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Sample records for analgesia reduce postoperative

  1. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  2. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv......Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity...... is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous...... regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme....

  3. Preventive analgesia for postoperative pain control: a broader concept

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    Vadivelu N

    2014-04-01

    Full Text Available Nalini Vadivelu,1 Sukanya Mitra,2 Erika Schermer,3 Vijay Kodumudi,4 Alan David Kaye,5 Richard D Urman61Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India; 3Yale College, New Haven, 4School of Liberal Arts and Science, University of Connecticut, Storrs, CT, 5Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 6Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USAAbstract: Pain from surgical procedures occurs as a consequence of tissue trauma and may result in physical, cognitive, and emotional discomfort. Almost a century ago, researchers first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and long-term postoperative pain, now referred to as central sensitization. Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage. Pre-emptive analgesia is an important concept in understanding treatment strategies for postoperative analgesia. Pre-emptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively but not after surgical incision. Additional research in pre-emptive analgesia is warranted to better determine good outcome measurements and a better appreciation with regard to treatment optimization. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics.Keywords: preventive analgesia, central

  4. Neuraxial block and postoperative epidural analgesia

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    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  5. Postoperative opioid analgesia: time for a reconsideration?

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    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain...

  6. Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

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    Robinson Yohan

    2011-05-01

    Full Text Available Abstract Background Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial. Patients and methods 150 patients (87 women treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B and 74 to ropivacain and oxycodone (group R. Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred. Results The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R. Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p Conclusions Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.

  7. Analgesia pós-operatória Postoperative analgesia

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    Betina Sílvia Beozzo Bassanezi

    2006-04-01

    Full Text Available JUSTIFICATIVAS E OBJETIVOS: A dor sempre foi uma das maiores preocupações do homem, entretanto, apesar dos progressos da ciência, ainda existem várias barreiras ao seu adequado tratamento, incluindo a falta de conhecimento por parte da equipe médica, sobre o mecanismo das diversas drogas e técnicas empregadas. O objetivo deste trabalho é abordar as principais drogas e técnicas empregadas no controle da dor pós-operatória, visando estimular o interesse sobre o assunto bem como aumentar a eficácia do tratamento dado aos pacientes. CONTEÚDO: Está ressaltada neste artigo, a importância da adequada analgesia pós-operatória, considerando as principais drogas e técnicas utilizadas no controle da dor, seus mecanismos de ação, posologias, vias de administração e efeitos colaterais, bem como a importância da integração de toda a equipe envolvida nos cuidados do paciente para o sucesso do tratamento. O tratamento inadequado da dor no pós-operatório não se justifica, pois há um arsenal considerável de drogas e técnicas analgésicas. O que se faz necessário, portanto, é que toda equipe, anestesistas, cirurgiões, e enfermeiros tenham conhecimento e estejam integrados na utilização deste arsenal.BACKGROUND AND OBJECTIVES: Pain has been one of the men's biggest worries. Despite of scientific progress there still exist many barriers in an adequate treatment of pain including the lack of knowledge of many drugs and pain management techniques. The objective of this study is to discuss the main drugs and analgesics process in an effort to stimulate our colleague interest about the subject and thus increasing treatment efficiency of our patients. CONTENTS: It is emphasized in this study the importance of an adequate postoperative analgesia discussing the main drugs and techniques used in pain management, their mechanism of action, dose, administration route and side effects of each drug. It is also pointed out the great importance

  8. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

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    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  9. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  10. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    Intravenous patient-controlled therapy is used routinely in postoperative care in much of the developed world. Intravenous patient-controlled analgesia results in higher patient satisfaction than conventional administration of analgesics, although it appears to have no advantage over conventional...... analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...... consideration. For example, opioid-tolerant patients need higher postoperative opioid doses to achieve satisfactory analgesic effect. In patients with renal or hepatic insufficiency, the elimination of some opioids may be substantially impaired, and the optimal opioid should be selected based on its...

  11. [Systemic analgesia for postoperative pain management in the adult].

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    Binhas, M; Marty, J

    2009-02-01

    Severe postsurgical pain contributes to prolonged hospital stay and is also believed to be a risk factor for the development of chronic pain. Locoregional anesthesia, which results in faster patient recovery with fewer side effects, is favored wherever feasible, but is not applicable to every patient. Systemic analgesics are the most widely used method for providing pain relief in the postoperative period. Improvements in postoperative systemic analgesia for pain management should be applied and predictive factors for severe postoperative pain should be anticipated in order to control pain while minimizing opioid side effects. Predictive factors for severe postoperative pain include severity of preoperative pain, prior use of opiates, female gender, non-laparoscopic surgery, and surgeries involving the knee and shoulder. Pre- and intraoperative use of small doses of ketamine has a preventive effect on postoperative pain. Multimodal or balanced analgesia (the combined use of various analgesic agents) such as NSAID/morphine, NSAID/nefopam, morphine/ketamine improves analgesia with morphine-sparing effects. Nausea and vomiting, the principle side effects of morphine, can be predicted using Apfel's simplified score; patients with a high Apfel score risk should receive preemptive antiemetic agents aimed at different receptor sites, such as preoperative dexamethasone and intraoperative droperidol. Droperidol can be combined with morphine for postoperative patient-controlled anesthesia (PCA). When PCA is used, dosage parameters should be adjusted every day based on pain evaluation. Patients with presurgical opioid requirements will require preoperative administration of their daily opioid maintenance dose before induction of anesthesia: PCA offers useful options for effective postsurgical analgesia using a basal rate equivalent to the patient's hourly oral usage plus bolus doses as required.

  12. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne;

    2005-01-01

    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the e...

  13. Prevention of postoperative pain by balanced analgesia

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Dirkes, W E;

    1990-01-01

    Fourteen patients undergoing colorectal surgery received an intraoperative afferent neural block with combined intrathecal and extradural local anaesthetics plus a balanced postoperative low-dose regimen of extradural bupivacaine 10 mg h-1-morphine 0.2 mg h-1 and systemic piroxicam 20 mg/24 h...

  14. Postoperative analgesia for Enhanced recovery in Joint replacement: Audit of a new electronic prescribing order set.

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    Wright, Jonathan; Cullinger, Benjamin; Bacarese-Hamilton, Ian

    2015-01-01

    Enhanced recovery in joint replacement has been shown to reduce length of inpatient stay, reduce re-admission rates, and can improve early functional recovery. Postoperative analgesia is an important component of the group of interventions required to form a holistic enhanced recovery protocol. The introduction of electronic prescribing provides the opportunity to introduce some standardisation, where clinically appropriate, in the prescription of an evidence based postoperative analgesia protocol. Enhanced recovery following joint replacement has been used at this institution since 2011. An order set for the postoperative analgesia protocol was introduced to the in house electronic prescribing system in August 2014 (JAC Medicines Management; JAC Computer Services Ltd., Basildon, UK). An audit was performed to follow the effect of the new system on compliance with the postoperative analgesia guidelines. Improvements were seen following introduction of the electronic prescribing protocol in all criteria of the guideline with a demonstrated improvement in overall compliance from 0% to 35% in the first loop, with subsequent audit showing further improvement to 59% compliance. Use of an embedded order set within an electronic prescribing system has demonstrated improved compliance with an enhanced recovery protocol. This ensures that the correct evidence based protocol is available to guide the junior clinician at the point of care, when the medication is being prescribed.

  15. Effect of preemptive analgesia with parecoxib sodium on the postoperative pain for gynecological laparoscopy

    Institute of Scientific and Technical Information of China (English)

    Yu-Jing Zhou

    2015-01-01

    Objective:To observe the effect of preemptive analgesia with parecoxib sodium on the postoperative pain and complications for patients undergoing gynecological laparoscopy. Methods:A total of 100 patients with ASA I-II grade who were admitted in our hospital from January, 2013 to February, 2014 and were undergoing gynecological laparoscopy were included in the study and randomized into the observation group and the control group. The patients in the observation group were given parecoxib sodium injection (40 mg) 30 min before operation and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery, while the patients in the control group were givens injections of parecoxib sodium injection (40 mg) and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery. The analgesia and sedation effects 4, 8, 12 h after the operation in the two groups were observed, and the postoperative additional fentanyl dosage and the adverse reactions were recorded.Results: The postoperative VAS score in each timing point and the total dosage of fentanyl in the observation group were significantly lower than those in the control group (P0.05).Conclusions: The preemptive analgesia with parecoxib sodium can reduce the dosage of postoperative analgesia medications with an accurate analgesic effect; therefore, it deserves to be widely recommended in the clinic.

  16. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Carstensen, M.; Møller, Ann

    2010-01-01

    In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient......-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. Our primary aim was to compare the effectiveness and safety of postoperative administered ketamine in addition to opioid for i.v. PCA compared with i.v. PCA with opioid alone. Studies were identified from the Cochrane Library 2003...... of 4.5. Pain was assessed using visual analogue scales or verbal rating scales. Six studies showed significant improved postoperative analgesia with the addition of ketamine to opioids. Five studies showed no significant clinical improvement. For thoracic surgery, the addition of ketamine to opioid...

  17. Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia

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    Alka Shah

    2013-02-01

    Full Text Available Background: For lower abdomen and lower limb surgery, spinal anaesthesia is most common modality used in routine. This study was conducted on 50 ASA 1 and 2 planned for lower limb and lower abdomen surgery. Methods: 50 patients of ASA 1 and 2 scheduled for lower limb and lower abdominal surgery were selected. Each patient received 4 milliliter volume of 0.75% isobaric ropivacaine + 5 microgram dexmedetomidine. At the intervals of 1 minute, 2 minute, 5 minute, 10 minute, 20 minute, 30 minute and 1 hour, 2 hour and 3 hour reading of pulse rate and blood pressure were recorded. Postoperatively, pain scores were recorded by using Visual Analogue Scale. Results: There were no significant changes in systolic and diastolic blood pressure after induction. The combination of ropivacaine and dexmedetomidine provided better postoperative analgesia and reduced requirement of diclofenac injection in first 24 hour. Conclusions: The patients showed excellent hemodynamic stability and postoperative analgesia to ropivacaine + dexmedetomidine. Thus it is a safe modality for lower limb and lower abdomen surgery as far as haemodynamic effects and postoperative analgesia is concerned. [Int J Basic Clin Pharmacol 2013; 2(1.000: 26-29

  18. Adenosine for postoperative analgesia: A systematic review and meta-analysis

    Science.gov (United States)

    2017-01-01

    Purpose Perioperative infusion of adenosine has been suggested to reduce the requirement for inhalation anesthetics, without causing serious adverse effects in humans. We conducted a meta-analysis of randomized controlled trials evaluating the effect of adenosine on postoperative analgesia. Methods We retrieved articles in computerized searches of Scopus, Web of Science, PubMed, EMBASE, and Cochrane Library databases, up to July 2016. We used adenosine, postoperative analgesia, and postoperative pain(s) as key words, with humans, RCT, and CCT as filters. Data of eligible studies were extracted, which included pain scores, cumulative opioid consumption, adverse reactions, and vital signs. Overall incidence rates, relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed-effects or random-effects models, depending on the heterogeneity of the included trials. Results In total, 757 patients from 9 studies were included. The overall effect of adenosine on postoperative VAS/VRS scores and postoperative opioid consumption was not significantly different from that of controls (P >0.1). The occurrence of PONV and pruritus was not statistically significantly different between an adenosine and nonremifentanil subgroup (P >0.1), but the rate of PONV occurrence was greater in the remifentanil subgroup (P 0.1). Conclusion Adenosine has no analgesic effect or prophylactic effect against PONV, but reduce systolic blood pressure and heart rates. Adenosine may benefit patients with hypertension, ischemic heart disease, and tachyarrhythmia, thereby improving cardiac function. PMID:28333936

  19. Offset analgesia is reduced in older adults.

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    Naugle, Kelly M; Cruz-Almeida, Yenisel; Fillingim, Roger B; Riley, Joseph L

    2013-11-01

    Recent studies indicate that aging is associated with dysfunctional changes in pain modulatory capacity, potentially contributing to increased incidence of pain in older adults. However, age-related changes in offset analgesia (offset), a form of temporal pain inhibition, remain poorly characterized. The purpose of this study was to investigate age differences in offset analgesia of heat pain in healthy younger and older adults. To explore the peripheral mechanisms underlying offset, an additional aim of the study was to test offset at 2 anatomical sites with known differences in nociceptor innervation. A total of 25 younger adults and 20 older adults completed 6 offset trials in which the experimental heat stimulus was presented to the volar forearm and glabrous skin of the palm. Each trial consisted of 3 continuous phases: an initial 15-second painful stimulus (T1), a slight increase in temperature from T1 for 5 seconds (T2), and a slight decrease back to the initial testing temperature for 10 seconds (T3). During each trial, subjects rated pain intensity continuously using an electronic visual analogue scale (0-100). Older adults demonstrated reduced offset compared to younger adults when tested on the volar forearm. Interestingly, offset analgesia was nonexistent on the palm for all subjects. The reduced offset found in older adults may reflect an age-related decline in endogenous inhibitory systems. However, although the exact mechanisms underlying offset remain unknown, the absence of offset at the palm suggests that peripheral mechanisms may be involved in initiating this phenomenon.

  20. ANALYSIS OF POSTOPERATIVE PAIN AFTER EXTRACTION OF IMPACTED MANDIBULAR THIRD MOLARS AND ADMINISTRATION OF PREEMPTIVE ANALGESIA

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    Deyan Neychev

    2017-09-01

    Full Text Available patients because of the effect of pain symptoms on the healing process and quality of life. The objective of this study is to make a quantitative and qualitative assessment of the postoperative pain in patients to whom preemptive analgesia was administered. Material and Methods: This is a randomised, placebo-controlled study in 80 patients who underwent surgical removal of impacted mandibular third molars. The patients were divided into three groups – with the preemptive administration of placebo, metamizole sodium and nimesulide. The short form of the McGill Pain Questionnaire (SF-MPQ and the Visual Analogue Scale (VAS were used for assessment and analysis of postoperative pain. Results: For the first 24 hours after molar extraction the comparison of the values of the various pain components showed a superior effect of the preemptive analgesia with nimesulide for the alleviation of sensory and total pain compared to metamizole sodium and placebo. In all three groups, pain intensity was highest at postoperative hour 6. Conclusion: Preemptive use of NSAIDs in the extraction of impacted mandibular third molars reduces the perception of postoperative pain and its intensity.

  1. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

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    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  2. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial.

    Science.gov (United States)

    Nilsson, U; Unosson, M; Rawal, N

    2005-02-01

    This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively. Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients' postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers. There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L(-1) decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups. This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption.

  3. Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient.

    Science.gov (United States)

    Chakraborty, Arunangshu; Goswami, Jyotsna; Patro, Viplab

    2015-02-01

    Quadratus lumborum block is a recently introduced variation of transversus abdominis plane block. In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic.

  4. Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study

    Science.gov (United States)

    Iyer, Sadasivan Shankar; Bavishi, Harshit; Mohan, Chadalavada Venkataram; Kaur, Navdeep

    2017-01-01

    Background: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. Materials and Methods: Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded. Results: Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest (P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h (P = 0.001). Conclusion: For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption. PMID:28928569

  5. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials.

    Science.gov (United States)

    McCarthy, Grace C; Megalla, Sohair A; Habib, Ashraf S

    2010-06-18

    Postoperative pain continues to be inadequately managed. While opioids remain the mainstay for postoperative analgesia, their use can be associated with adverse effects, including ileus, which can prolong hospital stay. A number of studies have investigated the use of perioperative intravenous lidocaine infusion for improving postoperative analgesia and enhancing recovery of bowel function. This systematic review was performed to determine the overall efficacy of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery in patients undergoing various surgical procedures. We searched the databases of MEDLINE, CINAHL and the Cochrane Library from 1966 to December 2009. We searched for randomized controlled comparisons of lidocaine infusion with placebo in the surgical setting and reporting on postoperative analgesia and other aspects of patient recovery from surgery. The quality of all included studies was assessed using the Modified Oxford Scale. Information on postoperative pain intensity and analgesic requirements was extracted from the trials and compared qualitatively. Other relevant data such as return of bowel function, length of hospital stay, intraoperative anaesthetic requirement and adverse effects were also compared. Sixteen trials were included. A total of 395 patients received intravenous lidocaine with 369 controls. In open and laparoscopic abdominal surgery, as well as in ambulatory surgery patients, intravenous perioperative infusion of lidocaine resulted in significant reductions in postoperative pain intensity and opioid consumption. Pain scores were reduced at rest and with cough or movement for up to 48 hours postoperatively. Opioid consumption was reduced by up to 85% in lidocaine-treated patients when compared with controls. Infusion of lidocaine also resulted in earlier return of bowel function, allowing for earlier rehabilitation and shorter duration of hospital stay. First flatus occurred up to 23 hours earlier

  6. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  7. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L;

    2005-01-01

    and ten consecutive patients scheduled for elective open colonic resection under general anaesthesia with combined thoracic epidural analgesia were prospectively studied. Postoperative epidural analgesia was maintained for 48 h with bupivacaine 2.5 mg/ml and morphine 50 µg/ml, 4 ml/h. Postoperative pain......The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  8. Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy

    DEFF Research Database (Denmark)

    Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A;

    2014-01-01

    MEASURES: Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. RESULTS: Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during...... coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p ....001, respectively), as well as the time to first mobilization (p operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery....

  9. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials

    DEFF Research Database (Denmark)

    Carstensen, M; Møller, A M

    2010-01-01

    In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient......-controlled analgesia (PCA) for postoperative pain in order to clarify this controversy. Our primary aim was to compare the effectiveness and safety of postoperative administered ketamine in addition to opioid for i.v. PCA compared with i.v. PCA with opioid alone. Studies were identified from the Cochrane Library 2003...... of 4.5. Pain was assessed using visual analogue scales or verbal rating scales. Six studies showed significant improved postoperative analgesia with the addition of ketamine to opioids. Five studies showed no significant clinical improvement. For thoracic surgery, the addition of ketamine to opioid...

  10. Postoperative analgesia for cleft lip and palate repair in children

    Directory of Open Access Journals (Sweden)

    Reena

    2016-01-01

    Full Text Available Acute pain such as postoperative pain during infancy was ignored approximately three decades ago due to biases and misconceptions regarding the maturity of the infant′s developing nervous system, their inability to verbally report pain, and their perceived inability to remember pain. More recently, these misconceptions are rarely acknowledged due to enhanced understanding of the developmental neurobiology of infant pain pathways and supraspinal processing. Cleft lip and palate is one of the most common congenital abnormalities requiring surgical treatment in children and is associated with intense postoperative pain. The pain management gets further complicated due to association with postsurgical difficult airway and other congenital anomalies. Orofacial blocks like infraorbital, external nasal, greater/lesser palatine, and nasopalatine nerve blocks have been successively used either alone or in combinations to reduce the postoperative pain. Since in pediatric population, regional anesthesia is essentially performed under general anesthesia, association of these two techniques has dramatically cut down the risks of both procedures particularly those associated with the use of opioids and nonsteroidal anti-inflammatory drugs. Definitive guidelines for postoperative pain management in these patients have not yet been developed. Incorporation of multimodal approach as an institutional protocol can help minimize the confusion around this topic.

  11. Perineural Dexamethasone to Improve Postoperative Analgesia with Peripheral Nerve Blocks: A Meta-Analysis of Randomized Controlled Trials

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    Gildasio S. De Oliveira

    2014-01-01

    Full Text Available Background. The overall effect of perineural dexamethasone on postoperative analgesia outcomes has yet to be quantified. The main objective of this quantitative review was to evaluate the effect of perineural dexamethasone as a nerve block adjunct on postoperative analgesia outcomes. Methods. A systematic search was performed to identify randomized controlled trials that evaluated the effects of perineural dexamethasone as a block adjunct on postoperative pain outcomes in patients receiving regional anesthesia. Meta-analysis was performed using a random-effect model. Results. Nine randomized trials with 760 subjects were included. The weighted mean difference (99% CI of the combined effects favored perineural dexamethasone over control for analgesia duration, 473 (264 to 682 minutes, and motor block duration, 500 (154 to 846 minutes. Postoperative opioid consumption was also reduced in the perineural dexamethasone group compared to control, −8.5 (−12.3 to −4.6 mg of IV morphine equivalents. No significant neurological symptoms could have been attributed to the use of perineural dexamethasone. Conclusions. Perineural dexamethasone improves postoperative pain outcomes when given as an adjunct to brachial plexus blocks. There were no reports of persistent nerve injury attributed to perineural administration of the drug.

  12. Continuous multimechanistic postoperative analgesia: a rationale for transitioning from intravenous acetaminophen and opioids to oral formulations.

    Science.gov (United States)

    Pergolizzi, Joseph V; Raffa, Robert B; Tallarida, Ronald; Taylor, Robert; Labhsetwar, Sumedha A

    2012-02-01

    Good surgical outcomes depend in part on good pain relief, allowing for early mobilization, optimal recovery, and patient satisfaction. Postsurgical pain has multiple mechanisms, and multimechanistic approaches to postoperative analgesia are recommended and may be associated with improved pain relief, lowered opioid doses, and sometimes a lower rate of opioid-associated side effects. Acetaminophen (paracetamol) is a familiar agent for treating many types of pain, including postsurgical pain. Oral acetaminophen has been shown to be safe and effective in a variety of acute pain models. Combination products using a fixed-dose of acetaminophen and an opioid have also been effective in treating postsurgical pain. Combination products with acetaminophen have demonstrated an opioid-sparing effect, which inconsistently results in a reduced rate of opioid-associated side effects. Intravenous (IV) acetaminophen and an opioid analgesic administered in the perioperative period may be followed by an oral acetaminophen and opioid combination in the postoperative period. Transitioning from an IV acetaminophen and opioid formulation to a similar but oral formulation of the same drugs appears to be a reasonable step in that both analgesic therapies are known to be safe and effective. For postsurgical analgesia with any acetaminophen product, patient education is necessary to be sure that the patient does not concurrently take any over-the-counter products containing acetaminophen and accidentally exceed dose limits.

  13. Magnesium sulfate in femoral nerve block, does postoperative analgesia differ? A comparative study

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    Hossam A. ELShamaa

    2014-04-01

    Conclusion: The current study concluded that the admixture of magnesium to bupivacaine provides a profound prolongation of the femoral nerve block, in addition to a significant decrease in postoperative pain scores and total dose of rescue analgesia, with a longer bearable pain periods in the first postoperative day.

  14. POSTOPERATIVE ANALGESIA WITH TRANSDERMAL DICLOFENAC VERSUS INTRAMUSCULAR DICLOFENAC – A COMPARATIVE STU DY

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    Soumya

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: The search for an ideal drug for postoperative anal gesia is ongoing. Diclofenac is commonly used drug for this purpose i n different routes. AIMS: To compare the efficacy of transdermal diclofenac with intramuscul ar diclofenac for postoperative analgesia. SETTINGS AND DESIGN: This prospective comparative study was conducted i n the department of anaesthesiology in a medical college & general hosp ital. METHODS AND MATERIALS: The study subjects were 200 patients of both sexes between 18 -50 years of age who were scheduled for elective laparoscopic, gynaecological & orthopaedic surgeries on limb. They divided into two groups. Group I received intramuscular injection of diclofenac sodium (75mg & Group II received transdermal diclofenac diethylamine patch (200mg pe r 75 sq.cm postoperatively. The outcome measures were pain intesity, changes in vital param eters, requirment for rescue analgesia & adverse effects. STATISTICAL ANALYSIS: Parametric data were analysed by using student t-te st (unpaired. Non parametric data were analysed by us ing test of association (chi-square test. RESULTS: The mean pain score was significantly high in intra muscular diclofenac group (Group I in laparoscopic & gynaecological surgeries (P = 0.0 02. Though the mean pain score was different among two groups in orthopaedic surgeries it was no t statistically significant (P = 0.377. There were no significant differences in vital parameters & adverse reactions in between two groups. The requirment of rescue anlgesia was significantly mor e in intramuscular diclofenac group (Group I. CONCLUSIONS: Transdermal diclofenac is more effective in reducing the intens ity of postoperative pain following laparoscopic & gynaecological surgeries but the eff ect is similar to intramuscular diclofenac in orthopedic limb surgeries

  15. [High thoracic epidural analgesia in the postoperative period after correction of congenital heart defects in children].

    Science.gov (United States)

    Slin'ko, S K

    1999-01-01

    The effects and side effects of thoracic epidural analgesia on the respiratory response, awakening time, and cooperation with nurses were studied. Forty children received epidural analgesia after open-heart surgery. Lidocaine was injected in a dose of 1.5-2 mg/kg every 1.5-2 h. Controls (16 pts) received intravenous fentanyl + diazepam analgesia. Respiratory response and awakening were significantly earlier (p < 0.001) in the epidural group. Cooperation with nurses was much better in this group, too. No side effects were observed in the epidural group. Therefore, thoracic epidural analgesia is a safe and effective method of postoperative analgesia for children subjected to open-heart surgery.

  16. EFFECT OF INTRAOPERATIVE ESMOLOL INFUSION ON POSTOPERATIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS: A RANDOMISED CONTROLLED TR IAL

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    Shreya

    2015-10-01

    Full Text Available BACKGROUND: Laparoscopic cholecystectomy, gaining worldwide popularity, can be performed on a short stay basis if postoperative pain is adequately addressed. Our present study determines the effect of intraoperative infusion of intravenous esmolol primarily in terms of postoperative analgesia and intraoperative haemodynamic stability. METHODS: 60 ASAPS 1 and 2 patients undergoing elective laparoscopic cholecystectomy were included in this randomi s ed, prospective, placebo - controlled clinical study. Patients were alloca ted into two groups to receive intraoperative intravenous esmolol (Group A, n=30 or normal saline (Group B, n=30 over a period of 10 minutes before induction. Intraoperative heart rate, mean arterial pressure and postoperative fentanyl requirement ( D uri ng first 6 postoperative hours were recorded. RESULTS: Postoperative requirement of fentanyl was significantly lower (92.73±17.42mcg in group A compared to 117.32±19.22mcg in group B, p value 0.05. CONCLUSION: Intravenous esmolol effectively reduces postoperative fentanyl requirement, thereby is a safe adjunct in the fie ld of postoperative analgesia for laparoscopic cholecystectomy.

  17. ANAESTHESIA, POSTOPERATIVE ANALGESIA AND EARLY REHABILITATION FOR UPPER EXTREMITY BONE AND MAJOR JOINTS SURGERY

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    A. V. Kurnosov

    2011-01-01

    Full Text Available A new method was developed to perform prolonged brachial plexus block with almost 100% effectiveness. It was also shown in 44 patients to be 33 % safer for local complications and 11,3 % safer for general complications than common used supraclavicular Winnie block (42 patients in control group, received opiates and NSAID for post-operative analgesia. This new method of analgesia allows effective rehabilitation after elbow arthroplasty to be started on the first day after the surgery.

  18. Continuous postoperative analgesia via quadratus lumborum block - an alternative to transversus abdominis plane block.

    Science.gov (United States)

    Visoiu, Mihaela; Yakovleva, Nataliya

    2013-10-01

    Different transversus abdominis plane blocks techniques cause variations in postoperative analgesia characteristics. We report the use of unilateral quadratus lumborum catheter for analgesia following colostomy closure. The catheter was placed under direct ultrasound visualization and had good outcomes: low pain scores and minimal use of rescue analgesic medication. No complications were reported in this pediatric patient. More studies are needed to evaluate the effectiveness and safety of this regional anesthesia technique.

  19. Audio-analgesia and Multi-disciplinary Pain Management: A Psychological Investigation into Acute, Post-operative Pain

    OpenAIRE

    Finlay, Katherine Anne

    2009-01-01

    Background: Audio-analgesia, the ability of music to reduce the perception of pain, has been a significant field of research in the past decade. This study aimed to investigate the impact of the musical constructs of harmonicity and rhythmicity on acute, post-operative pain. Method: 98 patients scheduled for primary total knee arthroplasty were randomly allocated at their pre-admissions clinic to one of four music listening groups, receiving commercially-available music. The...

  20. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, T G; Henneberg, S W; Hole, P

    1996-01-01

    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp......To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age...... of this age group may have a higher total postoperative morphine requirement following major surgery than older children and adolescents....

  1. The Effects of Thoracic Epidural Analgesia on Postoperative Pain and Myocardial Protection in Coronary Artery Bypass Surgery

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    Bestami Barış Çelik

    2015-03-01

    Full Text Available Aim: Thoracic epidural analgesia (TEA in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG on postoperative pain, myocardial protection, intensive care unit (ICU and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20 and control group (n=20. Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p<0.01. There was no difference in length of stay in the ICU, CK-MB and troponin I levels between the groups, however, length of hospital stay was shorter in TEA group. Conclusion: TEA with levobupivakain in CABG was found to provide stable hemodynamics, effective analgesia and to shorten length of hospital stay. (The Medical Bulletin of Haseki 2015; 53: 72-6

  2. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

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    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  3. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

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    Venkatraman R

    2016-01-01

    Full Text Available Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India Background and aim: Transversus abdominis plane block (TAP block is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods: Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A or normal saline (group B. Visual analog scale (VAS scores were used to assess pain. Paracetamol was given if VAS >3 and tramadol was used when VAS >6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results: The TAP block with ropivacaine (group A reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion: The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. Keywords: inguinal hernia repair, postoperative analgesia, ropivacaine, transversus abdominis block, ultrasound

  4. Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

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    Pei-Ching Hung

    2007-10-01

    Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

  5. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  6. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

  7. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine

  8. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  9. The use of different doses of metamizol for post-operative analgesia in dogs.

    Science.gov (United States)

    Imagawa, Vivianne H; Fantoni, Denise T; Tatarunas, Angélica C; Mastrocinque, Sandra; Almeida, Tatiana F; Ferreira, Fernando; Posso, Irimar P

    2011-07-01

    To evaluate the post-operative analgesic effect of metamizol (dipyrone) administered intravenously at three different doses (15 mg kg(-1), 25 mg kg(-1) and 35 mg kg(-1)) compared to placebo in dogs undergoing ovariohysterectomy. Prospective, comparative, randomized, blinded trial. Forty healthy bitches, aged 1-6 years, weighing 10-35 kg The animals were randomly divided into four groups and received their respective treatments immediately after surgery: placebo group (0.9% saline solution), D15 group (metamizol 15 mg kg(-1) IV), D25 group (metamizol 25 mg kg(-1) IV), D35 group (metamizol 35 mg kg(-1) IV). The following variables were measured: sedation, pulse rate (PR), respiratory rate (f(R)), arterial blood pressure (ABP), plasma catecholamines, serum cortisol, blood urea nitrogen (BUN) and creatinine metabolites, albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP), hemogram, platelet counts and level of analgesia which was assessed by visual analog (VAS), descriptive and behavioral scales. Patients were monitored for 48 hours after the administration of the analgesic agent. Rescue analgesia (tramadol, 2 mg kg(-1), intramuscularly) was provided for animals with pain scores ≥4, as determined by the VAS or descriptive scale. The D25 and D35 groups showed equivalent post-operative analgesia, as shown by decreased pain scores, according to the three different pain scales, and fewer animals that required rescue analgesia. Significantly lower serum cortisol concentrations were observed in the D25 and D35 groups when compared to the placebo and D15 groups. No hematologic, renal, hepatic or clinical adverse effects were observed during the treatment. Metamizol administered intravenously at 25 or 35 mg kg(-1) can provide adequate post-operative analgesia in bitches undergoing ovariohysterectomy. © 2011 The Authors. Veterinary Anaesthesia and Analgesia. © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary

  10. COMPARISON OF PREOPERATIVE RECTAL DICLOFENAC AND RECTAL PARACETAMOL FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

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    Ketaki

    2014-01-01

    Full Text Available Acute postoperative pain has adverse effects on the patients moral as well as various physiological functions of the body. We conducted a prospective randomized study to compare the efficacy of preoperative rectal diclofenac and paracetamol for postoperative analgesia in pediatric age group. Sixty children (3 – 13 yrs. undergoing minor surgical procedures were randomly alloc ated into 2 groups, group I comprising of 30 children who received diclofenac suppository post induction and group II comprising of 30 children who received paracetamol suppository post induction. Pain was assessed by the “Hanallah pain scale” which catego rizes pain based on 5 parameters, viz, systolic blood pressure, crying, movements, agitation (confused, excited, and complaints of pain 1 . We concluded that though both, diclofenac sodium and paracetamol are good postoperative analgesics when given by rect al route in pediatric patients undergoing minor surgeries, diclofenac sodium provides better analgesia than paracetamol when given by rectal route in pediatric patients.

  11. Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia.

