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Zhou D, Wang LK, Wu HY, Xiong GL, Yang XD. Lidocaine Spray for Acute Postsurgical Pain Control After Posterior Pharyngeal Flap Surgery. Laryngoscope 2024; 134:2438-2443. [PMID: 37991177 DOI: 10.1002/lary.31182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES This study evaluated the use of lidocaine spray for acute postsurgical pain control after posterior pharyngeal flap surgery. METHODS Fifty patients aged 4 to 14 years who were scheduled to undergo elective posterior pharyngeal flap surgery were randomized to receive 2.4% lidocaine spray (Group L) or an identical volume of placebo spray (Group C) on the surgical field at the end of the surgery. The primary outcome was the maximum postoperative pain score in the postanesthesia care unit. RESULTS The maximum pain score in Group L was significantly lower than that in Group C (p = 0.001). The incidence of moderate-to-severe pain in the postanesthesia care unit was significantly lower in Group L than that in Group C (p < 0.001). In the postanesthesia care unit, more patients in Group C were prescribed rescue analgesics (p < 0.001). The time to the first rescue analgesic was also significantly shorter in Group L (p < 0.001). The incidence and maximum score of emergence agitation were lower in Group L than in Group C. Compared with Group C, Group L showed earlier postoperative fluid intake (p = 0.001). Moreover, the score for parental satisfaction with pain control was higher in Group L than in Group C (p < 0.001). CONCLUSIONS Our findings indicated that the use of 2.4% lidocaine aerosol spray on the surgical site at the end of the surgery could produce good analgesia for acute postoperative pain, reduce the incidence and severity of EA, and shorten the time to restore fluid intake. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2438-2443, 2024.
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Affiliation(s)
- Dan Zhou
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Li-Kuan Wang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Hai-Yin Wu
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Guo-Li Xiong
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
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Koffler D, Eckstein J, Herman J, Martins-Welch D, Seetharamu N, Ghaly M, Kohn N, Potters L, Frank D, Sullivan K, Parashar B. Efficacy of ketamine mouthwash in the management of oral and pharyngeal toxicity associated with head and neck chemoradiotherapy: protocol for a phase II, Simon's two-stage trial. BMJ Open 2023; 13:e064809. [PMID: 37041046 PMCID: PMC10105995 DOI: 10.1136/bmjopen-2022-064809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Curative intent treatment of head and neck cancer (HNC) is frequently radiation therapy over 7 weeks with concurrent chemotherapy. This regimen is effective but carries a burden of toxicity leading to severe pain and treatment breaks portending inferior outcomes. Conventional palliation methods include opioids, anticonvulsants and local anaesthetics. Breakthrough toxicities are nevertheless ubiquitous and present an urgent unmet need. Ketamine is an inexpensive drug with mechanisms of analgesia outside the opioid pathway including N-methyl-D-aspartate (NMDA) receptor antagonism and a pharmacologically unique property of opioid desensitisation. Systemic ketamine is validated in randomised controlled trials for efficacy in reducing pain and/or opioid burden in the oncologic setting. Literature supports peripherally administered ketamine for pain control without systemic toxicity. These data support our rationale of using ketamine mouthwash to decrease acute toxicity of curative treatment of HNC, the efficacy of which is our aim to elucidate. METHODS AND ANALYSIS This is a phase II, Simon's two-stage trial. Patients have pathologically confirmed HNC and an intended regimen of 70 Gy of radiation with concurrent cisplatin. The protocol is initiated on diagnosis of grade 3 mucositis and consists of 2 weeks of 4 times daily (QID) ketamine mouthwash use. The primary endpoint is pain response defined as a combination of pain score and opioid use. 23 subjects will be enrolled in stage 1. If statistical criteria are met, 33 subjects will be enrolled in stage 2. Secondary endpoints include daily pain, daily opioid use, dysphagia at baseline and completion, nightly sleep quality, feeding tube placement and any unscheduled treatment breaks. ETHICS AND DISSEMINATION All trial data will be stored in an Institutional Review Board (IRB) approved database. The protocol is registered under Northwell IRB registration number #22-0292 and U.S. Food and Drug Administration (FDA) Investigational New Drug (IND) approval has been granted under IND number 161609. Results are intended to be published in an open-source journal and further data, statistics and source documents are available on request. TRIAL REGISTRATION NUMBER NCT05331131.
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Affiliation(s)
- Daniel Koffler
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Jacob Eckstein
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Joseph Herman
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Diana Martins-Welch
- Department of Palliative Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Nagashree Seetharamu
- Department of Medical Oncology, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Nina Kohn
- Division of Biostatistics, Feinstein Institute for Medical Research, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Manhasset, New York, USA
| | - Louis Potters
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Douglas Frank
- Department of Otolaryngology, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Kevin Sullivan
- Department of Medical Oncology, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Medicine, Donald and Barbara Zucker SOM at Hofstra/Northwell and Northwell Health Cancer Institute, Lake Success, New York, USA
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Sadeghpour Marvi H, Baloochi Beydokhti T, Sajjadi M, Khaleghimanesh B. Comparing Effects of Rhythmic Breathing and Lidocaine Spray on Pain Intensity During Needle Insertion Into Arteriovenous Fistula in Hemodialysis Patients: A Randomized Controlled Trial. Anesth Pain Med 2023; 13:e126384. [PMID: 37645007 PMCID: PMC10461387 DOI: 10.5812/aapm-126384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 08/31/2023] Open
Abstract
Background Hemodialysis patients suffer from pain caused by needle insertion into the fistula site. Non-pharmacological methods may be associated with acceptable effects. Objectives The present study aimed to compare the effects of two interventions on pain intensity during needle insertion into the arteriovenous fistula in hemodialysis patients. Methods This self-controlled, single-blind clinical trial was conducted on 54 hemodialysis subjects with arteriovenous fistula in Mashhad in 2021. In this regard, the patients were selected according to the inclusion criteria and randomly assigned to two groups (lidocaine spray and rhythmic breathing). In each group, pain intensity was assessed based on the visual analogue scale (VAS) before the intervention, followed by measuring the post-intervention pain intensity during three consecutive hemodialysis sessions every other day. Regarding the lidocaine spray group, two puffs of 10% lidocaine spray (20 mg) were sprayed on the needle insertion site five minutes before cannulation. However, the patients in another group took a long deep breath through the nose with three numbers, held their breath in the lungs for three numbers, and slowly exhaled through the mouth with three numbers two minutes before cannulation. The data were analyzed using SPSS software version 20, and Mann-Whitney U, Wilcoxon, chi-squared, and paired t-tests were run. In this study, P < 0.05 was considered significant. Results The results represented a significant decrease in the pain severity scores of both rhythmic breathing (P = 0.023) and lidocaine spray (P < 0.001) groups after the intervention. Moreover, a more significant difference was observed between pre-and post-intervention pain intensity scores in the group treated with lidocaine spray (1.16 ± 1.56) compared to the other group (0.508 ± 1.25). Conclusions The lidocaine spray group had a larger difference in the pre-and post-intervention pain intensity scores than the rhythmic group; however, the difference was not significant. The rhythmic breathing can be used by nurses as a non-pharmacological method with low complications in hemodialysis departments because of declining pain.
