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Chen YH, Chou WH, Yie JC, Teng HC, Wu YL, Wu CY. Influence of Catheter-Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial. J Pers Med 2021; 11:jpm11111099. [PMID: 34834451 PMCID: PMC8619661 DOI: 10.3390/jpm11111099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Patient-controlled epidural analgesia (PCEA) or epidural morphine may alleviate postcesarean pain; however, conventional lumbar epidural insertion is catheter–incision incongruent for cesarean delivery. Methods: In total, 189 women who underwent cesarean delivery were randomly divided into four groups (low thoracic PCEA, lumbar PCEA, low thoracic morphine, and lumbar morphine groups) for postcesarean pain management. Pain intensities, including static pain, dynamic pain, and uterine cramp, were measured using a 100 mm visual analog scale (VAS). The proportion of participants who experienced dynamic wound pain with a VAS score of >33 mm was evaluated as the primary outcome. Adverse effects, including lower extremity blockade, pruritus, postoperative nausea and vomiting, sedation, and time of first passage of flatulence, were evaluated. Results: The low thoracic PCEA group had the lowest proportion of participants reporting dynamic pain at 6 h after spinal anesthesia (low thoracic PCEA, 28.8%; lumbar PCEA, 69.4%; low thoracic morphine, 67.3%; lumbar morphine group, 73.9%; p < 0.001). The aforementioned group also reported the most favorable VAS scores for static, dynamic, and uterine cramp pain during the first 24 h after surgery. Adverse effect profiles were similar among the four groups, but a higher proportion of participants in the lumbar PCEA group (approximately 20% more than in the other three groups) reported prolonged postoperative lower extremity motor blockade (p = 0.005). In addition, the first passage of flatulence after surgery reported by the low thoracic PCEA group was approximately 8 h earlier than that of the two morphine groups (p < 0.001). Conclusions: Epidural congruency is essential to PCEA for postcesarean pain. Low thoracic PCEA achieves favorable analgesic effects and may promote postoperative gastrointestinal recovery without additional adverse effects.
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Affiliation(s)
- Ying-Hsi Chen
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Wei-Han Chou
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Jr-Chi Yie
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Hsiao-Chun Teng
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
| | - Yi-Luen Wu
- Department of Medical Education, National Taiwan University, Taipei 100, Taiwan;
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei 100, Taiwan; (Y.-H.C.); (W.-H.C.); (J.-C.Y.); (H.-C.T.)
- Correspondence: ; Tel.: +886-2-2356-2158; Fax: +886-2-2341-5736
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Miao F, Feng K, Feng X, Fan L, Lang Y, Duan Q, Hou R, Jin D, Wang T. The Analgesic Effect of Different Concentrations of Epidural Ropivacaine Alone or Combined With Sufentanil in Patients After Cesarean Section. Front Pharmacol 2021; 12:631897. [PMID: 33692693 PMCID: PMC7937801 DOI: 10.3389/fphar.2021.631897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Patients experience moderate-high intensity postoperative pain after cesarean section (CS). The aim of this study was to investigate the optimal concentrations of ropivacaine and sufentanil for use in controlling pain after CS. Methods: One hundred and seventy-four women undergoing elective CS were randomly allocated to four groups. Epidural analgesia was administered with 0.1% ropivacaine in the R1 group, 0.15% ropivacaine in the R2 group, a combination of 0.1% ropivacaine and 0.5 μg/ml of sufentanil in the R1S group, and a combination of 0.15% ropivacaine and 0.5 μg/ml of sufentanil in the R2S group (at a basal rate of 4 ml/h, bolus dose of 4 ml/20 min as needed). Pain scores (numerical rating scale [NRS]: 0-10 cm) at rest (NRS-R), during movement (NRS-M), and when massaging the uterus (NRS-U) were documented at 6 and 24 h. We also recorded patient satisfaction scores, time to first flatus, motor deficits, and adverse drug reactions. Results: NRS (NRS-R, NRS-M, NRS-U) scores in the R2S group (2 [1-3], 4 [3-5], 6 [5-6], respectively) were lower than in the R1 group (3 [3-4], 5 [4-6], 7 [6-8], respectively) (p < 0.001, p < 0.05, p < 0.01, respectively) at 6 h; and patient satisfaction (9 [8-10]) was improved compared to the R1 group (8 [6-8]) (p < 0.01). The time to first flatus (18.7 ± 11.8 h) was reduced relative to the R1 group (25.9 ± 12.0 h) (p < 0.05). The time to first ambulation was not delayed (p > 0.05). However, the incidence of pruritus (4 [9.3%]) was increased compared to the R2 group (0 [0]) (p < 0.05) at 6 h, and the incidence of numbness (23 [53.5%], 23 [53.5%]) was increased compared to the R1 group (10 [23.3%], 10 [23.3%]) (all p < 0.01) at both 6 and 24 h. Conclusions: Although we observed a higher incidence of pruritus and numbness, co-administration of 0.15% ropivacaine and 0.5 μg/ml of sufentanil administered epidurally optimized pain relief after CS, with treated subjects exhibiting lower NRS scores, shorter time to first flatus, and higher patient-satisfaction scores.