    Science.gov (United States)

    Stabille, Débora Miranda Diogo; Diogo Filho, Augusto; Mandim, Beatriz Lemos da Silva; de Araújo, Lúcio Borges; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

    2015-01-01

    The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. Efficacy of the Bilateral Ilioinguinal-Iliohypogastric Block with Intrathecal Morphine for Postoperative Cesarean Delivery Analgesia

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    Manuel C. Vallejo

    2012-01-01

    Full Text Available The ilioinguinal-iliohypogastric (IIIH block is frequently used as multimodal analgesia for lower abdominal surgeries. The aim of this study is to compare the efficacy of IIIH block using ultrasound visualization for reducing postoperative pain after caesarean delivery (CD in patients receiving intrathecal morphine (ITM under spinal anesthesia. Participants were randomly assigned to 1 of 3 treatment groups for the bilateral IIIH block: Group A = 10 mL of 0.5% bupivacaine, Group B = 10 mL of 0.5% bupivacaine on one side and 10 mL of a normal saline (NSS placebo block on the opposite side, and Group C = 10 mL of NSS placebo per side. Pain and nausea scores, treatment for pain and nausea, and patient satisfaction were recorded for 48 hours after CD. No differences were noted with respect to pain scores or treatment for pain over the 48 hours. There were no differences to the presence of nausea (P=0.64, treatment for nausea (P=0.21, pruritus (P=0.39, emesis (P=0.35, or patient satisfaction (P=0.29. There were no differences in pain and nausea scores over the measured time periods (MANOVA, P>0.05. In parturients receiving ITM for elective CD, IIIH block offers no additional postoperative benefit for up to 48 hours.

  13. Intrathecal morphine plus general anesthesia in cardiac surgery: effects on pulmonary function, postoperative analgesia, and plasma morphine concentration

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    Luciana Moraes dos Santos

    2009-04-01

    Full Text Available OBJECTIVES: To evaluate the effects of intrathecal morphine on pulmonary function, analgesia, and morphine plasma concentrations after cardiac surgery. INTRODUCTION: Lung dysfunction increases morbidity and mortality after cardiac surgery. Regional analgesia may improve pulmonary outcomes by reducing pain, but the occurrence of this benefit remains controversial. METHODS: Forty-two patients were randomized for general anesthesia (control group n=22 or 400 µg of intrathecal morphine followed by general anesthesia (morphine group n=20. Postoperative analgesia was accomplished with an intravenous, patient-controlled morphine pump. Blood gas measurements, forced vital capacity (FVC, forced expiratory volume (FEV, and FVC/FEV ratio were obtained preoperatively, as well as on the first and second postoperative days. Pain at rest, profound inspiration, amount of coughing, morphine solicitation, consumption, and plasma morphine concentration were evaluated for 36 hours postoperatively. Statistical analyses were performed using the repeated measures ANOVA or Mann-Whiney tests (*p<0.05. RESULTS: Both groups experienced reduced FVC postoperatively (3.24 L to 1.38 L in control group; 2.72 L to 1.18 L in morphine group, with no significant decreases observed between groups. The two groups also exhibited similar results for FEV1 (p=0.085, FEV1/FVC (p=0.68 and PaO2/FiO2 ratio (p=0.08. The morphine group reported less pain intensity (evaluated using a visual numeric scale, especially when coughing (18 hours postoperatively: control group= 4.73 and morphine group= 1.80, p=0.001. Cumulative morphine consumption was reduced after 18 hours in the morphine group (control group= 20.14 and morphine group= 14.20 mg, p=0.037. The plasma morphine concentration was also reduced in the morphine group 24 hours after surgery (control group= 15.87 ng.mL-1 and morphine group= 4.08 ng.mL-1, p=0.029. CONCLUSIONS: Intrathecal morphine administration did not significantly alter

  14. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  15. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

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    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  16. Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

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    Marcelo Soares Privado

    Full Text Available CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING: A randomized double-blind study was performed in Hospital São Paulo. METHODS: During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14 received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15 received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS: The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4% than in group 2 (100%: 95% confidence interval (CI = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07. Epidural bupivacaine supplementation was also lower in group 1 (14.3% than in group 2 (53.3%: 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26. There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups. CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986

  17. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection

    Directory of Open Access Journals (Sweden)

    Summayah Fallatah

    2016-01-01

    Full Text Available Background: Postoperative pain after breast cancer surgery is not uncommon. Narcotic based analgesia is commonly used for postoperative pain management. However, the side-effects and complications of systemic narcotics is a significant disadvantage. Different locoregional anesthetic techniques have been tried including, single and multiple levels paravertebral block (PVB, which seems to have a significant reduction in immediate postoperative pain with fewer side-effects. The aim of this study was to compare unilateral multiple level PVB versus morphine patient-controlled analgesia (PCA for pain relief after breast cancer surgery with unilateral lumpectomy and axillary lymph nodes dissection. Materials and Methods: Forty patients scheduled for breast cancer surgery were randomized to receive either preoperative unilateral multiple injections PVB at five thoracic dermatomes (group P, 20 patients or postoperative intravenous PCA with morphine (group M, 20 patients for postoperative pain control. Numerical pain scale, mean arterial pressure, heart rate, Time to first analgesic demand, 24-h morphine consumption side-effects and length of hospital stay were recorded. Results: PVB resulted in a significantly more postoperative analgesia, maintained hemodynamic, more significant reduction in nausea and vomiting, and shorter hospital stay compared with PCA patients. Conclusion: Multiple levels PVB is an effective regional anesthetic technique for postoperative pain management, it provides superior analgesia with less narcotics consumption, and fewer side-effects compared with PCA morphine for patients with breast cancer who undergo unilateral lumpectomy, with axillary lymph nodes dissection.

  18. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P

    1996-01-01

    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp...

  19. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

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    Hala Mostafa Gomaa

    2014-10-01

    Conclusion: Either intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

  20. Comparison of single dose transdermal patches of diclofenac and ketoprofen for postoperative analgesia in lower limb orthopaedic surgery

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    Reetu Verma

    2016-03-01

    Conclusions: Both ketoprofen and diclofenac transdermal patch are effective for postoperative analgesia but less number of patients required rescue analgesic in ketoprofen group. [Int J Res Med Sci 2016; 4(3.000: 718-721

  1. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

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    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  2. Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study

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    Shio Priye

    2015-01-01

    Full Text Available Objectives: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. Settings and Design: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Interventions: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU and randomly divided into two groups. Group A (n = 32 received a 12 h infusion of normal saline and group B (n = 32 received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS pain ratings, Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU. Student′s t-test, Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups. Results: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001. Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group (P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively. Incidence of delirium was less in dexmedetomidine group (P = 0.086+. Hemodynamic parameters were statistically insignificant. Conclusions: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

  3. Intrathecal clonidine for postoperative analgesia in elderly patients: the influence of baricity on hemodynamic and analgesic effects.

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    Baker, Amir; Klimscha, Walter; Eisenach, James C; Li, Xin-Hui; Wildling, Eckart; Menth-Chiari, Wolfgang A; Chiari, Astrid I

    2004-07-01

    Intrathecal (IT) clonidine is an effective analgesic, but it also produces hemodynamic depression and sedation which are likely to be related to IT clonidine's cephalad spread within the cerebrospinal fluid. We hypothesized that IT clonidine's side effects could be reduced without compromising the duration and quality of analgesia by injecting clonidine IT in a hyperbaric solution and elevating the patient's trunk. We prospectively randomized 30 elderly patients to receive IT 150 microg of either isobaric (ISO) or hyperbaric (HYPER) clonidine for postoperative analgesia after surgical repair of traumatic hip fracture. Hemodynamics, IV fluid administration, visual analog pain scores, sedation scores, and clonidine cerebrospinal fluid levels were recorded at fixed intervals. Patients in the ISO group required significantly more crystalloid fluid administration (median, 2500 mL; range, 1500-3000 mL) than those in the HYPER group (median, 1500; range, 500-3000 mL) to maintain adequate arterial blood pressure (P ISO than in the HYPER group (P ISO (median, 400 min; range, 115-400 min) than in the HYPER (median, 265 min; range, 205-400 min) group (P < 0.05). Sedation scores did not differ between groups. We conclude that increasing the baricity of IT clonidine solution in the conditions of our experiment reduces hemodynamic side effects but also analgesia from IT administered clonidine.

  4. Effectiveness of preemptive analgesia on postoperative pain following third molar surgery: Review of literatures

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    Akira Yamaguchi

    2013-11-01

    Full Text Available We investigated the efficacy of preemptive analgesia for mandibular third molar surgery by, reviewing of randomized controlled trials. In many of the studies, the preemptive use of NSAIDs before, tooth extraction demonstrated that the postoperative pain was better controlled beyond the expected, effect time, compared without such preemptive use. On the other hand, some studies reported that, compared to the administration before removal of the tooth, postoperative administration was, associated with better suppression of postoperative pain. This suggests that in postoperative pain after, removal of mandibular third molars, peripheral sensitization caused by reactive inflammation, following the tooth extraction and secondary central sensitization are more important factors than, direct central sensitization caused by surgical tissue damage. Accordingly, when a mandibular third, molar is removed, central sensitization due to tissue damage should be suppressed by, preadministration of analgesics. In order then to suppress postoperative peripheral sensitization, the, readministration of analgesics is considered more effective. Furthermore, although acid NSAIDs are, effective analgesics, the associated adverse events are of concern. Accordingly, acetaminophen (1000 mg, which, is devoid of anti-inflammatory effects but is a weak cyclooxygenase inhibitor, can be used for, preemptive analgesia administration.

  5. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

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    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  6. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  7. Control of postoperative pain after awake craniotomy with local intradermal analgesia and metamizol.

    Science.gov (United States)

    Grossman, Rachel; Ram, Zvi; Perel, Azriel; Yusim, Yakov; Zaslansky, Ruth; Berkenstadt, Haim

    2007-05-01

    Pain following brain surgery is a significant problem. Infiltration of the scalp with local intradermal anesthetics was suggested for postoperative pain control but was assessed only in the first hour postoperatively. To evaluate wound infiltration with a single dose of metamizol (dipyrone) for postoperative pain control in patients undergoing awake craniotomy. This open, prospective, non-randomized observational study, conducted in anesthesiology and neurosurgical departments of a teaching hospital, included 40 patients undergoing awake craniotomy for the removal of brain tumor. Intraoperative anesthesia included wound infiltration with lidocaine and bupivacaine, conscious sedation using remifentanil and propofol, and a single dose of metamizol (dipyrone) for postoperative pain control. Outcome was assessed by the Numerical Pain Scale on arrival at the postoperative care unit, and 2, 4 and 12 hours after the end of surgery. On arrival at the postoperative care unit, patients reported NPS scores of 1.2 +/- 1.1 in a scale of 0-10 (mean +/- SD) (median = 1, range 0-4). The scores were 0.8 +/-0.9, 0.9 +/- 0.9 and 1 +/- 0.9 at 2 hours, 4 hours and 12 hours after the end of surgery, respectively. Based on patients' complaints and NPS lower than 3, 27 patients did not require any supplementary analgesia during the first 12 postoperative hours, 11 patients required a single dose of oral metamizol or intramuscular diclofenac, one patient was given 2 mg of intravenous morphine, and one patient required two separate doses of metamizol. Although the clinical setup prevents the use of placebo local analgesia as a control group, the results suggest the possible role of local intradermal infiltration of the scalp combined with a single dose of metamizol to control postoperative pain in patients undergoing craniotomy.

  8. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J

    1995-01-01

    Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded...

  9. Predicting postoperative vomiting among orthopedic patients receiving patient-controlled epidural analgesia using SVM and LR.

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    Wu, Hsin-Yun; Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Chang, Kuang-Yi; Tsou, Mei-Yung; Ting, Chien-Kun

    2016-06-01

    Patient-controlled epidural analgesia (PCEA) has been applied to reduce postoperative pain in orthopedic surgical patients. Unfortunately, PCEA is occasionally accompanied by nausea and vomiting. The logistic regression (LR) model is widely used to predict vomiting, and recently support vector machines (SVM), a supervised machine learning method, has been used for classification and prediction. Unlike our previous work which compared Artificial Neural Networks (ANNs) with LR, this study uses a SVM-based predictive model to identify patients with high risk of vomiting during PCEA and comparing results with those derived from the LR-based model. From January to March 2007, data from 195 patients undergoing PCEA following orthopedic surgery were applied to develop two predictive models. 75% of the data were randomly selected for training, while the remainder was used for testing to validate predictive performance. The area under curve (AUC) was measured using the Receiver Operating Characteristic curve (ROC). The area under ROC curves of LR and SVM models were 0.734 and 0.929, respectively. A computer-based predictive model can be used to identify those who are at high risk for vomiting after PCEA, allowing for patient-specific therapeutic intervention or the use of alternative analgesic methods.

  10. The effect of kidney morcellation on operative time, incision complications, and postoperative analgesia after laparoscopic nephrectomy

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    Affonso H. Camargo

    2006-06-01

    Full Text Available INTRODUCTION: Compare the outcomes between kidney morcellation and two types of open specimen extraction incisions, several covariates need to be taken into consideration that have not yet been studied. MATERIALS AND METHODS: We retrospectively reviewed 153 consecutive patients who underwent laparoscopic nephrectomy at our institution, 107 who underwent specimen morcellation and 46 with intact specimen removal, either those with connected port sites with a muscle-cutting incision and those with a remote, muscle-splitting incision. Operative time, postoperative analgesia requirements, and incisional complications were evaluated using univariate and multivariate analysis, comparing variables such as patient age, gender, body mass index (BMI, laterality, benign versus cancerous renal conditions, estimated blood loss, specimen weight, overall complications, and length of stay. RESULTS: There was no significant difference for operative time between the 2 treatment groups (p = 0.65. Incision related complications occurred in 2 patients (4.4% from the intact specimen group but none in the morcellation group (p = 0.03. Overall narcotic requirement was lower in patients with morcellated (41 mg compared to intact specimen retrieval (66 mg on univariate (p = 0.03 and multivariate analysis (p = 0.049. Upon further stratification, however, there was no significant difference in mean narcotic requirement between the morcellation and muscle-splitting incision subgroup (p = 0.14. CONCLUSION: Morcellation does not extend operative time, and is associated with significantly less postoperative pain compared to intact specimen retrieval overall, although this is not statistically significant if a remote, muscle-splitting incision is made. Morcellation markedly reduces the risk of incisional-related complications.

  11. Role of transcutaneous electrical nerve stimulation in post-operative analgesia

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    Sukhyanti Kerai

    2014-01-01

    Full Text Available The use of transcutaneous electrical nerve stimulation (TENS as non-pharmacological therapeutic modality is increasing. The types of TENS used clinically are conventional TENS, acupuncture TENS and intense TENS. Their working is believed to be based on gate control theory of pain and activation of endogenous opioids. TENS has been used in anaesthesia for treatment of post-operative analgesia, post-operative nausea vomiting and labour analgesia. Evidence to support analgesic efficacy of TENS is ambiguous. A systematic search of literature on PubMed and Cochrane Library from July 2012 to January 2014 identified a total of eight clinical trials investigating post-operative analgesic effects of TENS including a total of 442 patients. Most of the studies have demonstrated clinically significant reduction in pain intensity and supplemental analgesic requirement. However, these trials vary in TENS parameters used that is, duration, intensity, frequency of stimulation and location of electrodes. Further studies with adequate sample size and good methodological design are warranted to establish general recommendation for use of TENS for post-operative pain.

  12. Effectiveness of Epidural Analgesia, Continuous Surgical Site Analgesia, and Patient-Controlled Analgesic Morphine for Postoperative Pain Management and Hyperalgesia, Rehabilitation, and Health-Related Quality of Life After Open Nephrectomy: A Prospective, Randomized, Controlled Study.

    Science.gov (United States)

    Capdevila, Xavier; Moulard, Sebastien; Plasse, Christian; Peshaud, Jean-Luc; Molinari, Nicolas; Dadure, Christophe; Bringuier, Sophie

    2017-01-01

    There is no widely recognized effective technique to optimally reduce pain scores and prevent persistent postoperative pain after nephrectomy. We compared continuous surgical site analgesia (CSSA), epidural analgesia (EA), and a control group (patient-controlled analgesic morphine) in patients undergoing open nephrectomy. Sixty consecutive patients were randomized to be part of EA, CSSA, or control groups postoperatively for 72 hours. All patients received patient-controlled analgesic morphine, if needed. Hyperalgesia was assessed on the first, second, and third postoperative days. Chronic pain characteristics and quality of life were analyzed at 1 and 3 months. The primary outcome was the pain score at 24 hours. Secondary outcomes were morphine consumption, postoperative rehabilitation, hyperalgesia, chronic pain incidence, and quality-of-life parameters. At 24 hours, mean ± standard deviation pain values at rest (2.4 ± 1.7, 2.2 ± 1.2, and 4.2 ± 1.2, respectively, in EA, CSSA, and control groups, P control group. Rehabilitation parameters improved sooner in the EA and CSSA groups. Median values of area of hyperalgesia differed at 48 hours between the EA group and the control group (36.4 cm) and (52 cm) (P = .01) and at 72 hours among the EA group, CSSA group, and the control group (40 cm, 39.5 cm, and 59 cm, respectively; P = .002). CSSA reduced the severity of pain and hyperalgesia at 1 month and optimized quality of life 3 months after surgery (role physical scores, P = .005). CSSA and EA significantly improve postoperative analgesia, reduce postoperative morphine consumption, area of wound hyperalgesia, and accelerate patient rehabilitation after open nephrectomy. CSSA significantly reduces the severity of residual pain 1 month after surgery and optimizes quality-of-life parameters 3 months after surgery.

  13. A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

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    Himanshu A. Shah

    2013-12-01

    Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated. [Int J Basic Clin Pharmacol 2013; 2(6.000: 723-727

  14. Perioperative low-dose ketamine improves postoperative analgesia following Cesarean delivery with general anesthesia.

    Science.gov (United States)

    Haliloglu, Murat; Ozdemir, Mehtap; Uzture, Neslihan; Cenksoy, Pinar Ozcan; Bakan, Nurten

    2016-03-01

    In this study, the effect of perioperative uses of low dose ketamine on post-operative wound pain and analgesic consumption in patients undergoing elective Cesarean section was evaluated. In randomized, double blind clinical trial, 52 women with American Society of Anesthesiologists (ASA) class I-II identification undergoing elective Cesarean section in general anesthesia were enrolled. In the ketamine group (group K), a ketamine bolus of 0.5 mg kg(-1) IV was administered at the time of induction of general anesthesia. After induction, a ketamine infusion of 0.25 mg kg(-1) h(-1) was started and discontinued at the end of surgery. Patients allocated to the control group (group C) were given identical volumes of saline. The cumulative dose of morphine consumption after surgery was measured as the primary outcome of this study. Secondary outcomes were pain control assessed by numeric rating scale (NRS) and need for rescue analgesia and incidence of side effects. The mean 24-h morphine consumption was lower in group K (p = 0,001). At 15 min postoperatively, NRS values were lower in group K than group C (p = 0,001). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (p > 0.05). Perioperative uses of low dose ketamine decreased post-operative opioid requirements, which was observed long after the normal expected duration of ketamine.

  15. Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer.

    Science.gov (United States)

    Cata, Juan P; Gottumukkala, Vijaya; Thakar, Dilip; Keerty, Dinesh; Gebhardt, Rodolfo; Liu, Diane D

    2014-02-01

    To determine whether postoperative epidural analgesia is associated with better recurrence-free survival and overall survival after lung cancer surgery. Retrospective study. Academic hospital. Data of patients with stage 1, stage 2, and stage 3 nonsmall cell lung cancer, who underwent tumor resection surgery, were studied. Patient data were grouped into three different postoperative pain management interventions: intravenous patient-controlled analgesia, patient-controlled epidural analgesia, and their combination. Univariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on overall survival and recurrence-free survival. The type of postoperative analgesia used for patients who underwent surgery for nonsmall cell lung cancer did not affect recurrence-free survival or overall survival. However, certain variables, including age ≥ 65 years, male gender, body mass index ≥ 25 kg/m(2), ASA physical status 4, and the need for preoperative blood transfusions, pneumonectomy, and postoperative radiation, were associated with decreased recurrence-free survival and overall survival. The type of postoperative analgesia used after surgery for nonsmall cell lung cancer is not associated with better 2-year or 5-year recurrence-free survival or overall survival rates. © 2013 Elsevier Inc. All rights reserved.

  16. Administration of paracetamol versus dipyrone by intravenous patient-controlled analgesia for postoperative pain relief in children after tonsillectomy

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    Mesut Sener

    2015-12-01

    Full Text Available BACKGROUND AND OBJECTIVE: We compared the efficacy of intravenous (IV paracetamol versus dipyrone via patient-controlled analgesia (PCA for postoperative pain relief in children. METHODS: The study was composed of 120 children who had undergone elective tonsillectomy after receiving general anesthesia. Patients were divided into 3 groups according to the dosage of postoperative intravenous-patient-controlled analgesia: paracetamol, dipyrone, or placebo. Pain was evaluated using a 0- to 100-mm visual analog scale and 1- to 4-pain relief score at 30 min, 1, 2, 4, 6, 12, and 24 h postoperatively. Pethidine (0.25 mg kg-1 was administered intravenously to patients requiring rescue analgesia. Pethidine requirements were recorded during the first 24 h postoperatively, and treatment related adverse effects were noted. RESULTS: Postoperative visual analog scale scores were significantly lower with paracetamol group compared with placebo group at 6 h (p 0.05. Postoperative pethidine requirements were significantly lower with paracetamol and dipyrone groups compared with placebo group (62.5%, 68.4% vs 90%, p 0.05. CONCLUSIONS: Paracetamol and dipyrone have well tolerability profile and effective analgesic properties when administered IV-PCA for postoperative analgesia in children after tonsillectomy.

  17. Evaluation of the effect of gabapentin on postoperative analgesia with epidural morphine after abdominal hysterectomy

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    Diptesh Aryal

    2017-07-01

    Full Text Available Background & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind study sixty ASA PS I and II patients undergoing abdominal hysterectomy were assigned to receive either placebo or gabapentin 1200mg 1 hour before surgery. Postoperatively, 0.125% bupivacaine with morphine 50 µg per kg body weight was used for epidural analgesia. Vital parameters, time to the first request for analgesic, visual analogue scale scoring for pain at rest and during movement, 24-hour morphine consumption, and side effects were studied.Results: The patients were comparable with respect to age, weight, ASA PS, baseline hemodynamic parameters and duration of surgery. Gabapentin significantly decreased the duration of analgesia compared to placebo (1078.26 min Vs. 303.5 min; P value <0.0001. The VAS scores at rest and during movement at 1, 2, 4, 8, 12, and 24h were significantly lower in gabapentin group. The total amount of morphine consumption in 24 h postoperatively was significantly lower in gabapentin group (1.93mg Vs. 6.30mg; P value <0.0001. The incidence of nausea and pruritus was significantly lower with gabapentin. Conclusion: Oral gabapentin 1200 mg as a premedication decreases the dose requirement of epidural morphine and postoperative pain after total abdominal hysterectomy. It also decreases the pain scores at rest and during movement significantly. 

  18. Lumbar plexus block for post-operative analgesia following hip surgery: A comparison of "3 in 1" and psoas compartment block

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    Uma Srivastava

    2007-01-01

    Full Text Available We used a single shot lumbar plexus block by posterior approach (Psoas compartment block- PCB or anterior approach (′3in1′ block for postoperative analgesia in the patients of hip fractures operated under spinal anaesthesia. The blocks were given at the end of operation with 0.25% of bupivacaine and pain was assessed using Verbal Rating scale at 1,6,12 and 24 hours postoperatively both during rest and physiotherapy. We also noted time for first analgesic, need of supplemental analgesics and quality of analgesia during 24 hours. The mean time for first demand of analgesia was 12.4 ±7.9 and 10.7±6.4 hrs in groups PCB and ′3 in 1′ respectively (p>0.05. Requirement of supplemental analgesics was considerably reduced and more than 80% patients in both groups needed only single injection of diclofenac in 24 hrs. It was concluded that both approaches of lumbar plexus block were effective in providing post operative analgesia after hip surgery.

  19. A COMPARISON OF KETOROLAC, DICLOFENAC AND PARACETAMOL FOR POSTOPERATIVE ANALGESIA FOLLOWING ABDOMINAL HYSTERECTOMY

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    Gaurav

    2015-11-01

    Full Text Available BACKGROUND Abdominal hysterectomy is associated with moderate-to-severe postoperative pain. Among non-opioid analgesics diclofenac, paracetamol and ketorolac are most commonly used. OBJECTIVES: The aim of this study was to compare the analgesic duration, efficacy and side effect profile of paracetamol, diclofenac and ketorolac administered intravenously in patients who underwent abdominal hysterectomy. METHODS In a prospective double-blinded study, in which 90 women undergoing elective abdominal hysterectomy under spinal anesthesia were randomly selected and divided into 3 groups to receive 1ml (75mg Diclofenac (Group D, 1ml (30mg Ketorolac (Group K and 100ml (1000mg Paracetamol (Group P. Two hours post spinal anesthesia, irrespective of completion of surgery study drug was administered intravenously. In post-operative ward analgesic, efficacy was assessed hourly using a visual analog scale (VAS, duration of motor blockade due to spinal anesthesia (Modified Bromage scale, time for rescue analgesia (VAS>4 were compared and occurrence of adverse effects noted. STATICS Collected data was analyzed using ANOVA. RESULTS The time taken to administer the first dose of rescue analgesic was significantly (P <0.05 delayed in the group K (276mins. Overall, mean postoperative VAS scores were significantly better with (Group K and VAS scores were not significantly different between other (Group P and (Group D. CONCLUSION Ketorolac was a better post-operative analgesic compared to diclofenac and paracetamol.

  20. A COMPARATIVE CLINICAL STUDY OF INTRAARTICULAR CLONIDINE V/S DEXMEDETOMIDINE IN ARTHROSCOPIC KNEE SURGERIES (ACL REPAIR FOR POSTOPERATIVE ANALGESIA

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    Basavaraj Patil

    2016-07-01

    Full Text Available BACKGROUND Both clonidine and dexmedetomidine morphine (Both a2 agonists provide enhanced patient analgesia after arthroscopic knee surgeries when administered via intraarticular route. OBJECTIVES To compare the duration of post-operative analgesia of clonidine and dexmedetomidine when administered intraarticularly as well as haemodynamic stability after arthroscopic knee surgeries. METHODOLOGY This is a randomized trial study involving 40 pts. of ASA grade 1 and 2 of aged between 18 and 60 yrs. Patients were divided randomly into two groups as group C (n=20 and group D (n=20. After arthroscopic knee surgeries, postoperative pain was measured by VAS score at 0, 30 mins, 60 mins, 90 mins, 120 mins and then every 2 hrly up to 24 hrs. Side effects and vital signs were also noted. Duration of analgesia was noted in each case as when VAS score ≥3. RESULTS Mean duration of analgesia in postoperative period in group D was 18.4 hrs. ± 4.95 and in group C 15.1 hrs. ± 2.71. Differences in duration of analgesia was statistically significant (P<0.05 when compared by student ‘t’ test. VAS scores were also lower in group D compared to group at 6, 8, 10, 12, 14, 16, 18, 20, 22, 24 hrs. postoperative period. No major side effects were noted in both groups in dosages used. CONCLUSION Dexmedetomidine produced more prolonged post-operative analgesia (mean 18.4 hrs. than clonidine (mean 15.1 hrs., which is statistically significant (P<0.05. No major side effects were noted in both groups in clinically used dosages.

  1. A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl for postoperative analgesia following laparoscopic surgery

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    Hemsen L

    2013-02-01

    Full Text Available Lisa Hemsen,1 Susan L Cusack,2 Harold S Minkowitz,3 Michael E Kuss41Innocoll Technologies, Athlone, Ireland; 2Cusack Pharmaceutical Consulting, Burlington, NJ, USA; 3Memorial Hermann Memorial City Medical Center, Houston, TX, USA; 4Premier Research Group, Austin, TX, USABackground: XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery.Methods: We implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days.Results: XaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours.Conclusion: XaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted.Keywords: laparoscopic, hernioplasty, hernia repair

  2. Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients.

    Science.gov (United States)

    Keller, Benjamin A; Kabagambe, Sandra K; Becker, James C; Chen, Y Julia; Goodman, Laura F; Clark-Wronski, Julianna M; Furukawa, Kenneth; Stark, Rebecca A; Rahm, Amy L; Hirose, Shinjiro; Raff, Gary W

    2016-12-01

    Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications. Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications. Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice. Retrospective study - level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Intraperitoneal Instillation of Lidocaine Improves Postoperative Analgesia at Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial.

    Science.gov (United States)

    Patel, Ruchira; Carvalho, Jose C A; Downey, Kristi; Kanczuk, Marcelo; Bernstein, Paul; Siddiqui, Naveed

    2017-02-01

    Cesarean delivery is a commonly performed procedure worldwide. Despite improvements in balanced multimodal analgesia, there remains a proportion of women for whom postoperative pain relief and patient satisfaction are still inadequate. Intraperitoneal instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the effect of intraperitoneal instillation of lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen. We studied women scheduled for elective cesarean delivery under spinal anesthesia. Spinal anesthesia was performed with 0.75% hyperbaric bupivacaine, fentanyl, and morphine. At the end of the cesarean delivery, immediately before parietal peritoneum or fascia closure, patients were randomized to receive either lidocaine (20 mL 2% lidocaine with epinephrine) or placebo (20 mL normal saline) instilled into the peritoneal cavity. The primary outcome was pain score on movement at 24 hours. Secondary outcomes were pain score at rest and on movement at 2, 24, and 48 hours; maternal satisfaction score; analgesic consumption; incidence of nausea, vomiting, and itching; and return of bowel function. Two hundred four women were recruited. Baseline characteristics were similar between the lidocaine and placebo groups. Pain scores at 24 hours postcesarean delivery on movement (parameter estimate 0.02 [95% confidence interval {CI} -0.14 to 0.18]; P = .823) and at rest (parameter estimate 0.00 [95% CI -0.32 to 0.33]; P = .986) were similar in both groups. Pain scores at 2 hours postcesarean delivery on movement (parameter estimate -0.58 [95% CI -0.90 to -0.26]; P = .001) and at rest (parameter estimate -1.00 [95% CI -1.57 to -0.43]; P = .001) were lower in the lidocaine group. Subgroup analysis of patients with peritoneum closure revealed significantly lower pain scores at 24 hours on movement (parameter estimate -0.33 [95% CI -0.64 to -0.03]; P = .032) in the

  4. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  5. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol

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    Meena Doda

    2009-01-01

    Full Text Available Thirty children, ASAI-II, aged between 2yrs-5yrs, undergoing sub umbilical operation (inguinal and penile surgery were selected for this double blind study. They were randomly divided in two groups, group Aand group B. Group A(n15 received 0.25%bupivacaine 0.5ml.kg -1 and Group B (n=15 received 0.25% bupivaeaine 0.5ml.kg -1 and tramadol 2mg.kg -1 as single shot caudal block. Postoperative pain was assessed by a modified TPPPS (Toddler-Preschool Postoperative Pain Scale and analgesic given only when the score was more than 3. In the first 24 hrs it was observed that the mean duration of time interval between the caudal block and first dose of analgesic was significantly long(9. lhrs in Group B as compared to Group A (6.3hrs which was much shorter(p< 0.01.There was no significant haemodynamie changes, motor weakness or respiratory depression in both groups. This study con-cluded that addition of tramadol 2mg.kg -1 to caudal 0.25% bupivacaine 0.5ml.kg -1 significantly prolong the duration of postoperative analgesia in children withoutprodueing much adverse effects.

  6. Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    孙立新

    2014-01-01

    Objective To investigate the feasibility of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting(OPCABG).Methods Upon the approval of institutional Ethics Committee and informed consent,forty patients ASAⅡorⅢaged 52-77 yr with BMI(body mass index)<30

  7. [Frequency of colonization and isolated bacteria from the tip of the epidural catheter implanted for postoperative analgesia].

    Science.gov (United States)

    Stabille, Débora Miranda Diogo; Filho, Augusto Diogo; Mandim, Beatriz Lemos da Silva; Araújo, Lúcio Borges de; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

    2015-01-01

    The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45hours (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. Postoperative epidural catheter analgesia, under this study conditions, was found to be low risk for bacterial colonization in patients at surgical wards. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Effects of buprenorphine, meloxicam, and flunixin meglumine as postoperative analgesia in mice.

    Science.gov (United States)

    Tubbs, Jacquelyn T; Kissling, Grace E; Travlos, Greg S; Goulding, David R; Clark, James A; King-Herbert, Angela P; Blankenship-Paris, Terry L

    2011-03-01

    C57BL/6NCrl male mice (n = 60; age, 6 to 7 wk) underwent partial hepatectomy or no surgery and were given 1 of 3 analgesics pre- and postoperatively. Food and water consumption, body weight, running wheel activity, locomotor activity, and serum corticosterone concentrations were measured before and after surgery. Mice that were surgically manipulated weighed significantly less on days 1 through 3 after surgery than did mice not manipulated surgically. On the day of surgery, the surgery groups consumed significantly less feed (-1.5±0.35 g) than did nonsurgery groups. There were no differences in water consumption on any day between surgery and nonsurgery groups or among the 3 analgesic groups. For running wheel activity, significant decreases in the surgery groups were seen at day 1 after surgery compared with baseline. Surgery groups that received buprenorphine and meloxicam returned to baseline activity levels on day 2 after surgery. Open-field testing revealed no significant differences in locomotor activity in any groups; however, posttreatment locomotor activity in the buprenorphine nonsurgery group was increased compared with baseline, and posttreatment locomotor activity in the flunixin meglumine surgery group was decreased compared with baseline. Serum corticosterone concentrations were within normal limits regardless of treatment in all groups. Comparison of the overall results indicated that meloxicam and buprenorphine, at the dose given, appear to be suitable postoperative analgesics for partial hepatectomy in mice. Flunixin meglumine at the given dosage (2.5 mg/kg) may not provide adequate analgesia for partial hepatectomy.