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Affiliation(s)
| | | | - Moosa Sajjadi
- School of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
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Opperman JB, Tshifularo MI. The application of xylocaine 10% pump-spray to improve immediate post-adenotonsillectomy pain in children: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2022; 161:111260. [PMID: 35963082 DOI: 10.1016/j.ijporl.2022.111260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Post-adenotonsillectomy pain is often severe, requiring substantial analgesia in the first 48-72 h. This pain is not only distressing to the patient and his or her parents, but often reflects poorly on an otherwise well performed procedure. Safe, simple and effective post-adenotonsillectomy pain control is still clinically elusive, even though a multitude of surgical and analgesic interventions have been proposed. OBJECTIVES To investigate the analgesic properties of immediate post-operative application of xylocaine 10% pump spray to the tonsillar fossae in children having undergone adenotonsillectomy and how this impacts on anesthetic emergence and pain control in the first 24-h. METHODS In this double-blinded, randomized, placebo-controlled trial, 80 children were stratified into two groups: Group I (3-8 years-old) and Group II (9-14 years-old). Within these groups, participants were randomized to receive either xylocaine 10% pump spray or normal saline 0.9% post-operatively. A standardized anesthetic/analgesic regime was used intra-operatively. The same surgeon performed all surgeries using bi-polar diathermy. Outcome variables included state of anesthetic emergence; pain scores at specific intervals; need for rescue analgesia; post-operative nausea and vomiting; time to first oral intake and comfort associated with initial oral intake. RESULTS Xylocaine 10% pump spray consistently provided superior pain control at all time intervals compared to normal saline 0.9% (p = 0.011). This was most pronounced in children 3-8 years old (Group I). Xylocaine 10% pump spray and normal saline 0.9% provided similar pain relief in children 9-14 years old (Group (II) (p = 0.640). Children receiving xylocaine had a decreased incidence of emergence delirium and consistently required less rescue analgesia (p = 0.005). Children who received xylocaine did not eat sooner post-operatively, but they experienced less pain when ingesting liquids (p = 0.003) and solids (p = 0.000). Children who received xylocaine did not experience increased post-operative complications (p = 1.000) or nausea and vomiting (p = 0.153). CONCLUSION Xylocaine 10% spray may serve as a valuable adjunct to effective pain control post-adenotonsillectomy, especially if long acting opioids are contraindicated, as with patients with obstructive sleep apnea. The benefit of xylocaine appears to be negligible when a long acting opioid is administered. The benefits of xylocaine were most noteworthy in children aged 3-8 years old. This is the largest trial (n = 80) to date to assess the efficacy of xylocaine spray in isolation post-adenotonsillectomy. Xylocaine also offers improved comfort with oral intake and decreases emergence delirium and need for rescue analgesia without any increase in post-operative complications. Local anesthesia may decrease costs and help to solve the conundrum of a painless adenotonsillectomy especially in resource-limited settings.
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Affiliation(s)
- Jacobus B Opperman
- Department of Otorhinolaryngology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Mashudu I Tshifularo
- Department of Otorhinolaryngology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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Bali A, Dang AK, Gonzalez DA, Kumar R, Asif S. Clinical Uses of Ketamine in Children: A Narrative Review. Cureus 2022; 14:e27065. [PMID: 35989801 PMCID: PMC9389002 DOI: 10.7759/cureus.27065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Ketamine is a phencyclidine derivative that acts as a noncompetitive N-methyl-D-aspartate as well as a glutamate receptor antagonist. It also has other minor mechanisms that contribute to its extensive drug profile. Ketamine is a bronchodilator and maintains normal airway reflexes and, thus, permits spontaneous respiration. This, coupled with the fact that it produces potent analgesia, makes it highly suitable for children. Despite its many merits, the drug’s side effects, along with its cultural image of being a drug of abuse, a drug used in veterinary medicine, or a “date-rape drug” have sullied its reputation within the armamentarium of medicine. Even though it is widely used in developing countries, its use in Western nations has diminished. We have strived to explore the various clinical uses of ketamine in children through this article. In addition, the article also highlights how some of the fears associated with using the drug are unfounded and provides ways by which the drug’s side effects can be prevented and managed.
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Shih MC, Long BD, Pecha PP, White DR, Liu YC, Brennan E, Nguyen MI, Clemmens CS. A scoping review of randomized clinical trials for pain management in pediatric tonsillectomy and adenotonsillectomy. World J Otorhinolaryngol Head Neck Surg 2022; 9:9-26. [PMID: 37006744 PMCID: PMC10050970 DOI: 10.1002/wjo2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. Data Sources PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). Methods A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain-related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. Results One hundred and eighty-nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual-assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self-comparisons. Conclusion Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta-analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively.
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Affiliation(s)
- Michael C. Shih
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Baylor College of Medicine Houston Texas USA
| | - Barry D. Long
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
- Department of Otolaryngology—Head and Neck Surgery Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - David R. White
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
| | - Yi‐Chun C. Liu
- Department of Otolaryngology—Head and Neck Surgery Baylor College of Medicine Houston Texas USA
- Department of Surgery ‐ Division of Pediatric Otolaryngology Texas Children's Hospital Houston Texas USA
| | - Emily Brennan
- Department of Research and Education Services Medical University of South Carolina Library Charleston South Carolina USA
| | - Mariam I. Nguyen
- Charleston County School of the Arts North Charleston South Carolina USA
| | - Clarice S. Clemmens
- Department of Otolaryngology—Head and Neck Surgery Medical University of South Carolina Charleston South Carolina USA
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Kumar A, Kohli A. Comeback of ketamine: resurfacing facts and dispelling myths. Korean J Anesthesiol 2021; 74:103-114. [PMID: 33423410 PMCID: PMC8024210 DOI: 10.4097/kja.20663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/17/2022] Open
Abstract
Initially known as CI-581, ketamine was first synthesized in 1962 as a replacement from phencyclidine. It has since been used as an anesthetic and analgesic. In addition, it has bronchodilating, sedative, and amnestic properties, preserving airway reflexes and sympathetic nervous system tone. Since the discovery of ketamine, it has been a major topic of discussion due to controversies regarding its usage in particular sets of patients. In the past 50 years, despite its potential benefits, it is not commonly used because of concerns of "emergence phenomenon," its use as a substance of abuse, and its systemic side effects. Since 2012, three World Health Organization reviews on ketamine have addressed its international control. Researchers have been studying this wonder drug for a decade worldwide. Many myths of ketamine regarding emergence phenomenon and its use in traumatic brain injury and open eye injury have been disproved in recent times. It is becoming popular in pre-hospital settings, critical care, emergency medicine, low-dose acute pain services, and adjuvant in regional anesthesia techniques. This review highlights the current consensus on the various applications of ketamine in the literature.
