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Postoperative Analgesia Following Caesarean Section: Intravenous Patient Controlled Analgesia Versus Conventional Continuous Infusion  [PDF]
Samina Ismail, Gauhar Afshan, Abdul Monem, Aliya Ahmed
Open Journal of Anesthesiology (OJAnes) , 2012, DOI: 10.4236/ojanes.2012.24028
Abstract: Background: Management of postoperative pain after caesarean section (C/S) requires a balance between pain relief and undesirable side effects of drugs and technique. In order to improve postoperative pain management after caesarean section, we compared intravenous patient controlled analgesia (IV-PCA) with our current hospital practice, which is continuous opioid infusion. Method: We enrolled one hundred and twenty patients in our prospective randomized trial after an uneventful elective caesarean section under spinal anaesthesia. All patients received 0.5 mg/kg bolus of pethidine on first complaint of pain or at 120 minutes after institution of spinal anaesthesia. Depending upon the randomization, Group P received IV-PCA with 0.15 mg/kg bolus pethidine with 10-minute lockout and Group C received continuous pethidine infusion at a rate of 0.15 mg/kg/hr. Statistical analysis: For qualitative variables means and standard deviations were computed and analyzed by T-test, Mann Whitney U test and repeated measures ANOVA. Frequency and percentages were computed for qualitative data and analyzed by Chi-Square and Fischer exact test. A p-value of less than 0.05 was treated as significant. Results: The numeric rating score for pain, need for rescue analgesia and incidence of nausea and vomiting was significantly lower (p-value < 0.001) in IV-PCA group as compared to continuous infusion group at 6, 12 and 24 hours postoperatively, 98% of the patients were satisfied with pain management in Group P as compared to 70% (p < 0.001) in Group C. Conclusion: Our results showed improved pain control, less need for rescue analgesia for breakthrough pain, lower incidence of nausea and vomiting and greater patient satisfaction with IV-PCA. In the absence of preservative free narcotics for intrathecal use, postoperative pain management can be significantly improved by using IV-PCA instead of continuous opioid infusion in patients undergoing caesarean section.
Comparison of patient-controlled analgesia and continuous infusion with intravenous tramadol in post-thoracotomy analgesia  [PDF]
G?nül Sa??ro?lu,Burhan Meydan,?lker ?skender,Mustafa Küpeli
Dicle Medical Journal , 2011,
Abstract: Objectives: We aimed to compare the consumption, and analgesic and adverse effects of tramadol that given via continuous intravenous infusion and intravenous patient-controlled analgesia.Materials and methods: Forty patients who planned for elective thoracotomy were included in this study. Group I patients received 100 mg loading dose, 5 mg hour-1 basal infusion, 20 mg bolus dose, 5 minutes locked out time, 4 hours limit of 300 mg tramadol. Group II patients received 100 mg loading dose followed by continuous infusion of 12 mg hour-1. Visual Analogue Scale (VAS) scores and sedation scores were determined at postoperative 0, 4, 16, 24th hours. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, respiratory rate, heart rate, peripheral O2 saturation scores were recorded at postoperative 0,1,2,4,8,16,24th hours. After 24 hours complications and amount of used tramadol were recorded.Results: A significant decrease was observed in VAS scores starting from the fourth hour compared to all other times in both groups (p<0.001). When the beginning time and the other times in groups was compared, there was a statistically significant decreasing observed in sedation scores starting from the 4th hour to all other times (p<0.001). Total tramadol consumption in group I (374.2±132.5 mg) was found to be significantly higher compared with group II (292.4±80.1 mg) (p<0.05). Hypotension was observed in four patients in group I and this difference was statistically significant (p<0.05).Conclusion: We concluded that tramadol given both intravenous methods was effective for analgesia after postthoracotomy pain.
Evidence in orthopaedics: comparison of intra-articular lidocaine vs. intravenous analgesia and sedation for reduction of acute shoulder dislocation
E. Ceccarelli,R. Bondì,S. Campi
Journal of Orthopaedics and Traumatology , 2004, DOI: 10.1007/s10195-0071-4
Abstract: Acute shoulder dislocation is the most common joint dislocation managed in emergency department. It has been commonly treated with closed reduction and the use of intravenous analgesia and sedation (IVAS). Recently, intra-articular lidocaine (IAL) has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. A careful literature analysis was performed to establish which anesthetic method is best indicated to reach a reduction that is easily performed, effective, relatively painless and safe, and to allow for expeditious discharge of the patient. To find the best evidence on the topic, we searched in the Cochrane Library, Health Technology Assessment (HTA) database, TRIP, Medline, CINAHL, and EMBASE. In the four prospective randomized clinical trials found, no statistically significant difference was detected between IAL and IVAS for reduction of acute anterior shoulder dislocations with regard to pain score, difficulty of reduction, and success rate. Although we cannot definitively state which is the best anesthetic method, we conclude that intra-articular injection of lidocaine is an excellent alternative for those patients for whom IVAS is not indicated.