  9. Bloqueio do plexo lombar no compartimento do psoas para analgesia pós-operatória em cirurgias ortopédicas Lumbar plexus blockage on psoas compartment for postoperative analgesia after orthopaedic surgeries

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2008-01-01

    thigh, femoral and obturator were blocked in 90% of patients. Blockage has reduced the amount of postoperative opioids, and 52.5% of patients required no additional postoperative analgesia, with analgesia duration of approximately 24 hours. There were no clinical signs or symptoms of bupivacaine toxicity, as well as no sequels secondary to nerves blockage. CONCLUSIONS: This report shows that injections into psoas compartment space is easy to perform and provides an effective blockage of the five nerves. The lumbar plexus blockage at the psoas compartment can be recommended for use in postoperative analgesia after orthopedic surgeries.

  10. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

    Directory of Open Access Journals (Sweden)

    Siddiqui A

    2016-05-01

    Full Text Available Asad Siddiqui,1 Andrew Tse,2 James E Paul,3 Peter Fitzgerald,4 Bernice Teh,51Department of Anesthesia, University of Toronto, Toronto, 2Department of Anesthesia, University of Ottawa, Ottawa, 3Department of Anesthesia, 4Department of Surgery, McMaster University, Hamilton, Ontario, Canada; 5Canterbury Anesthetic Services, Victoria, Australia Introduction: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure. Methods: Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12 received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21 received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39 received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10, with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or

  11. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

    Science.gov (United States)

    Siddiqui, Asad; Tse, Andrew; Paul, James E; Fitzgerald, Peter; Teh, Bernice

    2016-01-01

    Introduction Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children’s hospital, in patients undergoing the Nuss procedure. Methods Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12) received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21) received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39) received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10), with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or logistic regression adjusted for pain scores at baseline. The criterion for statistical significance was set a priori at alpha =0.05. Results Group A had significantly higher day-1 pain scores (score 5.42/10) than Group B (4.52/10; P=0.030) and Group C (4.49/10; P=0.015) after adjusting for baseline pain and age. No significant difference in maximum daily

  12. Transdermal nitroglycerine enhances postoperative analgesia of intrathecal neostigmine following abdominal hysterectomies

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    Fareed Ahmed

    2010-01-01

    Full Text Available This study was carried out to assess the effect of nitroglycerine (transdermal on intrathecal neostigmine with bupivacaine on postoperative analgesia and note the incidence of adverse effects, if any. After taking informed consent, 120 patients of ASA Grade I and II were systematically randomised into four groups of 30 each. Patients were premedicated with midazolam 0.05 mg/kg intravenously and hydration with Ringer′s lactate solution 10ml/kg preoperatively in the holding room. Group I patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline and transdermal placebo patch. Group II patients received Intrathecal injection of 15 mg bupivacaine with 5 mcg of neostigmine and transdermal placebo patch. Group III patients received Intrathecal injection of 15 mg bupivacaine with 1ml of normal saline with transdermal nitroglycerine patch (5 mg/24 hours. Group IV patients received Intrathecal injection of 15 mg bupivacaine with 5mcg of neostigmine and transdermal nitroglycerine patch (5 mg/24 hours, applied on a non anaesthetised area after 20 minutes. Groups were demographically similar and did not differ in intraoperative characteristics like sensory block, motor block, haemodynamic parameters and SpO 2 . The mean duration of analgesia was 202.17 minutes, 407.20 minutes, 207.53 minutes and 581.63 minutes in control group (I, neostigmine group (II, nitroglycerine group (III and nitroglycerine neostigmine group (IV respectively (P< 0.01. To conclude, our results show that transdermal nitroglycerine itself does not show any analgesic potential but it enhances the analgesic potential of intrathecal neostigmine.

  13. Effect of Ultrasound Guided Rectus Sheath Block on Postoperative Analgesia after Laparotomy with Transverse Incision in Children

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    Aydin Halefoglu

    2015-09-01

    Material and Methods: Forty patients with ASA I-II physical status, aged 3-7 years and undergoing laparotomy with transverse incision were randomly allocated into two groups. Patients were administered general anesthesia and before the beginning of surgery ultrasound guided RSB with 0.2 mL/kg, 0.25% of levobupivacaine and thirty minutes before the surgery the loading dose of morphine of 0.1 mg/kg intravenously were received in group RSB and group M, respectively. Analgesic drug pump with 0.01 mg/kg bolus doses of morphine and 30 minutes lockout interval was set up postoperatively in both groups. Concentrations (% and consumed amounts (mL/h of sevoflurane during the surgery and systolic and diastolic blood pressure, heart rate, and peripheral oxygen saturation values were recorded both intraoperative and postoperative period in each groups. Analgesic consumption with postoperative analgesic drug pump, FLACC pain scores, sedation level, nausea, vomiting, supplemental analgesic requirement and side effects were also recorded. Results: Demographic data and hemodynamic parameters were similar in both groups excepting that systolic arterial pressure values were reduced in group RSB than in group M. Inhaled concentration and consumed amounts of sevoflurane were decreased in group RSB compared with group M. Averages of consumptions of sevoflurane were 18.7+/-2.1 mL/h and 21.5 +/-2.9 mL/h in group RSB and group M, respectively (p<0.001. Postoperative FLACC scores, sedation scores, and morphine consumption for 24 hours were lower in group RSB than in group M (p<0.001. Three patients had nausea in group M, however no nausea and vomiting was observed in group RSB and any patients did not need supplemental analgesia postoperatively. Conclusions: Ultrasound guided RSB is superior to intravenous morphine according to intraoperative anesthetic gas consumption and postoperative pain control in children undergoing abdominal surgery using transverse incision. [Cukurova Med J 2015; 40

  14. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    BACKGROUND: Surgical injury leads to an endocrine-metabolic and inflammatory response with protein catabolism, increased cardiovascular demands, impaired pulmonary function and paralytic ileus, the most important release mechanisms being afferent neural stimuli and inflammatory mediators. RESULTS......: Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism. Furthermore, dynamic pain relief is achieved with improved pulmonary function and a pronounced reduction of postoperative ileus, thereby providing optimal conditions...

  15. Caudal analgesia and cardiothoracic surgery: a look at postoperative pain scores in a pediatric population.

    Science.gov (United States)

    Nguyen, Khoa N; Byrd, Heather S; Tan, Jonathan M

    2016-11-01

    Caudal epidural anesthesia has been shown to reduce stress response and shorten the time to extubation in children after cardiac surgery. Combined with general anesthesia, regional anesthesia has been proven to be safe and efficacious in the pediatric population. It is not known, however, whether the use of caudal anesthesia actually reduces postoperative pain scores and decreases postoperative opioid use. We retrospectively analyzed the charts of 199 children who underwent repair for atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot (TOF) at a major academic children's hospital between 2010 and 2013. Eighty-six patients underwent preoperative placement of caudal anesthesia (bupivacaine 0.25% 1 ml·kg(-1) up to 20 ml + clonidine 2mcg·kg(-1) + Duramorph 40 mcg·kg(-1) up to 2.5 mg) and 113 patients did not have a caudal block. Postoperative cardiac intensive care pain scores were analyzed according to standard nurse-recorded patient-appropriate pain scales ranging from 0 to 10 (CRIES for neonates and FLACC for 2 months-7 years). There was no statistical difference between caudal and noncaudal groups with respect to postoperative pain scores or with postoperative opioid requirements. There was a statistical significance with regard to intraoperative opioid use as noncaudal patients invariably received more opioid during the procedure. Although regional anesthesia reduced intraoperative opioid usage, there was no difference in postoperative opioid usage or pain scores. © 2016 John Wiley & Sons Ltd.

  16. Prospective observational study of the non-invasive assessment of immediate postoperative pain using the analgesia/nociception index (ANI).

    Science.gov (United States)

    Boselli, E; Daniela-Ionescu, M; Bégou, G; Bouvet, L; Dabouz, R; Magnin, C; Allaouchiche, B

    2013-09-01

    The analgesia/nociception index (ANI), a 0-100 non-invasive index calculated from heart rate variability, reflects the analgesia/nociception balance during general anaesthesia. The aim of this study was to evaluate the ANI in the assessment of immediate postoperative pain in adult patients undergoing general anaesthesia. Two-hundred patients undergoing scheduled surgery or endoscopy with general anaesthesia were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) after arousal from general anaesthesia. Receiver-operating characteristic (ROC) curves were built to assess the performance of ANI to detect patients with NRS>3 and NRS ≥ 7 on arrival in the postoperative care unit. A negative linear relationship was observed between ANI and NRS (ANI=-5.2 × NRS+77.9, r(2)=0.41, Psensitivity and specificity of ANI to detect patients with NRS>3 were 78 and 80%, respectively, with a negative predictive value of 88%, corresponding to an area under the ROC curve (AUC) of 0.86. At the threshold of 48, the sensitivity and specificity of ANI to detect NRS ≥ 7 were 92 and 82%, respectively, with a negative predictive value of 99%, corresponding to a ROC curve AUC of 0.91. A measurement of ANI during the immediate postoperative period is significantly correlated with pain intensity. The measurement of ANI appears to be a simple and non-invasive method to assess immediate postoperative analgesia.

  17. Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

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    Gabriela Carvalho Aquilino Santos

    2015-04-01

    Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 mg.kg-1. iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

  18. Music Reduces Postoperative Pain Perception in Male Patients after Abdominal Surgery under General Anesthesia

    OpenAIRE

    Varbanova MR; Neamtu A; Gaar E; Grigorov MV

    2016-01-01

    Background: Perioperative pain after abdominal surgery is difficult to manage. Despite the advent of multimodal analgesia techniques, the opioids remain the cornerstone of treatment. Since the opioids’ adverse effects are of concern immediate postoperatively, music as a modality that would influence human behavior, is of interest as an adjunct for acute pain management. Our hypothesis was that listening to instrumental music during the perioperative period reduces the pain level and decreases...

  19. Analgesia controlada pelo paciente reduz consumo de bupivacaína no bloqueio femoral no tratamento da dor pós-operatória após reconstrução do ligamento cruzado anterior do joelho Analgesia controlada por el paciente reduce consumo de bupivacaína en bloqueo femoral para manejo de dolor postoperatorio en reconstrucción de ligamento cruzado anterior de rodilla Patient controlled analgesia reduces the consumption of bupivacaine in femoral nerve block for the treatment of postoperative pain after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Victor A. Contreras-Domínguez

    2007-08-01

    a cada 30 min; Grupo 3 (n = 30: 5 mL.h-1 de B + C en PCA cada 30 min. Los pacientes fueron intervenidos bajo anestesia espinal. Se registró dolor posquirúrgico a las 2, 4, 6, 24 y 48 horas mediante Escala Visual Análoga (EVA, consumo de morfina y bupivacaína. RESULTADOS: No se registraron diferencias en las variables demográficas entre ambos grupos. El EVA postoperatorio entre las 2 y 48 horas no mostró diferencias. El consumo de morfina entre las 4 y 48 horas fue similar en los 3 grupos (p = 0,07. En el grupo en que sólo se utilizó modo PCA, el consumo de bupivacaína fue significativamente menor (p BACKGROUND AND OBJECTIVES: Continuous femoral nerve block (CFNB is used in postoperative analgesia of hip and knee replacement surgeries with good results. The objective of this study was to evaluate the usefulness of CFNB, comparing 3 administration schedules of bupivacaine in the arthroscopic anterior cruciate ligament (ACL repair of the knee. METHODS: A prospective, controlled study with 90 stable patients, physical status ASA I and II was undertaken. Patients were divided in three groups: Group 1 (n = 30: continuous infusion (CI at a rate of 10 mL.h-1 of 0.125% bupivacaine + clonidine 1 µg.ml-1 (B+C; Group 2 (n = 30: CI at a rate of 5 mL.h-1 + PCA with 2.5 ml of B+C every 30 minutes; Group 3 (n = 30: PCA with 5 mL.h-1 of B+C every 30 minutes. Patients underwent spinal anesthesia. Postoperative pain at 2, 4, 6, 24, and 48 hours, using the Visual Analogue Scale (VAS, and consumption of morphine and bupivacaine were recorded. RESULTS: There were no statistically significant differences regarding the demographic data in both groups. The postoperative VAS between 2 and 48 hours did not show any differences. Morphine consumption between 4 and 48 hours was similar in all 3 groups (p = 0.07. The consumption of bupivacaine was significantly lower in the group that used only PCA (p < 0.001. CONCLUSIONS: Continuous femoral nerve block is a useful technique to manage

  20. Development of the fentanyl iontophoretic transdermal system (ITS) for patient-controlled analgesia of postoperative pain management.

    Science.gov (United States)

    Minkowitz, Harold S; Danesi, Hassan; Ding, Li; Jones, James B

    2015-09-01

    The fentanyl iontophoretic transdermal system (ITS) is a needle-free, patient-activated drug delivery system used for patient-controlled analgesia in adult hospitalized patients with postoperative pain. The system design has been updated to a separated system consisting of a Controller and a Drug Unit, and has had regulatory submissions in USA and Europe in 2014. Fentanyl ITS has been shown to be therapeutically equivalent to morphine intravenous (iv.) patient-controlled analgesia. One of the advantages of fentanyl ITS is that patients have better mobility as there is no need for an iv. pump, iv. lines and pole. The introduction of the updated fentanyl ITS will add a versatile tool to the postoperative pain management armamentarium.

  1. Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

    Science.gov (United States)

    Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

    2017-06-01

    Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

  2. Mechanisms of postoperative pain

    Institute of Scientific and Technical Information of China (English)

    YUE Yun

    2007-01-01

    @@ The practice of modern anaesthesiology has extended into perioperative medicine. Due to their expertise in analgesic drug pharmacology and peripheral nerve blocking, anaesthesiologists have pioneered in the management of acute postoperative pain. Effective postoperative analgesia reduces the incidence of postoperative chronic pain, improves the functioning of organs following surgery and shortens the hospital stay.1,2 Although a variety of analgesic techniques and preventative approaches are at the disposal of modem aneasthesiologists, including patient controlled epidural analgesia (PCEA), patient controlled intravenous analgesia, multimodal analgesia and pre-empty analgesia.Despite this array of strategies, these predominantly opioid based techniques are still limited by side-effects such as vomiting, nausea, itching and urinary retention.To optimize further the management of acute postoperative pain, basic mechanisms of postoperative pain must be explored and new treatments must continue to be developed.

  3. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  4. A comparison of the postoperative analgesic efficacy between epidural and intravenous analgesia in major spine surgery: a meta-analysis

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    Meng Y

    2017-02-01

    Full Text Available Yichen Meng,* Heng Jiang,* Chenglin Zhang,* Jianquan Zhao, Ce Wang, Rui Gao, Xuhui Zhou Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People’s Republic of China *These authors contributed equally to this work Abstract: Postoperative analgesia remains a challenge for orthopedic surgeons. The aim of this meta-analysis is to compare the efficacy of epidural analgesia (EA and intravenous patient-controlled analgesia (IV-PCA following major spine surgery. We searched electronic databases, including the PubMed, EMBASE, Ovid and Cochrane databases, for randomized controlled trials (RCTs published before June 2016. The quality of the included trials was assessed using the Cochrane risk-of-bias tool. Random effects models were used to estimate the standardized mean differences (SMDs and relative risks (RRs, with the corresponding 95% confidence intervals (CI. Subgroup analyses stratified by the type of epidural-infused medication and epidural delivery were also performed. A total of 17 trials matched the inclusion criteria and were chosen for the following meta-analysis. Overall, EA provided significantly superior analgesia, higher patient satisfaction and decreased overall opioid consumption compared with IV-PCA following major spine surgery. Additionally, no differences were found in the side effects associated with these two methods of analgesia. Egger’s and Begg’s tests showed no significant publication bias. We suggest that EA is superior to IV-PCA for pain management after major spine surgery. More large-scale, high-quality trials are needed to verify these findings. Keywords: adolescent idiopathic scoliosis, lumbar fusion, epidural analgesia, intravenous application, perioperative pain

  5. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C; Bigler, D;

    1988-01-01

    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

  6. Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial

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    Nalan Celebi

    2014-09-01

    Full Text Available Background and objectives: Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia. Methods: This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group and 30 patients received normal saline and remifentanil (control group as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded. Results: The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group. Conclusions: Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.

  7. Factors that Affect Intravenous Patient-Controlled Analgesia for Postoperative Pain Following Orthognathic Surgery for Mandibular Prognathism

    Science.gov (United States)

    Aoki, Yoshinori; Yoshida, Kaori; Nishizawa, Daisuke; Kasai, Shinya; Ichinohe, Tatsuya; Ikeda, Kazutaka; Fukuda, Ken-ichi

    2014-01-01

    The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (Pbimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535). Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008). The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the present study will contribute to adequately relieving individual patients from postoperative pain. PMID:24893040

  8. Analgesia postoperatoria en la queiloplastia del lactante. Estudio comparativo: bloqueo infraorbitario intraoral bilateral con bupivacaína 0,25% con adrenalina vs. analgesia intravenosa con tramadol Postoperative analgesia for the management of chieloplasty in the breast-fed baby. Comparative study: bilateral intraoral blockade of the infraorbitary nerve with bupivacaine 0.25% plus adrenaline versus intravenous analgesia with tramadol

    Directory of Open Access Journals (Sweden)

    J. A. Delgado

    2005-05-01

    Reanimation, length of analgesia, degree of discomfort and pain severity were assessed. The presence of complications or side effects was also recorded. Data were analyzed using the t Student and the χ² test. Results: No differences were found regarding demographic features. Analgesia lasted more in group A (7.3 ± 5.1 h compared to group B (2.8 ± 2.2 h (p < 0.01. Subjective assessment of pain severity was higher in group B (2.23 ± 0.83 compared to group A (0.66 ± 0.6 (p < 0.01. Degree of comfort, as assessed through an objective scale, was significantly greater in the group undergoing blockade with local anesthetic. Discussion: Anesthesia for neonates undergoing surgical reparation of harelip with intraoral bilateral blockade of the infraorbitary nerve is a safe, simple and quick technique that provides a lasting postoperative analgesia and also reduces the risks of respiratory depression, since it allows a lower use of opiate analgesics and, hence, an immediate and comfortable awakening.

  9. COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF ETORICOXIB VS PLACEBO AS PREEMPTIVE ANALGESIA FOR ACUTE POSTOPERATIVE PAIN RELIEF IN ORTHOPEDIC SURGERIES

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    Sowbhagya Lakshmi

    2014-07-01

    Full Text Available BACKGROUND: Etoricoxib, a selective Cox-2 inhibitor has been found to be effective as preemptive analgesia for acute postoperative pain. This study evaluates the effect of preoperative use of oral etoricoxib on postoperative pain relief and sleep in patients undergoing lumbar laminectomies. MATERIALS & METHODS: In this prospective, randomized controlled study, fifty patients (ASA I & II aged between 20-50yrs scheduled to undergo lumbar laminectomies were given either etoricoxib 120mg (Group E or placebo (Group P orally one hour before surgery. Visual analog score (VAS was assessed at 0, 6, 12, 18, and 24 hours at rest and on movement. Sleep overnight, total fentanyl consumption, incidence of nausea and vomiting, intra-operative blood loss and patient satisfaction were noted. RESULTS: In our study we found that there was reduction in VAS at rest and on movement in the etoricoxib group when compared with the control group at all intervals till 24 hours postoperatively. Total fentanyl consumption was higher in control group in postoperative period. CONCLUSION: Single preoperative oral dose (120mg of etoricoxib given one hour before surgery, has significantly reduced the postoperative pain at rest and on movement and improved sleep in patients undergoing lumbar laminectomies without any side effects and with good patient’s satisfaction

  10. Comparative Study of Greater Palatine Nerve Block and Intravenous Pethidine for Postoperative Analgesia in Children Undergoing Palatoplasty

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    Manjunath R Kamath

    2009-01-01

    Full Text Available Greater palatine nerve block anaesthetizes posterior portions of the hard palate and its overlying soft tissues. This study compared the efficacy, safety, and ease of the nerve block for cleft palate surgeries in children with i.v. pethidine for postoperative pain management. A prospective, double blind, randomized trial, enrolled 50 children aged below 10 years scheduled for palatoplasty and were alternatively allocated to two groups. Group A received intravenous pethidine 1mg.kg-1, whereas Group B, bilateral greater palatine nerve block with bupivacaine 0.25%, 1ml on each side, before the surgical stimulation. Modified Aldrete Scoring System, Children′s Hospital Eastern Ontario Pain Scale (CHEOPS and Brussels Sedation Score were employed to assess recovery, quality of analgesia and sedation respectively, by the nursing staff. Whenever pain score was> 8, 0.5mg.kg-1 of pethidine was given intravenously for rescue analgesia in both groups. Recovery scores were better in Group B (p=0.007. In the immediate postoperative period, pain score was more in Group A (number of patients with pain score> 8, 44% v/s 12%, p= .0117. Requirement for rescue analgesia was more in Group A (60 times v/s 7. The average sedation scores were similar. There was a higher incidence of agitation in Group A (66 vs. 30. The incidence of deep sedation was nearly half in Group B (34 Vs 63. Greater palatine nerve block was considered successful in 88% of cases. Greater palatine nerve block produces more effective, consistent and prolonged analgesia than pethidine.

  11. Evaluation of caudal dexamethasone with ropivacaine for post-operative analgesia in paediatric herniotomies: A randomised controlled study

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    Santosh Choudhary

    2016-01-01

    Full Text Available Background and Aims: Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing infra-umbilical surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone 0.1 mg/kg as an adjuvant to the ropivacaine improved analgesic efficacy after paediatric herniotomies. Methods: Totally 128 patients of 1–5 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective inguinal herniotomy were randomly allocated to two groups in double-blind manner. Group A received 1 ml/kg of 0.2% ropivacaine caudally and Group B received 1 ml/kg of 0.2% ropivacaine, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by faces, legs, activity, cry and consolability tool score, rescue analgesic requirement and adverse effects were noted for 24 h. Results: Results were statistically analysed using Student's t-test. Pain scores measured at 1, 2, 4, and 6 h post-operative, were lower in Group B as compared to Group A. Mean duration of analgesia in Group A was 248.4 ± 54.1 min and in Group B was 478.046 ± 104.57 min with P = 0.001. Rescue analgesic requirement was more in Group A as compared to Group B. Adverse effects after surgery were comparable between the two groups. Conclusion: Caudal dexamethasone added to ropivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal ropivacaine alone.

  12. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery.

    Science.gov (United States)

    Landwehr, Susanne; Kiencke, Peter; Giesecke, Thorsten; Eggert, Dirk; Thumann, Gabriele; Kampe, Sandra

    2005-10-01

    .8 6 to 19.6). None of the patients experienced itching; one patient in the Meta Group developed a mild erythema. There was no statistical difference in the incidence of nausea (Plac vs. Para Group: p = 0.94, Plac vs. Meta Group: p = 0.98, Para vs Meta Group: p = 0.95) or vomiting (Plac vs. Para Group: p = 0.73, Plac vs. Meta Group: p = 0.85, Para vs Meta Group: p = 0.86) between the groups. Patients in the Plac Group experienced significantly more often sedation than patients in the Meta Group (p = 0.049). There was a trend of higher sedation in the Plac Group than in the Para Group, which did not reach statistical significance (p = 0.07). There was no difference in sedation between the Meta and the Para Groups (p = 0.84). IV paracetamol 1 g has a similar analgesic potency as IV metamizol 1 g for postoperative analgesia after retinal surgery.

  13. Dexmedetomidine Analgesia Effects in Patients Undergoing Dental Implant Surgery and Its Impact on Postoperative Inflammatory and Oxidative Stress

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    Sisi Li

    2015-01-01

    Full Text Available The aim of the study was to determine whether or not dexmedetomidine- (DEX- based intravenous infusion in dental implantation can provide better sedation and postoperative analgesia via suppressing postoperative inflammation and oxidative stress. Sixty patients were randomly assigned to receive either DEX (group D or midazolam (group M. Recorded variables were vital sign (SBP/HR/RPP/SpO2/RR, visual analogue scale (VAS pain scores, and observer’s assessment of alertness/sedation scale (OAAS scores. The plasma levels of interleukin-6 (IL-6, tumor necrosis factor alpha (TNF-α, antioxidant superoxide dismutase (SOD, and the lipid peroxidation product malondialdehyde (MDA were detected at baseline and after 2, 4, and 24 h of drug administration. The VAS pain scores and OAAS scores were significantly lower for patients in group D compared to group M. The plasma levels of TNF-α, IL-6, and MDA were significantly lower in group D patients than those in group M at 2 h and 4 h. In group M, SOD levels decreased as compared to group D at 2 h and 4 h. The plasma levels of TNF-α, IL-6, and MDA were positively correlated with VAS pain scores while SOD negatively correlated with VAS pain scores. Therefore, DEX appears to provide better sedation during office-based artificial tooth implantation. DEX offers better postoperative analgesia via anti-inflammatory and antioxidation pathway.

  14. Dexmedetomidine Analgesia Effects in Patients Undergoing Dental Implant Surgery and Its Impact on Postoperative Inflammatory and Oxidative Stress.

    Science.gov (United States)

    Li, Sisi; Yang, Yang; Yu, Cong; Yao, Ying; Wu, Yujia; Qian, Lian; Cheung, Chi Wai

    2015-01-01

    The aim of the study was to determine whether or not dexmedetomidine- (DEX-) based intravenous infusion in dental implantation can provide better sedation and postoperative analgesia via suppressing postoperative inflammation and oxidative stress. Sixty patients were randomly assigned to receive either DEX (group D) or midazolam (group M). Recorded variables were vital sign (SBP/HR/RPP/SpO2/RR), visual analogue scale (VAS) pain scores, and observer's assessment of alertness/sedation scale (OAAS) scores. The plasma levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), antioxidant superoxide dismutase (SOD), and the lipid peroxidation product malondialdehyde (MDA) were detected at baseline and after 2, 4, and 24 h of drug administration. The VAS pain scores and OAAS scores were significantly lower for patients in group D compared to group M. The plasma levels of TNF-α, IL-6, and MDA were significantly lower in group D patients than those in group M at 2 h and 4 h. In group M, SOD levels decreased as compared to group D at 2 h and 4 h. The plasma levels of TNF-α, IL-6, and MDA were positively correlated with VAS pain scores while SOD negatively correlated with VAS pain scores. Therefore, DEX appears to provide better sedation during office-based artificial tooth implantation. DEX offers better postoperative analgesia via anti-inflammatory and antioxidation pathway.

  15. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery

    DEFF Research Database (Denmark)

    Weibel, S; Jokinen, J; Pace, N L

    2016-01-01

    % CI -0.47 to 0.03). Subgroup analysis and trial sequential analysis suggested pain reduction for patients undergoing laparoscopic abdominal surgery or open abdominal surgery, but not for patients undergoing other surgeries. There was limited evidence of positive effects of lidocaine on postoperative...... infusion. RESULTS: Forty-five trials (2802 participants) were included. Meta-analysis suggested that lidocaine reduced postoperative pain (visual analogue scale, 0 to 10 cm) at 1-4 h (MD -0.84, 95% CI -1.10 to -0.59) and at 24 h (MD -0.34, 95% CI -0.57 to -0.11) after surgery, but not at 48 h (MD -0.22, 95......) and indirectness (small studies). CONCLUSIONS: There is limited evidence suggesting that i.v. lidocaine may be a useful adjuvant during general anaesthesia because of its beneficial impact on several outcomes after surgery....

  16. Continuous spinal analgesia with levobupivacaine for postoperative pain management: Comparison of 0.125% versus 0.0625% in elective total knee and hip replacement: A double-blind randomized study

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    Alessandro D′Ambrosio

    2015-01-01

    Full Text Available Background and Aims: Continuous spinal anesthesia (CSA has not been widely used for postoperative analgesia, mainly to avoid complications from the subarachnoid injection. Recently, the introduction of low caliber CSA catheters (Spinocath ® , has allowed to decrease anesthetics doses and volumes with good analgesia and reduced complications. The aim of this present study was to compare two concentrations of levobupivacaine administered through CSA for postoperative pain management after major orthopedic surgery. Secondary outcomes were adverse events associated with CSA. Material and Methods: Thirty-two patients were randomized to receive sufentanil 1 mcg/h plus levobupivacaine 0.125%-1 ml/h (Group A 0.125 or 0.0625%-2 ml/h (Group B 0.0625 for postoperative analgesia through CSA catheter, connected to the elastomeric pump over 48 h. The quality of analgesia was assessed based on pain intensity by Visual Analogic Scale (VAS. Sensory and motor function, hemodynamic, and respiratory parameters were recorded for 96 h after surgery, after which the catheter was removed. In addition, joint mobility was assessed, and any side effects were noted. Results: VAS score was ≤30 mm in 25 patients. Three patients in Group A 0.125 and 4 in Group B 0.0625 (NS, received a rescue dose of levobupivacaine. Median VAS in Group A 0.125 was lower than in Group B 0.0625 on T 1 h (8 ± 11 vs 16 ± 11; P < 0.05, and on T 4 h (11 ± 8 vs 18 ± 1; P < 0.05. All patients remained hemodynamically stable. There were no significant differences between groups for postoperative joints mobility. Conclusion: Levobupivacaine at a dose of 1.25 mg/h administered by CSA provides good quality analgesia independent of concentration and solution volume in patients undergoing total knee and hip replacement.

  17. Carprofen provides better post-operative analgesia than tramadol in dogs after enucleation: A randomized, masked clinical trial

    Science.gov (United States)

    Delgado, Cherlene; Bentley, Ellison; Hetzel, Scott; Smith, Lesley J

    2015-01-01

    Objective To compare analgesia provided by carprofen or tramadol in dogs after enucleation. Design Randomized, masked trial Animals Forty-three dogs Procedures Client-owned dogs admitted for routine enucleation were randomly assigned to receive either carprofen or tramadol orally 2 hours prior to surgery and 12 hours after the first dose. Dogs were scored for pain at baseline, and postoperatively at 0.25, 0.5, 1, 2, 4, 6, 8, 24, and 30 hours after extubation. Dogs received identical premedication and inhalation anesthesia regimens, including premedication with hydromorphone. If the total pain score was ≥9, if there was a score ≥ 3 in any one category, or if the visual analog scale score (VAS) was ≥35 combined with a palpation score of >0, rescue analgesia (hydromorphone) was administered and treatment failure was recorded. Characteristics between groups were compared with a Student’s t-test and Fisher’s exact test. The incidence of rescue was compared between groups using a log rank test. Pain scores and VAS scores between groups were compared using repeated measures ANOVA. Results There was no difference in age (p=0.493), gender (p=0.366) or baseline pain scores (p=0.288) between groups. Significantly more dogs receiving tramadol required rescue analgesia (6/21) compared to dogs receiving carprofen (1/22; p=0.035). Pain and VAS scores decreased linearly over time (p=0.038, ptramadol in dogs undergoing enucleation. PMID:25459482

  18. Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Rosenberg, J

    1994-01-01

    BACKGROUND AND OBJECTIVES. A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids......) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third...

  19. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Carstensen, M; Møller, A M

    2010-01-01

    In experimental trials, ketamine has been shown to reduce hyperalgesia, prevent opioid tolerance, and lower morphine consumption. Clinical trials have found contradictory results. We performed a review of randomized, double-blinded clinical trials of ketamine added to opioid in i.v. patient...... for i.v. PCA was superior to i.v. PCA opioid alone. The combination allows a significant reduction in pain score, cumulative morphine consumption, and postoperative desaturation. The benefit of adding ketamine to morphine in i.v. PCA for orthopaedic or abdominal surgery remains unclear. Owing to huge...

  20. A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA BY CAUDAL EPIDURAL ROUTE USING BUPIVACAINE WITH TRAMADOL AND BUPIVACAINE WITH FENTANYL IN PAEDIATRIC BELOW UMBILICAL SURGERIES

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    Meera

    2015-05-01

    Full Text Available The aim of this study was to compare the effectiveness of Bupivacaine (0.25% 0.5 ml/kg with Fentanyl 1μg/kg and Bupivacaine (0.25% 0.5 ml/kg with Tramadol 2 mg/kg in caudal block for postoperative analgesia. In the present study, 60 children of ASA I and II, aged between 5-12 years who were scheduled for below umbilical surgical procedures were randomly allotted into 2 groups (30 each to receive either bupivacaine with fentanyl or bupivacaine with tramadol. Caudal block was performed after induction of general anesthesia, no analgesics were given intra-operatively. Postoperative analgesia was evaluated by Numerical Rating Scale and sedation was assessed by five point sedation score. Postoperative analgesia was supplemented with Syrup Paracetamol (10mg/kg when Numerical Rating Scale was 4. Any adverse effect like respiratory depression, urinary retention, nausea and vomiting were recorded in all patients. Caudal tramadol with bupivacaine produced significant increased postoperative analgesia. The duration of analgesia was 861±23 minutes in tramadol with bupivacaine group, as compared to 353.46±31.79 minutes in fentanyl with bupivacaine group. No significant difference found in sedation score in both groups in first hour postoperatively. Two cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed urinary retention in postoperative period. Four cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed nausea and vomiting. Our study showed that caudal tramadol with bupivacaine provided longer duration of postoperative analgesia without having significant side effects.