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Affiliation(s)
- Abhijit Kumar
- Department of Anesthesiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Amit Kohli
- Department of Anesthesiology, Maulana Azad Medical College, New Delhi, India
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Eerdekens M, Radic T, Sohns M, Khalil F, Bulawa B, Elling C. Outcomes of the Pediatric Development Plan of Tapentadol. J Pain Res 2021; 14:249-261. [PMID: 33542654 PMCID: PMC7853428 DOI: 10.2147/jpr.s290487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
The opioid analgesic tapentadol was the first pain medication to be developed for the treatment of pain in children under a formal process established by the regulatory authorities. This article summarizes the outcomes of the pediatric development program for tapentadol across the entire age range from birth (including neonates) to adolescents <18 years of age. In addition, the challenges experienced when designing and conducting the pediatric tapentadol clinical trials as well as the interactions with the regulatory authorities are discussed. As a first outcome, the oral solution of tapentadol was authorized in the EU in 2018 as a new treatment option in the hospital setting for moderate to severe acute pain in children from 2 to <18 years of age.
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Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2020; 76:947-961. [PMID: 33201518 PMCID: PMC8247026 DOI: 10.1111/anae.15299] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
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Affiliation(s)
- N Aldamluji
- Department of Adult Anaesthesiology, Sidra Medicine, Qatar
| | - A Burgess
- Department of Otolaryngology Head and Neck Surgery, Com Maillot-Hartmann Private Hospital, Neuilly sur Seine, France
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - J Raeder
- Department of Anaesthesiology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H Beloeil
- Department of Anaesthesiology and Critical Care, Université Rennes, Rennes, France
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Abdollahpour A, Saffarieh E, Zoroufchi BH. A review on the recent application of ketamine in management of anesthesia, pain, and health care. J Family Med Prim Care 2020; 9:1317-1324. [PMID: 32509610 PMCID: PMC7266204 DOI: 10.4103/jfmpc.jfmpc_875_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 12/15/2022] Open
Abstract
Ketamine is considered as a promising drug for many clinical applications even after five decades since its discovery. Ketamine is a dissociative anesthetic agent with a variety of pharmacological effects from anesthetic induction and maintenance to analgesic and sedative depending on the consuming dose. It can be used solely or in combination with other co-adjuvant drugs, increasing their efficacy. Many therapeutic properties of ketamine have been attributed to its antagonism mechanism to N-Methyl-D-aspartate receptor. Identifying new properties of ketamine such as neuroprotective, antiinflammatory, and antitumor effects, on one hand, and taking advantage of subanesthetic regimens of ketamine, on the other hand, have resulted in a widespread use of ketamine in various clinical applications. Ketamine is solvable in aqueous and lipid solutions, providing convenient administration via multiple routes, including oral, nasal, rectal, intravenous, intramuscular, subcutaneous, transdermal, sublingual, and intraosseous administration. Application of ketamine has some advantages over other sedative and anesthetic agents. It produces bronchodilation status, allowing for most secure induction of anesthesia in patients with life-threatening asthma and intense acute bronchial constriction. Ketamine has an excellent hemodynamic profile, makes it the agent of choice for patients with unstable hemodynamics, such as shocked or hypotensive patients. Ketamine usage has been associated with a lower risk of respiratory depression and relatively more conserved airway reflexes. Although being an anesthetic agent, ketamine has been increasingly used in subanesthetic doses for acute and chronic pain as well as depression. Using ketamine in pre and postoperative pain management is well established. However, the studies on ketamine performance in pain management demonstrated contradicting results. On the other hand, various side effects along with no confirmatory data on long-term treatment demand great caution when using ketamine for treating complex chronic pains. The present study aimed to provide a general review on the recent applications of ketamine in anesthesia, pain management, and critical care.
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Affiliation(s)
- Abolfazl Abdollahpour
- Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Elham Saffarieh
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Muse D, Tarau E, Lefeber C, Sohns M, Brett M, Goldberg J, Rosenburg R. Pharmacokinetics, safety, and efficacy of tapentadol oral solution for treating moderate to severe pain in pediatric patients. J Pain Res 2019; 12:1777-1790. [PMID: 31213888 PMCID: PMC6549717 DOI: 10.2147/jpr.s197039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background: This trial is part of the global pediatric clinical development program investigating the administration of the strong analgesic tapentadol in children and adolescents. Patients and methods: The single site, open-label phase 2 trial evaluated the pharmacokinetic profile of tapentadol and its major metabolite, tapentadol-O-glucuronide, as well as safety and tolerability and efficacy of a single dose of tapentadol oral solution (1 mg/kg) in patients (2 to <18 years) undergoing dental, ear, nose, or throat surgery. Blood sampling and pain intensity measurements were conducted using age-appropriate schedules and rating scales, respectively. Adverse events were monitored throughout the trial. Results: Sixty-six patients were treated. They were stratified by age: Group 1 (12 to <18 years), n=21; Group 2 (6 to <12 years), n=28; and Groups 3 (3 to <6 years) and 4 (2 to <3 years), n=17. Serum tapentadol concentrations observed in these pediatric patients were within the range observed in adults after administration of a single tapentadol immediate-release dose (50-100 mg), whereas those of the metabolite tapentadol-O-glucuronide were within the same range or lower than in adults who received comparable single doses of tapentadol. Pain intensity improved over time across all age groups. The most common treatment-emergent adverse events were nausea (24.2%), vomiting (16.7%), dizziness (9.1%), and headache (6.1%). Conclusion: A single dose of tapentadol oral solution (1 mg/kg) administered to pediatric patients (2 to <18 years) resulted in serum tapentadol concentrations within the targeted range shown to be safe and efficacious in adults. Tapentadol demonstrated good tolerability and safety; within the limitations of the trial design, improvements in postsurgical pain intensity were observed across the age groups. Tapentadol may provide a new treatment option in the management of moderate to severe pediatric pain.
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Affiliation(s)
- Derek Muse
- Jean Brown Research, Salt Lake City, UT, USA
| | - Eva Tarau
- Grünenthal USA Inc., Overland Park, KS, USA
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12
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Jang YJ, Kim HO. [The Effect of Pain Relieving Intervention During Infiltration among Gamma Knife Surgery Patients for Stereotactic Frame Fixation]. J Korean Acad Nurs 2018; 48:221-231. [PMID: 29735881 DOI: 10.4040/jkan.2018.48.2.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to compare the effects of three interventions on pain, blood pressure, and pulse rate during infiltration anesthesia in patients about to undergo gamma knife surgeries. METHODS The three interventions employed in a university-affiliated Hospital in J City, South Korea were as follows: EMLA cream plus Vapocoolant spray (Vapocoolant, n=30), EMLA cream plus 10.0% Lidocaine spray (Lidocaine, n=30), and EMLA cream only (EMLA, n=30). The equivalent control-group pre test - post test study design was used. Pain was assessed subjectively using the numeric rating scale (NRS) and objectively using a Galvanic Skin Response (GSR) tester. NRS scores were assessed after infiltration anesthesia and the GSR was assessed during infiltration anesthesia. Blood pressure and pulse rate were assessed twice: before and after infiltration anesthesia. Data were collected between August 3, 2016 and March 24, 2017. RESULTS NRS scores after infiltration anesthesia and the GSR during infiltration anesthesia were significantly lower in the Vapocoolant group than in the Lidocaine and EMLA groups (F=13.56, p<.001 and F=14.43, p<.001, respectively). The increase in systolic blood pressure (F=4.77, p=.011) and in pulse rates (F=4.78, p=.011) before and after infiltration anesthesia were significantly smaller in the Vapocoolant group than in the Lidocaine and EMLA groups; however, no significant differences were observed in diastolic blood pressures (F=1.51, p=.227). CONCLUSION EMLA cream plus Vapocoolant spray was the most effective intervention to relieve pain and to lower increase in systolic blood pressure and pulse rate caused by infiltration anesthesia for stereotactic frame fixation. Thus, application of Vapocoolant spray in addition to EMLA cream is highly recommended as a nursing intervention for patients undergoing gamma knife surgeries.
