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Nalbuphine added to intrathecal morphine in total knee arthroplasty; effect on postoperative analgesic requirements and morphine related side effects
MA Moustafa, RS Saleh
Alexandria Journal of Medicine , 2012,
Abstract: Introduction: Intrathecal morphine is widely used for postoperative pain control in major orthopaedic surgery. However, its use is associated with frequent side effects. Aim of the work: Aim of the work was to investigate the effects of intrathecal coadministration of nalbuphine with intrathecal morphine on morphine related side effects and postoperative analgesic requirements. Methods: In this study, the intrathecal addition of 1 mg nalbuphine hydrochloride to a combination of 3 ml hyperbaric bupivacaine 0.5% and 0.2 mg morphine sulfate was tried in patients undergoing total knee arthroplasty. Results: Patients who received intrathecal nalbuphine suffered significantly less than the control group from vomiting and pruritus meanwhile there was no effect on the postoperative analgesic requirements or the incidence of urinary retention. Intrathecal addition of nalbuphine to morphine decreased the opioid related side effects without affection of post operative analgesia Conclusions: The addition of nalbuphine to morphine intrathecally decreases the opioid related side effects without affection of postoperative analgesia. This combination can improve postoperative pain management in patients undergoing knee surgery under spinal anaesthesia.
Postoperative pain scores and analgesic requirements after thyroid surgery: Comparison of three intraoperative opioid regimens  [cached]
Motamed C.,Merle J.C.,Yakhou L.,Combes X.
International Journal of Medical Sciences , 2006,
Abstract: Purpose: This study was designed to compare the effect on postoperative pain, opioid consumption and the length of stay in postoperative care unit (PACU) after three different intraoperative analgesic regimens in thyroid surgery. Methods: Seventy five patients were enrolled into the study and assigned to one of three groups, fentanyl, sufentanil or remifentanil (n=25 for each group). Before the end of surgery, paracetamol 1 gr and nefopam 20 mg was also administered in all patients. Pain scores, opioid demand and the length of stay in PACU were assessed in a blind manner. Results: Post operative pain scores were significantly lower in the fentanyl and sufentanil groups compared to remifentanil group (55 ± 15, and 60 ± 10 versus 78± 12, P < 0.05). Patients in the remifentanil group stayed longer in the PACU 108± 37 min versus 78±31 and 73 ± 25 min, (P< 0.05). Conclusion: After remifentanil based analgesia, anticipation of postoperative pain with opioid analgesic appears mandatory even for surgery rated as being moderately painful, otherwise longer opioid titration due to higher pain scores might delay discharge time.
Comparison of postoperative analgesic efficacy and safety of parecoxib and ketorolac in patients of inguinal hernia  [cached]
Ajit M. Zende,Rama R. Bhosale
International Journal of Basic & Clinical Pharmacology , 2013, DOI: 10.5455/2319-2003.ijbcp20130814
Abstract: Background: The present study was conducted to compare postoperative analgesic efficacy and safety profile of intravenous parecoxib with intravenous ketorolac in patients operated for inguinal hernia. Methods: It was six months, prospective, randomized parallel group, open label study in patients operated for inguinal hernia. Each patient was randomly assigned the analgesic drug treatment and was grouped as control group (ketorolac treated) and study group (parecoxib treated). Results: The present study has shown that parecoxib has similar analgesic efficacy as that of ketorolac, with parecoxib having significant longer duration of analgesic action. Parecoxib sodium was well tolerated in all patients and most of patients rated parecoxib as well as ketorolac as either good or excellent. Conclusions: The study demonstrated that parecoxib compares favorably with ketorolac and parecoxib can be recommended as a useful component of postoperative pain control in hernia surgery. [Int J Basic Clin Pharmacol 2013; 2(4.000): 414-420]
Assessment of ropivacaine postoperative analgesic effect after periapical maxillary incisors surgery  [PDF]
Tijani? Milo?,Buri? Nikola,Jovanovi? Goran,Stojanovi? Simona
Vojnosanitetski Pregled , 2012, DOI: 10.2298/vsp1205405t
Abstract: Background/Aim. Ropivacaine is a relatively new longacting local anesthetic. The aim of this study was to compare the postoperative analgesic effect of topical anesthetics ropivacaine 0.75% and lidocaine 2% with adrenaline in the postoperative treatment of periapical lesions in the maxilla. Methods. The study was conducted on 60 subjects, divided into two groups. The study-group received 0.75% ropivacaine without a vasoconstrictor, while the control group was treated with 2% lidocaine with adrenaline (1 : 80.000). Block anesthesia for n. infraorbitalis was used and local anesthetics were applied also on the palatine side for the end branches of n. nasopalatinus. The following parameters were observed: time elapsed from the application of an anesthetic until the first occurrence of pain after the surgery and first intake of an analgesic, the intensity of initial pain, pain intensity 6 h after the application of anesthetics and the total number of analgesics taken within 24 h after the completion of surgery. Results. The pain appeared statistically significantly earlier in the patients who had been given lidocaine with adrenaline (p < 0.001), while statistically significantly higher mean values of initial postoperative pain (p < 0.05) and pain intensity 6 h after the intervention (p < 0.01) were also registered in the same group of patients. In the period of 24 h upon the intervention, the study-group patients were taking less analgesics as compared to the control-group subjects (46.6% vs 73.3%), who were given analgesics earlier, although no statistically significant differences were observed related to the number of analgesic doses taken. Conclusion. The results of our study indicate a better postoperative analgesic effect of ropivacaine as compared to lidocaine with adrenaline.