  1. A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

    Directory of Open Access Journals (Sweden)

    Subramaniam R

    2003-01-01

    Full Text Available AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour, 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6% children in ketoprofen group had pain at recovery compared to 17/42 (40.4% in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

  2. CUMMULATIVE EFFECT OF INCISIONAL INFILTRATION IN ADDITION TO WOUND INSTILLATION, AMONG TWO SESSIONS OF TUMESCENT ANALGESIA IN POSTOPERATIVE MODIFIED RADICAL MASTECTOMY (MRM PATIENTS

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    Sreenivasa Rao

    2015-06-01

    Full Text Available AIMS: This study was conducted to evaluate and compare the efficacy of two sequential sessions of tumescent analgesia in modified radical mastectomy patients for immediate postoperative pain relief. MATERIALS AND METHODS: In this prospective randomized controlled study 100 patients treated by MRM for operable breast carcinoma in S.V.R.R.G.G. Hospital and Sri Venkateswara Medical College , Tirupati , were included in the study. They were evaluated for two consecutive sessions of tumescent analgesia. Session I involved infiltration of 20 cc of 0.25% bupivacaine subcutaneously in to the incisional area plus wound i nstillation of 100 CC of 0.4% xylocaine with adrenaline with 1 mg of butorphanol through the axillary drains. Pain was assessed every 30 minutes by using visual analogue scale ( VAS . Pain of VAS - 3 was taken as cut off point and session II of wound instillation ( 100 CC of 0.4% xylocaine with adrenaline with 1 mg of butorphanol through the axillary drains alone was executed. The efficacy of these two methods of tumescent analgesia was assessed and compared. Statistical analysis was performe d using SPSS version. RESULTS : Session I tumescent analgesia conferred 9 to 10 hours of pain relief and session II for 7 to 8 hours. CONCLUSION : Incisional infiltration of bupivacaine showed cumulative effect and imporved the quality and duration of analgesia in MRM patients in the immediate postoperative period . Tumescent analgesia is a simple and effective means of providing good postoperative pain relief without any major side - effects.

  3. Effect of peri-operative intravenous infusion of lignocaine on haemodynamic responses to intubation, extubation and post-operative analgesia

    Institute of Scientific and Technical Information of China (English)

    Yu-Mei Peng; An-Min Shao

    2016-01-01

    Objective: To study the effect of peri-operative intravenous infusion of lignocaine on haemodynamic responses to intubation, extubation and post-operative analgesia. Methods:A total of 90 patients performed with elective laparoscopic cholecystectomy under total anesthesia were randomly divided into three groups with 30 patients in each group. In Group A, patients received 6 mL normal saline as bolus over 10 min followed by 6 mL/h infusion, whereas in Group B, patients were intravenously injected with 2%lignocaine at the rate of 1 mg/kg intravenous injection, 10 min later, conducting intravenous infusion at the rate of 1 mg/kg/h until an hour after operation. In Group C, patients were intravenously injected with 2%lignocaine at a rate of 1.5 mL/kg intravenous injection, 10 min later, conducting intravenous infusion at a rate of 1.5 mL/kg/h until an hour after operation. We recorded the heart rate (HR)and mean arterial pressure (MAP)of before infusion lignocaine (T0), before induction (T1), intubation (T2), 3 min after intubation (T3), 10 min after intubation (T4), extubation (T5), 3 min after extubation (T6)and 10 min after extubation (T7). We also recorded the total injection dosage of ketorolac and pentazocine. Results:The HR and MAP of Group A on T2 and T5 were higher than T0, whereas, the HR and MAP in Groups B and C on T2 and T5 were lower than that of in Group A. The pain-free period in Groups B and C was longer than Group A. The ketorolac and pentazocine requirement in Groups B and C were lower than Group A. Conclusions:Patients were administrated with 2%lignocaine before operation at a rate of 1 mg/kg intravenous injection bolus, 10 min later at the rate of 1 mL/kg/h or 1.5 mL/kg intravenous infusion until an hour after operation. Administration of lignocaine can effectively prevent the change of haemodynamics resulting from intubation and extubation. Furthermore, it can significantly relieve the postoperative pain and reduce the usage amount of analgesic

  4. Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism.

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    Yoshinori Aoki

    Full Text Available The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (P<0.001. No significant difference in the time course of fentanyl administration was found between males and females (P = 0.653, with no interaction between time course and sex (P = 0.567. No significant difference in the time course of fentanyl administration was found among anesthesia methods, such as fentanyl induction followed by fentanyl maintenance, fentanyl induction followed by remifentanil maintenance, and remifentanil induction followed by remifentanil maintenance (P = 0.512, but an interaction between time course and anesthesia method was observed (P = 0.004. A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008, with no interaction between time course and surgical method (P = 0.535. Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008. The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the

  5. 微信在术后使用PCEA患者中的应用%Application of Wechat in Patients Treated with Postoperative Epidural Controlled Analgesia (PCEA)

    Institute of Scientific and Technical Information of China (English)

    赖红燕; 沈洁; 邱小丹; 李军

    2016-01-01

    Objective To discuss the application effect of Wechat education in patient treated with postoperative epidural controlled analgesia (PCEA).Methods In total of 200 postoperative patients who need treated with PCEA were divided into two groups, control group and observation group. 100 patients in control group were educated routinely by nurses. 100 patients in observing group were educated by acute pain service group (APS) through Wechat. Routine education was adopted in control group and routine education combined with Wechat education during PCEA treatment until 24 hour after extubation was adopted in observation group.Results There was statistically significant difference in analgesic effect of the two groups (P0.05). According to the comparison of catheter care in the two groups, catheter extraction rate and pump loss rate in the two groups were similar, and there were no statistically significant differences (P>0.05). Catheter displacement rate in control group was 16%, and in observation group it was 14%. Catheter displacement rate in control group was higher, and the difference was statistically significant (P<0.01). According to the comparison of satisfaction degree, satisfaction rate in control group was 86% and in observation group was 100%. Satisfaction rate in observation group was higher and the difference was statistically significant (P<0.001).Conclusion Wechat education among postoperative patients treated with PCEA can improve the awareness of pain, self-management ability and nursing ability of patients, improve effect of analgesia, reduce the incidence rate of catheter displacement and increase satisfaction rate of patients.

  6. Comparison of the pro-postoperative analgesia of intraoperative dexmedetomidine with and without loading dose following general anesthesia

    Science.gov (United States)

    Fan, Wei; Yang, Haikou; Sun, Yong; Zhang, Jun; Li, Guangming; Zheng, Ying; Liu, Yi

    2017-01-01

    Abstract Intraoperative dexemdetomidine (DEX) with or without loading dose is well-established to improve postoperative pain control in patient-controlled analgesia (PCA). This study was designed to compare the pro-analgesia effect between the 2 in patients received general anesthesia. Seventy patients shceduced abdominal surgery under general anesthesia were randomly assigned into 3 groups which were maintained using propofol/remifentanil/Ringer solution (PRR), propofol/remifentanil/dexmedetomidine with (PRDw) or without (PRDo) a loading dose of dexmedetomidine before induction. PRDw/o patients displayed a greater Romsay sedation score measured immediately after surgery. When compared with PRR patients, those from the PRDw/o group had an increased time to first request of postoperative morphine and decreased 24 hours total morphine consumption. No significant difference was observed between patients from the PRDw and PRDo groups with respect to these parameters. The present study suggests that the administration of a DEX loading dose does not affect the pro-analgesic effect of intraoperative use of DEX on morphine-based PCA. PMID:28207529

  7. Analgesia postoperatoria tras artroplastia de rodilla mediante bloqueo femoral continuo con ropivacaína Postoperative analgesia after knee arthroplasty through continuous femoral blockage with ropivacaine

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    M. Reina

    2004-02-01

    intervenidos de artroplastia total de rodilla, constituyendo una técnica fácil de realizar, con un elevado grado de satisfacción en los pacientes estudiados.Introduction: The aim of this study was to determine the degree of pain and satisfaction after surgery of patients that received analgesia through continuous femoral blockage for total knee arthroplasty. Material and method: ASA I-III patients diagnosed of gonarthrosis and undergoing total knee arthroplasty under intradural anaesthesia were included. In the recovery unit and under the residuary effects of intradural anaesthesia, a catheter was placed near the femoral nerve, with neurostimulation. An initial bolus of 30 ml of ropivacaine 0.375% was administered, followed by continuous infusion of ropivacaine 0.125% 10 ml.h-1 maintained during the first 48 hours of postoperative. The following variables were recorded: postoperative pain at 24 and 48 hours as assessed through EVA, pain location, presence of motor blockage, paresthesia-dysesthesia and side effects, as well as drugs used in case of inappropriate analgesia, technical difficulty and degree of satisfaction after 48 hours. Results: Eight patients were included, with an average weight and height of 78 kg and 157 cm, respectively. Pain severity recorded at 24 hours was EVA 0 (62.5%, EVA 5 (25% and EVA 6 (12.5%. At 48 hours, 87.5% of patients had EVA 0 and 12,5%, EVA 4. All the patients with pain located it at the popliteal bone. Motor blockage was absent in all the patients. Paresthesia and nausea were present in 25% of patients at 24-48 hours. Intravenous NSAIs were used to complement the therapy in patients with inadequate anaesthesia, except for one patient in which a sciatic nerve blockage was performed using the anterior approach. The technique was easy to perform in 87.5% of patients and very difficult in 12.5%. Degree of satisfaction scored > 7 in all the patients. Conclusions: In our series, continuous 3-in-1 blockage provided effective analgesia in

  8. Influence of pre-emptive versus preventive analgesia with oral acetaminophen on postoperative pain in painful ophthalmic surgeries: which one is better?

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    Hassanali Soltani

    2007-06-01

    time of the first analgesic use and analgesic consumption.

    CONCLUSIONS: The use of oral acetaminophen as pre-emptive analgesia one hour before painful ophthalmic surgeries may reduce postoperative pain intensity.

    KEY WORDS: Ophthalmic surgery, postoperative pain, pre-emptive analgesia, preventive analgesia, acetaminophen.

  9. Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

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    Neha Baduni

    2016-01-01

    Full Text Available Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM, and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

  10. Anaesthesia and postoperative analgesia in surgical neonates with or without Downs syndrome: Is it really different?

    NARCIS (Netherlands)

    A.J. Valkenburg (Abraham); M. van Dijk (Monique); T.G. de Leeuw (Tom); C.J.H.M. Meeussen (Conny ); C.A.J. Knibbe (Catherijne); D. Tibboel (Dick)

    2012-01-01

    textabstractBackgroundReports conflict on optimal postoperative analgesic treatment in children with intellectual disability. We retrospectively compared postoperative analgesics consumption between neonates with and without Downs syndrome in relation to anaesthesia requirements and pain scores. Met

  11. COMPARISON OF BUTORPHANOL AND BUPRENORPHINE AS AN ADJUVANT TO LOCAL ANAESTHESIA IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR POST-OPERATIVE ANALGESIA

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    Vinod

    2014-04-01

    Full Text Available BACKGROUND: Supraclavicular brachial plexus block provides anesthesia for surgeries around elbow, forearm and hand. With advent of opioid receptors, variety of opioid agents is used for postoperative analgesia via brachial plexus block. Butorphanol and Buprenorphine can be used along with local anesthetics to provide post op analgesia. AIMS: 1 To study the onset and extent of sensory and motor blockade. 2 To compare the duration of postoperative analgesia in two groups. METHODOLOGY: A study was carried out in 30 patients aged 18-60yr of ASA grade I & II of either sex in each group undergoing orthopedic upper limb surgeries via supraclavicular brachial plexus block. Injection Butorphanol 1mg (Group-I and Buprenorphine150µg (Group-II were added to local anesthetic mixture. Onset of sensory and motor blockade, extent of blockade and occurrence of any complications were studied in both the groups. All patients were observed for analgesia hourly until patient demanded analgesia post-operatively by VAS pain score. RESULTS: In Group II (Buprenorphine onset of sensory, motor blockade and complete blockade was delayed as compared to Group I (Butorphanol. In Group I patients, VAS score was 39.44  16.66 at the end of 5 hours while in Group II patients 50.35  25.65 VAS score at the end of 8 hours. So the duration of analgesia was upto 5-6 hours in Group I, where it was upto 8-9 hours in Group II. CONCLUSION: Both drugs are potent analgesic in brachial plexus block, but Buprenorphine is more potent and produces longer duration of postoperative analgesia than Butorphanol.

  12. COMPARISON OF EPIDURAL ANESTHESIA AND POSTOPERATIVE ANALGESIA WITH ROPIVACAINE AND FENTANYL IN OFF - PUMP CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED, CONTROLLED STUDY

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    Kaushal

    2014-01-01

    Full Text Available BACKGROUND: Our aim was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion with ropivacaine and Fentanyl in off - pump coronary bypass grafting. INTRODUCTION : In cardiosurgical patients, high thoracic epidural anesthesia (EA with local anesthetics and opioids can provide effective analgesia and reduce the number of perioperative complications. However, the use of EA in coronary surgery is controversial, and it is still unclear whether EA influences lung fluid balance , cardiopulmonary function and clinical outcome in OPCAB. Thus, the method requires further evaluation and its potential benefits in coronary patients should be weighed against its risks. MATERIALS AND METHODS : A prospective study was performed in 4 0 patients undergoing coronary artery bypass surgery who received high thoracic epidural analgesia. Group 1 received thoracic epidural 0.2% ropivacaine (bolus 10 ml, 10 min before starting surgery while group 2 pts. received Fentanyl 2 mcg/ml (bolus 10 ml , 10 min before starting surgery, then rate of epidural infusion adjusted between 3 - 8 ml/ hr. of the same concentration according to response. The Regimens aimed at a visual analog scale (VAS score < or = 4/10 . Hemodynamic parameters and blood gases were measured from extubation till 24 h after OPCAB. RESULTS : O utcome measures included the incidence of Visual Analogue Score (VAS < or =4/10, infusion rate adjustments and side - effects. Patients receiving ropivacaine were less likely to experience pain < or =4/10 (P' = 0.002; the infusion rate was lower (P' = 0.024; required less rate adjustments (P' = 0.001; a less need for noradrenaline (P' = 0.001 and antiemetic drugs (P' = 0.001. There were no significant differences between the groups for sedation s cores or the incidence of respiratory depression. CONCLUSION : This study suggests that ropivacaine 0.2% may be superior to fentanyl 2 microg/ml. We found a reduced number of

  13. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

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    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  14. Severe cast burn after bunionectomy in a patient who received peripheral nerve blocks for postoperative analgesia

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    Joelle W Boeve

    2011-03-01

    Full Text Available Patrick K Boyle, John J Badal, Joelle W BoeveDepartment of Anesthesiology, Arizona Health Sciences Center, Tucson, AZ, USAAbstract: Although regional anesthesia offers advantages for intraoperative and postoperative pain relief, it is not possible without complications. A case of a significant burn injury after splint placement is described after a peripheral nerve block was performed for postoperative pain management. It is our hope that this case alerts physicians and others involved in the management of postoperative patients to the challenges of managing a blocked extremity after thermal cast placement and offers solutions that can be standardized.Keywords: Peripheral nerve block, cast burn, postoperative complication

  15. Single dose oral clonidine premedication does not enhance postoperative, single low dose epidural morphine analgesia in hysterectomy patients.

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    Oofuvong, Maliwan; Chanvej, Laksamee; Thongsuksai, Paramee

    2005-03-01

    In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

  16. Postoperative analgesia with intramuscular morphine at fixed rate versus epidural morphine or sufentanil and bupivacaine in patients undergoing major abdominal surgery

    NARCIS (Netherlands)

    Broekema, AA; Veen, A; Fidler, [No Value; Gielen, MJM; Hennis, PJ

    1998-01-01

    We assessed the efficacy and side effects of postoperative analgesia with three different pain regimens in 90 patients undergoing major abdominal surgery. The patients were randomly assigned to one of three groups: epidural morphine (EM) or sufentanil (ES), both combined with bupivacaine, or IM morp

  17. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results

    DEFF Research Database (Denmark)

    Lund, J; Jenstrup, M T; Jæger, P;

    2011-01-01

    Because both the saphenous nerve and in part the obturator nerve are traversing the adductor canal of the thigh, we hypothesised that repeated administration of a local anaesthetic (LA) into this aponeurotic space could be a useful option for post-operative analgesia after knee replacement surgery....... A systematic search of the literature pertinent to the blockade of the saphenous and/or obturator nerves for pain relief after knee surgery was conducted. Further, pain and opioid requirements were evaluated in eight patients receiving a continuous blockade of the saphenous and obturator nerve (adductor-canal......-blockade) after total knee arthroplasty (TKA). Finally, we performed cross-sectional MR scans of the adductor canal after injection of ropivacaine 30ml in one patient. The systematic literature search revealed only one controlled study, where selective blockade of the saphenous nerve was investigated...

  18. The Effects of Single-Dose Rectal Midazolam Application on Postoperative Recovery, Sedation, and Analgesia in Children Given Caudal Anesthesia Plus Bupivacaine

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    Sedat Saylan

    2014-01-01

    Full Text Available Background. This study aimed to compare the effects of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, and sedation and to find out its adverse effects in children having lower abdominal surgery. Methods. 40 children between 2 and 10 years of ASA I-II were randomized, and they received caudal anesthesia under general anesthesia. Patients underwent the application of caudal block in addition to saline and 1 mL/kg bupivacaine 0.25%. In the postoperative period, Group C (n = 20 was given 5 mL saline, and Group M (n = 20 was given 0.30 mg/kg rectal midazolam diluted with 5 mL saline. Sedation scale and postoperative pain scale (CHIPPS of the patients were evaluated. The patients were observed for their analgesic need, first analgesic time, and adverse effects for 24 hours. Results. Demographic and hemodynamic data of the two groups did not differ. Postoperative sedation scores in both groups were significantly lower compared with the preoperative period. There was no significant difference between the groups in terms of sedation and sufficient analgesia. Conclusions. We conclude that caudal anesthesia provided sufficient analgesia in peroperative and postoperative periods, and rectal midazolam addition did not create any differences. This trial is registered with ClinicalTrials.gov NCT02127489.

  19. Buprenorphine for postoperative analgesia: Axillary brachial plexus block versus intramuscular administration in a placebo-controlled trial

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    Deepali Thakur

    2015-01-01

    Full Text Available Background and Aims: Peripheral administration of opioids has been suggested for prolongation of regional analgesia. This prospective, randomized, double-blind placebo-controlled study was undertaken to compare the effect of regional (axillary brachial plexus block [ABPB] versus intramuscular (IM buprenorphine (2 μg/kg in adults. Material and Methods: Seventy-five adults undergoing upper limb surgery received ABPB with local anaesthetic (15 ml 0.5% bupivacaine, 15 ml 2% lignocaine with adrenaline 1:200,000, 9 ml normal saline [NS]. In addition, regional group RB (n = 25 received buprenorphine 2 μg/kg in ABPB and 1 ml NS IM. Systemic Group SB (n = 25 received 1 ml NS in ABPB and buprenorphine 2 μg/kg IM. Group C (n = 25 received 1 ml NS in ABPB and IM. Onset, duration of sensory and motor block, hemodynamic parameters, sedation score, pain scores using visual analog scale, duration of postoperative analgesia, rescue analgesic (RA requirement, adverse events, and patient satisfaction were noted. Results: Demographics, onset and duration of sensory, motor block were similar. RB group had longest duration of analgesia (20.61 ± 1.33 h compared to SB (10.91 ± 0.90 h and control group (5.86 ± 0.57 h (P < 0.05 RB vs. SB/C and SB vs. C. RA requirement was highest in the control group and least in RB group (P = 0.000 RB vs. SB/C and SB vs. C. SB group had a maximum number of side effects (P = 0.041, SB vs. RB/C. Patient satisfaction was highest with group RB (P < 0.05 RB vs. SB/C, and P = 0.06 SB vs. C. Conclusion: Buprenorphine 2 μg/kg in axillary plexus block provides significantly prolonged analgesia with less RA requirement and greater patient satisfaction compared to IM administration. This is highly suggestive of action on peripheral opioid receptors.

  20. Comparison of Effect of Intrathecal Sufentanil-Bupivacaine and Fentanyl-Bupivacaine Combination on Postoperative Analgesia

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    Ishwar Singh

    2008-01-01

    Full Text Available Fifty ASA grade I/II patients scheduled for elective lower abdominal, lower limb and urological procedures were divided into two groups of 25 each .The first group (Group S received 2.5 ml of heavy bupivacaine with 0.2. ml sufentanil made up to 3 ml with saline. The second group (Group F received 2.5 ml of heavy bupivacaine with 0.5 ml of fentanyl. From our study it can be concluded that bupivacaine sufentanil combination although had shorter onset of action, but had more side effects especially nausea, vomiting and headache. The time for rescue analgesia in both groups was however similar.

  1. Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

    Science.gov (United States)

    Ris, F; Findlay, JM; Hompes, R; Rashid, A; Warwick, J; Cunningham, C; Jones, O; Crabtree, N

    2014-01-01

    Introduction Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection. Methods This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0–3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool). Results There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, pflatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen. Conclusions Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural. PMID:25350178

  2. COMPARISON OF EFFECT OF MAGNESIUM SULPHATE AND PRESERVATIVE-FREE KETAMINE AS AN ADJUNCT TO EPIDURAL BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN ABDOMINAL HYSTERECTOMY

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    Radha Korumbil Raghavan

    2017-08-01

    Full Text Available BACKGROUND Neuraxial blocks are the most common method of anaesthesia in abdominal hysterectomies and epidural technique has been used widely to provide both anaesthesia and postoperative analgesia. It has become a common practice to use polypharmacy approach for treatment of intra and postoperative pain, because no drug has yet been identified that specifically inhibit nociception without side effects. The aim of the study is to compare the effects of magnesium sulphate versus preservative-free ketamine as an adjunct to epidural bupivacaine for postoperative analgesia in abdominal hysterectomy. MATERIALS AND METHODS After obtaining informed consent, the patients were divided into 3 groups of 40 each to receive 20 mL 0.5% bupivacaine (group B, 19 mL 0.5% bupivacaine + 50 mg magnesium sulphate (group BM, 19 mL 0.5% bupivacaine + 50 mg preservative-free ketamine (group BK. Epidural catheter was inserted at L1-L2 space using standard technique. Correct placement was confirmed by a test dose of 2% lignocaine + adrenaline 1 in 2 lakhs. Postoperative analgesia were assessed by VAS score and 0.125% bupivacaine infusion and 1 g paracetamol IV infusion was given as rescue analgesics when VAS ≥4. Onset duration, motor block and side effects were also monitored. RESULTS Mean time of duration of onset in group B, BM, BK were 20, 14, 18 minutes, respectively. Mean time for rescue analgesia were 180, 240 and 480 minutes in group 1, 2 and 3, respectively. These differences were statistically significant. The side effects noticed in each group were not statistically significant. CONCLUSION The onset of effect is faster when magnesium sulphate were added as an adjunct to bupivacaine as compared to preservativefree ketamine. The postoperative analgesia is found to be more with preservative-free ketamine as compared to magnesium sulphate without any significant side effects.

  3. Intraoperative haloperidol does not improve quality of recovery and postoperative analgesia

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    Amin Ebneshahidi

    2013-01-01

    Conclusion: Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.

  4. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

    DEFF Research Database (Denmark)

    Fischer, H.B.; Simanski, C.J.; Sharp, C.

    2008-01-01

    The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are th...... techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain) Udgivelsesdato: 2008/10...

  5. Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: a double-blind, randomized, crossover study.

    Science.gov (United States)

    Colombini, Bella L; Modena, Karin C S; Calvo, Adriana M; Sakai, Vivien T; Giglio, Fernando P M; Dionísio, Thiago J; Trindade, Alceu S; Lauris, José R P; Santos, Carlos F

    2006-08-01

    Comparison of the clinical efficacy of 4% articaine in relation to 2% mepivacaine, both with 1:100,000 epinephrine, in the prevention of postoperative pain after lower third molar removal. Twenty patients underwent removal of bilateral lower third molars under local anesthesia (articaine or mepivacaine) in 2 separate appointments, in a double-blind, randomized, and crossed manner. Objective and subjective parameters were recorded for paired comparison of postoperative courses. Duration of analgesia provided by articaine and mepivacaine was 198.00 +/- 25.86, and 125.40 +/- 13.96 min, respectively (P = .02), whereas the duration of anesthesia was 273.80 +/- 15.94 and 216.85 +/- 20.15 min, respectively (P = .06). Both solutions exerted no important effects upon arterial pressure, heart rate, or oxygen saturation (P > .05). Articaine provides a longer period of analgesic effect and a tendency for a longer period of anesthesia as compared to mepivacaine. The presence of a vasoconstrictor agent in local anesthetic solutions does not seem to influence hemodynamic parameters during lower third molar removal in healthy subjects.

  6. Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty.

    Science.gov (United States)

    Xu, Zhongwei; Zhang, Hua; Luo, Jiao; Zhou, Aiguo; Zhang, Jian

    2017-09-01

    This study was aimed to evaluate the efficacy of preemptive analgesia (PA) by using celecoxib combined with low-dose tramadol/acetaminophen (tramadol/APAP) in treating post-operative pain of patients undergoing unilateral total knee arthroplasty (TKA). A total of 132 patients scheduled for TKA were included in this study. Three-day pre-operative medication was administrated in PA group with subsequent effective intra- and post-operative multimodal analgesia, while control patients received multimodal analgesia without PA. Visual analog scale (VAS) was utilized to assess the pain intensity at rest and during movement. VAS scores of participants were recorded 3 days before surgery, 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Moreover, the length of hospital stay, expense of hospitalization, C-reactive protein (CRP) values during hospitalization, and complications during medication were also recorded. PA showed superiority over control at 3 weeks (P = 0.013) and 6 weeks (P = 0.046) in resting pain, and 1 week (P = 0.015), 3 weeks (P = 0.003), 6 weeks (P = 0.003) and 3 months (P = 0.012) postoperatively in movement pain. There was no statistically significant difference in the length of hospital stay, total expense, CRP values, as well as complications. Based on satisfactory intra- and post-operative analgesia, PA by 3-day administration of celecoxib and low-dose tramadol/APAP might be an effective and safe therapy regarding patients undergoing TKA in terms of alleviating post-operative pain.

  7. Impact of the CYP2D6 genotype on post-operative intravenous oxycodone analgesia

    DEFF Research Database (Denmark)

    Zwisler, S T; Enggaard, T P; Mikkelsen, S

    2009-01-01

    Background: Oxycodone is a semi-synthetic opioid with a mu-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O-demethylation via the polymorphic CYP2D6. The aim of this study was to investig......Background: Oxycodone is a semi-synthetic opioid with a mu-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O-demethylation via the polymorphic CYP2D6. The aim of this study...... for the first time in patients that the oxymorphone formation depends on CYP2D6, but we found no difference in the post-operative analgesic effect of intravenous oxycodone between the two CYP2D6 genotypes....

  8. Effect of Dexmedetomidine on Postoperative Analgesia and the Incidence of Postoperative Delirium in Elderly Patients%右美托咪定对老年患者术后镇痛和术后谵妄的影响

    Institute of Scientific and Technical Information of China (English)

    周东民; 董子明

    2014-01-01

    Objective To investigate the effect of dexmedetomidine on postoperative analgesia and the incidence of postoperative delirium in elderly patients. Methods Sixty elderly patients waiting for the selective orthopaedics operation with general anesthesia were randomly allocated to one of 2 groups (n=30 each): dexmedetomidine group (A group) and physiological-saline group (B group). In A group, patients received dexmedetomidine hydrochloride infusion in 10 min using syringe pump (0.5 μg/kg) before induction, then dexmedetomidine was administrated continually at the rate of 0.2 μg/(kg•h) until the end of operation. In B group, physiological-saline was given. All the patients of both groups received patient-controlled intravenous analgesia (PCIA) with sufentanyl. The visual analogue scores(VAS) of pain at the time of 2 h, 4 h, 6 h, 12 h, 24 h post-operation, as well as the times of PCIA in 12 h and 24 h post-operation were recorded. The occurrence of postoperative delirium was evaluated regularly until the seventh postoperative day. Results Compared with B group, the times of PCIA in 12 h and 24 h post-operation was signiifcantly reduced (P<0.05) and VAS score at the time of 2 h, 4 h, 6 h post-operation decreased (P<0.05), as well as the occurrence of postoperative delirium was signiifcantly reduced (P<0.05) in A group. Conclusion In the elderly patients, intravenous infusion of dexmedetomidine can effectively assist the postoperative analgesic efifcacy and reduce the occurrence of postoperative delirium.%目的:探讨右美托咪定对老年患者术后镇痛及术后谵妄的影响。方法择期全麻下行骨科手术的老年患者60例,随机分为右美托咪定组(A组)和生理盐水组(B组),每组30例。A组患者麻醉诱导前10min经静脉泵注0.5μg/kg的右美托咪定,并以0.2μg/(kg•h)持续输注至手术结束。B组患者以生理盐水代替右美托咪定,用法、用量相同。两组患者术后均使用舒芬太尼

  9. Neuronal plasticity and pre-emptive analgesia: implications for the management of postoperative pain

    DEFF Research Database (Denmark)

    Dahl, J B

    1994-01-01

    of analgesic effects and efficacy may differ from the clinical situation. In a study of patients undergoing gynaecological laparotomy, increased sensitivity to noxious electrical stimulation of the sural nerve was observed postoperatively, with a corresponding trend in the nociceptive flexion reflex...

  10. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    findings: The nature of central sensitization during acute and chronic postsurgical pain share common features, and there may be interactions between acute and persistent postoperative pain. The term ‘pre-emptive analgesia’ should be abandoned and replaced by the term ‘preventive analgesia’. Recent studies......This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive analgesia is still...

  11. Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials.

    Science.gov (United States)

    Costa, Fábio Wildson Gurgel; Esses, Diego Felipe Silveira; de Barros Silva, Paulo Goberlânio; Carvalho, Francisco Samuel Rodrigues; Sá, Carlos Diego Lopes; Albuquerque, Assis Filipe Medeiros; Bezerra, Tácio Pinheiro; Ribeiro, Thyciana Rodrigues; Sá Roriz Fonteles, Cristiane; Soares, Eduardo Costa Studart

    2015-01-01

    The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.

  12. Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients

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    Koh JC

    2017-04-01

    Full Text Available Jae Chul Koh, Young Song, So Yeon Kim, Sooyeun Park, Seo Hee Ko, Dong Woo Han Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Abstract: In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20–39 years and elderly (age ≥70 years patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6–48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001. Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%, numbness or motor weakness (67.8% vs 11.5%, urinary retention (7.4% vs 8.7%, dizziness (2.2% vs 5.2%, and hypotension (3.1% vs 20.3%. In conclusion, PCEA was more frequently associated with numbness, motor

  13. Comparison of local infiltration and epidural analgesia for postoperative pain control in total knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis

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    Huan Yan

    2016-11-01

    Full Text Available Pain management after total knee arthroplasty (TKA and total hip arthroplasty should permit early mobilization with minimal pain. Local infiltration analgesia (LIA is a new popular method for decreasing postoperative pain. The goal of this meta-analysis is to evaluate the efficacy of LIA in comparison with epidural analgesia. A literature search was performed in PubMed, EMBASE, the OVID database, Web of Science, and the Cochrane Library databases. The risk of bias was assessed using the Cochrane collaboration tool. Outcomes of interest included visual analog scale score, range of flexion, length of stay, and complications. Nine trials involving 537 patients met the inclusion criteria. LIA provides better pain relief and larger range of motion in TKA patients compared to epidural analgesia at the late postoperative period. No significant difference was observed in regard to the length of stay and complications. The current evidence shows that the use of local infiltration is effective for postoperative pain management in TKA patients. More high-quality randomized controlled trials with long-term follow-up are required for examining the long-term efficacy and safety of local infiltration. 

  14. Postoperative Analgesia After Wound Infiltration With Tramadol and Dexmedetomidine as an Adjuvant to Ropivacaine for Lumbar Discectomies: A Randomized-controlled Clinical Trial.