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Affiliation(s)
- Fangfang Miao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuexin Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Long Fan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Lang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfang Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ruixue Hou
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Jin
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Fonseca R, Gonçalves D, Bento S, Valente E. Postoperative Epidural Analgesia in Cesarean Section: Comparison of Therapeutic Schemes. Cureus 2020; 12:e12166. [PMID: 33489578 PMCID: PMC7813929 DOI: 10.7759/cureus.12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Cesarean section is associated with moderate to severe postoperative pain. Its adequate control is fundamental to postpartum functional recovery, prevention of chronic pain, and postpartum depression. In this context, neuraxial analgesia has shown superior results. However, the best pharmacological regimen is still unknown. This study intended to compare the performance of three epidural therapeutic schemes (0.1% ropivacaine combined with epidural morphine vs 0.2% ropivacaine combined with epidural morphine vs morphine bolus) in pain intensity and its adverse effects in the early postoperative period of cesarean section. Methods A retrospective observational study was carried out. The sample included 204 women who underwent cesarean section after previous epidural catheter placement. Demographic and clinical data were collected. Pain intensity in rest, movement at 24 and 48 hours, and adverse effects (pruritus, nausea, sedation, respiratory depression, hypotension, urinary retention and paresthesias) were recorded. Results Statistical analysis revealed no differences in mean pain scores between groups on the first and second postoperative days. The incidence of adverse effects was significantly lower in the morphine bolus group. Conclusion Epidural morphine therapy is an effective option with an adequate safety profile. The addition of a local anesthetic seems to offer no benefit in this context, increasing the incidence of adverse effects.
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Sato I, Iwasaki H, Luthe SK, Iida T, Kanda H. Comparison of intrathecal morphine with continuous patient-controlled epidural anesthesia versus intrathecal morphine alone for post-cesarean section analgesia: a randomized controlled trial. BMC Anesthesiol 2020; 20:138. [PMID: 32493372 PMCID: PMC7268233 DOI: 10.1186/s12871-020-01050-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Several neuraxial techniques have demonstrated effective post-cesarean section analgesia. According to previous reports, it is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. However, little is known whether adding PCEA to IM is effective or not. The aim of this study was to compare post-cesarean section analgesia between IM with PCEA and IM alone. Methods Fifty patients undergoing elective cesarean section were enrolled in this prospective randomized study. Patients were randomized to one of two groups: IM group and IM + PCEA group. All patients received spinal anesthesia with 12 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 150 μg of morphine. Patients in IM + PCEA group received epidural catheterization through Th11–12 or Th12-L1 before spinal anesthesia and PCEA (basal 0.167% levobupivacaine infusion rate of 6 mL/h, bolus dose of 3 mL in lockout interval of 30 min) was commenced at the end of surgery. A numerical rating scale (NRS) at rest and on movement at 4,8,12,24,48 h after the intrathecal administration of morphine were recorded. In addition, we recorded the incidence of delayed ambulation and the number of patients who requested rescue analgesics. We examined NRS using Bonferroni’s multiple comparison test following repeated measures analysis of variance; p < 0.05 was considered as statistically significant. Results Twenty-three patients in each group were finally analyzed. Mean NRS at rest was significantly higher in IM group than in IM + PCEA group at 4 (2.7 vs 0.6), 8 (2.2 vs 0.6), and 12 h (2.5 vs 0.7), and NRS during mobilization was significantly higher in IM group than in IM + PCEA group at 4 (4.9 vs 1.5), 8 (4.8 vs 1.9), 12 (4.9 vs 2), and 24 h (5.7 vs 3.5). The number of patients who required rescue analgesics during the first 24 h was significantly higher in IM group compared to IM + PCEA group. No significant difference was observed between the groups in incidence of delayed ambulation. Conclusions The combined use of PCEA with IM provided better post-cesarean section analgesia compared to IM alone. Trial registration UMIN-CTR (Registration No. UMIN000032475). Registered 6 May 2018 – Retrospectively registered.