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Affiliation(s)
- Young Jun Jang
- Department of Nursing, Chonbuk National University Hospital, Jeonju, Korea
| | - Hyeon Ok Kim
- College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea.
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Hamed MA, Al-Saeed MA. The Efficacy of Intravenous Magnesium Sulfate versus Intravenous Paracetamol on Children Posttonsillectomy Pain and Analgesic Requirement: A Randomized Controlled Study. Anesth Essays Res 2018; 12:724-728. [PMID: 30283184 PMCID: PMC6157232 DOI: 10.4103/aer.aer_113_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: One of the most common complications of tonsillectomy is pain, which leading to delayed recovery and later hospital discharge. Aims: We intended to compare the efficacy of magnesium sulfate versus paracetamol on the posttonsillectomy pain and analgesic requirement. Settings and Design: This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods: A total of 60 children with the American Society of Anesthesiologists physical status classes I and II, aged 3–12 years, scheduled for tonsillectomy were randomly divided into two groups each group contains 30 patients: (Group M): received an initial loading dose of magnesium sulfate 30 mg/kg over 15 min started with induction followed by continuous infusion of 10 mg/kg/h for 1 h regardless of the operation time and (Group P): received paracetamol infusion 10 mg/kg started with induction and continued for 1 h. Postoperatively, a blinded postanesthesia care unit (PACU) nurse observed the quality of analgesia using the face, legs, activity, cry, and consolability pain scores, bleeding, and sedation. Statistical Analysis Used: Student's t-test and Chi-square test were used for analysis. Results: Regarding postoperative pain, there was a statistically significant difference between the two groups at the time of admission in PACU (P = 0.025) as children who experienced pain already had taken rescue analgesic to alleviate pain. There was a statistically significant difference between the two groups regarding the need for analgesics (P = 0.038). There was no statistically significant difference regarding bleeding and sedation scores between the two study groups. Conclusions: Magnesium sulfate provided better postoperative analgesia and reduced need for analgesics after tonsillectomy compared to paracetamol, and regarding the incidence of bleeding and the degree of sedation the outcome in both groups was readily comparable.
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Affiliation(s)
- Mohamed Ahmed Hamed
- Department of Anesthesiology, Faculty of Medicine, Fayoum University, Faiyum, Egypt
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Mahshidfar B, Mofidi M, Fattahi M, Farsi D, Hafezi Moghadam P, Abbasi S, Rezai M. Acute Pain Management in Emergency Department, Low Dose Ketamine Versus Morphine, A Randomized Clinical Trial. Anesth Pain Med 2017; 7:e60561. [PMID: 29696126 PMCID: PMC5903386 DOI: 10.5812/aapm.60561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/16/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022] Open
Abstract
Background Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED). Objectives This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients. Methods In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour. Results Fifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P < 0.001, P < 0.001 respectively). Two complications (drop in O2 saturation below 90% and flushing) were significantly greater in the morphine group. Conclusions The results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine.
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Affiliation(s)
- Babak Mahshidfar
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
- Corresponding author: Babak Mahshidfar, Assistant Professor of Emergency Medicine, Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran. Tel: +98-9122508170, E-mail:
| | - Mani Mofidi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Maryam Fattahi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Davood Farsi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Peyman Hafezi Moghadam
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Saeed Abbasi
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
| | - Mahdi Rezai
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Hazrat Rasoul Akram Complex Emergency Department, Tehran, Iran
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The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial. Urolithiasis 2017; 45:591-595. [DOI: 10.1007/s00240-017-0971-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
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Redmann AJ, Wang Y, Furstein J, Myer CM, de Alarcón A. The use of the FLACC pain scale in pediatric patients undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2017; 92:115-118. [PMID: 28012511 DOI: 10.1016/j.ijporl.2016.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 1) Determine the usage rate of opioid pain medication after adenotonsillectomy (T&A). 2) Review the use of the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale for T&A patients 3) Determine the rate of postoperative physician contacts for pain related complaints. METHODS A retrospective case series review was performed on 125 pediatric patients undergoing T&A and subsequent 23-hour postoperative observation at an academic tertiary care center from June-August of 2015. Postoperative pain scores using the FLACC pain scale, the utilization of opioid pain medications, and the number of postoperative contacts for pain were recorded. RESULTS Average age of patients was 5.7 years and 50% were female. 90% of T&A's were performed for adenotonsillar hypertrophy. The post-tonsillectomy hemorrhage rate was 4%. 70 (56%) patients required postoperative opioid pain medication, with (30) 43% of these patients requiring more than one dose. The mean number of opioid doses was 1.64 ± 0.9 and was not related to age, weight or gender. FLACC scores were highly associated (spearman correlation 0.77) with the amount of opioid medication given. Mean FLACC scores decreased over time after T&A. 20% of patients contacted a physician for unsatisfactory pain control postoperatively with 6% requiring emergency department visits and 14% contacting the office via phone call. CONCLUSIONS A significant portion of pediatric patients undergoing T&A require postoperative opioids for pain control. The FLACC scale is a valuable way of quantifying post-operative T&A pain in pediatric patients. Despite routine pain management postoperatively, a significant proportion of patients require contact with a physician postoperatively for pain management.
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Affiliation(s)
- Andrew J Redmann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States.
| | - Yu Wang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - James Furstein
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Charles M Myer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Alessandro de Alarcón
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, United States; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Khajavi MR, Navardi M, Shariat Moharari R, Pourfakhr P, Khalili N, Etezadi F, Imani F. Combined Ketamine-Tramadol Subcutaneous Wound Infiltration for Multimodal Postoperative Analgesia: A Double-Blinded, Randomized Controlled Trial after Renal Surgery. Anesth Pain Med 2016; 6:e37778. [PMID: 27847695 PMCID: PMC5101596 DOI: 10.5812/aapm.37778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/12/2016] [Accepted: 07/10/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pain is an important consideration after renal surgery. A multimodal approach to postoperative pain management could enhance analgesia by risking fewer side effects after surgery. Objectives The aim of this study was to evaluate the clinical efficacy of the subcutaneous infiltration of ketamine and tramadol at the incision site to reduce postoperative pain. Methods Sixty-four patients between 18 and 80 years old who were scheduled for elective renal surgery were enrolled in a double-blind randomized controlled study. At the end of the surgery, patients were divided into four groups with 16 patients in each group: the saline group, who were treated with 10 mL of saline solution; the K group, who were treated with 1 mg/kg etamine in 10 mL of saline solution; the T group, who were treated with 1 mg/kg tramadol in 10 mL of saline solution; and the K/T group, who were treated with 0.5 mg/kg ketamine with 0.5 mg/kg tramadol in 10 mL of saline solution. In each group, the solution was infiltrated subcutaneously at the incision site. The postoperative pain scores and rescue analgesic consumption of the patients in each group were recorded for 24 hours and compared. The primary goal of the study was to compare the results of patients treated with a combined ketamine and tramadol subcutaneous wound infiltration, patients treated with a tramadol subcutaneous wound infiltration, and patients treated with a ketamine subcutaneous wound infiltration. Results Sixty-four patients were enrolled in the study. Pain intensity and cumulative meperidine consumption were significantly lower in the K/T group (27 mg; 95% confidence interval, 25.2 - 53.2) in comparison with the group that received a saline infusion during the first 24 hours after surgery (P < 0.001). The sedation score of the K, T, and K/T groups were significantly higher than the saline group (P < 0.001). Conclusions The combined subcutaneous infiltration of ketamine and tramadol at the incision site produces better analgesia and an opioid-sparing effect during the first 24 hours when compared with the control group and the groups that received a subcutaneous infiltration of only ketamine or tramadol.