    Science.gov (United States)

    Mitra, Saikat; Purohit, Shobha; Sharma, Mamta

    2017-10-01

    Crippling postoperative pain linked with lumbar discectomies not only shackles patient's normal daily activities but also lengthens their hospital stay. So, allaying postoperative pain in these patients has become a substantive component in neuroanesthesia to expedite neurological recovery. Wound infiltration with local anesthetics is widely used to optimize postoperative pain. Different adjuvants like dexmedetomidine and tramadol when added to local anesthetics prolongs postoperative analgesia. The aim of this trial was to evaluate the analgesic efficacy of tramadol and dexmedetomidine when added to ropivacaine for wound infiltration in lumbar discectomies. This study was prospective, randomized, double-blind, controlled in nature conducted among 45 adult patients belonging to American Society of Anesthesiologists' physical status 1 and 2, of either sex aged between 30 and 70 years undergoing elective lumbar discectomies. They were randomly allocated into 3 equal groups: group R received 100 mg of 0.5% ropivacaine (20 mL) and 2 mL normal saline, group RT received 100 mg of 0.5% ropivacaine (20 mL) and 2 mg/kg tramadol (2 mL), and group RD received 100 mg of 0.5% ropivacaine (20 mL) and 0.5 μg/kg dexmedetomidine (2 mL) (total volume, 22 mL). Visual analog scale at 0, 2, 4, 6, 12, 18, and 24 hours; time to first rescue analgesia, total supplemental analgesic consumption and side effects (if any) were assessed during first 24 hours postoperatively. The median time to first rescue analgesia (median; 95% confidence interval [CI]) in group RD was 930 (854.3 to 1005.7) minutes. This was significantly longer (P=0.000) than group RT (420 [366.3 to 473.7] min) or group R (270 [243.2 to 296.8] min). Postoperative diclofenac consumed (median [interquartile range]) was 150 (150 to 200) mg in group R, 150 (75 to 150) mg in group RT and 75 (75 to 150) mg in group RD (P=0.008). Significant differences in mean visual analog scale scores were observed among the 3 groups at hours 0

  15. The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

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    Isra Karaduman

    2017-01-01

    Full Text Available Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL, in Group P (n=66, infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n=64, none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.

  16. COMPARATIVE STUDY OF BUPIVACAINE 0.25% VERSUS ROPIVACAINE 0.5% IN TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES: A RANDOMISED CONTROLLED TRIAL

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    Neha

    2014-04-01

    Full Text Available BACKGROUND: Transversus Abdominis Plane Block (TAPB is a regional anesthesia technique. It provides analgesia after lower abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of lower abdominal wall skin and muscles via local anesthetic deposition above Transversus Abdominis muscle. We evaluated efficacy of unilateral TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower abdominal surgeries like hernia repair, appendicectomy in a hospital based, single blind, and prospective, randomized controlled clinical trial. METHOD: 75 adult patients undergoing elective unilateral lower abdominal surgery were randomized to undergo TAPB with ropivacaine (n = 25 or bupivacaine (n = 25 or Normal saline (n = 25. At end of surgery performed under spinal anesthesia unilateral TAPB on side of surgery was performed using 20 ml of 0.5 % ropivacaine or 0.25 % bupivacaine or saline. Each patient was assessed postoperatively by a blinded investigator in post-anesthesia care unit every 5 minutes for half an hour, then every 15 minutes till 2 hours and at 4, 6, 12, 24, 48 hours postoperatively in ward. RESULT: Mean duration of analgesia was 420.6 minutes with SD of +14.01 in Bupivacaine group and 2187 minutes with SD of +1011.09 in Ropivacaine group which was found to be statistically significant. CONCLUSION: Hence 0.5% ropivacaine provided longer duration of analgesia than 0.25 % bupivacaine when used in TAPB on patients of lower abdominal surgeries. There were no complications attributable to TAPB or drugs under study

  17. Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study.

    Science.gov (United States)

    Lefevre, N; Klouche, S; de Pamphilis, O; Herman, S; Gerometta, A; Bohu, Y

    2016-11-01

    Femoral nerve block (FNB) is considered as a major advance in anterior cruciate ligament (ACL) reconstruction as it reduces the need for parenteral opioids. However, the incidence of transient or even permanent neurological deficits due to the FNB is estimated at 1.94% after knee surgery. The primary objective of this study was to compare local infiltration analgesia (LIA) to FNB during ACL reconstruction procedures. The study hypothesis was that LIA was not less effective than FNB on early postoperative pain. A retrospective analysis of data collected prospectively in the FAST cohort included a series of continuous patients who underwent primary repair for isolated ACL with a hamstring graft in 2013-2014. Changes in our anesthesia practices over time allowed us to form three successive groups: Group 1 - FNB, Group 2 - FNB+LIA, Group 3 - LIA only. Ultrasound-guided FNB was done pre-operatively. The LIA was done at the end of the procedure by the surgeon with systematic infiltration of all skin incisions and the hamstring donor site; no intra-articular injections were performed. The primary endpoint was the average early postoperative pain (Days 0-3) described by the patient on a visual analogue scale (0-10). Sample size calculation pointed to 36 subjects being needed per group for a non-inferiority study. The study involved 126 patients: G1=42, G2=38, G3=46. The patients were comparable at enrolment. The average early postoperative pain levels were 3.1±2.4, 2.8±2.0 and 2.5±2.2, respectively (P=0.66). A trend toward higher intake of tramadol was noted in the LIA group on D0 to D3, with a significant trend test on Day 1 (P=0.03) and Day 2 (P=0.02). After reconstruction of isolated ACL tears with a hamstring graft, FNB is not more effective than LIA on patients' early postoperative pain. Patients who received a FNB consumed significantly less opioid-like analgesics. III - Prospective, comparative, non-randomized study. Copyright © 2016 Elsevier Masson SAS. All

  18. The Effect of Rectal Diclofenac in Post-Cesarean Analgesia and Reducing the Patients Opioid Sedative Needs

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    S. Rabiee

    2006-10-01

    Full Text Available Introduction & Objective: Post operation pain is one of the most common compliant in every surgery. The objective of this study was to determine whether the prophylactic use of rectal sodium diclofenac produces effective analgesia after cesarean section.Materials & Methods: This randomized single blind controlled trial was carried out in Hamadan Fatemieh Hospital. The study period was from ِAugust 2000 to May 2001. Eighty patients undergoing both emergency and elective cesarean section were studied. They had uncomplicated operations that prolonged less than 90 minutes. They were divided in two groups; the test group (40 patients received 100 mg rectal diclofenac immediately before cesarean section followed by 50 mg at 6 hours after surgery. The second forty patients as control group received 50 mg pethidine during recovery but they did not receive any diclofenac suppositories.Results: The results indicated that the severity of pain according to visual analogue scale(VAS in the study group was not significantly lower than those of control group at recovery, 6 and 12 after surgery but the received analgesic in the study group was dramatically less than control group (P<0.05. The number of consumed pethidine was significantly lower in test group as compared to those of control group (16 and 64 times in test and control group respectively. The incidence of sedation and constipation was significantly lower in the test group (P<0.01. Also the incidence of nausea and post-operative pyrexia was comparable in the 2 group.Conclusion: Rectal diclofenac provides effective analgesia when given after cesarean section. It also reduces the patients’ opioid sedative needs.

  19. Dexmedetomidine Combined with Fentanil on Haemorrhoidectomy Postoper-ative Patient Controlled In-travenous Analgesia%右美托咪定复合芬太尼用于痔术后自控镇痛

    Institute of Scientific and Technical Information of China (English)

    崔艳苓; 耿立成

    2014-01-01

    目的:探讨右美托咪啶复合芬太尼在痔手术后行自控镇痛的效果。方法:100例痔术后患者随机双盲分为F组(芬太尼8μg/mL,PCA)和FD组(芬太尼8μg/mL复合右美托咪啶4μg/mL,PCA)行自控镇痛。观察24 h内PCA自控追加要求,疼痛强度,患者情绪变化以及PCA相关的不良事件的记录。结果:FD组在术后0~48 h内显著降低芬太尼需要量,从术后第4 h开始显著降低疼痛级别;FD组焦虑情绪和血浆皮质醇浓度较F组显著降低。结论:右美托咪定复合芬太尼行静脉自控镇痛可显著节约芬太尼用量,减少恶心发生率,无过度镇静和不良的血流动力学变化。%Objective To examine whether combining dexmedetomidine and fentanyl for patient-controlled analgesia (PCA) could improve analgesia while reducing fentanyl-related side-effects. Methods One hundred patients undergoing haemorrhoidectomy were allocated to receive either fentanyl alone 8μg/mL (Group F) or fen-tanyl 8 μg/mL plus dexmedetomidine 4 μg/mL (Group FD) for postoperative i.v. PCA, which was programmed to deliver 0.5 mL per demand with a 15 min lockout interval. Cumulative PCA requirements, pain intensities and PCA-related adverse events were recorded for 24 h after operation. Results Compared with Group F, patients in Group FD required considerably less fentanyl during the 0~48 h postoperative period and reported significant-ly lower pain levels from the fourth postoperative hour onwards. At each observational time point, decreases in level of anxiety and plasma cortisol concentration were significantly greater in Group FD than in Group F. Their was no apparent bradycardia, hypotension, oversedation, or respiratory depression in Group FD. Conclusion The addition of dexmedetomidine to i.v. fentanyl resulted in superior analgesia, significant fentanyl sparing, less fentanyl-induced nausea, and was devoid of additional sedation and untoward haemodynamic changes.

  20. Evaluation of the Effect of Intravenous Lidocaein Infusion on Postoperative Analgesia after Cesarean Section under Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    M. H. Bakhshaei

    2013-04-01

    Full Text Available Introduction & Objective: Many surgical patients still experience moderate to severe pain after surgery despite efforts to administer new drugs and techniques. Postoperative analgesia clearly enhances patient’s satisfaction and facilitates earlier mobilization and rehabilitation. lidocaein has been introduced as part of post operative pain management and clinical studies revealed analgesic actions in patients with chronic neuropathic pain. Our goal in this study was to determine the effect of intravenous lidocaein on post operative pain of women under-going cesarean section under spinal anesthesia. Materials & Methods: In this double blinded clinical trial study, 72 patients candidate for Ce-sarean section under spinal anesthesia were randomly selected and divided in two groups. In the case group, infusion of1.5 mg/kg lidocaein and in the control group infusion of the same volume normal saline started 15 minutes before the beginning of operation. After spinal anes-thesia with definite technique in both groups, infusion of 1.5 mg/kg/h lidocaein in case group and the same volume normal saline in the control group was administered and continued till 0.5 hour after finishing the operation. Data including systolic and diastolic blood pressure, heart rate, analgesic score according VAS and using of analgesic drugs were recorded during 24 hours after the operation. Results: Pain intensity according to VAS score in the time 2,6,12 hours post operation were significantly lower in the case group ( P2= 0.05, P6 = 0.01, P12= 0.05 .Analgesic consumption in form of suppository & IV,24 hours after surgery, was significantly lower in the case group.(P=0.001. Conclusion: Lidocaein infusion can decrease pain intensity & analgesic consumption after ce-sarean section under spinal anesthesia. (Sci J Hamadan Univ Med Sci 2013; 20 (1:9-14

  1. COMPARISON OF EPIDURAL BUPIVACAINE; FENTANYL AND THEIR COMBINATION FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL AND LOWER EXTREMITY SURGERY: A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND CONTROLLED TRIAL

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    Purba

    2016-03-01

    Full Text Available BACKGROUND Epidural analgesia with local anaesthetics and opioids provide good control of postoperative pain in lower abdominal and lower extremity surgery. AIM To evaluate and compare the analgesic action and adverse effects of epidural bupivacaine, fentanyl and their combination in postoperative period. METHODS 75 patients undergoing elective infraumbilical surgery were allocated in three groups in a randomized double blinded fashion. Postoperative analgesia was maintained with continuous infusion of epidural drug in the following manner: Group B: Injection Bupivacaine 0.125% @ 0.1mL/kg/hr through epidural route; Group F: Injection Fentanyl 4µg/mL @ 0.1mL/kg/hr through epidural route; Group BF: Injection Bupivacaine 0.0625% and Fentanyl 2µ/mL @ 0.1mL/kg/hr through epidural route. RESULTS VAS score were almost similar in all three groups at 00, 04, 08hrs and not clinically significant at that point of time. VAS score showed significant difference at 12, 20 and 24 hrs, being persistently lower in Gr BF than Gr B and Gr F. According to VRS Scale Score at 04 hrs majority of patients of all three groups had mild-to-moderate pain (p=0.278. At 08 hrs, 24% (p=0.082, 12 hrs 60% (<0.001, 16 hrs 68% (<0.001, 20 hrs 88% (<0.001 and 24 hrs 84% (<0.001 of Gr BF patients were pain free which are clinically significant. At the end of 08, 12, 16, 20, 24 postoperative hours, no patients of any groups had residual motor paralysis. Rescue analgesic needed in Gr BF patients were significantly less than other two groups. CONCLUSION Combined bupivacaine and fentanyl infusion through an epidural route provides better analgesia in comparison to bupivacaine and fentanyl alone. Total drug, rescue analgesic requirement and adverse effects are much lower in combined group.

  2. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS......: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity....

  3. Bloqueos nerviosos periféricos de la extremidad inferior para analgesia postoperatoria y tratamiento del dolor crónico Lower limb continuous peripheral nerve blocks for postoperative analgesia and chronic pain

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    V. Domingo

    2004-05-01

    , are the less known and rarely used. In this paper, we summarize the recent advances in lumbosacral plexus block, with special remark on continuous catheter blocks for postoperative analgesia and chronic pain treatment. The use of long action local anes-thetics combined with a weak motor block, like ropivacaine, permits the combination of a single skin injection technique to achieve an adequate intraoperative analgesia with continuous infusion ones for postoperative analgesia. A detailed knowledge of anatomy as well as cutaneous nerve distribution is needed for the performance of these techniques. The introduction of several image-based techniques, principally ultrasound imaging, may improve the accuracy of nerve localization and needle placement. It also can help to prevent accidental puncture to vessels and other neighbouring structures. Continuous plexus and peripheral nerve blocks offer the potential benefits of prolonged analgesia with fewer side effects, greater patient satisfaction, and faster functional recovery after surgery.

  4. Intra-articular mepivacaine reduces interventional analgesia requirements during arthroscopic surgery in dogs.

    Science.gov (United States)

    Dutton, T A G; Gurney, M A; Bright, S R

    2014-08-01

    To document efficacy of intra-articular mepivacaine in dogs based on the hypothesis that this would blunt the haemodynamic response to a nociceptive stimulus (arthroscopic surgery), reducing interventional analgesia requirements. A dose of mepivacaine 2% 0 · 1 ml/kg (2 mg/kg) was injected intra-articularly into one randomly assigned elbow joint before surgery in eight dogs undergoing bilateral elbow arthroscopy. Baseline haemodynamic measurements were recorded immediately before the start of each arthroscopic procedure and repeated at arthrocentesis, saline distension of the joint, incision, arthroscopic cannula and obturator insertion and placement of the second portal and haemodynamic variability calculated. If baseline parameters increased by more than 20% suggesting nociception, 1 µg/kg fentanyl was administered intravenously. Significantly less fentanyl was required during arthroscopy on the mepivacaine treated elbows compared to the non-treated elbows (P = 0 · 003) and the time to first fentanyl administration was significantly longer (P = 0 · 0001) in the mepivacaine treated elbows (21 · 2 ± 4 · 9 minutes) compared to the non-treated elbows (6 · 1 ± 2 · 3 minutes). Haemodynamic variability was significantly reduced in the mepivacaine group (heart rate P = 0 · 04, mean arterial pressure P = 0 · 003). Intra-articular mepivacaine blunts the haemodynamic response to arthroscopic surgery in dogs and reduces interventional analgesia requirement. © 2014 British Small Animal Veterinary Association.

  5. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination

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    Kalpana S Vora

    2012-01-01

    Conclusion: Epidural administration of a combination of sufentanil and morphine offered the advantage of faster onset of action and longer duration of analgesia as compared to the two drugs administered alone.

  6. Effect of buprenorphine as an adjunct with plain local anesthetic solution in supraclavicular brachial plexus block on quality and duration of postoperative analgesia

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    Surekha Patil

    2015-01-01

    Full Text Available Background and Aims: Supraclavicular brachial plexus block is ideal for upper limb surgical procedures. Buprenorphine, an agonist antagonist opioid has been used as an adjunct to prolong analgesia. We aimed to evaluate the quality and duration of postoperative analgesia by addition of buprenorphine to local anesthetic solution. Material and Methods: A prospective, randomized, double-blind control study was conducted on 50 healthy patients of ASA Grade I/II of age group 20-70 years scheduled for orthopedic and reconstructive surgery of upper limb under supraclavicular brachial plexus block. Patients were allocated into two groups, 25 in each group viz.: Group B (buprenorphine group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 3 μg/kg buprenorphine diluted to 1 ml normal saline. Group C (control group received 20 ml 0.5% bupivacaine + 15 ml 2% lignocaine with adrenaline (1:200,000 + 4 ml normal saline + 1500 units hyaluronidase + 1 ml normal saline. The parameters observed were onset and duration of sensory and motor block, quality and duration of analgesia and side-effects. Results: The mean duration of postoperative analgesia was significantly longer in Group B (16.04 ± 3.19 h than in Group C (6.20 ± 0.74 h. There was no difference between two groups on mean onset of sensory block. The mean duration motor block was significantly longer in Group B (4.93 ± 0.94 h than in Group C (2.25 ± 0.62 h [P < 0.05]. The mean duration of sensory block was also significantly longer in Group B (5.71 ± 0.94 h than in Group C (4.94 ± 0.70 h with P < 0.05. Conclusion: Addition of 3 μg/kg buprenorphine to 0.5% bupivacaine for supraclavicular brachial plexus block prolonged duration of postoperative analgesia and sensory blockade without an increase in side effects.

  7. Clinical evaluation of XaraColl®, a bupivacaine-collagen implant, for postoperative analgesia in two multicenter, randomized, double-blind, placebo-controlled pilot studies

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    Cusack SL

    2012-06-01

    Full Text Available Susan L Cusack,1 Mark Jaros,2 Michael Kuss,3 Harold S Minkowitz,4 Peter Winkle,5 Lisa Hemsen61Cusack Pharmaceutical Consulting, Burlington, NJ, 2Summit Analytical, Denver, CO, USA; 3Premier Research Group, Austin, TX, USA; 4Memorial Hermann Memorial City Medical Center, Houston, TX, USA; 5Advanced Clinical Research Institute, Anaheim, CA, USA; 6Innocoll Technologies, Athlone, IrelandBackground: XaraColl®, a collagen-based implant that delivers bupivacaine to the site of surgical trauma, is under development for postoperative analgesia. Because of differing patient attitudes to postoperative pain control and the inability to assess baseline pain, standard clinical methods for evaluating analgesic efficacy are compromised and justify application of novel integrated approaches.Methods: We conducted two independent, multicenter, double-blind, placebo-controlled studies in men undergoing unilateral inguinal hernioplasty by open laparotomy to evaluate the safety and efficacy of XaraColl at different doses (100 mg and 200 mg of bupivacaine hydrochloride; study 1 and 2, respectively. Enrolled patients (50 in study 1 and 53 in study 2 were randomized to receive active or placebo implants in a 1:1 ratio. Postoperative pain intensity and use of supplementary opioid medication were recorded through 72 hours. Safety was assessed through 30 days. The principal efficacy variables were the summed pain intensity (SPI, total use of opioid analgesia (TOpA, and an integrated endpoint (I-SPI-TOpA. Each variable was analyzed at 24, 48, and 72 hours after implantation. A pooled analysis of both studies was also performed retrospectively.Results: Through 24 and 48 hours, XaraColl-treated patients experienced significantly less pain in study 1 (P < 0.001 and P = 0.012, respectively whereas they took significantly less opioid analgesia in study 2 (P = 0.004 and P = 0.042, respectively. Over the same time intervals in the pooled analysis, treated patients experienced

  8. Effect of Low-Dose (Single-Dose Magnesium Sulfate on Postoperative Analgesia in Hysterectomy Patients Receiving Balanced General Anesthesia

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    Arman Taheri

    2015-01-01

    Full Text Available Background and Aim. Aparallel, randomized, double blinded, placebo-controlled trial study was designed to assess the efficacy of single low dose of intravenous magnesium sulfate on post-total abdominal hysterectomy (TAH pain relief under balanced general anesthesia. Subject and Methods. Forty women undergoing TAH surgery were assigned to two magnesium sulfate (N=20 and normal saline (N=20 groups randomly. The magnesium group received magnesium sulfate 50 mg·kg−1 in 100 mL of normal saline solution i.v as single-dose, just 15 minutes before induction of anesthesia whereas patients in control group received 100 mL of 0.9% sodium chloride solution at the same time. The same balanced general anesthesia was induced for two groups. Pethidine consumption was recorded over 24 hours precisely as postoperative analgesic. Pain score was evaluated with Numeric Rating Scale (NRS at 0, 6, 12, and 24 hours after the surgeries. Results. Postoperative pain score was lower in magnesium group at 6, 12, and 24 hours after the operations significantly (P<0.05. Pethidine requirement was significantly lower in magnesium group throughout 24 hours after the surgeries (P=0.0001. Conclusion. Single dose of magnesium sulfate during balanced general anesthesia could be considered as effective and safe method to reduce postoperative pain and opioid consumption after TAH.

  9. Analgesia pós-operatória para cesariana: a adição de clonidina à morfina subaracnóidea melhora a qualidade da analgesia? Analgesia postoperatória para cesárea: ¿la adición de clonidina a la morfina subaracnoidea mejora la calidad de la analgesia? Postoperative analgesia for cesarean section: does the addiction of clonidine to subarachnoid morphine improve the quality of the analgesia?

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    José Francisco Nunes Pereira das Neves

    2006-08-01

    ína hiperbárica a 0,5% (12,5 mg, morfina (100 µg y clonidina (15 µg y BM30 - bupivacaína hiperbárica a 0,5% (12,5 mg, morfina (100 µg y clonidina (30 µg, administradas separadamente. En el perioperatorio, fueron anotados el consumo de efedrina y la evaluación del recién nacido por el índice de Apgar. En el postoperatório, el dolor se evaluó en la 12ª hora por la Escala Analógica Visual, el tiempo para la solicitación de analgésicos y efectos colaterales postoperatórios, como comezón, náuseas, vómitos, bradicardia, hipotensión arterial y sedación. Los valores fueron considerados significativos cuando p BACKGROUND AND OBJECTIVES: The mechanism of action of alpha2-adrenergic analgesia has been explored for more than one hundred years. The increased duration of the sensitive and motor blockades caused by clonidine is dose-dependent and has antinociceptive properties. The objective of this study was to evaluate whether the addition of 15 to 30 µg of clonidine to spinal anesthesia for cesarean sections with 0.5% hyperbaric bupivacaine (12.5 mg and morphine (100 µg improves the quality of postoperative analgesia. METHODS: We realized a prospective, randomized study that included 60 patients divided in 3 groups: BM - 0.5% hyperbaric bupivacaine (12.5 mg and morphine (100 µg, BM15 - 0.5% hyperbaric bupivacaine (12.5 mg, morphine (100 µg, and clonidine (15 mg, and BM30 - 0.5% hyperbaric bupivacaine (12.5 mg, morphine (100 µg, and clonidine (30 µg, administered separately. In the perioperative period the use of ephedrine and the newborn's Apgar score were recorded. In the postoperative period, the pain was evaluated in the 12th h by the VAS, the length of time it took the patient to ask for analgesics, and the postoperative side effects, such as pruritus, nausea, vomiting, bradycardia, hypotension, and sedation. The values were considered significant when p < 0.05. RESULTS: The groups were homogenous. The use of ephedrine and the evaluation by the Apgar

  10. Analgesia invasiva domiciliaria en el manejo del dolor postoperatorio en cirugía mayor ambulatoria mediante bombas elastoméricas intravenosas Home invasive analgesia in the management of postoperative pain alter outpatient major surgery using intravenous elastomeric pumps

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    R. Rodríguez de la Torre

    2011-06-01

    los pacientes mostró un alto grado de satisfacción, un 16% de los pacientes satisfacción moderada y un 0,2% poca satisfacción. Conclusión: nuestro estudio demuestra la viabilidad y seguridad de la utilización de infusores elastoméricos endovenosos como método de analgesia postoperatoria, que permiten controlar los casos de dolor moderado a severo en procedimientos aplicados a la cirugía ambulatoria. Sin embargo se necesitan más estudios comparativos con técnicas analgésicas convencionales, así como con diferentes regímenes de infusión.Introduction: moderate to severe postoperative pain is still a problem in outpatient surgery, since it causes patient flow problems and delays the discharge of patients, being one of the major causes of re-hospitalization and hence a relevant quality indicator of these Units. The use of home invasive analgesic techniques, in all their regimes, can be effective for the management of postoperative pain in these surgical procedures and allow them to be included in outpatient surgery programs. Objectives: the aim of our study was to determine the feasibility and safety of the use of elastomeric continuous perfusion pumps for the administration of home continuous endovenous analgesia, as well as to assess analgesic effectiveness and degree of satisfaction of patients undergoing outpatient surgerys. Material and methods: we conducted a simple retrospective study in 463 patients. After the surgical procedure was performed under multimodal analgesia, two differents elastomeric endovenous pumps (dexketoprofeno pump or metamizol pump were used. Pain intensity by means of a visual analog scale and a plain oral scale, the need for supplemental analgesics. At home (24 hours after the surgical operation, the Home Care Unit checked side effects, sleep disorders, pain intensity, need of rescue analgesia and degree of satisfaction. Results: 69% of the patients report absence or slight pain 24 h after the surgical operation, just 16 out of

  11. ANALGESIA IN SMALL CHILDREN

    African Journals Online (AJOL)

    Opioids provide effective analgesia, but also have known side ... significance of the study lies in the improvement in post-operative pain management in children after day-case .... have required intervention or delay in discharge from hospital.

  12. Effect of single dose pretreatment analgesia with three different analgesics on postoperative endodontic pain: A randomized clinical trial

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    Priyank Sethi

    2014-01-01

    Full Text Available Introduction: One of the aims of root canal treatment is to prevent or eliminate pain. Postoperative endodontic pain control continues to be a significant challenge. Aim: To compare and evaluate the effect of single oral dose of 100 mg of tapentadol, 400 mg of etodolac, or 10 mg of ketorolac as a pretreatment analgesic for the prevention and control of postoperative endodontic pain in patients with symptomatic irreversible pulpitis. The incidence of side effects was recorded as secondary outcome. Materials and Methods: Sixty emergency patients with moderate to severe pain, diagnosed with symptomatic irreversible pulpitis were randomly allocated (1:1:1 to any of the three groups; tapentadol, etodolac, or ketorolac. Medications were administered 30 min before beginning of the endodontic treatment. Patients recorded pain intensity on 10 cm visual analog scale (VAS after treatment, for upto 24 h. Results: At 24 h, mean ±standard deviation (SD of VAS scores (in cm for tapentadol, etodolac, and ketorolac were 0.89 ± 0.83, 2.68 ± 2.29, and 0.42 ± 0.69, respectively. Kruskal-Wallis (K-W test showed significant difference among the three groups (P = 0.001. Mann-Whitney test showed significantly lower VAS scores in tapentadol and ketorolac than etodolac group (P = 0.013 and 0.001, respectively. Conclusions: Single oral dose of 10 mg of ketorolac and 100mg of tapentadol as a pretreatment analgesic significantly reduced postoperative endodontic pain in patients with symptomatic irreversible pulpitis when compared to 400 mg of etodolac.

  13. POST-OPERATIVE ANALGESIA IN PATIENTS UNDERGOING MAJOR SURGERIES: EFFECT OF ADDING IV KETAMINE TO MORPHINE IN PRESENCE OF MORPHINE RESISTANT PAIN

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    Blessy

    2014-05-01

    Full Text Available Peri-operative management of opioid resistant pain is major clinical problem especially in the immediate postoperative period. The role of NMDA receptor in the processing of nociceptive input has lead naturally to renewed clinical interest in NMDA receptor antagonist such as ketamine. This paper reviews the use and efficacy of adding low dose ketamine to morphine in management of acute post-operative pain in patients who perceive pain in spite of large consumption of morphine and added advantages of decreasing opioid consumption and there by resulting in minimizing dose related side effects. We conducted a randomized double blind study on 120 patients undergoing major abdominal surgery. All patients were kept in PACU post operatively and were given basal analgesia with IV morphine till maximum of 100µg /kg within 30 min period, but if patient still complained of pain (≥6 of 10 on VAS with an acceptable cognition state (≥15 in the MMSE and who rated themselves not sedated (≥5 of 10 on VAS were taken as resistant to morphine and were enrolled in one of the two treatment groups. The MS group received 3 boluses of 30 µg/kg of morphine plus saline whereas MK group received 3 boluses of 15 µg of morphine plus 250 µg/kg of ketamine. The total dose of morphine required by MK patients (0.42±0.12 mg/kg was significantly less than MS patients (1.21±0.43mg/kg. (P<0.0001. The quality of analgesia was in favor of MK group even in terms of rescue analgesia as amount of diclofenac required was double in MS patients than in MK patients. (186.84 ± 37.83 vs. 83.57 ±30.28, P= 0.0001. The VAS score at rest and ambulation was significantly less in MK group as compared to MS group at 180 minutes (P<0.001. The 10 minute level of wakefulness (1-10 VAS in the MS group (6.88±1.09 was significantly (P < 0.0001 less than MK group (8.28 ± 0.43. Postoperative nausea and vomiting was seen in 68.37% of MS patients as compared to only 8.30% of MK patients (P=0

  14. Analgesia pós-operatória plexular contínua: estudo dos efeitos colaterais e do risco de infecção dos cateteres Analgesia postoperatoria plexular continua: estudio de los efectos colaterales y de riesgo de infección de los catéteres Postoperative continuous plexular analgesia: a study on the side effects and risk factors of catheter infection

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    Juliano Rodrigues Gasparini

    2008-12-01

    áuseas/vómitos fue de 1,3 y de un 16,6%, respectivamente. Hubo colonización en un 8,6% de los 280 catéteres examinados. No hubo infecciones, lesiones nerviosas, ni tampoco repercusiones sistémicas. CONCLUSIONES: El uso preoperatorio de antibióticos y el tipo de aguja utilizado fueron factores de riesgo para la colonización de los catéteres.BACKGROUND AND OBJECTIVES: The importance of postoperative analgesia has increased over the years. Plexular catheters represent a good option for high quality analgesia with reduced systemic repercussions. The objective of the present study was to evaluate the incidence of side effects and complications in postoperative analgesia with plexular catheters and identify risk factors for bacterial colonization of the catheters. METHODS: Patients undergoing orthopedic surgeries between March of 2005 and January of 2007 received analgesia via plexular catheters. The incidence of side effects and complications of this technique were evaluated. In some of the cases, the catheter tip was cultured. RESULTS: Four hundred and thirty-three patients were evaluated. Urinary retention and nausea/vomiting had an incidence of 1.3 and 16.6%, respectively. Of 280 catheters examined, 8.6% were colonized. Infections, nerve lesions, or systemic repercussion were not observed. CONCLUSIONS: The use of antibiotics preoperatively and the type of needle were the risk factors of infection identified.

  15. Management strategies to reduce risk of postoperative infections

    Science.gov (United States)

    Galor, Anat; Goldhardt, Raquel; Wellik, Sarah R.; Gregori, Ninel Z.; Flynn, Harry W.

    2013-01-01

    Postoperative infections, although rare, are still of great concern to the ophthalmologist. The incidence of post-cataract endophthalmitis is low, with a range of .28 per 1,000 to 2.99 per 1000. In addition to intraoperative considerations such as poor wound construction, vitreous loss, topical anesthesia, and prolonged surgical time, other risk factors include preoperative factors such as a diseased ocular surface and systemic immunosuppression. Potential methods of reducing risk of endophthalmitis after anterior segment surgery are discussed and available literature is summarized. PMID:24319649

  16. Intraoperative administration of tramadol for postoperative nurse-controlled analgesia resulted in earlier awakening and less sedation than morphine in children after cardiac surgery.

    Science.gov (United States)

    Chu, Ya-Chun; Lin, Su-Man; Hsieh, Ying-Chou; Chan, Kwok-Hon; Tsou, Mei-Yung

    2006-06-01

    In adults, intraoperative administration of tramadol could result in earlier recovery and less sedation than morphine. In this controlled, randomized, double-blind study, we investigated whether an intraoperative initial dose of tramadol could cause more rapid awakening from general anesthesia, less sedation, and earlier tracheal extubation than morphine in children during the immediate postoperative period. Forty children aged 1-6 yr, scheduled for atrial or ventricular septal defect repair and tracheal extubation in the pediatric intensive care unit, were randomly allocated to receive morphine, initial dose 0.2 mg/kg, or tramadol 2 mg/kg given at the end of sternal closure, followed by nurse-controlled analgesia (bolus 0.02 mg/kg of morphine and 0.2 mg/kg of tramadol) with background infusions (0.015 mg x kg(-1) x h(-1) for morphine and 0.15 mg x kg(-1) x h(-1) for tramadol). Postoperatively, children receiving tramadol had earlier awakening from general anesthesia (P = 0.02) and were less sedated at 1 and 2 h postoperatively (P = 0.03 and P = 0.01, respectively). Tracheal extubation was earlier in the tramadol group (P = 0.01). Lengths of pediatric intensive care unit stay did not differ between groups. Times to first trigger of nurse-controlled analgesia bolus and objective pain scores during the 48 h observation period were comparable between groups. The incidence of desaturation and emesis were similar between groups. The patients ate well and did not differ on Day 1 or Day 2.