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Affiliation(s)
- Izumi Sato
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hajime Iwasaki
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Sarah Kyuragi Luthe
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.,Department of Anesthesiology, Indiana University School of Medicine, 1130 W. Michigan Street, Fesler Hall 204, Indianapolis, IN, 46202, USA
| | - Takafumi Iida
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
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Xie W, Zhuang W, Chen L, Xie W, Jiang C, Liu N. 4218T/C polymorphism associations with post-cesarean patient-controlled epidural fentanyl consumption and pain perception. Acta Anaesthesiol Scand 2018; 62:376-383. [PMID: 29148033 DOI: 10.1111/aas.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/03/2017] [Accepted: 10/29/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The utilization of intrathecal opioids is an efficacious component of post-cesarean section pain management. Given that growing evidence indicates that calcitonin gene-related peptide (CGRP) plays a key role in the development of peripheral sensitization and is associated with enhanced pain, we hypothesized that CGRP 4218T/C polymorphism is associated with the variability in fentanyl consumption for post-cesarean analgesia. METHODS We recruited 548 patients who presented for elective cesarean delivery, and used polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze CGRP 4218T/C polymorphism. We examined the association of CGRP 4218T/C polymorphism and post-operative fentanyl consumption for analgesia as well as adverse reactions to fentanyl in those patients who received cesarean section surgeries. RESULTS We found that the CGRP 4218T/C polymorphism has a significant effect on pain perception, analgesic requirement, and nausea and vomiting for the first 24 h after cesarean delivery in patients who received PCEA fentanyl. Individuals with the C/C genotype had more pain, required more PCEA fentanyl, and experienced a lower incidence of nausea and vomiting. CONCLUSION These results indicated that patients with C/C genotype may have reduced sensitivity to fentanyl analgesia and/or increased pain perception, and were more willing to use PCEA fentanyl to manage their pain.