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Affiliation(s)
- Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Navardi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shariat Moharari
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Pourfakhr
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Community and Preventive Medicine Specialist, Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Etezadi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Farsad Imani, Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123088460, Fax: +98-2166348550, E-mail:
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Khajavi MR, Sabouri SM, Shariat Moharari R, Pourfakhr P, Najafi A, Etezadi F, Imani F. Multimodal Analgesia With Ketamine or Tramadol in Combination With Intravenous Paracetamol After Renal Surgery. Nephrourol Mon 2016; 8:e36491. [PMID: 27703954 PMCID: PMC5039960 DOI: 10.5812/numonthly.36491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/09/2016] [Accepted: 05/21/2016] [Indexed: 01/15/2023] Open
Abstract
Background Opioids are generally the preferred analgesic agents during the early postoperative period. Objectives The present study was designed to assess and compare the multimodal analgesic effects of ketamine and tramadol in combination with intravenous acetaminophen after renal surgery. Patients and Methods This randomized, double-blinded, clinical trial was conducted on 80 consecutive patients undergoing various types of kidney surgeries in Sina hospital in Tehran in 2014 - 2016. After extubation, the patients were randomly assigned to receive intravenous paracetamol (1 gr) plus tramadol (0.7 mg/kg) (PT group) or paracetamol (1 gr) plus ketamine (0.5 mg/kg) (PK group) within ten minutes. Pain severity was assessed by the visual analog scale (VAS), and the level of agitation was assessed by the Ramsey sedation scale (RSS). Morphine consumption was assessed within the first six hours after drug injection, and hemodynamic parameters were assessed at 5, 10, and 20 minutes after infusion, at the time of transfer from recovery to the ward, and also at one and six hours after transfer to the ward. Results Postoperative pain scores were significantly lower in the PK group than in the PT group during all study time points. The mean dose of morphine needed at recovery in the PK group was lower compared with the PT group (0.47 ± 0.94 mg versus 1.50 ± 1.35 mg/P = 0.001). The level of agitation based on the RSS score was significantly lower in the PK group than in the PT group at 10 and 20 minutes after drug administration. The total postoperative complication rate in the PK group was lower than in the PT group (20% versus 53.3%, P = 0.007). In this regard, catheter bladder discomfort was more frequent in the PT group than in the PK group (43.3% versus 3.3%, P < 0.001). Conclusions The combination of intravenous paracetamol 1 gr and ketamine 0.5 mg/kg resulted in an overall reduction in pain scores, decreased postoperative analgesic requirements, and lower agitation score compared with intravenous paracetamol 1 gr and tramadol 0.7 mg/kg for patients undergoing renal surgery.
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Affiliation(s)
- Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mehdi Sabouri
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Reza Shariat Moharari
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Pejman Pourfakhr
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Pejman Pourfakhr, Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Hassan Abad Sq., Tehran, IR Iran. Tel: +98-9122008857, Fax: +98-2166348550, E-mail:
| | - Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Farhad Etezadi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Kimiaei Asadi H, Nikooseresht M, Noori L, Behnoud F. The Effect of Administration of Ketamine and Paracetamol Versus Paracetamol Singly on Postoperative Pain, Nausea and Vomiting After Pediatric Adenotonsillectomy. Anesth Pain Med 2016; 6:e31210. [PMID: 27110529 PMCID: PMC4834744 DOI: 10.5812/aapm.31210] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/17/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Tonsillectomy is one of the most common surgeries in children and posttonsillectomy pain and agitation management is a great challenge for anesthesiologists. OBJECTIVES The aim of this study was to compare the efficacy of a single dose of ketamine combined with paracetamol with paracetamol alone in the management of postoperative pain in tonsillectomy. MATERIALS AND METHODS In this study, the subjects were randomly allocated into the two groups: the ketamine and control. Intravenous paracetamol infusion (15 mg/kg) was started 15 minutes before the end of surgery in both groups, continued with the IV injection of ketamine (0.25 mg/kg) in the ketamine group and an equal volume of saline in the control group. Using the children's hospital of eastern Ontario (CHEOPS) pain scale, pain and agitation score and also the incidence of nausea and vomiting after the surgery were recorded in 0.5, 6 and 12 hours after the operation. Data were analyzed using SPSS software version 16 and P value less than 0.05 was considered as statistically significant in all cases. RESULTS There was no significant difference between the two groups considering demographic data (age, sex distribution, weight and height). The CHEOPS pain scales were significantly lower in the ketamine group compared to the control group at 0.5 and 6 hours after the surgery (P = 0.003 and P = 0.023, respectively). There was no significant difference in the CHEOPS scale at 12 hours after the surgery, dose of adjuvant analgesic and the incidence of nausea and vomiting after the surgery between the two groups. CONCLUSIONS According to the results of the current study, postoperative analgesia in children was improved in the ketamine group. Therefore, for better management of posttonsillectomy pain, low-dose ketamine administration with paracetamol is recommended.
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Affiliation(s)
- Hosein Kimiaei Asadi
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahshid Nikooseresht
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding author: Mahshid Nikooseresht, Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran. Tel/Fax: +98-5138414499, E-mail:
| | - Lida Noori
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatholah Behnoud
- Department of Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran
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Shariat Moharari R, Valizade A, Najafi A, Etezadi F, Hosseini SR, Khashayar P, Khajavi MR, Mojtahedzadeh M. Analgesic Efficacy of Nephrostomy Tract inFiltration of Bupivacaine and Ketamine after Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Trial. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:619-26. [PMID: 27642334 PMCID: PMC5018291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recently, the use of ketamine as a systemic and local analgesic drug in reducing post-operative pain is studied more frequently. OBJECTIVES The aim of the present study was to assess the analgesic efficacy of IV ketamine injection inaddition to nephrostomy tract infiltration of ketamine-bupivacaine on postoperative pain relief after tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Patients (n = 100), with renal stone who were candidates for PCNL were randomized to five groups with 20 cases in each: Group C, 10 mL of saline solution was infiltrated into the nephrostomy tract; Group B, 10 mL of 0.25% bupivacaine was infiltrated into the nephrostomy tract; Group BK1, 10 mL of 0.25% bupivacaine plus 0.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group BK2, 10 mL of 0.25% bupivacaine plus 1.5 mg/kg ketamine was infiltrated into the nephrostomy tract; Group K, 10 mL of saline solution containing 0.5 mg/kg ketamine was intravenously administered. Post-operative pain scores were compared between groups as the primary objective. Comparison of Sedation Scores, rescue analgesic consumption, time to the first rescue analgesics administration, hemodynamic and SpO2 values were regarded as the secondary objective. RESULTS Mean VAS scores in the first 30 min and total analgesic consumption in the first 24 h of post-operative period were significantly lower in groups BK1 and BK2 in comparison with the other groups (P < 0.05). Also, time to first rescue analgesics administration was longer in the same groups (P < 0.05). CONCLUSIONS Infiltration of ketamine plus bupivacaine provides superior analgesic effects in PCNL surgery compared with other methods.