  17. Association between KCNJ6 (GIRK2) gene polymorphism rs2835859 and post-operative analgesia, pain sensitivity, and nicotine dependence.

    Science.gov (United States)

    Nishizawa, Daisuke; Fukuda, Ken-ichi; Kasai, Shinya; Ogai, Yasukazu; Hasegawa, Junko; Sato, Naomi; Yamada, Hidetaka; Tanioka, Fumihiko; Sugimura, Haruhiko; Hayashida, Masakazu; Ikeda, Kazutaka

    2014-01-01

    G-protein-activated inwardly rectifying potassium (GIRK) channels are expressed in many tissues and activated by several Gi/o protein-coupled receptors, such as opioid and dopamine receptors, and thus are known to be involved in the modulation of opioid-induced analgesia, pain, and reward. We focused on a GIRK-channel subunit that plays a pivotal role in the brain, GIRK2, and investigated the contribution of genetic variations of the GIRK2 (KCNJ6) gene to individual differences in the sensitivity to opioid analgesia. In our initial linkage disequilibrium analysis, a total of 27 single-nucleotide polymorphisms (SNPs) were selected within and around the regions of the KCNJ6 gene. Among them, the rs2835859 SNP, for which associations with analgesia and pain have not been previously reported, was selected in the exploratory study as a potent candidate SNP associated with opioid analgesic sensitivity. The results were corroborated in further confirmatory study. Interestingly, this SNP was also found to be associated with sensitivity to both cold and mechanical pain, susceptibility to nicotine dependence, and successful smoking cessation. The results indicate that this SNP could serve as a marker that predicts sensitivity to analgesic and pain and susceptibility to nicotine dependence.

  18. Influencia de la analgesia epidural sobre la incidencia de taquiarritmias en el postoperatorio de la cirugía pulmonar Influence of epidural analgesia on the incidence of tachyarrhythmia during pulmonary surgery postoperative

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    A. Gutiérrez-Guillén

    2004-02-01

    Full Text Available Objetivos: Valorar la influencia del uso de analgesia epidural torácica (AET intra y postoperatoria sobre la presentación de taquiarritmias en el postoperatorio de las resecciones pulmonares. Material y métodos: Se han analizado, de forma retrospectiva, los cursos postoperatorios de 200 pacientes consecutivos intervenidos de resecciones pulmonares mayores (lobectomías, bilobectomías y neumonectomías en nuestro hospital durante el periodo comprendido entre octubre de 1998 y junio de 2002. En este tiempo se ha introducido progresivamente en nuestro Servicio la AET como parte de la técnica anestésica en cirugía pulmonar. Se ha analizado la influencia del empleo de AET en la presentación de episodios de taquiarritmia supraventricular en las primeras 48 horas de postoperatorio. Resultados: Se empleó AET para el manejo anestésico y control del dolor postoperatorio en el 49,5% de los casos (99/200. No existen diferencias significativas entre los grupos de pacientes con y sin AET en cuanto a edad, sexo, riesgo ASA, duración de la intervención y tipo de resecciones practicadas. Presentaron crisis de taquiarritmia el 9,5% de los pacientes (19/200, tratándose, en todos los casos, de fibrilación auricular paroxística. Entre los pacientes que no recibieron AET la tasa de arritmias fue del 13,86% (14/101, mientras que en aquellos en los que se empleó AET como parte de la técnica anestésica y durante el postoperatorio, dicha tasa fue del 5,05% (5/99, siendo dicha diferencia estadísticamente significativa (p=0,034. Conclusiones: El empleo de AET como parte de la técnica anestésica y para el manejo del dolor postoperatorio en cirugía de resección pulmonar parece ejercer un efecto protector en cuanto al desarrollo de fibrilación auricular en el postoperatorio inmediato. Se discuten las posibles causas de este efecto.Objectives: To assess the impact of intra- and post-operative thoracic epidural analgesia (TEA on the incidence of tachy

  19. The Edible Brown Seaweed Ecklonia cava Reduces Hypersensitivity in Postoperative and Neuropathic Pain Models in Rats

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    Jae Goo Kim

    2014-06-01

    Full Text Available The current study was designed to investigate whether edible brown seaweed Ecklonia cava extracts exhibits analgesic effects in plantar incision and spared nerve injury (SNI rats. To evaluate pain-related behavior, we performed the mechanical withdrawal threshold (MWT and thermal hypersensitivity tests measured by von Frey filaments and a hot/cold plate analgesia meter. Pain-related behavior was also determined through analysis of ultrasonic vocalization. The results of experiments showed MWT values of the group that was treated with E. cava extracts by 300 mg/kg significantly increased; on the contrary, number of ultrasonic distress vocalization of the treated group was reduced at 6 h and 24 h after plantar incision operation (62.8%, p < 0.05. Moreover, E. cava 300 mg/kg treated group increased the paw withdrawal latency in hot-and cold-plate tests in the plantar incision rats. After 15 days of continuous treatment with E. cava extracts at 300 mg/kg, the treated group showed significantly alleviated SNI-induced hypersensitivity response by MWT compared with the control group. In conclusion, these results suggest that E. cava extracts have potential analgesic effects in the case of postoperative pain and neuropathic pain in rats.

  20. Paracetamol e dipirona por via endovenosa aplicados à analgesia pós-operatória de pacientes pediátricos submetidos à amigdelectomia em hospital-dia: um estudo prospectivo, randomizado, duplo-cego, placebo controlado Intravenous paracetamol and dipyrone for postoperative analgesia after day-case tonsillectomy in children: a prospective, randomized, double blind, placebo controlled study

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    Aysu Inan Kocum

    2013-02-01

    randomized to receive intraoperative infusions of paracetamol (15 mg/kg, dipyrone (15 mg/kg or placebo (0.9% NaCl. Evaluation was carried out at 0.25, 0.50, 1, 2, 4, 6h postoperatively. Pethidine 0.25 mg/kg was utilized as rescue analgesic. Cumulative pethidine requirement was the primary outcome. Pain intensity measurement, pain relief, sedation level, nausea and vomiting, postoperative bleeding and any other adverse effects were noted. RESULTS: No significant difference was found in pethidine requirement between paracetamol and dipyrone groups. Cumulative pethidine requirement was significantly less in paracetamol and dipyrone groups vs. placebo. No significant difference was observed between groups in postoperative pain intensity scores throughout the study. CONCLUSION: Intravenous paracetamol is found to have a similar analgesic efficacy as intravenous dipyrone and they both help to reduce the opioid requirement for postoperative analgesia in pediatric day-case tonsillectomy.

  1. Adjunct High Frequency Transcutaneous Electric Stimulation (TENS) for Postoperative Pain Management during Weaning from Epidural Analgesia Following Colon Surgery: Results from a Controlled Pilot Study.

    Science.gov (United States)

    Bjerså, Kristofer; Jildenstaal, Pether; Jakobsson, Jan; Egardt, Madelene; Fagevik Olsén, Monika

    2015-12-01

    The potential benefit of nonpharmacological adjunctive therapy is not well-studied following major abdominal surgery. The aim of the present study was to investigate transcutaneous electrical nerve stimulation (TENS) as a complementary nonpharmacological analgesia intervention during weaning from epidural analgesia (EDA) after open lower abdominal surgery. Patients were randomized to TENS and sham TENS during weaning from EDA. The effects on pain at rest, following short walk, and after deep breath were assessed by visual analog scale (VAS) grading. Number of patients assessed was lower than calculated because of change in clinical routine. Pain scores overall were low. A trend of lower pain scores was observed in the active TENS group of patients; a statistical significance between the groups was found for the pain lying prone in bed (p TENS use in postoperative pain management during weaning from EDA after open colon surgery. Further studies are warranted in order to verify the potential beneficial effects from TENS during weaning from EDA after open, lower abdominal surgery.

  2. Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

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    Glabglay Prapakorn

    2010-10-01

    Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction. Trial registration number NCT01017380

  3. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  4. Clinical observation of flurbiprofen axetil injection combined with intravenous fentanyl in the postoperative analgesia%氟比洛芬酯注射液联合芬太尼静脉输注用于术后镇痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    东斌

    2015-01-01

    目的:探讨氟比洛芬酯注射液联合芬太尼静脉输注用于术后镇痛的临床效果。方法选取我院2014年3月~2015年8月腰椎骨折患者共90例,随机分为观察组和对照组。对照组术后持续输注芬太尼,观察组术前静脉推注氟比洛芬酯注射液,并于术后持续静脉输注芬太尼。观察术后镇痛效果。结果观察组术后6、12h的VAS评分情况,术后镇痛优良率95.6%,均优于对照组,组间比较有差异(P<0.05)。结论氟比洛芬酯注射液联合芬太尼用于术后镇痛,能够降低患者不良反应的发生率,具有良好的术后镇痛效果。%ObjectiveTo discuss the clinical effect of flurbiprofen axetil injection combined with intravenous fentanyl in the postoperative analgesia.MethodsA total of 90 patients with lumbar spine fractures from March 2014 to August 2015 were randomly divided into observation group and control group. The control group, postoperative continuous infusion of fentanyl group in preoperative intravenous push flurbiprofen axetil injection, injection on postoperative continuous intravenous fentanyl at the same time. To observe the postoperative analgesic effect.Results Observation of postoperative VAS score of 6, 12h, postoperative analgesia was 95.6%, were superior to control group, there are differences between the comparison between groups (P<0.05).Conclusionflurbiprofen axetil injection combined with intravenous fentanyl for postoperative analgesia, can reduce the incidence of adverse reactions in patients with, has the good postoperative analgesia effect.

  5. 氯诺昔康与丁丙诺啡术后镇痛效果比较%Comparison of postoperative analgesia between lornoxicam and buprenorphine

    Institute of Scientific and Technical Information of China (English)

    王秀峰

    2010-01-01

    Objective To study the efficacy arid side effects of postoperative analgesia between Lornoxicam and Buprenorphine. Methods Sixty ASA I-II patients were randomly divided into Lomoxicam group(group A) and Buprenorphine group(group B). Analgesiae were subcutaneously injected via an electronic patients controlled analgesic pump post surgeries. The visual analgesiae sacle( VAS) was used to evaluate the postoperative pain relief,and analgesic response was recorded. Result There were no significant differences between Lomoxicam and Buprenorphine about the analgesic response(P>0. 05),moreover,no stastical differences in the patients demography,analgesic and anesthetic type were associated with the analgestic outcomes. Conclusion Lomoxicam without respiratory distuber-ance was a good alternative to Buprenorphine in PCSA.%目的 比较氯诺昔康和丁丙诺啡的术后镇痛效果及不良反应.方法 60例ASA Ⅰ-Ⅱ级患者,随机分为两组:氯诺昔康A组(n=30)和丁丙诺啡B组(n=30),两组均通过电子泵经皮下给药.采用视觉模拟评分法(VAS)测定患者的术后镇痛效果,记录不良反应.结果 两组患者的性别、年龄、身高、手术类型和麻醉方法等一般情况差异无统计学意义(P>0.05).两组的术后镇痛效果和不良反应的指标均差异无统计学意义(P>0.05).结论 在术后患者自控镇痛中,氯诺昔康因其与丁丙诺啡相似的镇痛效果且无呼吸抑制的优点可以作为丁丙诺啡的替代用药.

  6. The pharmacokinetics and safety of an intraoperative bupivacaine-collagen implant (XaraColl® for postoperative analgesia in women following total abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Cusack SL

    2013-03-01

    Full Text Available Susan L Cusack,1 Philip Reginald,2 Lisa Hemsen,3 Emmanuel Umerah21Cusack Pharmaceutical Consulting, Burlington, NJ, USA; 2Departments of Gynaecology and Anaesthetics, Wexham Park Hospital, Slough, SL2 4HL, UK; 3Innocoll Technologies, Athlone, IrelandBackground: XaraColl®, a collagen-based intraoperative implant that delivers bupivacaine to the site of surgical trauma, is under development for postoperative analgesia. We examined the pharmacokinetics, safety and efficacy of XaraColl following implantation in women undergoing total abdominal hysterectomy.Methods: Three XaraColl implants, each containing 50 mg bupivacaine hydrochloride, were implanted in 12 women undergoing total abdominal hysterectomy for a benign condition. Serum samples were obtained through 96 hours for pharmacokinetic analysis. Patients received acetaminophen 1000 mg every 6 hours, diclofenac 50 mg every 8 hours, and were given access to intravenous morphine for breakthrough pain via patient-controlled analgesia during the first 24 hours. Pain intensity was assessed at regular intervals using a 100 mm visual analog scale. Safety was assessed through 30 days.Results: The pharmacokinetic profile displayed a double peak in bupivacaine concentration with the second peak occurring up to 24 hours after the first and at a generally higher concentration. The time to maximum concentration (tmax varied from 0.5 to 24 hours (median 12 hours according to which peak predominated. The mean maximum concentration (Cmax was 0.22 µg/mL and the maximum individual Cmax was 0.44 µg/mL, which are well below the established systemic toxicity threshold. Morphine use was generally low (mean 16.8 mg; median 6.5 mg and compared favorably with institutional experience. At 6 hours post-surgery, 11 patients recorded pain scores ≤ 20 mm, 6 recorded ≤ 10 mm, and 2 reported no pain. Scores continued to decline throughout the study. The product was considered safe and well tolerated.Conclusion: Xara

  7. 曲马多术后静脉镇痛的临床观察%Clinical study on the effect of intravenous tramadol on postoperative analgesia

    Institute of Scientific and Technical Information of China (English)

    陈淑萍; 赵红梅

    2001-01-01

    Objective To determine the clinical effect of intravenous tramadol on postoperative analgesia.Method sixty (ASA physical status Ⅰ or Ⅱ)adult patients were randomly divided into two groups.In group Ⅰ(n=30)tramadol 800mg and droperidol 10mg were diluted to 100ml in normal saline,while in group Ⅱ(n=30)fentanyl 0.8mg and droperidol 10mg were diluted to 100ml in normal saline.Baxter-4900 type analgesia pump was chosen for this study.Loading dose was given followed with continuous pump infusion.Result ①There were no significant differences in BP,HR and SpO2 after tramadol was used when Compared with those before tramadol was administared(P>0.05).②There was no significant difference in VAS between both groups(P>0.05).Conclusion Intravenous tramadol is effective on postoperative analgesia.%目的 观察曲马多术后静脉镇痛的临床效应。方法 60例(ASAⅠ-Ⅱ)手术患者随机分成二组:Ⅰ组(n=30),镇痛药液为曲马多800mg加氟哌利多100mg,经生理盐水稀释至100ml;Ⅱ组(n=30),镇痛药液为芬太尼0.8mg加氟哌利多10mg,经生理盐水稀释至100ml。选用Baxter-49002型镇痛泵,选择负荷剂量加持续剂量(微泵连续给药模式)。结果 Ⅰ组患者循环、呼吸变化同用药前比较无明显差异(P>0.05),镇痛效应VAS评分差异无显著性意义(P>0.05)。结论 术后静脉镇痛用曲马多是可行的。

  8. Avoiding aortic clamping during CABG reduces postoperative stroke

    Science.gov (United States)

    Moss, Emmanuel; Puskas, John D; Thourani, Vinod H; Kilgo, Patrick; Chen, Edward P; Leshnower, Bradley G; Lattouf, Omar M; Guyton, Robert A.; Glas, Kathryn E; Halkos, Michael E.

    2014-01-01

    Objective The purpose of this study was to determine whether the incidence of postoperative stroke (PS) could be reduced by eliminating aortic clamping during CABG. Methods From 2002–2013, 12,079 patients underwent primary, isolated CABG at a single US academic institution. Aortic manipulation was completely avoided by using in-situ internal mammary arteries for inflow in 1,552 (12.9%) patients (no-touch), a clampless facilitating device (CFD) was used for proximal anastomoses in 1,548 (12.8%) patients, and aortic clamping was used in 8,979 (74.3%) patients. These strategies were assessed in a logistic regression model controlling for relevant variables. Results The overall incidence of PS was 1.4% (n=165), with an unadjusted incidence of 0.6% (n=10) in the no-touch group, 1.2% (n=18) in the CFD group, and 1.5% (n=137) in the clamp group (p<0.01 for no-touch vs clamp). The ratio of observed to expected stroke rate increased as the degree of aortic manipulation increased, from 0.48 in the no-touch group, to 0.61 in the CFD group, and 0.95 in the clamp group. Aortic clamping was independently associated with an increase in PS compared to a no-touch technique (AOR 2.50, p<0.01). When separated by CPB utilization, both the off-pump partial clamp and on-pump cross-clamp techniques increased the risk of PS compared to no-touch (AOR 2.52, p<0.01 and AOR 4.25, p<0.001, respectively). Conclusion A no-aortic touch technique has the lowest risk for postoperative stroke for patients undergoing CABG. Clamping the aorta during CABG increases the risk of PS, regardless of the severity of aortic disease. PMID:25293356

  9. Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial.

    Directory of Open Access Journals (Sweden)

    Lijian Pei

    Full Text Available The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121 or fentanyl with sevoflurane general anesthesia (GA group, n = 126. Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours, less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,, less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5], but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg. Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery.ClinicalTrial.gov NCT00418457.

  10. The fentanyl HCl patient-controlled transdermal system (PCTS): an alternative to intravenous patient-controlled analgesia in the postoperative setting.

    Science.gov (United States)

    Sinatra, Raymond

    2005-01-01

    Inadequate pain control in the postoperative period not only contributes to patient discomfort, but also causes physiological changes that may result in increased risk of myocardial ischaemia, deep vein thrombosis and pulmonary embolism. These events complicate postoperative recovery and may lead to longer hospital stays as well as increased healthcare costs. Patient-controlled analgesia (PCA) has emerged as an effective way for patients to manage their pain, allowing self-administration of small doses of analgesics to maintain a certain level of pain control. PCA is most commonly delivered via an intravenous (IV) or epidural route, and while patient satisfaction is higher with PCA than with conventional methods of analgesic administration, the invasiveness, costs and risk of errors associated with currently available modalities may limit their utility. These systems also require significant healthcare resources, as nurses must manually program the pumps to deliver the correct amount of medication. Several new PCA modalities are being developed to address these limitations. These systems deliver drug through a variety of routes, including nasal transmucosal and transdermal. Most notably, a self-contained, credit card-sized, transdermal PCA system is currently in the final stages of development. The fentanyl HCl patient-controlled transdermal system (PCTS; IONSYS, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ) uses an imperceptible, low-intensity direct current to transfer fentanyl on demand across the skin into the systemic circulation. This compact system is patient-activated, can be applied to the patient's upper arm or chest, and is designed to manage moderate-to-severe pain requiring opioid analgesia. The system delivers a preprogrammed amount of fentanyl HCI over 10 minutes, for a total of 80 doses, or for 24 hours, whichever occurs first. The on-demand dosing and pharmacokinetics of this system differentiate it from the passive transdermal formulation of

  11. Psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy:A complementary approach to drug analgesia

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM:To assess whether psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy.METHODS:Two hundred and sixty-two patients,who required hepatic arterial chemoembolization for hepatic malignancy and postembolization pain,were randomized into control group(n = 46,receiving medication)and intervention group(n = 216,receiving psychological intervention and medication in turn).The symptom checklist-90 (SCL-90) was used to scale the psychological symptoms of the patients before operation.Pain was scored with a 0 to 10 numeric rating scale(NRS-10)before and after analgesia as well as after psychological intervention(only in intervention group).RESULTS:All psychological symptomatic scores measured with SCL-90 in the intervention group were higher than the normal range in Chinese (P < 0.05).The somatization,phobia and anxiety symptomatic scores were associated with pain numerical rating score before analgesia(r = 0.141, 0.157 and 0.192,respectively,P < 0.05).Patients in both groups experienced pain relief after medication,psychotherapy or psychotherapy combined with medication during the procedure (P < 0.01).Only some patients in the intervention group reported partial or entire pain relief (29.17% and 2.31%) after psychological intervention.The pain score after analgesia in the intervention group was significantly lower than that in the control group (P < 0.01).CONCLUSION:Severe psychological distress occurs in patients with hepatic malignancy.Psychological intervention reduces pain scores significantly during hepatic arterial chemoembolization therapy and is thus,highly recommended as a complementary approach to drug analgesia.

  12. Analgesia postoperatoria con lornoxicam frente a metamizol en cirugía mayor ambulatoria: Estudio prospectivo aleatorio Postoperative analgesia with lornoxicam versus metamizol for outpatient major surgery: A randomized prospective study

    Directory of Open Access Journals (Sweden)

    B. Tapia

    2005-10-01

    procedure, all patients received a single dose of metamizol i.v. Oral analgesics were administered when patients started to develop tolerance and were randomized to one of the following groups: Lornoxicam Group (n = 35, with one tablet of lornoxicam 8 mg each 12 hours; or Metamizol Group, with one tablet of metamizol 575 mg each 8 hours. Post-operative pain was assessed at four different time points during the postoperative process: at the reanimation unit after surgery, at the beginning of the analgesic treatment with oral tolerance, upon hospital discharge and 48 hours after surgery. We used the Visual Analogue Scale (VAS, a simple numerical scale to assess pain through a phone call performed at 48 hours, patient satisfaction at the end of the procedure, patient opinion regarding the medication received and need for rescue medication. Results: We did not find any statically significant differences in VAS scores at the reanimation unit, the beginning of the oral analgesic treatment or the assessment of pain 48 hours after surgery. VAS scores upon hospital discharge were lower in the metamizol group compared to the lornoxicam group (p < 0.05. Patient satisfaction and patient opinion regarding the medication received were also better in the metamizol group (p < 0.05. No significant differences were observed regarding the need for rescue medication. Discussion: Both drugs provide appropriate postoperative analgesia, but perhaps the dosage regime used in the metamizol group provided better analgesia upon hospital discharge and improved subjective assessment of patients regarding the analgesic drug received.

  13. Comparison of parecoxib and patient controlled intravenous analgesia as a postoperative analgesic following the arthroscopic shoulder-elbow surgery:a case control study%帕瑞昔布与静脉镇痛泵对肩关节镜外科术后早期镇痛疗效的研究

    Institute of Scientific and Technical Information of China (English)

    江小成; 鲁谊; 姜春岩

    2013-01-01

    compared with the control group.Moreover,the parecoxib 40 mg group presented better postoperative pain relief and less adverse effects than the PCIA group during the first 3 days after operation.In order to study their early postoperative pain relief of the three groups,we compared the results that the pain scores of their first three postoperative days minus that on the day of operation,respectively.The results showed that the parecoxib group presented better postoperative pain relief than the PCIA group.Drug adverse reactions were found in 33 out of 105 patients (31.4%)of the analgesia pump group,but only 6 out of 54 patients (11.1%)in the parecoxib group had those adverse reactions.The differences were statistically significant (P <0.05 ).Discussion At present,PCIA has been widely performed in orthopaedic postoperative analgesia for the patients of skeletal and muscle inj uries.Fentanyl was one of the most common analgesics among the traditional opioid drugs with the use of the analgesia pump. It acted on the posterior horn of spinal cord,reduced occurance of pain information,and might be a potent narcotic analgesics with characteristics of strong and quick effects,short duration and so on.It can be used in pain of a variety of causes.However,during blocking pain information transmission, fentanyl could produce above-spinal analgesia,accompanied with adverse reactions,such as respiratory depression, reduced gastrointestinal peristalsis, somnolence, nausea and vomiting, calm, skin itching,urinary retention,blurred vision,slow heart rate and drug dependence,and so on.Moreover, these adverse reactions are positively related with dose.Ekman found that opioid analgesics can also activate the damage mechanism of body,which results in the intensified body′s sensitivity to pain and induction of hyperalgesia.The curative effect of opioid is poor for the sport pain,which is not good for their early postoperative exercise and functional recovery.So,with the deepening of the

  14. Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Venetiana Panaretou

    2012-01-01

    Full Text Available Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16 and the control group (Group B, n=14. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO 2 levels and the calculation of regional-arterial CO 2 difference (ΔPCO 2 . Additional measurements included mean arterial pressure (MAP, cardiac output (CO, systemic vascular resistance (SVR, and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO 2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

  15. Combined general–epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Science.gov (United States)

    Panaretou, Venetiana; Siafaka, Ioanna; Theodorou, Dimitrios; Manouras, Andreas; Seretis, Charalampos; Gourgiotis, Stavros; Katsaragakis, Stylianos; Sigala, Fragiska; Zografos, George; Filis, Konstantinos

    2012-01-01

    Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results. PMID:23493852

  16. Metamizole (Dipyrone) as an Alternative Agent in Postoperative Analgesia in Patients with Contraindications for Nonsteroidal Anti-Inflammatory Drugs.

    Science.gov (United States)

    Konijnenbelt-Peters, Jorieke; van der Heijden, Charlotte; Ekhart, Corine; Bos, Jacqueline; Bruhn, Jörgen; Kramers, Cornelis

    2017-03-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) play an important role in multimodal pain management. In patients with a contraindication for NSAIDs, pain management is challenging. A recent Dutch anesthesiology guideline propagates the use of metamizole (dipyrone) in these patients. Metamizole is a controversial drug, its use being previously discouraged because of the risk for agranulocytosis. We discuss whether metamizole could be an alternative to classical NSAIDs and opioids in postoperative pain management despite this drawback. Literature review and pharmacovigilance research based on World Health Organization adverse effect registrations. Metamizole causes fewer gastric and duodenal ulcers than other nonselective NSAIDs, and the risk for bleeding is limited. It is unknown whether it is safer than a nonselective NSAID combined with a proton pump inhibitor. Although the drug appears to be safe for renal function in healthy volunteers, data in high-risk patients (eg, those with heart or renal failure) are lacking. The incidence of metamizole-induced agranulocytosis is controversial, but the risk is likely to be limited with short-term postoperative use in this selected group of patients. Although firm evidence is lacking, metamizole may be safer for the upper intestinal tract and kidneys than other NSAIDs, and could alternatively be used in patients with an increased risk for stomach or renal problems. Hereby, improved postoperative pain relief can potentially be achieved. The risk for metamizole-induced agranulocytosis is judged to be acceptable. © 2016 World Institute of Pain.

  17. Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing.

    Directory of Open Access Journals (Sweden)

    Alparslan Turan

    Full Text Available Evidence suggests that recurrent nocturnal hypoxemia may affect pain response and/or the sensitivity to opioid analgesia. We tested the hypothesis that nocturnal hypoxemia, quantified by sleep time spent at an arterial saturation (SaO2 < 90% and minimum nocturnal SaO2 on polysomnography, are associated with decreased pain and reduced opioid consumption during the initial 72 postoperative hours in patients having laparoscopic bariatric surgery.With Institutional Review Board approval, we examined the records of all patients who underwent laparoscopic bariatric surgery between 2004 and 2010 and had an available nocturnal polysomnography study. We assessed the relationships between the time-weighted average of pain score and total opioid consumption during the initial 72 postoperative hours, and: (a the percentage of total sleep time spent at SaO2 < 90%, (b the minimum nocturnal SaO2, and (c the number of apnea/hypopnea episodes per hour of sleep. We used multivariable regression models to adjust for both clinical and sleep-related confounders.Two hundred eighteen patients were included in the analysis. Percentage of total sleep time spent at SaO2 < 90% was inversely associated with total postoperative opioid consumption; a 5-%- absolute increase in the former would relatively decrease median opioid consumption by 16% (98.75% CI: 2% to 28%, P = 0.006. However, the percentage of total sleep time spent at SaO2 < 90% was not associated with pain. The minimum nocturnal SaO2 was associated neither with total postoperative opioid consumption nor with pain. In addition, neither pain nor total opioid consumption was significantly associated with the number of apnea/hypopnea episodes per hour of sleep.Preoperative nocturnal intermittent hypoxia may enhance sensitivity to opioids.

  18. Effects of preemptive analgesia with parecoxib sodium on postoperative analgesia and delirium of patients with hand injury%帕瑞昔布钠超前镇痛对手外伤术后镇痛及术后谵妄的影响

    Institute of Scientific and Technical Information of China (English)

    洪英才; 麻伟青

    2012-01-01

    patients received the same prescription of patient - controlled intravenous analgesia( PCIA )in which fentanyl was used as the postoperative analgesic drug with the background dose of 0. 5 μg/( kg · h ),locking time of 15 min, single dose of 0. 125 μg/kg,and loading dose of 0. 6 μg/kg. The visual analog scale( VAS ),the first time and the total times of pressing PCIA button, and adverse effects within 48 h after the operation were observed and recorded. Meanwhile the ratio of POD in each group was recorded within 7 d after the operation. Results The VAS score of group P was significantly lower than those of group C at 1,2,4, 8 ,and 12 h after the operation( P <0. 05 ). The first time of pressing PCIA button in group P was significantly later than that in group C ( P <0. 01 ). The total pressing times of group P were significantly lower than those of group C at each time points within 48 h after the operation( P <0. 05 ). There was no significant difference in the incidence of adverse reactions between the two groups. The ratio of POD after the operation in group P( 8/90 )was significantly lower than that in group C( 21/90 )( P <0. 01 ). Conclusion Preemptive analgesia with parecoxib sodium can effectively and safely improve the effects of postoperative analgesia on patients with hand injury and reduce the incidence of POD in these patients.

  19. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial.

    Science.gov (United States)

    Ahmed, Zulfiqar; Samad, Khalid; Ullah, Hameed

    2017-01-01

    The main advantages of video assisted thoracoscopic surgery (VATS) include less post-operative pain, rapid recovery, less postoperative complications, shorter hospital stay and early discharge. Although pain intensity is less as compared to conventional thoracotomy but still patients experience upto moderate pain postoperatively. The objective of this study was to assess the efficacy and morphine sparing effect of intercostal nerve block in alleviating immediate post-operative pain in patients undergoing VATS. Sixty ASA I-III patients, aged between 16 to 60 years, undergoing mediastinal lymph node biopsy through VATS under general anaesthesia were randomly divided into two groups. The intercostal nerve block (ICNB group) received the block along with patient control intravenous analgesia (PCIA) with morphine, while control group received only PCIA with morphine for post-operative analgesia. Patients were followed for twenty four hours post operatively for intervention of post-operative pain in the recovery room and ward. The pain was assessed using visual analogue scale (VAS) at 1, 6, 12 and 24 hours. There was a significant decrease in pain score and morphine consumption in ICNB group as compared to control group in first 6 hours postoperatively. There was no significant difference in pain scores and morphine consumption between the two groups after 6 hours. Patients receiving intercostal nerve block have better pain control and less morphine consumption as compared to those patients who did not receive intercostal nerve block in early (6 hours) post-operative period.

  20. Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial

    Directory of Open Access Journals (Sweden)

    Licia Santos Santana

    2016-01-01

    analgesia for pain relief. Trial registration: NCT01600495. [Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC (2016 Transcutaneous electrical nerve stimulation (TENS reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. Journal of Physiotherapy 62: 29–34

  1. Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery.

    LENUS (Irish Health Repository)

    Mannion, Stephen

    2012-02-03

    We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. In a randomized, prospective, double-blind trial, 36 patients requiring hip fracture surgery received PCB and general anesthesia. Patients were randomized into three groups. Each patient received PCB with 0.4 mL\\/kg of levobupivacaine 0.5%. The control group (group L) received IV saline, the systemic clonidine group (group IC) received IV clonidine 1 mug\\/kg, and the peripheral clonidine group (group C) received IV saline and PCB with clonidine 1 microg\\/kg. The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L (mean +\\/- sd, 13.4 +\\/- 6.1 versus 7.3 +\\/- 3.6 h; P = 0.03). There was no difference between group C and group L (10.3 +\\/- 5.9 versus 7.3 +\\/- 3.6 h; P > 0.05). The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption. There were no significant differences among groups regarding postoperative adverse effects (bradycardia, hypotension, sedation, and nausea). We conclude that IV but not perineural clonidine (1 microg\\/kg) prolongs analgesia after PCB without increasing the incidence of adverse effects.