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Affiliation(s)
- W. Xie
- Department of Anesthesiology; Quanzhou First Hospital; Quanzhou China
| | - W. Zhuang
- Department of Anesthesiology; Huian Hospital; Quanzhou China
| | - L. Chen
- Department of Anesthesiology; Huian Hospital; Quanzhou China
| | - W. Xie
- Department of Anesthesiology; Quanzhou First Hospital; Quanzhou China
| | - C. Jiang
- Department of Anesthesiology; Quanzhou First Hospital; Quanzhou China
| | - N. Liu
- Department of Anesthesiology; Quanzhou First Hospital; Quanzhou China
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Cohen S, Chhokra R, Stein MH, Denny JT, Shah S, Mohiuddin A, Naftalovich R, Zhao R, Pashkova A, Rolleri N, Patel AG, Hunter-Fratzola CW. Ropivacaine 0.025% mixed with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml is effective for epidural patient-controlled analgesia after cesarean section. J Anaesthesiol Clin Pharmacol 2015; 31:471-7. [PMID: 26702203 PMCID: PMC4676235 DOI: 10.4103/0970-9185.169065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Aims: We aimed to determine the ropivacaine concentration that provided adequate analgesia with early ambulation and minimal urinary retention or other side-effects when used with fentanyl and epinephrine for patient-controlled epidural analgesia (PCEA) after elective cesarean section. Material and Methods: Forty-eight patients were randomized to four groups in a double-blinded fashion. All groups received an initial 10 ml/h of epidural study solution for 24 h. The solution contained: 0.2, 0.1, 0.05, or 0.025% ropivacaine for Groups I-IV, respectively, with fentanyl 3.0 μg/ml and epinephrine 0.5 μg/ml. Patients could administer additional PCEA doses of 4 ml of their study solution with a lock-out time of 10 min. Overall satisfaction, side-effects, motor block, neurologic function, and pain using Visual Analog Scale were assessed. Results: Patients in all groups showed no difference in sedation, pruritus, nausea, vomiting, and uterine cramps. Pain scores at rest were lower for Group IV than Groups I-III (P < 0.001). Twelve, five, one, and zero patients could not ambulate in Groups I-IV, respectively. Nine, nine, two, and zero (III <I and II, P = 0.02; IV P = 0.001) patients reported urinary retention in Groups I-IV, respectively. Overall satisfaction scores were high for all groups. Neonatal behavior score was similar and high in all groups. Conclusion: 0.025% ropivacaine PCEA combined with fentanyl and epinephrine provided effective pain relief after cesarean section with early ambulation and without sensory loss, urinary retention, or increase of side-effects.
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Affiliation(s)
- Shaul Cohen
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Renu Chhokra
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Mark H Stein
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - John T Denny
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Shruti Shah
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Adil Mohiuddin
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Rotem Naftalovich
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA ; Department of Anesthesiology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Rong Zhao
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Anna Pashkova
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Noah Rolleri
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Arpan G Patel
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
| | - Christine W Hunter-Fratzola
- Department of Anesthesiology, Rutgers, The State University of New Jersey - Robert Wood Johnson Medical School, New Brunswick, USA
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Marcus H, Gerbershagen H, Peelen L, Aduckathil S, Kappen T, Kalkman C, Meissner W, Stamer U. Quality of pain treatment after caesarean section: Results of a multicentre cohort study. Eur J Pain 2014; 19:929-39. [DOI: 10.1002/ejp.619] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/08/2022]
Affiliation(s)
- H. Marcus
- Department of Anaesthesiology and Intensive Care Medicine; University of Cologne; Germany
| | - H.J. Gerbershagen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - L.M. Peelen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; The Netherlands
| | - S. Aduckathil
- Department of Anaesthesiology and Intensive Care Medicine; University of Cologne; Germany
| | - T.H. Kappen
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - C.J. Kalkman
- Department of Anaesthesiology and Intensive Care Medicine; University Medical Centre Utrecht; The Netherlands
| | - W. Meissner
- Department of Anaesthesiology and Intensive Care Medicine; Jena University Hospital; Germany
| | - U.M. Stamer
- Department of Anaesthesiology and Intensive Care Medicine; University of Bern; Switzerland
- Department of Anaesthesiology and Pain Medicine; Inselspital, University of Bern; Switzerland
- Department of Clinical Research; University of Bern; Switzerland
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Matsota P, Nakou M, Kalimeris K, Batistaki C, Pandazi A, Kostopanagiotou G. A single dose of celecoxib 200 mg improves postoperative analgesia provided via patient-controlled epidural technique after caesarean section. Arch Med Sci 2013; 9:877-82. [PMID: 24273573 PMCID: PMC3832813 DOI: 10.5114/aoms.2012.31253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 01/15/2012] [Accepted: 01/29/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Celecoxib in a dose of 200 mg is safe for the breast feeding mother, as its milk levels are extremely low. We investigated the efficacy of celecoxib in improving postoperative pain management in parturients under patient-controlled epidural analgesia (PCEA). MATERIAL AND METHODS We studied 64 healthy parturients undergoing elective caesarean section under combined spinal-epidural anesthesia. Postoperative analgesia was performed via PCEA with ropivacaine 0.15% and fentanyl 2 µg/ml (4 ml bolus administration, lock-out 15 min). Patients were randomly allocated to receive either only PCEA (n = 32) or PCEA plus celecoxib 200 mg orally (n = 32). Paracetamol 500 mg was given orally as rescue analgesia. We recorded visual analogue scale (VAS) scores for pain at rest and movement, attempted and given PCEA doses, Bromage scores, level of sensory blockade, rescue doses of paracetamol, maternal side effects during the first 24 h after the PCEA instrumentation, and the overall patient satisfaction. RESULTS Fifty-six patients completed the entire protocol. Patient demographics, duration of surgery, side effects, attempted and given PCEA doses, and motor and sensory blockade did not differ between the groups. Significantly lower VAS scores at rest and movement, fewer paracetamol doses (p = 0.039) and increased patient satisfaction (p = 0.001) were found in the celecoxib group compared to controls. CONCLUSIONS A single dose of 200 mg of celecoxib effectively improved pain management in parturients with PCEA, limited the need for supplemental analgesics and improved efficacy of analgesia, increasing patient satisfaction.