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Affiliation(s)
- Reza Shariat Moharari
- Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Valizade
- Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Atabak Najafi
- Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farhad Etezadi
- Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Reza Hosseini
- Associate professor of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Patricia Khashayar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Khajavi
- Anesthesiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. ,
| | - Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res 2015; 8:283-90. [PMID: 25886322 PMCID: PMC4258981 DOI: 10.4103/0259-1162.143110] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Ketamine was introduced commercially in 1970 with the manufacturer's description as a "rapidly acting, nonbarbiturate general anesthetic" and a suggestion that it would be useful for short procedures. With the help of its old unique pharmacological properties and newly found beneficial clinical properties, ketamine has survived the strong winds of time, and it currently has a wide variety of clinical applications. It's newly found neuroprotective, antiinflammatory and antitumor effects, and the finding of the usefulness of low dose ketamine regimens have helped to widen the clinical application profile of ketamine. The present article attempts to review the current useful applications of ketamine in anesthesia, pain and critical care. It is based on scientific evidence gathered from textbooks, journals, and electronic databases.
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Affiliation(s)
- Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Kaushic A Theerth
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Radhika S Deva
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Mahgoobifard M, Mirmesdagh Y, Imani F, Najafi A, Nataj-Majd M. The analgesic efficacy of preoperative oral Ibuprofen and acetaminophen in children undergoing adenotonsillectomy: a randomized clinical trial. Anesth Pain Med 2014; 4:e15049. [PMID: 24660156 PMCID: PMC3961035 DOI: 10.5812/aapm.15049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 01/07/2023] Open
Abstract
Background: Adenotonsillectomy is one of the most common surgical procedures in children. Several complications and morbidities are common after nasal surgeries and the most common is pain. Several techniques have been employed to reduce the severity of postoperative pain. One of the preoperative techniques is pre-emptive analgesia through preventive central hypersensitization. This technique is performed by applying analgesic methods before the onset of nociceptive stimuli, consequently decreasing postoperative analgesics requirements. Objectives: Preoperative oral drug administration for pain analgesia is performed in several methods. The aim of this study was to compare the analgesic effects of preoperatively administration of oral acetaminophen and ibuprofen. Patients and Methods: In a double-blinded, randomized placebo-controlled study, sixty 4-12 years old ASA I or II children scheduled for elective adenotonsillectomy, were assigned to receive either acetaminophen 15 mg/kg, ibuprofen 10 mg/kg or placebo 30 minutes before the operation. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), upon arrival to the post anesthetic care unit (PACU) and ward. Findings were analyzed by SPSS version 17 using variance analysis and Tukey’s test. Results: The average pain intensities were significantly lower in acetaminophen group based on the CHEOPS in both PACU and ward compared to ibuprofen or placebo groups; but there was no difference in pain intensity between the ibuprofen and placebo groups. Pain intensity in PACU in Acetaminophen group was 7.05 ± 0.64 vs. 8.38 ± 1.20 in placebo group and 8.14 ± 0.85 in ibuprofen group, pain intensity in ward in the acetaminophen group was 6.0.87 ± 0.85in the acetaminophen group, vs. 8.04 ± 1.02 in placebo group, and 7.78 ± 0.78 in ibuprofen group. Conclusions: This study showed that administration of oral acetaminophen 30 minutes preoperatively, resulted in significantly lower pain intensity in children undergoing adenotonsillectomy in PACU and ward, compared to ibuprofen and placebo.
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Affiliation(s)
- Maziar Mahgoobifard
- Department of Anesthesiology and Children and Adolescent Health Research Center, Ali-Ebne Abitaleeb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Yalda Mirmesdagh
- Heart Value Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoomeh Nataj-Majd
- Research Development Center of Arash Woman's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Masoomeh Nataj-Majd, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-2177883283, Fax: +98-2177883196, E-mail:
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Jabbari Moghaddam Y, Seyedhejazi M, NaderPour M, Yaghooblua Y, Golzari S. Is fasting duration important in post adenotonsillectomy feeding time? Anesth Pain Med 2014; 4:e10256. [PMID: 24660151 PMCID: PMC3961023 DOI: 10.5812/aapm.10256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/07/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background: Adenotonsillectomy is a common otolaryngology surgery. Nausea and vomiting are the most common complications of this procedure with a prevalence ranging from 49% to 73 %. Objectives: Our aim was to evaluate the effects of short time fasting protocol on decreasing postoperative pain, nausea and vomiting, and initiation of oral feeding after adenotonsillectomy. Patients and Methods: 120 children aged 4 to 14 years candidates for adenotonsillectomy were randomly divided into intervention and control groups (n = 120, 60 in each group). Each patient of the intervention group was given oral dextrose 10% as much volume as he could consume at 3 and 6 hours prior to the operation. All the data including pain severity, nausea and vomiting of the patients, the time of oral feeding initiation etc. were gathered in checklists after the operation. Statistical analyses were then performed using Statistical Package for the Social Sciences (SPSS) software version 16. Descriptive statistical methods and mean difference test for independent groups and chi square test or Fisher exact test, and if regression needed model test were applied. A P value of 0.05 or less was considered statistically significant. Results: The amount of Acetaminophen administered for the intervention group was significantly lower than the control group, and also the time of oral feeding initiation was significantly shorter in the intervention group than the control group (P < 0.005). Pain severity at all occasions following surgery was significantly lower in the intervention group than the control group (P < 0.001). Although frequency of nausea at recovery time was significantly lower in the intervention group than the control group (P < 0.002), there were no significant differences in frequency of nausea between the two groups at other postoperative occasions. Postoperative vomiting frequency was not significant between the two groups at any occasions. Conclusions: The findings of this survey showed that shortening the duration of pre-adenotonsillectomy fasting period and hydration of patients several hours prior to the operation might be effective in decreasing postoperative pain and facilitating postoperative oral feeding initiation. Nevertheless this method does not seem to prevent postoperative nausea and vomiting.
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Affiliation(s)
- Yalda Jabbari Moghaddam
- Department of Otolaryngology, Head and Neck Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahin Seyedhejazi
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding author: Mahin Seyedhejazi, Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran. Tel.: +98-9141150981, Fax: +98-4115262280, E-mail:
| | - Mosoud NaderPour
- Department of Otolaryngology, Head and Neck Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yoosef Yaghooblua
- Department of Otolaryngology, Head and Neck Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Golzari
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
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Dahi-Taleghani M, Fazli B, Ghasemi M, Vosoughian M, Dabbagh A. Effect of intravenous patient controlled ketamine analgesiaon postoperative pain in opium abusers. Anesth Pain Med 2014; 4:e14129. [PMID: 24701419 PMCID: PMC3961031 DOI: 10.5812/aapm.14129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/22/2013] [Accepted: 12/01/2013] [Indexed: 12/29/2022] Open
Abstract
Background: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers. Objectives: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers. Patients and Methods: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant. Results: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group Conclusions: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.