Cost-effectiveness analysis of the analgesic therapy of postoperative pain
Secoli, Silvia Regina;Padilha, Kátia Grillo;Litvoc, Júlio;
Revista Latino-Americana de Enfermagem , 2008, DOI: 10.1590/S0104-11692008000100007
Abstract: the study aimed to compare cost-effectiveness of analgesic schemes administered to 89 patients submitted to hemorrhoidectomy, on the 1st postoperative day. the descriptive and retrospective study was carried out in a general hospital, sao paulo, brazil. in order to carry out the cost-effectiveness analysis, the five most frequently used analgesic schemes were identified in practice. the main outcome was the absence of breakthrough pain episodes. while calculating the costs, analgesics and all devices related to the schemes were taken into consideration. codeine 120mg+acetaminophen 2000mg was the most effective therapy with the lowest cost per patient with no breakthrough pain episodes ($65.23). incremental analysis indicated that codeine 120mg+acetaminophen 2000mg+ketoprofen 200mg involved the additional cost of $238.31 in case an extra effectiveness benefit was needed. the analysis showed that the most suitable choice of analgesic therapy should consider the resources available at the institution along with economic and clinical aspects.
Postoperative Analgesic Effects of Carprofen Following Osteotomy and Laparotomy in Dogs
Muharrem Erol,Celal Izci
Journal of Animal and Veterinary Advances , 2012, DOI: 10.3923/javaa.2011.922.927
Abstract: This study investigated the effects of postoperative pain following soft and hard tissue operations in dogs on Adrenocorticotrophic Hormone (ACTH) levels, dopamine levels, haemocoel values and blood gases. It also evaluated the results of the applied treatments. The study was carried out in 4 groups each comprising 6 dogs. Dogs in the 1st and 3rd groups underwent laparotomy and those in the 2nd and 4th groups underwent osteotomy. Carprofen (4.4 mg kg-1) (Rimadyl, Pfizer) was administered subcutaneously as an analgesic to the dogs in the 1st and 2nd groups following the operation. Venous blood samples were collected from the animals before the operation and in the subsequent hours to determine the ACTH and dopamine levels. In the postoperative period, ACTH and dopamine levels were significantly higher in the groups that underwent osteotomy than in the groups that underwent laparotomy (p<0.05). Statistically significant decreases were observed in the groups that received analgesia after the 2nd h (p<0.05). In this study, effective postoperative analgesia is required after both soft and hard tissue operations. Furthermore, effective and rapid implementation of the process is important for postoperative animal welfare and rapid return to normal physiological functions.
Assessment of metoclopramid's postoperative analgesic efficiency during elective gynecologic operations  [PDF]
?brahim ?zgür ?nsel,Ziya Saliho?lu
Medical Journal of Bakirk?y , 2008,
Abstract: Objective: Opioids are the most preferred agents in pain control. Their use may cause some dose dependent undesired effects. The administration of other anesthetic agents in combination with opioids may reduce the requirement for opioids. Our purpose is to evaluate the analgesic efficiency of metoclopramid administered in combination with pethidine. Material and Methods: In this double-blind study, the following random groups were formed with a total of 100 subjects. Control Group: no metoclopramid administered (n=25), Group M 0.25: 0.25 mg/kg metoclopramid administered at the end of the surgery (n=25), Group M 0.5: 0.5 mg/kg metoclopramid administered at the end of the surgery (n=25), Group M 0.5 extubation: 0.5 mg/kg metoclopramid administered after extubation (n=25). Results: We identified that the metoclopramid administered in elective gynecologic operations does not have any effect on the numeric rating scale values within the first 30 minutes following the extubation. Nevertheless, we observed that if a 0.5 mg/kg dose is administered immediately after the extubation, there is a significant decrease in the pethidine use within the first 24 hours after the 3rd hour. Conclusion: Consequently, we can conclude that metoclopramid administered in elective gynecologic operations has a postoperative analgesic efficiency.