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Affiliation(s)
- Paraskevi Matsota
- 2 Department of Anaesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Athens, Greece
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Lu L, Zhang W, Wu X, Wang X, Zhang M, Zhu Q, Ding X, Xu Z, Gao S, Gao J. A novel ropivacaine-loaded in situ forming implant prolongs the effect of local analgesia in rats. Arch Med Sci 2013; 9:614-21. [PMID: 24049519 PMCID: PMC3776163 DOI: 10.5114/aoms.2012.30829] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 01/25/2012] [Accepted: 02/20/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Prolonged postoperative analgesia cannot be achieved by a single injection of local anesthetic solution. The objective of this study was to optimize the formulation of a ropivacaine hydrochloride (Ropi-HCl) loaded in situ forming implant (ISI) by addition of different co-solvents, and evaluate the in vitro release of Ropi-HCl, and the analgesic effect and toxicity of the optimized formulation in rats. MATERIAL AND METHODS Triacetin (TA), benzyl benzoate (BB) and polyethylene glycol 400 (PEG 400) were used as additives and added to the solvent of N-methyl-2-pyrrolidone (NMP). Drug release to the surface and inner structural properties of the formed implant were evaluated by scanning electron microscopy (SEM). The analgesic effect was determined by injection near the rat sciatic nerve. RESULTS The solvent system added with TA or BB significantly decreased the burst release, whereas PEG 400 increased the Ropi-HCl burst release from the formulation. Over 70% of the incorporated Ropi-HCl was released from all formulations in 14 days in the in vitro assay. The SEM showed that the surface of NMP-BB formulation was less porous and more homogeneous, compared with the other formulations. Compared with Ropi-HCl injection, the optimized formulation (NMP-BB) significantly prolonged the analgesic effect in 48 h (p < 0.05), with a mild degree of motor block from 3 h to 12 h. Histological evaluation of the injection site revealed only mild inflammatory infiltration without obvious pathological nerve alterations. CONCLUSIONS The biodegradable Ropi-HCl-loaded ISI system with NMP-BB may prove to be an attractive and safe alternative for the delivery of parenteral local anesthetics to prolong pain relief.
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Affiliation(s)
- Lei Lu
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
- Department of Pharmaceutics, PLA No. 323 Hospital, Xi'an, Shaanxi, PR China
| | - Wei Zhang
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
- Department of Pharmaceutics, PLA No. 522 Hospital, Luoyang, Henan, PR China
| | - Xin Wu
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Xiaoyu Wang
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Min Zhang
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Quangang Zhu
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Xueying Ding
- Department of Pharmaceutics, School of Pharmacy, Second Military Medical University, Shanghai, PR China
| | - Zhiyun Xu
- Department of Thoracic-Cardio Surgery, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Shen Gao
- Department of Pharmaceutics, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Jing Gao
- Department of Pharmaceutics, School of Pharmacy, Second Military Medical University, Shanghai, PR China
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