  2. 罗哌卡因术毕切口浸润在腰椎手术术后镇痛中的应用%Application of Ropivacaine in Postoperative Incision Infiltration in the Postoperative Analgesia of Lumbar Spine Surgery

    Institute of Scientific and Technical Information of China (English)

    杨晓瑞; 钟坤根; 李琳; 郝建华

    2015-01-01

    Objective To observe the clinical efficacy of postoperative ropivacaine incision infiltration in the postoperative analgesia and sedation of lumbar spine surgery.Methods A total of 98 patients in the First Affiliated Hospital of PLA General Hospital during Jan.2013 and Jan.2014 for lumbar spine surgery were included in the study,and were randomly divided into two groups,49 cases in each group.The trial group was administered ropivacaine infiltration in the incision after surgery.The control group was adminis-tered physiological saline infiltration in the incision after surgery.The postoperative 4,8,12,24 h visual ana-logue scale(VAS) scores and Ramsay sedation scores after extubation were recorded,and incidence of the postoperative adverse reactions was recorded as well.Results VAS immediately after tracheal extubation and postoperative 2,4,8,12 h in the trial group and control group:(1.2 ±0.6) scores,(1.3 ±0.9) scores, (2.3 ±1.0) scores,(3.3 ±1.3) scores,(3.0 ±1.1) scores,(2.6 ±1.0) scores;(2.6 ±1.0) scores, (3.4 ±1.3) scores,(3.8 ±1.5) scores,(4.0 ±1.4) scores,(4.5 ±1.1) scores,(2.8 ±1.0) scores, Ramsay were (2.2 ±0.3) scores,(2.3 ±0.9) scores,(2.5 ±0.7) scores,(2.3 ±0.6) scores,(2.2 ± 0.8) scores,(2.3 ±0.7) scores;(3.6 ±0.8) scores,(3.3 ±0.7) scores,(3.5 ±0.6) scores,(3.6 ± 1.0) scores,(3.5 ±0.8) scores,(3.4 ±0.9) scores.VAS and Ramsay in the trial group were lower than those of the control group,with statistically significant difference (P<0.05).The adverse reactions rate of the trial group was 30.6%,of the control group was 44.9%,the difference was statistically significant ( P<0.05).Conclusion Lumbar surgery with ropivacaine incision infiltration can significantly reduce early post-operative VAS score,has obvious analgesic effect is obvious.%目的:观察腰椎手术全身麻醉术毕切口浸润罗哌卡因对术后镇痛及镇静的临床疗效。方法选取2013年1月至2014年1月于解放军总医院第一附

  3. The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study

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    Salman AE

    2013-01-01

    Full Text Available A Ebru Salman,1 Fahri Yetisir,2 Banu Yürekli,3 Mustafa Aksoy,1 Murat Yildirim,2 Mehmet Kiliç21Anesthesiology and Reanimation Department, 2General Surgery Department, Atatürk Research and Training Hospital, Ankara, Turkey; 3Endocrinology Department, Bozyaka Research and Training Hospital, Izmir, TurkeyPurpose: In this prospective, randomized, double-blind study, our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane (TAP block with a placebo block in patients undergoing unilateral inguinal hernia repair.Methods: After receiving hospital ethical committee approval and informed patient consents, American Society of Anesthesiologists (ASA I–III patients aged 18–80 were enrolled in the study. Standard anesthesia monitoring was applied to all patients. After premedication, spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space. Patients were randomly allocated into 2 groups. Group I (n = 32 received a placebo block with 20 mL saline, Group II (n = 32 received semi-blind TAP block with 0.25% bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure. At the end of the operation, intravenous (IV dexketoprofen was given to all patients. The verbal analog scale (VAS was recorded at 2, 4, 6, 12, and 24 hours postoperatively. Paracetamol IV was given to patients if their VAS score > 3. A rescue analgesic of 0.05 mg/kg morphine IV was applied if VAS > 3. Total analgesic consumption and morphine requirement in 24 hours were recorded.Results: TAP block reduced VAS scores at all postoperative time points (P < 0.001. Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II (P < 0.01.Conclusion: Semi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic

  4. In children undergoing umbilical hernia repair is rectus sheath block effective at reducing post-operative pain? Best evidence topic (bet).

    Science.gov (United States)

    Rajwani, Kapil M; Butler, Sarah; Mahomed, Anies

    2014-12-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was: In children undergoing umbilical hernia repair is a rectus sheath block (RSB) better than local anaesthetic infiltration of the surgical site, at reducing post-operative pain? From a total of 34 papers, three studies provided the best available evidence on this topic. One randomised clinical trial showed RSB had a better analgesic effect in the immediate post-operative period. In another randomised trial opioid consumption in the peri-operative period was found to be significantly lower in patients administered RSB. These improvements in pain and analgesia consumption need to be balanced against the expertise, training, equipment required, time implications and complications of performing a RSB.

  5. Efeito preemptivo da morfina por via venosa na analgesia pós-operatória e na resposta ao trauma cirúrgico Efecto preemptivo de la morfina por vía venosa en la analgesia pós-operatoria y en la respuesta al trauma quirúrgico The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

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    Levent Kiliçkan

    2001-12-01

    otro tratamiento, el resultado de otros estudios comparando los efectos del tratamiento pré-operatorio al mismo tratamiento iniciado después de la cirugía, produjeron efectos inconsistentes. Las razones para esa falta de consistencia no son claras. Son pocos los estudios sobre la relación entre analgesia preemptiva y el consumo de analgésicos y la respuesta al trauma quirúrgico. El objetivo de este estudio fue evaluar el efecto preemptivo de la morfina por vía venosa preemptiva en el consumen pós-operatorio de analgésicos y en la respuesta al trauma quirúrgico. MÉTODO: Participaron de este estudio 60 pacientes, estado físico ASA I ó II, con edades entre 20 y 60 años, escaladas para histerectomía abdominal total y salpingo-ooferectomia bilateral, que fueron aleatoriamente distribuidos en tres grupos de 20 pacientes. Grupo I (n=20 - 0,15 mg.kg-1 de morfina después de la inducción anestésica y suero fisiológico durante el cerramiento del peritoneo Grupo II (n=20 - suero fisiológico después de la inducción y 0,15 mg.kg-1 de morfina durante el cerramiento del peritoneo. Grupo III (n=20 suero fisiológico durante la inducción y el cerramiento del peritoneo. Fueron medidos los niveles sanguíneos de cortisol y de glucosa y hecho el contage de leucocitos en los períodos pré y pós-operatorios. RESULTADOS: El consumen total de morfina pós-operatoria fue significativamente mas bajo en el grupo I comparado al grupo III (p BACKGROUNDS AND OBJECTIVES: Although initial studies of preemptive analgesia showed that preoperative blockade with local anaesthetics or pre-operative administration of systemic opioids was more effective in reducing postoperative pain than control conditions involving no treatment, the result of subsequent investigations comparing the effects of pre-operative treatment with the same treatment initiated after surgery have produced inconsistent results.The reasons for the lack of consistency are not clear. Studies about the relationship

  6. Manejo de la analgesia postoperatoria en las primeras 24 horas en un Hospital de segundo nivel: Estudio observacional Postoperative analgesia treatment during the first 24 hours in a second level hospital.

    Directory of Open Access Journals (Sweden)

    D. L. Fernández

    2006-01-01

    y GC (%: morfina: 28, 11.7 ± 12.6 mg/día, 100%; meperidina: 58, 333.4 ± 108.7 mg/día, 35.2%; tramadol: 13, 218.9 ± 80.2 mg/día, 59.3%. Consumo de analgésicos antiinflamatorios no esteroideos (Nº pacientes, X ± DE: diclofenaco ( 39, 223.1 ± 52.5 mg/día; metamizol (74, 6.86 ± 1.8 mg/día ambos superiores a las dosis recomendadas. Conclusiones: Como conclusión pensamos que los resultados expuestos demuestran la ineficacia de la medicación analgésica empleada en el postoperatorio, debida a fallos en la prescripción y en el cumplimiento de la misma. La formación continuada, la implicación de los anestesiólogos y del personal de enfermería y el compromiso institucional son elementos fundamentales para corregir los errores observados en el tratamiento del dolor postoperatorio.Objective: We carried out this study in our second level hospital to evaluate the fulfillment and effectiveness of postoperative analgesics administered without appropriate guidelines during the first 24 h after surgical procedures where the intensity of pain is considered moderate-severe. Method: We included 119 patients above 18 years of age, who underwent orthopedic surgery: total knee or hip replacement, vertebral arthrodesis, shoulder surgery and laparotomies. Postoperative analgesics (base and rescue were prescribed according to criterion of the responsible anesthesiologist through lack of appropriate protocols. The use of morphine, epidural analgesia and PCA (patient controlled analgesia devices were restricted to recovery room and critical care unit. In hospitalized patients the prescribed opiates were meperidine and tramadol by intramuscular and intravenouse route, respectively. The opiates were always associated to nonsteroidal antiinflammatory drugs (NSAIDs as metamizol or diclofenac and analgesics as paracetamol. Intensity of pain was measured by VAS 0-100 mm and verbal scale (VS 1-4, 24 h after surgery (24 and we registered the maxim intensity of pain (Max perceived

  7. Analgesia pós-operatória em cirurgia ortopédica: estudo comparativo entre o bloqueio do plexo lombar por via perivascular inguinal (3 em 1 com ropivacaína e a analgesia subaracnóidea com morfina Analgesia pós-operatoria en cirugía ortopédica: estudio comparativo entre el bloqueo del plexo lombar por vía perivascular inguinal (3 en 1 con ropivacaína y la analgesia subaracnóidea con morfina Postoperative analgesia following orthopedic surgery: a study comparing perivascular lumbar plexus inguinal block with ropivacaine (3 in 1 and spinal anesthesia with morphine

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    Neuber Martins Fonseca

    2003-04-01

    perivascular inguinal, llamado de bloqueo 3 en 1, ha sido utilizado para analgesia pós-operatoria. El objetivo de este estudio fue comparar la analgesia pós-operatoria del bloqueo 3 en 1 a la de la morfina subaracnóidea en pacientes sometidos a cirugías ortopédicas en miembro inferior (MI. MÉTODO: Fueron estudiados 40 pacientes escalados para cirugía ortopédica de MI, de ambos sexos, estado físico ASA I y II, con edades entre 15 y 75 años, distribuidos en 2 grupos (M y BPL. Fue realizada anestesia subaracnóidea en todos los pacientes, en L3-L4 ó L4-L5, con 20 mg de bupivacaína isobárica a 0,5%. En el grupo M (n = 20 fue asociado 50 µg de morfina al anestésico local. En el grupo BPL (n = 20 fue realizado el bloqueo 3 en 1 al término de la cirugía, utilizando 200 mg de ropivacaína a 0,5%. Se evaluó la analgesia y la intensidad del dolor a las 4, 8, 12, 14, 16, 20 y 24 horas después del término de la cirugía, el nivel del bloqueo subaracnóideo, el tiempo quirúrgico y las complicaciones. RESULTADOS: La duración de la analgesia en el grupo BPL fue de 13,1 ± 2,47, en cuanto en el grupo M todos los pacientes referían dolor y ausencia de bloqueo motor en el primero instante evaluado (4 horas. Hubo falla del bloqueo de uno de los 3 nervios en 3 pacientes. La incidencia de náusea y prurito fue significativamente mayor en el grupo M. Cuanto a la retención urinaria, no hubo diferencia significante entre los grupos. No hubo depresión respiratoria, hipotensión arterial o bradicardia. La analgesia pós-operatoria fue mas efectiva en el grupo BPL, comparada al grupo M a las 4, 8, 12,14 y 16 horas. A las 20 y 24 horas no hubo diferencia significante entre los grupos.BACKGROUND AND OBJECTIVES: Perivascular Lumbar plexus inguinal block, (3-in-1 block has been used for postoperative analgesia. This study aimed at comparing postoperative analgesia of 3-in-1 block and spinal morphine in patients submitted to lower limb orthopedic surgeries (LL. METHODS: Forty ASA I

  8. A new, lateral, continuous, combined, femoral–sciatic nerve approach via a single skin puncture for postoperative analgesia in intramedullary tibial nail insertion

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    Imbelloni LE

    2013-02-01

    Full Text Available Luiz Eduardo Imbelloni,1,2 Carlos Rava,1,3 Marildo A Gouveia21Faculdade de Medicina Nova Esperança, 2Institute for Regional Anesthesia, 3Complexo Hospitalar de Mangabeira Governador Tarcisio Burity, João Pessoa, BrazilBackground: The prevalence of anterior knee pain following intramedullary tibial nail insertion is high. Continuous peripheral nerve blockade is an alternative method of pain control to opiods. This case illustrates the use of femoral nerve and sciatic nerve peripheral catheters with an elastomeric infusion pump for major intramedullary nailing surgery.Case report: A 36-year-old male with fractures to the left leg bones presented for placement of an intramedullary nail under spinal anesthesia. At the end of the procedure, access to the lateral femoral and sciatic continuous nerve block was achieved by using a stimulator connected to a 110 mm 18G Tuohy needle. Postoperative analgesia was provided with a 40-hour infusion of 0.1% bupivacaine (400 mL at a rate of 10 mL hour-1 with an elastomeric pump. Anesthetic dispersion and contrast were investigated. The analog scale remained with scores below 3 during the 40 hours after surgery, and boluses were not necessary.Conclusion: The use of a femoral and sciatic nerve peripheral catheter offered an alternative to conventional pain control. Continuous femoral–sciatic peripheral blockade via a skin puncture with an infusion of 0.1% bupivacaine with elastomeric pumps is a safe and effective procedure in adults.Keywords: local anesthetic, bupivacaine, continuous peripheral nerve block, orthopedic surgery, tibia, elastomeric pump

  9. A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CLINIC AL TRIAL TO ASSESS THE EFFICACY OF DEXAMETHASONE TO PR OVIDE POSTOPERATIVE ANALGESIA AFTER PARAVERTEBRAL BLOCK I N PATIENTS UNDERGOING ELECTIVE THORACOTOMY

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    Dhurjoti Proad

    2013-01-01

    Full Text Available ABSTRACT:BACKGROUND: In an attempt to improve the recovery and early reha bilitation after thoracotomy, various methods of pain-relief ha ve been tried to prolong the duration and to improve the quality of postoperative analgesia. Parave rtebral block using steroids like dexamethasone, administered as an adjuvant along wi th local anaesthetic agents, could be of particular interest. METHODS: Fifty patients undergoing elective thoracotomy were randomly assigned to one of the following groups containing t wenty five patients each. Group D patients received 8 mg (2 ml of dexamethasone added to 18 m l of 0.25% levobupivacaine as paravertebral block (total volume 20 ml. Group L pat ients received 18 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (20 ml i n total as paravertebral block. Analgesic effect was evaluated by measuring pain intensity (VA S score and duration of analgesia. RESULTS: A longer delay was observed between paravertevral b lock with study medication and first requirement of supplementary analgesic in g roup D (602.24±78.72 minutes compared to group L (410.48±56.64 minutes. Total con sumption of diclofenac sodium in first 24 hours in postoperative period was significantly les s in group D. No significant side effects were noted. CONCLUSION: Dexamethasone, used as adjuncts to levobupivacaine f or thoracic paravertebral block in patients undergoing thoracotom y, improve the quality and prolong the duration of post operative analgesia.

  10. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Science.gov (United States)

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  11. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Directory of Open Access Journals (Sweden)

    Tongyu Chen

    2016-01-01

    Full Text Available The aim of this study was to evaluate the effect of electroacupuncture (EA on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.

  12. Bupivacaína-buprenorfina vs. bupivacaína por vía caudal para analgesia postoperatoria en el paciente pediátrico en cirugía ortopédica Bupivacaine-buprenorphine vs. caudal bupivacaine as postoperative analgesia for pediatric patients undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    M. E. Flores Arana

    2011-04-01

    Full Text Available Introducción: el dolor postoperatorio en el niño constituye una entidad especial ya que en el influyen varios factores, por tanto es una experiencia no esperada por el niño y más difícil de tratar. Objetivos: evaluar y comparar la duración y calidad de la analgesia postoperatoria caudal así como la estabilidad hemodinámica y los efectos adversos entre bupivacaína-buprenorfina contra bupivacaína. Material y método: ensayo clínico controlado, prospectivo, longitudinal y comparativo; se estudian 40 pacientes de 1 a 7 años, para cirugía ortopédica bajo bloqueo caudal en el HTO No 21 de Monterrey, Nuevo León, de mayo 2009 a enero 2010. Se asignan en forma aleatoria a dos grupos: grupo A bupivacaína 0,25% 1,4 ml/kg y grupo B se le administrará bupivacaína al 0,25% 1,4 ml/kg adicionada de 1 μg/kg de buprenorfina. La intensidad del dolor postoperatorio se medirá a través del EVA, NIPS Y CRIES a las 2, 4, 6, 12 y 24 horas posteriores. Análisis estadístico: T de Student, U de Mann-Whitney; y prueba de Chi cuadrado. Resultados: el tiempo de administración del primer analgésico posterior a cirugía fue más corto en el grupo A (5,33 vs. 8,46 horas, con una diferencia a favor del grupo B (p Background: postoperative pain in children is a special entity and that the influence various factors, therefore it is an unexpected experience for the child and more difficult to treat. Objective: to evaluate and compare the length and quality of post-operative caudal analgesia and hemodynamic stability and adverse effects between bupivacaine-buprenorphine against bupivacaine. Material and methods: a controlled clinical trial, prospective, longitudinal, comparative study included 40 patients 1-7 years for orthopedic surgery under caudal block in the HTO No 21, of Monterrey, Nuevo Leon, from May 2009 to January 2010. Are assigned at random to two groups: group A 0.25% bupivacaine 1.4 ml/kg, and group B bupivacaine mL/kg 0.25% 1.4 mg/kg of

  13. Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction.

    Science.gov (United States)

    Baygin, Ozgul; Tuzuner, Tamer; Isik, Berrin; Kusgoz, Adem; Tanriver, Mehmet

    2011-07-01

    This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain. This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%. The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P tooth extraction. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  14. Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zimel, Melissa N. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Riedel, Elyn R. [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Healey, John H. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Weill Medical College of Cornell University, Department of Orthopaedic Surgery, New York, NY (United States)

    2015-09-15

    This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population. In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa. Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings. CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation. (orig.)

  15. Choice of analgesia patterns in postoperative patients with respiratory insufficiency%合并呼吸功能不全病人术后镇痛方式选择

    Institute of Scientific and Technical Information of China (English)

    石岩; 刘大为

    2011-01-01

    大手术常会导致或加重呼吸功能不全,术后疼痛为常见原因之一.由于顾虑镇痛药物对病人呼吸的不良影响,特别是对合并呼吸功能不全者,临床医生更是不敢镇痛或镇痛不足,从而陷入"基础合并呼吸功能不全一手术打击及术后疼痛一加重呼吸功能不全"的恶性循环.可见,选择对呼吸系统负面影响最小,甚至能从机制上促进呼吸功能恢复的镇痛方式,对合并呼吸功能不全的病人具有重要意义.%Major surgical procedures usually cause or exacerbate respiratory insufficiency, and postoperative pain is one of the common reasons.However, clinicians seldom or never use any analgesics for such patients, when considering the respiratory side effects of the analgesics, as results in a vicious circle of "baseline respiratory insufficiency-surgical attack and postoperative pain-deteriorated respiratory insufficiency".It is important to choose an appropriate postoperative analgesic pattern in patients with baseline respiratory insufficiency to promote their function recovery and to reduce postoperative complications.

  16. Bloqueio pleural bilateral: analgesia e funções pulmonares em pós-operatório de laparotomias medianas Bloqueo pleural bilateral: analgesia y funciones pulmonares en pós-operatorio de laparotomias medianas Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies

    Directory of Open Access Journals (Sweden)

    Karl Otto Geier

    2004-08-01

    TODO: Bloqueo pleural bilateral fue realizado en decúbito dorsal horizontal en 21 pacientes con 20 ml de bupivacaína a 0,375% con adrenalina a 1:400.000 administrados por catéter en cada hemitórax durante el pós-operatorio inmediato. Soluciones aleatorias de bupivacaína y de solución fisiológica fueron administradas por estudiantes en la práctica o enfermeras que desconocían el contenido de las jeringas, y sus resultados analgésicos evaluados de acuerdo con la escala de dolor Prince Henry al comparar los valores pre y pós-bloqueo pleural bilateral. En función del dolor pós-operatorio, ensayos espirométricos de las funciones pulmonares también fueron determinados mediante un espirómetro portátil. RESULTADOS: Analgesia pós-operatoria, con duración media de 247,75 ± 75 minutos fue constatada en todos los pacientes con la bupivacaína, aunque haya persistido dolor residual de menor intensidad en la región suprapúbica en cinco pacientes (8% y en dos pacientes en la apófisis xifóide (3,2%. Ningún efecto analgésico fue obtenido con solución fisiológica. De frente al dolor pós-operatorio, las funciones pulmonares, evaluadas antes y después de los bloqueos, registraron mejoría con la bupivacaína en CVF (p BACKGROUND AND OBJECTIVES: Notwithstanding pleural block having become almost an analgesic panacea, contradictory results have been published. This study aimed at observing analgesic and spirometric behavior of pulmonary function in the immediate postoperative period of 21 patients submitted to urgency median laparotomies under bilateral pleural block. METHODS: Bilateral pleural block was induced in the supine position with 20 mL of 0.375% bupivacaine with 1:400,000 epinephrine administered via catheter in each hemithorax during the immediate postoperative period. Randomized bupivacaine and saline were administered by residents or nurses blind to syringes content, and their analgesic outcomes were evaluated according to Prince Henry's pain score by

  17. Hyperbaric oxygen preconditioning improves postoperative cognitive dysfunction by reducing oxidant stress and inflammation.

    Science.gov (United States)

    Gao, Zhi-Xin; Rao, Jin; Li, Yuan-Hai

    2017-02-01

    Postoperative cognitive dysfunction is a crucial public health issue that has been increasingly studied in efforts to reduce symptoms or prevent its occurrence. However, effective advances remain lacking. Hyperbaric oxygen preconditioning has proved to protect vital organs, such as the heart, liver, and brain. Recently, it has been introduced and widely studied in the prevention of postoperative cognitive dysfunction, with promising results. However, the neuroprotective mechanisms underlying this phenomenon remain controversial. This review summarizes and highlights the definition and application of hyperbaric oxygen preconditioning, the perniciousness and pathogenetic mechanism underlying postoperative cognitive dysfunction, and the effects that hyperbaric oxygen preconditioning has on postoperative cognitive dysfunction. Finally, we conclude that hyperbaric oxygen preconditioning is an effective and feasible method to prevent, alleviate, and improve postoperative cognitive dysfunction, and that its mechanism of action is very complex, involving the stimulation of endogenous antioxidant and anti-inflammation defense systems.

  18. Does effective postoperative pain management influence surgical morbidity?

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

    after major procedures. In lower body procedures, however, intra- and early postoperative pain relief with epidural or spinal anaesthesia reduces blood loss and thromboembolic complications. It is hypothesized that effective postoperative pain relief may significantly improve outcome only if integrated......It has been assumed that adequate postoperative pain relief will improve outcome from surgery, but several controlled trials have demonstrated that pain treatment with nonsteroidal anti-inflammatory drugs, patient-controlled analgesia or epidural techniques will not significantly improve outcome...

  19. Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills.

    NARCIS (Netherlands)

    Galvin, E.; Boesjes, H.; Hol, J.; Ubben, J.F.; Klein-Nulend, J.; Verbrugge, S.J.

    2010-01-01

    BACKGROUND: Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia. METHODS: Patients scheduled for extraco

  20. Does wound infi ltration of tramadol reduce postoperative pain in laparoscopic or open herniorrhaphy?

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    Remziye Sıvacı

    2012-09-01

    Full Text Available Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim of this study was to evaluate the effects of administered tramadol at wound closure on postoperative painand analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH or tension free open inguinal herniorrhaphy (TFOH.Methods: Twenty patients were randomly divided into two groups (n= 10 in each as LH or TFOH. Patients received infiltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure. Postoperative pain was assessed with a Visual Analog Scale (VAS at 3, 6, 12, and 24 hours postoperatively. Additional requirements of tramadol for postoperative pain releif were registered.Results: VAS scores at postoperative 12 and 24 hours were signifi cantly higher according to 3rd hour VAS scores in both groups. The VAS scores at 12 hours after operation signifi cantly lower in LH group than inTFOH group (1.5 ± 0.97 vs 5.1 ± 0.99. Additional requirements of tramadol for postoperative pain releif were significantly lower in LH group.Conclusion: We conclude that wound infi ltration of 200 mg tramadol reduce postoperative pain in LH group.

  1. Analgesia pós-operatória para procedimentos cirúrgicos ortopédicos de quadril e fêmur: comparação entre bloqueio do compartimento do psoas e bloqueio perivascular inguinal Analgesia postoperatoria para procedimientos quirúrgicos ortopédicos de cadera y fémur: comparación entre bloqueo del compartimiento del psoas y bloqueo perivascular inguinal Postoperative analgesia for orthopedic surgeries of the hip and femur: a comparison between psoas compartment and inguinal paravascular blocks

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2006-12-01

    estudio mostró que la inyección en el compartimiento del psoas fue más fácil y más efectiva en el bloqueo de los cinco nervios del plexo lumbar.BACKGROUND AND OBJECTIVES: This study evaluated the efficacy of a single injection of 0.25% bupivacaine in the psoas compartment or inguinal paravascular for postoperative analgesia in patients undergoing orthopedic surgeries using a peripheral nerve stimulator. METHODS: One hundred patients who had a lumbar plexus block through the psoas compartment were compared to 100 patients who had an inguinal paravascular block, using a peripheral nerve stimulator, with 40 mL of 0.25% bupivacaine. The analgesia of the ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves was assessed 4, 8, 12, 16, 20, and 24 hours after the end of the surgical procedure. Pain severity was also evaluated in the same period. The amount of opioids administered in the postoperative period was recorded. A radiological study with non-ionic contrast was done in five patients in each group to evaluate the dispersion of the anesthetic. RESULTS: The ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves were blocked in 92% of the patients with psoas compartment block versus 62% in those with inguinal paravascular block. Lumbar plexus block reduced the need for opioids, and 42% of the patients who underwent psoas compartment block and 36% of the patients who underwent inguinal paravascular block did not need additional analgesics in the postoperative period. Analgesia lasted for approximately 21 hours in the psoas compartment block and 15 hours in the inguinal paravascular block. CONCLUSIONS: Psoas compartment block and inguinal paravascular block are excellent techniques for postoperative analgesia in orthopedic surgeries, decreasing the need for opioids. This study showed that the injection in the psoas compartment was easier and more effective in blocking the five nerves of the lumbar plexus.

  2. 术后镇痛对冠心病患者围术期心肌损伤的影响%Effects of Postoperative Different Analgesia Styles on Perioperative Myocardial Injury in Coronary Heart Disease Patients Undergoing Thoracic Surgery

    Institute of Scientific and Technical Information of China (English)

    严丽萍; 吴明慧; 陈丽; 王莹

    2011-01-01

    Objective To compare the effects of postoperative different analgesia on the myocardial injury in coronary heart disease patients undergoing thoracic surgery, and to offer a theoretical foundation for better analgesia. Methods Fouty patients, ASA Ⅱ - Ⅲ ,undergoing thoracic surgery under general anesthesia combined with epidural block were randomly allocated to patientcontrolled intravenous analgesia(PCIA) group( n = 20) and patient-controlled epidural analgesia( PCEA ) group( n = 20 ). Blood samples were prepared for the measurement of cTnI. The ST segment changes were recorded. The analgesia effect was assessed using visual analog scores(VAS). Results The values of cTnI in PECA group were significant lower than those in group PICA ( P <0.05 ). The total leads of depression of ST segment (NST) and sum of depression of ST segment( Σ ST) in PECA group were fewer than those in group PICA at different time points (P < O. 05). Conclusion Compared with group PICA, PECA gets a better analgesia and may significantly protect the myocardial.%目的 比较不同镇痛方法对胸科冠心病患者围术期心肌损伤的影响,为胸科冠心病患者选择适宜的术后镇痛方式.方法 择期行胸科手术的冠心病患者40例,ASAⅡ~Ⅲ级,随机分为静脉自控镇痛组(HCA组),硬膜外自控镇痛组(PECA组),每组20例.两组患者均在全麻复合硬膜外阻滞下手术,术毕分别接PICA和PECA.观察两组患者在围术期血清肌钙蛋白Ⅰ(cTnI)浓度及心电图ST段变化,用视觉模拟评估法评估镇痛效果(VSA评分).结果 两组患者术毕血浆cTnI浓度PECA组比PICA组的浓度明显降低(P<0.05).术后各时点心电图ST段改变导联数(NST)和ST段压低幅度的总和(∑ST)PECA组明显比PICA组减少(P<0.05).结论 胸科冠心病患者术后使用PECA镇痛对防治心肌受损有一定的保护作用.

  3. Intrapleural analgesia after endoscopic thoracic sympathectomy.

    Science.gov (United States)

    Silva, Patrícia Gomes da; Cataneo, Daniele Cristina; Leite, Fernanda; Hasimoto, Erica Nishida; Barros, Guilherme Antonio Moreira de

    2011-12-01

    To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

  4. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

    Science.gov (United States)

    Arumugam, Sudha; Lau, Christine SM; Chamberlain, Ronald S

    2016-01-01

    Objectives Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. Materials and methods A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. Results A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; Pfentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. Conclusion The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment plans among patients undergoing elective surgery. PMID

  5. Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain.

    Science.gov (United States)

    Crowe, Linda; Chang, Anne; Fraser, Jennifer A; Gaskill, Deanne; Nash, Robyn; Wallace, Karen

    2008-12-01

    Objectives  The primary objective of this systematic review was to assess the effectiveness of nursing interventions for the relief/reduction of post-operative pain when compared with either standard care or other nursing interventions. Inclusion criteria  Types of studies This review included randomised controlled trials (RCTs) and other quasi-randomised experimental research designs. Types of participants Adults treated for post-operative pain in an acute care hospital. Types of interventions Interventions included in the review were only those directly administered by nursing staff such as: (i) administration of analgesia: including oral, intramuscular injection, patient controlled analgesia, epidural; (ii) pre-operative patient education; (iii) assessment and documentation of intensity of pain at regular intervals; (iv) protocols, clinical pathways or flow-sheets used in the management of pain; and (v) non-pharmacological interventions such as massage and relaxation. Types of outcome measures The primary outcome was the relief or reduction of post-operative pain. Other measures included analgesia consumption, patient satisfaction and length of hospital stay. Search strategy  Search terms were chosen after reviewing text words and MeSH terms in relevant articles and databases. A search for published and unpublished research covering the period 1985-2004 (inclusive) was conducted, using 11 major electronic databases. Reference lists of retrieved articles were hand searched. The search was restricted to reports published in English. Assessment of quality  The methodological quality of eligible studies was appraised by two independent reviewers, using a standardised critical appraisal tool. Differences in opinion were decided by consensus after discussion with a third investigator. Data extraction and analysis  Data were extracted from the studies that met the criteria for methodological quality. Two reviewers independently extracted data for each

  6. Preoperative analgesia for children and adolescents to reduce pain associated with dental treatment.

    Science.gov (United States)

    McCann, Catherine

    2017-03-01

    Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, ISI Web of Science, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled clinical trials of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents up to 17 years of age. Children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia were excluded.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Standard Cochrane methodological approaches were used.ResultsFive trials involving 190 patients were included. None of the studies were at low risk of bias. Three trials involved dental treatment and two involved orthodontic treatment. Three of the included trials compared paracetamol with placebo. Meta-analysis of the two trials showed no evidence of a benefit in taking paracetamol preoperatively; (RR) for postoperative pain of 0.81 (95%CI; 0.53 to 1.22). Four trials compared ibuprofen with placebo. Pooled data from two studies showed a statistically significant mean difference in severity of postoperative pain of -13.44 (95%CI; -23.01 to -3.88) on a visual analogue scale (0 to 100), which indicated a probable benefit. Both trials were at high risk of bias and the quality of the evidence is low.ConclusionsFrom the available evidence, we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in using preoperative analgesics prior to orthodontic separator placement. The quality of the evidence is low. Further randomised clinical trials should be completed with appropriate sample sizes and well defined outcome measures.

  7. 帕瑞昔布钠超前镇痛对子宫肌瘤患者术后镇痛效果及细胞免疫功能的影响%Effect of Parecoxib Sodium Preemptive Analgesia on Postoperative Analgesia and Cellular Immune Function in Patients with Uterine Fibroids

    Institute of Scientific and Technical Information of China (English)

    李明勇; 王倩青

    2014-01-01

    the control group received 5 mL saline intravenously.Postoperative pain conditions of the two groups were e‐valuated by using visual analog scale(VAS method). The PCIA pump first trigger time ,effective compression number and the total amount of fentanyl were recorded. Venous blood was collected before operation ,6 h(T1 ) ,24 h(T2 ) ,48 h(T3 )and 72 h(T4 ) after operation ,respectively. T lymphocyte subsets of CD3+ ,CD4+ and CD8+ and NK cells were detected by using FACS Cali‐bur flow cytometer.The ratio of CD4+ /CD8+ was calculated.Results After 4 ,8 ,12 ,24 and 48 h ,the pain scores of patients were significantly lower in the advanced group than in the control group(all P<0.05). The PCIA pump first trigger time was longer ,effective compression number and the total amount of fentanyl of patients were less in the advanced group than in the control group ,the differences were statistically significant(all P<0.05). At T1 ,T2 and T3 ,CD3+ and CD4+ were significantly higher in the advanced group than in the control group(P<0.05).At T1 and T2 ,CD4+ /CD8+ was significantly higher in the advanced group than in the control group(both P<0.05).At T2 and T3 ,the NK was significantly higher in the advanced group than in the control group(both P<0.05).Conclusion Parecoxib sodium preemptive analgesia used in patients with uterine fi‐broids can reduce postoperative pain ,reduce the amount of analgesics ,reduce the immune suppression ,and improve immune function in patients after surgery.

