more rescue antiemetics. The addition of ketorolac or ramosetron to the PCA of young and elderly patients can be effective to prevent rescue analgesics or antiemetics use.
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Affiliation(s)
- Jae Chul Koh
- From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute (JCK, SYK, SC); and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea (JL)
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12
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Shin SW. Medications in Treatment of Postherpetic Neuralgia. Korean J Pain 2014; 27:1-2. [PMID: 24478894 PMCID: PMC3903794 DOI: 10.3344/kjp.2014.27.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sang Wook Shin
- Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea
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