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Affiliation(s)
- Mastane Dahi-Taleghani
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Benjamin Fazli
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Ghasemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vosoughian
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Dabbagh
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Ali Dabbagh, Anesthesiology Research Center, ShahidBeheshti University of Medical Sciences, Tehran, Iran. Tel: +98-989121972368, Fax: +98-982122432572, E-mail: ,
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Haddadi S, Marzban S, Karami MS, Heidarzadeh A, Parvizi A, Naderi Nabi B. Comparing the duration of the analgesic effects of intravenous and rectal acetaminophen following tonsillectomy in children. Anesth Pain Med 2014; 4:e13175. [PMID: 24660154 PMCID: PMC3961018 DOI: 10.5812/aapm.13175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/28/2013] [Accepted: 09/30/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Postoperative pain control (especially, after adenotonsillectomy) has a very important effect on recovery time, hospitalization duration, hemodynamic disorders, bleeding, nausea, vomiting and medical costs. OBJECTIVES The aim of this study was to investigate and compare the effects of intravenous and rectal acetaminophen on controlling post-adenotonsillectomy pain in children, and duration of their analgesic effects. PATIENTS AND METHODS In this randomized double-blinded clinical trial, 96 children aged 4 - 10 years old with ASA physical status I or II who were candidates for adenotonsillectomy surgery in Amir-al-Momenin Hospital, Rasht, Iran were entered into the study and randomly divided into two equal groups. Anesthesia in both groups was induced injecting fentanyl-thiopental and at racurium; afterwards is of lurane was used to maintain anesthesia. After anesthesia induction, one group received intravenous and the other one, rectal acetaminophen, and were later compared based on CHIPPS criteria. RESULTS Data analysis indicated a significant relationship between reduction of postoperative pain and the use of intravenous or rectal acetaminophen (P = 0.0001); in group receiving IV acetaminophen, only 10.4% of patients had no pain whereas in group receiving rectal acetaminophen, this number reached 43.8%. Also, on 4 and 6 hour time intervals, pain in rectal acetaminophen receiving group was less than that in IV acetaminophen receiving group (P < 0.05). Demand for additional analgesic medication in rectal acetaminophen receiving group was less than that in IV group (P = 0.0001). CONCLUSIONS Post-operative pain in rectal acetaminophen group was less than that in intravenous acetaminophen group, and rectal acetaminophen group demanded their first additional analgesic medication later.
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Affiliation(s)
- Soudabeh Haddadi
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shideh Marzban
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Abtin Heidarzadeh
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Parvizi
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahram Naderi Nabi
- Anesthesia Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Entezary SR, Farshadpour S, Alebouyeh MR, Imani F, Emami Meybodi MK, Yaribeygi H. Effects of preoperative use of oral dextromethorphan on postoperative need for analgesics in patients with knee arthroscopy. Anesth Pain Med 2013; 4:e11187. [PMID: 24660143 PMCID: PMC3961019 DOI: 10.5812/aapm.11187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/25/2013] [Accepted: 07/04/2013] [Indexed: 12/12/2022] Open
Abstract
Background Studies have shown that N-methyl-D-aspartate receptor (NMIDA) plays an essential role in postoperative pain. It seems that use of NMDA receptor antagonists such as Dextromethorphan intensifies the analgesic effects of opioids. Objectives In this study, we evaluated the effect of preoperative administration of Dextromethorphan on postoperative pain reduction. Patients and Methods This double blind randomized clinical trial was conducted on arthroscopic surgery candidates. Participants were randomly allocated to interventions and assigned to two groups of Dextromethorphan and placebo. In Dextromethorphan group, the patients received 1 mg/kg Dextromethorphan orally the night before the operation. Pain severity based on the visual analog scale (VAS) up to 16 hours postoperation, use of opioids, and the first request for analgesics were recorded postoperatively. Results A total of 112 patients in the Dextromethorphan (n = 54) and placebo groups (n = 58) were evaluated. No significant difference was detected between the two groups for age, sex or ASA. The mean amount of opioid consumption was significantly lower in patients who received Dextromethorphan (10.7 ± 5.6 mg) compared to the placebo group (13.1 ± 5.6 mg), (P = 0.03). The mean time until the first opioid request in patients who received Dextromethorphan was longer than that in the placebo group (P = 0.01). Conclusions The study results demonstrated that preemptive use of Dextromethorphan reduced postoperative pain and opioid consumption.
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Affiliation(s)
- Saeid Reza Entezary
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Farshadpour
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Saeedeh Farshadpour, Department of Anesthesiology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-9131511461, E-mail:
| | - Mahmood Reza Alebouyeh
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Habibollah Yaribeygi
- Department of Physiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
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28
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Imani F, Faiz HR, Sedaghat M, Hajiashrafi M. Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery. Anesth Pain Med 2013; 4:e12162. [PMID: 24660145 PMCID: PMC3961015 DOI: 10.5812/aapm.12162] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Postoperative pain is one of the most important complications encountered after surgery. A number of options are available for treating pain following surgery. One of those options is the use of intravenous patient-controlled analgesia (PCA). Ketamine is an anesthetic drug relieving pain with its NMDA receptor antagonistic effect. OBJECTIVES This study is aiming at better pain management after abdominal surgery; the effects of adding ketamine to intravenous fentanyl plus acetaminophen PCA were evaluated. PATIENTS AND METHODS In a double-blind randomized clinical trial 100 patients, ASA I or II, 20 - 60 years old were divided into two groups. These patients were abdominal surgery candidates. In order to control postoperative pain in the control group an IV patient-control analgesia (PCA) containing fentanyl 10 μg/mL plus acetaminophen 10 mg/mL was instructed to be used for the patients, but the patients in ketamine group received ketamine 0.5 mg/mL plus control group PCA content. During the first 48 hours after surgery, ketamine patients were evaluated every 8 hours (at rest, while moving and coughing) to determine their pain scores using VAS scale, sedation score, additional analgesics, nausea and vomiting. RESULTS There were no significant demographic differences between two groups. Pain scores (at rest, while moving and coughing) during the first 48 hours were not significantly different between two groups (P values = 0.361, 0.367 and 0.204, respectively). Nausea scores were significantly lower in the ketamine group (P = 0.026). CONCLUSIONS The addition of ketamine to intravenous fentanyl plus acetaminophen PCA had not extra effects in relieving post abdominal surgery pain.