Analgesic Effect of Harpagophytum procumbens on Postoperative and Neuropathic Pain in Rats  [PDF]
Dong Wook Lim,Jae Goo Kim,Daeseok Han,Yun Tai Kim
Molecules , 2014, DOI: 10.3390/molecules19011060
Abstract: Harpagophytum procumbens, also known as Devil’s Claw, has historically been used to treat a wide range of conditions, including pain and arthritis. The study was designed to investigate whether H. procumbens extracts exhibit analgesic effects in plantar incision and spared nerve injury (SNI) rats. The whole procedure was performed on male SD rats. To evaluate pain-related behavior, we performed the mechanical withdrawal threshold (MWT) test measured by von Frey filaments. Pain-related behavior was also determined through analysis of ultrasonic vocalization (USVs). The results of experiments showed MWT values of the group that was treated with 300 mg/kg H. procumbens extract increased significantly; on the contrary, the number of 22–27 kHz USVs of the treated group was reduced at 6 h and 24 h after plantar incision operation. After 21 days of continuous treatment with H . procumbens extracts at 300 mg/kg, the treated group showed significantly alleviated SNI-induced hypersensitivity responses by MWT, compared with the control group. These results suggest that H. procumbens extracts have potential analgesic effects in the case of acute postoperative pain and chronic neuropathic pain in rats.
The analgesic effect of Magnesium Sulfate in postoperative pain of inguinal hernia repair
Mehraein A,Azad M A,Sadeghi M
Tehran University Medical Journal , 2007,
Abstract: Background: Magnesium Sulfate (MgSO4) has been used as a pharmacologic agent in different situations for many years in the treatment of tachyarrhythmias, myocardial ischemia, preeclampsia, and tocolysis among others. The analgesic effect of MgSO4 for postoperative pain has been used since the 1990s. Postoperative pain is one of the most common complications in the perioperative period and can result in serious consequences in different organs if left untreated. Inguinal herniorrhaphy is among the most common surgeries and is almost always accompanied by severe pain. The object of this study is to determine the effect of a pre-induction infusion of MgSO4 on the reduction of postsurgical pain after herniorrhaphy. Methods: This double-blind, randomized clinical trial included 105 ASA class I and class II herniorrhaphy patients at Shariati Hospital in years 2004 and 2005. For statistical analysis, the 2 and T tests were used. The patients were divided into three groups based on block randomization. Patients in the following groups received: Group A, 200 ml of normal saline infusion (placebo); Group B, 25 mg/kg MgSO4 in 200 ml of normal saline; Group C, 50 mg/kg MgSO4 in 200 ml of normal saline. All groups were infused twenty minutes before induction of anesthesia using identical methods and dosage in all three groups. Heart rate and mean arterial pressure (MAP) at pre- and postintubation and so at skin incision time were charted. Visual analog scale (VAS) pain score, nausea, vomiting and the amount of morphine used before recovery room discharge and in six, twelve and twenty-four hours after recovery discharge was recorded. Results: The average age for the different groups was as follows: Group A: 33.6, Group B: 37.37, Group C: 32.74. Nausea and vomiting between the case and control groups were not statistically different (60% vs. 71.4%, p=0.0499), nor was the amount of Morphine used. On recovery room discharge, the VAS scores were 8.1, 7.2, and 5.5 for the first, second and third groups, respectively (P<0.001). However, no statistical significance was found for the VAS scores six hours after recovery room discharge. Conclusion: The results in this study show that pre-induction with MgSO4 has no remarkable effect on decreasing postoperative pain or morphine use for inguinal herniorrhaphy.
Comparative study of intrathecal pethidine versus lignocaine as an anaesthetic and a postoperative analgesic for perianal surgery.  [cached]
Chaudhari L,Kane D,Shivkumar B,Kamath S
Journal of Postgraduate Medicine , 1996,
Abstract: 100 patients with ASA risk I & II and undergoing perianal surgery were studied for anaesthetic effects and postoperative analgesia following either intrathecal pethidine or lignocaine. Saddle block was performed either with intrathecal pethidine 5% (50 mg/ml) 0.5 mg/kg or 1 ml of 5% lignocaine. Sensory and motor block postoperative analgesia, need for additional analgesia were studied. The onset of sensory and motor blockade with lignocaine was faster than pethidine. However the sensory and motor blockade lasted longer with pethidine. The duration of postoperative analgesia was 15.39 +/- 5.14 hours as against duration of postoperative analgesia with lignocaine which was 1.3 +/- 0.53 hours. Only 10% of patients in the pethidine group required intramuscular analgesic supplementation whereas 30% of patients in the lignocaine group required intramuscular analgesic supplementation.
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