The effects of intravenous aminoacid infusion on myocardial functions and postoperative analgesia during abdominal aortic surgery  [PDF]
Mustafa Turhan,Ay?e Baysal,Mevlüt Do?ukan,Hüseyin Toman
Dicle Medical Journal , 2013,
Abstract: Objective: Effects of intravenous aminoacid infusion onmyocardial functions and postoperative analgesia in abdominalaortic surgery were investigated.Materials and methods: Forty patients were randomlydivided into groups of general anaesthesia with or withoutaminoacid infusion (Group 1 and 2, n=10), combinedgeneral+epidural with or without amino acid infusion (Group3 and 4, n=10). Cardiac risk was evaluated using 2007 AHA/ACC and modified Goldman classifications. Intravenousaminoacid solution of 80 g/L was infused at 2.5 ml/kg/h for atotal of 8 hours. General anaesthesia included intravenousremifentanil, rocuronium, sevoflurane. The lumbar epiduralinclude; 10 mL of 0.25% bupivacaine; bolus dose, an infusionof 0.25% bupivacaine; 4 ml/h for 24 hours. Heart rate,arterial blood pressures were collected intraoperative every10 minute, 1, 24 hour postoperatively. Plasma creatinekinase MB fraction, troponin levels, pain assessment withnumeric analog scale were collected preoperatively, 1, 24hour postoperatively. Postoperative 24 hour analgesic usage,complications were recorded.Results: Patients with mild and severe cardiac risk werehigher in 2007 AHA/ACC classification (26/40, 65%) thanmodified Goldman risk classification (5/40, 12.5%) (p=0.04).In comparison between groups, myocardial enzyme levelsand complications showed no difference (p>0.05). The useof analgesics were lower in group 3 and 4 in comparison togroup 1 and 2 (p=0.002).Conclusion: During abdominal aortic surgery, intravenousinfusion of amino acid did not show significant changes onintraoperative and postoperative hemodynamic parametersand myocardial enzymes. The patients received combinedgeneral plus epidural anaesthesia showed more successfulpostoperative analgesia.Key words: Amino acid, abdominal aorta, vascular surgery,epidural anesthesia, general anesthesia, keratin kinase,troponin, postoperative analgesia
Evaluation of the Effectiveness of Lidocaine Infusion in Reduction of Postoperative Pain
F Heshmati,H Noroozinia,R Abbasivash,AR Mahoori
Journal of Shahid Sadoughi University of Medical Sciences , 2006,
Abstract: Introduction: Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control. Methods: In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% (1.5mg/kg followed by 1.5 mg/ kg /h infusion) was started 30 minutes before operation, and continued 1hour after operation. In control group, normal saline (placebo) was used. After 24hours, pain of patients and systemic analgesic consumption was assessed and analyzed. Results: Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24hours after operation. Conclusion: Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA (Patient Controlled Analgesia) and measurement of blood levels of lidocaine were limitations of this study.
Intravenous Lidocaine for Perioperative Use  [PDF]
Marasini Bidur, Xiaodong Qiu, Limbu Sujata
Open Journal of Anesthesiology (OJAnes) , 2019, DOI: 10.4236/ojanes.2019.94007
Abstract: Introduction and Background: Lidocaine was recognised only as a local anesthetic and anti-arrhythmic drug for past decades. Nonetheless, more recently its utility in perioperative setting is being appreciated globally. This review aims to analyse its work beyond its traditional use when employed intravenously in perioperative setting and overall impact on postoperative period. Content: A total of 41 articles were selected for study while 13 of them were chosen for data presentation. Databases such as CENTRAL, MEDLINE/Pubmed, LILACS, Ovid and Scielo were used to search the articles using keywords like Intravenous lidocaine, local anesthetics, perioperative analgesia or postoperative pain. A bolus dose of 1.5 mg/kg and maintenance dose of 2 - 3 mg/kg/h of intravenous lidocaine was used to bring out its analgesic effect and its positive impact on postoperative stage in nearly all the selected studies. Its anti-inflammatory, antinociceptive and immunomodulatory effects were also addressed. Conclusion: Perioperative implication of systemic lidocaine not only lessens pain perception but also assures early return of bowel function, lower incidence of postoperative nausea and vomiting, opioid sparing effect and shorter length of hospital stay. Thus, implementation of lidocaine as a part of perioperative approach should be seriously considered. Its role in surgeries other than abdominal needs more detailed study. In spite of current results encouraging, it may be too early to claim its similar impact in other types of surgeries.