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Affiliation(s)
- Farnad Imani
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical sciences, Tehran, Iran
| | - Hamid Reza Faiz
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical sciences, Tehran, Iran
| | - Minow Sedaghat
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical sciences, Tehran, Iran
- Corresponding author: Minow Sedaghat, Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical sciences, Tehran, Iran. Tel: +98-5116095864, Fax: +98-2166509059, E-mail:
| | - Maryam Hajiashrafi
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical sciences, Tehran, Iran
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Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Shariat Moharari R. Conscious Sedation and Analgesia in Colonoscopy: Ketamine/Propofol Combination has Superior Patient Satisfaction Versus Fentanyl/Propofol. Anesth Pain Med 2013; 3:208-13. [PMID: 24223364 PMCID: PMC3821150 DOI: 10.5812/aapm.9653] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/01/2013] [Accepted: 02/10/2013] [Indexed: 01/08/2023] Open
Abstract
Background Colonoscopy is performed without preparing sedation in many countries. However,
according to the current literature patients are more satisfied when appropriate
sedation is prepared for them. Objectives We hypothesize that propofol-ketamine may prepare more patient satisfaction compared to
propofol-fentanyl combination. Patients and Methods Sixty adult patients older than 18 with ASA physical status of I, II or III were
enrolled in the present study after providing the informed consent. They were
prospectively randomized into two equal groups: 1- Group PF: was scheduled to receive IV
bolus dose of fentanyl 1µg/kg and propofol 0.5mg/kg. 2- Group PK: was scheduled to
receive IV bolus dose of ketamine 0.5mg/kg and propofol 0.5mg/kg. As a primary goal,
patient’s satisfaction was assessed by the use a Likert five-item scoring system
in the recovery. Comparisons of hemodynamic parameters (mean heart rate, mean systolic
blood pressure, mean diastolic blood pressure), mean Spo2 values during the procedure
and side effects such as nausea, vomiting, and psychological reactions during the
recovery period were our secondary goals. Level of sedation during the colonoscopy was
assessed with the Observer’s Assessment of Alertness/Sedation score (OAA/S). Results Mean satisfaction scores in the group PK were significantly higher than the group PF (P
= 0.005) while the level of sedation during the procedure was similar (P = 0.17).
Hemodynamic parameters and SpO2 values were not significantly different (P > 0.05).
Incidence of nausea and vomiting was the same in both groups. Conclusions IV bolus injection of propofol-ketamine can lead to more patients’ satisfaction
than the other protocols during colonoscopy.
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Affiliation(s)
- Mohammadreza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran
University of Medical Sciences, Tehran, Iran
| | - Azra Emami
- Department of Anesthesiology, Sina Hospital, Tehran
University of Medical Sciences, Tehran, Iran
| | - Farhad Etezadi
- Department of Anesthesiology, Sina Hospital, Tehran
University of Medical Sciences, Tehran, Iran
- Corresponding author: Farhad Etezadi, Department of
Anesthesiology, Sina Hospital, Hassan Abad Sq., Tehran University of Medical Sciences,
Tehran, Iran. Tel: +98-2122048483, Fax: +98-2166348553, E-mail:
| | - Saeid Safari
- Department of Anesthesiology, Rasoul Akram Medical center,
Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Sharifi
- Department of Gastroenterology, Sina Hospital, Tehran
University of Medical Sciences, Tehran, Iran
| | - Reza Shariat Moharari
- Department of Anesthesiology, Sina Hospital, Tehran
University of Medical Sciences, Tehran, Iran
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Gousheh SM, Nesioonpour S, Javaher foroosh F, Akhondzadeh R, Sahafi SA, Alizadeh Z. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesth Pain Med 2013; 3:214-8. [PMID: 24223365 PMCID: PMC3821153 DOI: 10.5812/aapm.9880] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 02/13/2013] [Accepted: 02/27/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively. OBJECTIVES We evaluated the effect of intravenous Paracetamol on postoperative pain in patients undergoing laparoscopic cholecystectomy. PATIENTS AND METHODS This is a randomized double- blind clinical trial study. 30 patients ASA class I, aged 18 to 50 years, candidate for laparoscopic cholecystectomy were recruited, and randomly divided into two equal groups. Group A (paracetamol group) received 1 gr paracetamol and group B received placebo ten minutes after the induction of anesthesia. 0.1 mg/Kg Morphine was administered intravenously based on patients compliant and pain score >3. Pain score and the opioids consumption were recorded in the first six hours postoperative. Patient's pain was measured by the VAS (Visual Analog Scale). RESULTS The pain score was lower in group A (P= 0.01), but the morphine consumption showed no significant difference between the groups (P= 0.24) during the first 6 hours postoperatively. CONCLUSIONS Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone.
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Affiliation(s)
| | - Sholeh Nesioonpour
- Department of Anesthesiology, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran
| | | | - Reza Akhondzadeh
- Department of Anesthesiology, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran
| | - Sayed Ali Sahafi
- Department of Anesthesiology, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran
| | - Zeinab Alizadeh
- Department of Anesthesiology, Ahvaz Jundishapur University
of Medical Sciences, Ahvaz, Iran
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Boroumand P, Zamani MM, Saeedi M, Rouhbakhshfar O, Hosseini Motlagh SR, Aarabi Moghaddam F. Post tonsillectomy pain: can honey reduce the analgesic requirements? Anesth Pain Med 2013; 3:198-202. [PMID: 24223362 PMCID: PMC3821146 DOI: 10.5812/aapm.9246] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/21/2013] [Accepted: 02/24/2013] [Indexed: 01/22/2023] Open
Abstract
Background Tonsillectomy with or without adenoidectomy is one of the most common surgical
procedures performed worldwide, especially for children. Oral honey administration
following tonsillectomy in pediatric cases may reduce the need for analgesics via
relieving postoperative pain. Objectives The aim of this study was to evaluate the effects of honey on the incidence and
severity of postoperative pain in patients undergoing tonsillectomy. Patients and Methods A randomized, double blind, placebo controlled study was performed. One hundred and
four patients, who were older than eight, and were scheduled for tonsillectomy, were
divided into two equal groups, honey and placebo. Standardized general anesthesia, and
postoperative usual analgesic, and antibiotic regimen were administrated for all
patients. Acetaminophen plus honey for the honey group, and acetaminophen plus placebo
for the placebo group were given daily. They began to receive honey or placebo when the
patients established oral intake. Results The difference between acetaminophen and acetaminophen plus honey groups was
statistically significant both for visual analogue scale (VAS), and number of
painkillers taken within the first three postoperative days. The consumption of
painkillers differed significantly in every five postoperative days. No significant
difference was found between groups regarding the number of awaking at night. Conclusions Postoperative honey administration reduces postoperative pain and analgesic
requirements in patients after tonsillectomy. As the side effects of honey appear to be
negligible, consideration of its routine usage seems to be beneficial along with routine
analgesics.
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Affiliation(s)
- Peyman Boroumand
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | - Mohammad Mahdi Zamani
- Department of Anesthesiology, Firoozgar Hospital, Iran
University of Medical Sciences (IUMS), Tehran, Iran
| | - Masoumeh Saeedi
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | - Omid Rouhbakhshfar
- Department of Otolaryngology, Zahedan University of Medical
Science, Zahedan, Iran
| | | | - Fatemeh Aarabi Moghaddam
- Students’ Scientific Research Center, School of
Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Fatemeh Aarabi Moghaddam,
Students’ Scientific Research Center, School of Medicine, Tehran University of
Medical Sciences, 3rd floor, Poorsina St., Tehran, Iran. Tel/Fax: +98-2166418588, E-mail:
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