Acute Myotoxic Effects of by Infusion of Prilocaine and Lidocaine in Rats
M.C. Ragbetli,M. Yalama,E. Erdogan,N. Cengiz,I. Kati,C. Ragbetli
Journal of Animal and Veterinary Advances , 2012,
Abstract: We assumed to examine the acute myotoxic effects of infusion of the local anesthetic lidocaine and prilocaine on the gluteus maximus muscle after continuous peripheral nerve blockade in rats. Eight adult female Sprague-Dawley average weighing 150-200 g rats were used in this study. Firstly, all of the animals were anesthetized with ketamine (50 mg kg-1) for 6 h. Then, prilocaine (right) and lidocaine (left) were used in equal volume (5 mg mL-1) for continuous peripheral nerve blockades of the posterior extremity at a rate of 0.3 mL h-1 for a total period of 6 h in 5 animals. The remaining 3 animals as control group were treated with physiological saline on both sides at 0.3 mL h-1 for a total period of 6 h. For routine histological observation, the infusion area was dissected and tissue samples including peripheral muscle were taken. For routine histological observation, the infusion area was dissected and tissue samples including peripheral muscle were taken. Method histological hazards as myotoxicite were not observed in skeletal muscle tissue after the infusion of prilocaine and lidocaine. There were no complications cases of local anesthesia. Prilocaine and lidocaine as local anesthetics might be applied safely by infusion.
Bupivacaine versus lidocaine analgesia for neonatal circumcision
Orit C Stolik-Dollberg, Shaul Dollberg
BMC Pediatrics , 2005, DOI: 10.1186/1471-2431-5-12
Abstract: Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours.Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59%) were given acetaminophen following circumcision compared to only 3 (16%) in the bupivacaine group (P < 0.01). Regression analysis showed that the only significant variable associated with the need for acetaminophen was the use of lidocaine (R2 = 20.6; P = 0.006).DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.The issue of whether or not to circumcise a male infant one week after birth (when medically permissible) is essentially nonexistent in Israel. In an atmosphere of celebration and feasting, the procedure ("brit mila") has been carried out for over 4,000 years by non-physicians ("mohelim"). A mohel uses no anesthesia when performing the circumcision. The baby is given a few drops of sacramental wine and the mohel applies tight bandaging to the wound. The past few years, however, have witnessed a small but growing trend of young couples who seek to have their newborns circumcised by doctors using some kind of anesthesia in order to obviate the baby's pain and discomfort as well as their own anxiety. This cultural change has elicited interest among Israeli doctors in seeking optimal management of their newborn patients.Anesthesia is not routinely administered for neonatal circumcision for a variety of reasons, among them the relatively short duration of the intervention, the perceived lack of importance of the pain, and concerns of toxicity from the medications [1]. It is now recognized that neonates are capable of both perceiving and exhibiting reproducible responses to pain, and
Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia  [PDF]
Jonathan B. Koea,Yatin Young,Kerry Gunn
HPB Surgery , 2009, DOI: 10.1155/2009/271986
Abstract: Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV) fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr) or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively) was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, =.06), less postoperative IV fluids (median 1200 mL versus 4300 mL, =.03) than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, =.05) and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, =.02). Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.
Adding magnesium to lidocaine for intravenous regional anesthesia  [cached]
Parviz Kashefi,Kamran Montazeri,Azim Honarmand,Abdolah Moradi
Journal of Research in Medical Sciences , 2008,
Abstract: BACKGROUND: Magnesium (Mg) has been used as an adjuvant medication in postoperative analgesia. We planed this study to assess the effects of Mg, when added to lidocaine in intravenous regional anesthesia (IVRA) on the tourniquet pain. METHODS: Forty patients undertaking hand surgery were randomly allocated into 2 groups to be given IVRA. They received 20 ml lidocaine 1% diluted with 20 ml saline to a total of 40 ml in the group L (n = 20) or 7.5 ml magnesium sulfate 20% plus 20 ml lidocaine 1% diluted with 12.5 ml saline to a total of 40 ml in the group M (n = 20). Sensory and motor block onset and recovery times, anesthesia and operation qualities were recorded. Before and after the tourniquet use at 5, 10, 15, 20, 30, 40, and 50 minutes, hemodynamic variables, tourniquet pain, and analgesic use were noted. Subsequent to the tourniquet deflation, at 6, 12, and 24 hours, hemodynamic variables, pain, time to first analgesic requirement, analgesic use and side effects were recorded. RESULTS: Shortened sensory and motor block onset times were established in group M (P < 0.05). Visual analog scale (VAS) scores were less in group M at 20, 30, 40, and 50 minutes after tourniquet inflation (P < 0.05). Intraoperative, analgesic requirement was less in group M (P < 0.05). Anesthesia excellence, as determined by the anesthesiologist and surgeon, was significantly better in group M (P < 0.05). Time to the first analgesic requirement in group M was 53.75 ± 6.94 minutes and in group L was 40.76 ± 14.55 minutes (P < 0.05). Postoperative VAS scores were higher at 6, 12, and 24 hours in group L (P < 0.05). CONCLUSIONS: Adding Mg to lidocaine for IVRA enhanced the quality of anesthesia and analgesia without causing side effects. KEYWORDS: Magnesium sulfate, intravenous regional anesthesia, postoperative pain.
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