  8. Avaliação da analgesia pós-operatória em pacientes submetidos à cirurgia orificial com anestesia local associada ou não à morfina Evaluation of the postoperative analgesia in patients submitted to anorectal surgery with local anesthesia associated or not the morphine

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2007-03-01

    groups were submitted to the same protocol standardized sedative during the surgery and postoperative analgesia. The intensity of pain was evaluated when it appeared, the time with analgesia was analyzed and other complications were registered. The intensity of pain was similar in both groups, the time with analgesia was longer in the group where morphine was used, although it was not significant in the statistics and the complications after the surgery were not significant in both groups. So the infiltration of morphine in the anorectal region has benefices in the postoperative analgesia but it was not significant in the statistics and it does not increase the complications related with morphine as urinary retention and itching.

  9. Effect of dexmedetomidine on postoperative analgesia pump dose and effect%右美托咪啶对术后患者止痛泵药物剂量及效果的影响研究

    Institute of Scientific and Technical Information of China (English)

    姬斌; 孔微微; 南洋; 黄葱葱; 李军

    2015-01-01

    目的:探讨右美托咪啶对术后患者止痛泵药物剂量及效果的影响。方法收集温州医科大学附属第二医院收治的行全身麻醉下行上腹部手术患者50例,根据术后止痛药物不同分为对照组和实验组,每组各25例,分别给予相应的药物治疗,治疗结束后,对所有患者的视觉模拟评分(visual analogue scale,VAS)、舒适度评分(bruggrman comfort scale,BCS)、不良反应发生率以及止痛泵药物用量进行检测。结果实验组患者VAS评分显著低于对照组(P<0.05);实验组患者BCS评分显著高对照组(P<0.05);实验组患者不良反应发生率显著低于对照组(P<0.05);实验组患者止痛泵药物用量显著低于对照组(P<0.05)。结论右美托咪啶能够显著降低术后患者的疼痛程度,降低不良反应发生率,减少止痛泵药物的用量。%Objective To investigate effect of dexmedetomidine on postoperative analgesia pump dose and effect.Methods 50 cases of patients with abdominal surgery under general anesthesia were selected.According to the postoperative analgesic drugs were divided into control group and experimental group, 25 cases in each group were given corresponding drug treatment.After treatment, the visual analogue scale, comfort score, adverse reaction rate and dosage of analgesic drugs were detected and compared.Results Compared with the control group,the VAS score were lower(P <0.05),the BCS score were higher(P<0.05),the adverse reaction rate were lower(P<0.05),the dosage of analgesic pump were lower(P<0.05). Conclusion Dexmedetomidine can significantly reduce postoperative pain degree of patients, reduce the incidence of adverse reaction, reduce analgesic dosage of the drug pump.

  10. 布托啡诺复合小剂量氯氨酮用于剖宫产术后镇痛%Postoperative analgesia of cesarean section by buprenorphine hydrochloride combined with low ketamine

    Institute of Scientific and Technical Information of China (English)

    张勇; 邓燕

    2010-01-01

    目的 观察术后硬膜外持续泵入布托啡诺复合小剂量氯胺酮用于剖宫产术后镇痛的效果和对初乳及不良反应的影响. 方法选择40例Ⅰ~Ⅱ级择期或急症孕足月行剖宫产手术后的产妇,年龄23~35岁,随机分为两组.A组为观察组(n=20),用布托啡诺0.1 mg/kg+氯胺酮1 mg/kg+生理盐水至 100 ml持续泵入;B组为对照组(n=20),用0.15%罗哌卡因+0.004%芬太尼+0.1%地塞米松+生理盐水总量100 ml持续泵入.观察产妇术后各时间段的视觉模拟镇痛评分(VAS)、镇静评分、泌乳时间,并对术后产妇的总体感觉满意度进行评分.结果 A、B两组在泵药后4、12、24、48 h的VAS评分、镇静评分差异无统计学意义(P>0.05).A组产妇的总体感觉满意度高于B组(P0.05).结论 布托啡诺复合小剂量氯胺酮硬膜外持续泵入用于剖宫产术后镇痛可以提供满意的镇痛效果,而且也有利于术后产妇的恢复,并且不影响泌乳.%Objective To observe the analgesia effects of buprenorphine hydrochloride combined with low ketamine that continued to pump into epidural space,which were used to treat postoperative analgesia of cesarean section and to study their on colostrums and side reactions. Methods Forty patients were at age of 23-35 years and term pregnancy, who were 1-2 grade or emergency.These cases were randomly divided into two groups: group A(study group,n=20) and group B(control group,n=20),group A were treated with buprenorphine hydrochloride(0.1 mg/kg)+ ketamine(1 mg/kg)+NS(coming to 100 ml),which continued to pump into epidural space. Group B were treated with ropivacaine(0.15%)+febtanyl citrate(0.004%)+dexame thasone(0.1%)(coming to 100 ml), which continued to pump into epidural space.We observe postoperative parturients mimic analgesia VAS of visual sense,sedation VAS,lactigenous time and the total degree of satisfaction. Results There were no significant difference between group A and group B about mimic analgesia

  11. Observation of Clinical Effect of Intravenous Dezocine Combined with Tramadol for Cesarean Section Control Intravenous Analgesia for Postoperative%地佐辛复合曲马多用于剖宫产术后静脉自控镇痛的效果观察

    Institute of Scientific and Technical Information of China (English)

    李斌

    2014-01-01

    Objective:To evaluate the effect and safety of Dezocine combined with Tramadol for cesarean section control intravenous analgesia for postoperative. Method:Selecting the author’s hospital treated 40 routine waist hard joint anesthesia cesarean section patients,by using the method to random number table they were divided into Tramadol group(group A) and Dezocine combination with Tramadol group(group B),20 cases in each,were given intravenous analgesia. Observing and recording the patient’s vital signs,pain score(VAS),sedation scores(Ramsay),comfort score(BCS) and adverse reactions.Result:Two groups of postoperative VAS,BCS grade,Ramsay,incidence of adverse reactions compared differences had no statistical significance (P>0.05).Conclusion:With sheen and postoperative intravenous,Tramadol combined with Dezocine used for cesarean section self-control analgesia effect is good,can reduce the adverse reaction.%目的:评价剖宫产术后应用地佐辛联合曲马多进行静脉自控镇痛(PCIA)的临床效果和安全性。方法:选取笔者所在医院收治的40例行腰硬联合麻醉剖宫产手术患者,采用随机数字表法将其分为曲马多组(A组)和地佐辛联合曲马多组(B组),各20例,分别给予静脉镇痛。观察并记录患者的生命体征、疼痛评分(VAS)、镇静评分(Ramsay)、舒适度评分(BCS)及不良反应。结果:术后两组的VAS、BCS评分、Ramsay评分、不良反应发生率比较差异无统计学意义(P>0.05)。结论:地佐辛和曲马多联合用于剖宫产术后静脉自控镇痛效果好,能降低不良反应。

  12. 舒芬太尼复合地佐辛在术后镇痛中的应用%Application of sufentanil combined with dezocine in postoperative analgesia

    Institute of Scientific and Technical Information of China (English)

    沈彦坡

    2015-01-01

    Objective To explore the effect of sufentanil combined with dezocine applied in postoperative patient controlled intravenous analgesia (PCIA) for patients undergoing thoracotomy.Methods A total of 120 patients, who underwent thoracotomy, were randomly divided into three group with 40 cases in each group. They all received PCIA. The analgesic formula for group A, as sufentanil combined with dezocine group, was sufentanil 1.25μg/kg + dezocine 0.4 mg/kg+ondansetron 8 mg, diluted to 100 ml by normal saline; that for group B, as sufentanil group, was sufentanil 2.5μg/kg+ondansetron 8 mg, diluted to 100 ml by normal saline; and that for group C, as dezocine group, was dezocine 0.8 mg/kg+ondansetron 8 mg, diluted to 100 ml by normal saline. Intravenous inhalation anesthesia and general anesthesia were applied during surgery and PCIA after surgery. Visual analogue scale (VAS), degree of sedation scores (Ramsay), and adverse reactions were observed in 4 h, 8 h, 12 h, 24 h, and 48 h after surgery in the three groups.Results In postoperative 4 h, 8 h and 12 h, group C had higher VAS score than groups A and B (P<0.05), and groups B and C had higher Ramsay scores than group A (P<0.05). Group B had higher incidences of drowsiness, dizziness, nausea, and emesis than groups A and C (P<0.05).Conclusion Sufentanil combined with dezocine in PCIA for thoracotomy is safe and effective, with good analgesic effect and few adverse reactions.%目的:探讨舒芬太尼复合地佐辛应用于开胸手术患者术后自控静脉镇痛(PCIA)的效果。方法择期行开胸手术的患者120例,随机分为三组,每组40例,术后均行PCIA。镇痛药配方:A组,舒芬太尼复合地佐辛组,舒芬太尼1.25μg/kg+地佐辛0.4 mg/kg+昂丹司琼8 mg+生理盐水稀释至100 ml;B组,舒芬太尼组,舒芬太尼2.5μg/kg+昂丹司琼8 mg+生理盐水稀释至100 ml;C组,地佐辛组,地佐辛0.8 mg/kg +昂丹司琼8 mg+生理盐水稀释至100 ml。术中采用

  13. Advances in patient-controlled analgesia: the role of fentanyl ITS

    Directory of Open Access Journals (Sweden)

    Ian Power

    2009-01-01

    Full Text Available Ian Power, Jon G McCormackDepartment of Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Royal Infirmary, Edinburgh, UKAbstract: Effective pain relief is an essential component of a patient’s peri-operative care package. Good analgesia has been shown to reduce the incidence of cardiovascular, respiratory and thrombo-embolic complications following surgery. Satisfactory analgesia facilitates early patient ambulation following surgery, which may reduce in-patient stay. Patient-controlled analgesia (PCA systems are a well established standard therapy for acute post-operative pain; however some practical limitations limit their clinical utility. The fentanyl inotophoretic transdermal system (ITS is a novel self-contained needle-free PCA device, which delivers boluses of fentanyl transdermally. This system has been shown to provide analgesia equivalent to conventional PCA modalities, with unique design features that may confer advantages to patients and staff, including facilitating patient mobilization in the post-operative phase. This review will discuss the technology of iontophoretic systems, the pharmacology of transdermal fentanyl delivery, and some practical implications of the fentanyl ITS.Keywords: iontophoresis, transdermal, patient-controlled analgesia, fentanyl, post-operative pain

  14. Effect of Pre-Designed Instructions for Mothers of Children with Hypospadias on Reducing Postoperative Complications

    Science.gov (United States)

    Mohamed, Sanaa A.

    2015-01-01

    Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of…

  15. Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery

    Science.gov (United States)

    Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy

    2015-01-01

    Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…

  16. Effects of two kinds of analgesia methods on the postoperative recovery of patients receiving thoracotomy%两种不同镇痛方法对开胸手术术后恢复的影响

    Institute of Scientific and Technical Information of China (English)

    卢强; 黄立军; 张志培; 闫小龙; 李小飞; 韩勇

    2012-01-01

    Objective To compare the effects of intravenous analgesia with intercostal nerve cryotherapy on postoperative recovery in patients receiving thoracotomy. Methods Sixty patients undergoing thoracic surgery were randomly divided into 2 groups (each n = 30) : intercostal nerve freezing group (INC group) and patient-controlled intravenous analgesia group (PCA group). The degree of pain was assessed by numeric pain intensity score (NRS). The adverse reaction was recorded also. Results Postoperative complications, ambulation time, and time to normal activity were not significantly different between the two groups (P> 0.05). The postoperative side effects in PCA group were severer than those in INC group (P 0.05). The pain score was significantly decreased in INC group than that in PCA group in 3 ~ 7 days after surgery (P 0.05). Conclusions Intercostal nerve freezing technique is a better analgesia method after thoracic surgery treatment with fewer side effects, but the chest tube drainage was increased and the time to remove the chest tube was longer.%目的:比较经静脉自控镇痛、肋间神经冷冻术两种镇痛方法对开胸手术患者术后恢复的影响.方法:60 例开胸手术患者随机分为肋间神经冷冻组(INC 组)和患者静脉自控镇痛组(PCA 组).疼痛强度评分法(NRS)评估术后疼痛程度.结果:(1)两组比较,术后并发症、下床时间、正常活动时间差异无统计学意义(P>0.05).而术后副反应比较,PCA 组较INC 组严重(P0.05);术后第3 ~ 7 天,INC 组较PCA 组疼痛明显减轻(P0.05).结论:肋间神经冷冻术是比较好的胸部手术术后镇痛治疗方法,副作用小,但术后胸引管引流量增加,拔除胸引管时间延长.

  17. Incidência de depressão respiratória no pós-operatório em pacientes submetidos à analgesia venosa ou peridural com opioides Incidencia de depresión respiratoria en el postoperatorio en pacientes sometidos a la analgesia venosa o epidural con opioides The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids

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    Leonardo Teixeira Domingues Duarte

    2009-08-01

    fueron tratados con PCA venosa con morfina, mientras que el último recibió analgesia epidural con fentanil. El promedio de edad fue de 30,5 ± 24,7 años; el tiempo medio entre el término de la anestesia hasta el aparecimiento de la depresión respiratoria fue de 18,1 ± 26,3 horas. El aparecimiento de depresión respiratoria fue significativamente más frecuente en la PCA venosa con morfina (p = 0,001 y en una edad menor que 16 años (p BACKGROUND AND OBJECTIVES: Intravenous or epidural patient-controlled analgesia (PCA is a safe and effective technique in the treatment of postoperative pain. However, the use of opioids is not devoid of risks,and respiratory depression represents the most feared complication. The objective of the present study was to describe the incidence of respiratory depression associated with postoperative analgesia with the intravenous or epidural administration of opioids and the characteristics of the patients who developed this complication. METHODS: This is a retrospective, incidence study in patients who underwent surgeries at the Hospital SARAH Brasília from December 1999 to December 2007 and treated with intravenous or epidural PCA with opioids. Respiratory depression was defined as: respiratory rate < 8 bpm, need to use naloxone, or peripheral oxygen saturation below 90%. RESULTS: Two thousand seven hundred and ninety patients were evaluated; 635 of those patients received intravenous PCA and 2155 epidural analgesia. Seven patients developed postoperative respiratory depression (0.25%. Six of those patients were treated with intravenous PCA with morphine, while the last one received epidural analgesia with fentanyl. Patients had a mean age of 30.5 ± 24.7 years; the mean time between the end of anesthesia and the development of respiratory depression was 18.1 ± 26.3 hours. The incidence of respiratory depression was significantly higher in PCA with intravenous morphine (p = 0.001 and age below 16 years (p < 0.05. CONCLUSIONS: The

  18. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  19. Preemptive analgesia with ketamine for laparoscopic cholecystectomy

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    Harsimran Singh

    2013-01-01

    Full Text Available Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy.

  20. Preemptive analgesia with Ketamine for Laparoscopic cholecystectomy

    Science.gov (United States)

    Singh, Harsimran; Kundra, Sandeep; Singh, Rupinder M; Grewal, Anju; Kaul, Tej K; Sood, Dinesh

    2013-01-01

    Background: The aim of preemptive analgesia is to reduce central sensitization that arises from noxious inputs across the entire perioperative period. N-methyl d-aspartate receptor antagonists have the potential for attenuating central sensitization and preventing central neuroplasticity. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were randomized into four groups of 20 patients each, who were administered the study drug intravenously 30 min before incision. Groups A, B, and C received ketamine in a dose of 1.00, 0.75 and 0.50 mg/kg, respectively, whereas group D received isotonic saline. Anesthetic and surgical techniques were standardized. Postoperatively, the degree of pain at rest, movement, and deep breathing using visual analogue scale, time of request for first analgesic, total opioid consumption, and postoperative nausea and vomiting were recorded in postanesthesia care unit for 24 h. Results: Pain scores were highest in Group D at 0 h. Groups A, B, and C had significantly decreased postoperative pain scores at 0, 0.5, 3, 4, 5, 6, and 12 h. Postoperative analgesic consumption was significantly less in groups A, B, and C as compared with group D. There was no significant difference in the pain scores among groups A, B, and C. Group A had a significantly higher heart rate and blood pressure than groups B and C at 0 and 0.5 h along with 10% incidence of hallucinations. Conclusion: Preemptive ketamine has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. The lower dose of 0.5 mg/kg being devoid of any adverse effects and hemodynamic changes is an optimal dose for preemptive analgesia in patients undergoing laparoscopic cholecystectomy. PMID:24249984

  1. 地佐辛用于腹部全麻手术后的镇痛效果评价%Analgesic effect evaluation of dezocine in postoperative analgesia in abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    李楠; 王平英

    2014-01-01

    Objective To investigate analgesia of dezocine in abdominal anesthesia postoperative.Methods 80 cases (ASA I ~II)abdominal surgery under general anesthesia patients required postoperative analgesia,according to different postoperative analgesia drug,patients were randomly divided into 2 groups:dezocine group (group D),dezocine 0.6 mg/kg+ondansetron 4mg plus 0.9% sodium chloride to 100 mL,loading dose of intravenous patient controlled analgesia (PCIA);fentanyl group (group F),fentanyl 12 g/kg+ondansetron 4mg plus 0.9% sodium chloride to 100 mL,loading dose plus PCIA,recorded after 2,4,8,12,24,48 h visual analog scale (VAS)and Ramsay sedation score.Results The 2 groups were not statistically significant differences in VAS score and Ramsay score,and the incidence of adverse reaction of fentanyl group was significantly higher than that of dezocine group (P<0.01).Conclusion Dezocine group could provide analgesia safe and comfortable for patients after abdominal operation under general anesthesia.%目的:探讨地佐辛在腹部全麻手术术后镇痛效果。方法80例(ASAⅠ~Ⅱ级)全麻腹部手术要求术后镇痛的患者,按术后镇痛药物不同随机均分为2组(n=40):地佐辛组(D组)地佐辛0.6 mg/kg+昂丹司琼4mg加0.9%氯化钠至100 mL,负荷剂量经静脉患者自控镇痛(intravenous patient-controlled analgesia,PCIA);芬太尼组(F组)芬太尼12μg/kg+昂丹司琼4mg加0.9%氯化钠至100 mL,负荷剂量加PCIA,记录术后2、4、8、12、24、48 h的视觉模拟评分(visual analog scale,VAS)及Ramsay镇静评分。结果2组VAS评分及Ramsay评分差异无统计学意义,而不良反应发生率芬太尼组显著高于地佐辛组(P<0.01)。结论地佐辛组可为腹部全麻手术后患者提供较安全和舒适的镇痛作用。

  2. 丁丙诺啡超前镇痛对围术期应激反应和术后自控镇痛的影响%Preemptive analgesia effects of buprenorphine on stress responses and postoperative pain management

    Institute of Scientific and Technical Information of China (English)

    粱琪; 金梅生

    2012-01-01

    Objective: To study the preemptive analgesia effects of buprenorphine on postoperative pain management and stress responses. Methods: 60 patients underwent spinal surgery were randomly divided into two groups with 30 cases each, patients in group P were administrated with 0. 15mg buprenorphine intravenously 30 min before operation. In group C, patients were administrated with 0. 15mg buprenorphine at the end of operation. All patients received postoperative analgesia with patient controlled intravenously analgesia(PCIA). The analgesic effect was evaluated by VAS score at 2,6,12,24 and 48 h after operation. The concentration of Cor and CRP in serum a-head of anesthesia induction (TO) and at 6h (Tl) , 12h (T2) after operation was measured. Results: VAS scores of group P were significantly lower than those in group C at the different time point (P<0. 05). The concentrations of Cor and CRP in two groups were significantly increased at Tl, T2, respectively, as compared with values at TO. Compared to group C, the concentrations of Cor and CRP were significantly lower at Tl and T2 than those in group P (P<0. 05). Conclusion;Preemptive analgesia with buprenorphine can more effectively inhibit perioperatively stress responses and have effective postoperative analgesia.%目的:观察丁丙诺啡超前镇痛对围术期患者应激反应及自控镇痛的影响.方法:60例于全身麻醉下行脊柱内固定术患者,随机分为超前镇痛(P)组,于手术开始前30min静脉缓慢注射丁丙诺啡0.15mg;术后镇痛(C)组,于手术结束时静脉缓慢注射丁丙诺啡0.15mg.两组患者术后均行静脉自控镇痛.术后不同时间点观察视觉模拟评分(VAS).并于麻醉前(T0)、术后6h(T1)、术后12h(T2)分别测定皮质醇(Cor)、C反应蛋白(CRP).结果:P组与C组均能在术后产生良好的镇痛效果,P组在术后2、6、12、24、48h VAS评分显著低于C组(P<0.05),24h内各时点PCIA有效按压次数P组明显少于C组(P<0.05),与T0

  3. Clinical analysis of the effects and the side effects of different patterns of postoperative analgesia%不同镇痛方式术后镇痛效果及不良反应临床分析

    Institute of Scientific and Technical Information of China (English)

    廖小卒; 李斌飞; 张志刚; 文静; 程周; 康乐燕

    2011-01-01

    Objective To explore the effects and the side effects of different pattems of postoperative analgesia. Methods The data of postoperative analgesia in 725 patients underwent obstetrics and gynecology operation was analysed retrospectively, patient-controlled intravenous analgesia (PCIA) with 352 cases (PCIA group) or patient-controlled epidural analgesia(PCEA ) with 373 cases(PCEA group ). The analgesic effect, sedation scale and side effects were compared. Results The analgesic effect and sedation scale at 12,24 h after operation in PCEA group was lower than that in PCIA group (P <0.05). The incidence of vomiting in PCEA group was lower than that in PCIA group [6.4%(24/373) vs. 9.9%(35/352)], the incidence of itchy skin and infection in PCEA group were higher than those in PCIA group [4.8%(18/373)vs. 2.6% (9/352), 3.2%( 12/373 ) vs. 0], there was significant difference between two groups (P < 0.05 ). Old people fell less pain than wrinkly and young people (P<0.05). Conclusions The effect of PCEA is better than PCIA. Paresthesia is main in PCEA. Vomiting is more in PCIA. Old people feel less pain than wrinkly and young people. So postoperative analgesia is selected by concrete conditions.%目的探讨不同镇痛方式的术后镇痛效果及不良反应。方法回顾性分析725例下腹部妇产科手术患者术后镇痛情况,其中行患者自控静脉镇痛(PCIA)352例(PCIA组),行患者自控硬膜外镇痛(PCEA)373例(PCEA组),比较两组患者的镇痛效果、镇静评分及不良反应等。结果 PCEA组术后12、24h数字评定量表(NRS)评分和镇静评分均低于PCIA组(P<0.05);呕吐发生率低于PCIA组[6.4%(24/373)比9.9% (35/352)],皮肤瘙痒、感觉异常发生率高于PCIA组[4.8%(18/373)比2.6%( 9/352),3.2%( 12/373)比0](P<0.05);老年患者自述疼痛率低于中、青年患者(P<0.05)。结论PCEA效果优于PCIA,感觉异常主要在PCEA,呕吐以PCIA居多,老年患者的自

  4. Research progress on postoperative analgesia for pectus excavatum in pediatric patients after Nuss procedure%儿童漏斗胸Nuss术后镇痛的研究进展

    Institute of Scientific and Technical Information of China (English)

    周晨; 金海燕; 李建华; 胡智勇

    2013-01-01

    Pectus excavatum is the common congenital chest wall deformity in children, and Nuss procedure is the conventional surgical treatment for this disease. Nuss procedure is superior to Ravitch correction for it is less harmful in terms of the surgical technique. However,Nuss procedure is associated with severe postoperative pain, thus adequate postoperative analgesia is important. In this review,factors that influence the postoperative pain after Nuss procedure, the pain managements, the related complications and the side effects of drugs are discussed.%漏斗胸是儿童中最常见的先天性胸壁畸形,而Nuss术是目前最先进的矫形术式.其优点是避免了过去Ravitch术带来的巨大创伤,但所造成的术后疼痛的严重程度却不亚于开胸术.因此,合理有效的术后镇痛就显得十分重要.文中就影响儿童漏斗胸Nuss术后疼痛的因素、镇痛方式和相关并发症,以及药物不良反应的研究进展予以综述.

  5. Ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty: a multicenter randomized controlled study

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    Fen Wang

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received postoperative analgesia from October 2012 to January 2013. In 22 patients, ultrasound and nerve stimulator guided continuous femoral nerve block were performed for analgesia (CFNB group; in 24 patients, epidural analgesia was done (PCEA group. The analgesic effects, side effects, articular recovery and complications were compared between two groups. RESULTS: At 6 h and 12 h after surgery, the knee pain score (VAS score during functional tests after active exercise and after passive excise in CFNB were significantly reduced when compared with PCEA group. The amount of parecoxib used in CFNB patients was significantly reduced when compared with PCEA group. At 48 h after surgery, the muscle strength grade in CFNB group was significantly higher, and the time to ambulatory activity was shorter than those in PCEA group. The incidence of nausea and vomiting in CFNB patients was significantly reduced when compared with PCEA group. CONCLUSION: Ultrasound and nerve stimulator guided continuous femoral nerve block provide better analgesia at 6 h and 12 h, demonstrated by RVAS and PVAS. The amount of parecoxib also reduces, the incidence of nausea and vomiting decreased, the influence on muscle strength is compromised and patients can perform ambulatory activity under this condition.

  6. 神经外科开颅术后患者疼痛及控制状况的调查%Investigation of postoperative pain and analgesia of patients after craniotomy

    Institute of Scientific and Technical Information of China (English)

    张雪梅; 侯春梅; 王会文; 韩如泉

    2012-01-01

    目的 调查神经外科开颅手术患者术后疼痛及控制状况,为术后镇痛治疗提供依据.方法 选择北京天坛医院神经外科开颅手术患者100例,采用疼痛视觉模拟评分( VAS)、Ramsay镇静评分于术后2h和24h评估患者意识和疼痛状况,并进行术后疼痛调查问卷,记录不良事件.结果 本组患者术后均使用静脉镇痛泵.术后2h无痛38例(38%),轻度疼痛49例(49%),中度疼痛12例(12%),重度疼痛1例(1%);术后24h无痛24例(24%),轻度疼痛30例(30%),中度疼痛36例(36%),重度疼痛10例(10%).结论 神经外科开颅手术患者术后存在不同程度的疼痛,术后镇痛需要进一步深化.%Objective To investigate the postoperative pain and analgesia of patients after craniotomy,so as to provide a basis for postoperative pain control.Methods A total of 100 craniotomy patients in Tiantan Neurosurgery Institute in Beijing were investigated with numeric rating scale ( NRS ),Glasgow coma scale,OAA/S sedation scale and Ramsay sedation scale.Postoperative pain and conscious were evaluated in 2 and 24 hours after operation,and questionnaire was used as well as the side effects were recorded.Results All patients received intravenous analgesia pump after the surgery.In 2 hours,38 felt no pain (38%),49 had mild pain (49%),12 had moderate pain ( 12% ) and 1 had severe pain ( 1% ),while in 24 hours,24 felt no pain (24%),30 had mild pain (30%),36 had moderate pain (36%) and 10 had severe pain (10%).Conclusions There are different degrees of postoperative pain after craniotomy,and pain control should be carried on further more.

  7. 吗啡与羟考酮用于经皮肾镜取石术后镇痛效果比较%Comparison of Postoperative Analgesia Efficacy of Morphine Versus Oxycodone After Percuta-neous Nephrolithotomy

    Institute of Scientific and Technical Information of China (English)

    田开林; 范本祎; 秦勤; 许军; 彭波; 袁俊斌

    2015-01-01

    [Objective] To compare the analgesia efficacy of morphine versus oxycodone after percutaneous nephrolithotomy (PCNL) .[Methods] The opioid consumption ,pain relief and side effects of morphine versus oxycodone after PCNL were examined by minimizing somatic pain component .During October 2013 and Sep‐tember 2014 ,a total of 50 adult patients were recruited and randomized to receive either morphine or oxycodo‐ne intravenously as postoperative pain treatment .During the first 4 postoperative hours ,opioid consumption , pain scores and side effects (nausea ,dizziness ,respiratory effects & itching ) were recorded .[Results] The postoperative opioid consumption varied considerably .However ,the mean opioid consumption was comparable for two groups ( P>0 .05) .Nausea was significantly less frequent with morphine ( P<0 .05) .[Conclusion]Morphine and oxycodone have similar analgesia efficacies during the first 4 postoperative hours .However ,the frequency of nausea is significantly less for morphine users .%【目的】对比研究吗啡与羟考酮用于经皮肾镜碎石取石术(PCNL)后的镇痛效果。【方法】回顾性分析2013年10月至2014年9月在本院行PCNL术治疗的50名患者,根据术后给予不同的镇痛药物将患者分为吗啡组(25例)和羟考酮组(25例)。比较两组患者术后4 h镇痛药物的使用量、疼痛视觉模拟评分(VAS)及不良反应(如恶心,头晕,呼吸抑制和瘙痒)等指标。【结果】两组患者VAS评分及镇痛药的平均使用量均无统计学差异(P >0.05),吗啡组患者不良反应恶心的发生率明显少于羟考酮组(P <0.05)。【结论】吗啡与羟考酮对行PCNL术的患者镇痛效果相当,但吗啡较羟考酮可减少不良反应恶心的发生率。

  8. Effects of different anaesthesia methods on postoperative analgesia of radical gastrectomy%全身麻醉复合硬膜外麻醉对胃癌术后镇痛的影响

    Institute of Scientific and Technical Information of China (English)

    路喻清; 冯阳阳; 史军军; 张向东; 胡彬

    2011-01-01

    Objective: To observe the effects of different anaesthesia methods on postoperative analgesia of radical gastrectomy. Methods: Ninety patients ( ASA Ⅰ or Ⅱ ) with gastric carcinoma were randomly divided into two groups ( G + E, G ). All patients were given preemptive analgesia and PCIA. Visual analogue scale ( VAS ) was used to assess the pain intensity at 2, 4,8,24 and 48h after surgery. Results: VAS of G + E group at 2,4,8 hours after surgery were significantly less than G group ( P < 0.05 ) . The effective press frequency of G + E group in 24 hours after surgery was significantly less than G group ( P < 0.05 ) . Adverse reaction of G + E group was significantly less than G group ( P < 0.05 ). Conclusion: General anaesthesia plus epidural anesthesia used in gastric carcinoma can significantly enhance the effect of postoperative analgesia and decrease adverse reaction.%目的:观察全身麻醉复合硬膜外麻醉对胃癌手术病人术后镇痛的影响.方法:90例择期行胃癌根治术患者,ASA I-II 级,年龄33-60 岁,随机均分为2组:G+E(全麻+硬膜外)组和G(单纯全麻)组.均采用超前镇痛和PCIA.观察术后48h内(2,4,8,24,48h)的镇痛评分(VAS),PCA使用次数,不良反应.结果:术后2,4,8h G+E(全麻+硬膜外)组的VAS评分明显低于G(单纯全麻)组(P<0.05).术后24h内PCA按压次数G+E(全麻+硬膜外)组明显低于G(单纯全麻)组(P<0.05).G+E(全麻+硬膜外)组的不良反应发生率明显低于G(单纯全麻)组(P<0.05).结论:胃癌手术时应用全身麻醉复合硬膜外麻醉可以明显加强术后镇痛效果,降低不良反应.

  9. 小剂量氯胺酮复合舒芬太尼术后静脉镇痛的临床观察%Clinical observation of small dose ketamine combined with sufentanyl for postoperative intravenous analgesia

    Institute of Scientific and Technical Information of China (English)

    倪洪湖; 刘永材; 谢永香

    2014-01-01

    目的:比较小剂量氯胺酮复合舒芬太尼与单纯舒芬太尼用于术后静脉镇痛的临床疗效。方法选择80例ASAⅠ~Ⅱ级下肢骨折行切开复位内固定术的患者,随机分成两组,每组40例,均以一次性静脉镇痛泵行术后镇痛。KS组:氯胺酮80μg/(kg·h)+舒芬太尼0.25μg/(kg·h);S组:舒芬太尼0.5μg/(kg·h)。两组镇痛泵中药物均用生理盐水稀释至100 ml。观察并记录患者术后6、12、24、48 h 镇痛评分、恶心呕吐、皮肤瘙痒、尿潴留和幻觉的发生率。结果 KS组各时点的镇痛评分均较S组低(P﹤0.05)。S组的恶心呕吐、皮肤瘙痒、尿潴留发生率较KS组高(P﹤0.05)。两组患者均无幻觉发生。结论小剂量氯胺酮在术后静脉镇痛中能增强舒芬太尼的镇痛作用,且不增加不良反应。%Objective To compare the clinical effects of small dose ketamine combined with sufentanyl and single use of sufentanyl on postoperative intravenous analgesia. Methods Eighty patients with ASAⅠ~Ⅱstage lower limb fracture under-went open reduction and internal fixation were randomly divided into two groups,with 40 cases in each group. All of the patients were given disposable intravenous analgesia pump. Group KS:ketamine 80 μg/( kg·h)plus sufentanyl 0. 25 μg/( kg·h);Group S:sufentanyl 0. 5 μg/(kg·h). The drugs in each group were diluted in 100 ml normal saline. The analgesia scores,in-cidences of nausea and vomiting,skin itching,urinary retention and illusion were recorded at 6,12,24,48 hours after operation. Results The analgesia scores of group KS at each time point were significantly lower than those of group S(P﹤0. 05). The in-cidences of nausea,vomiting,skin itching and urinary retention of group S were significantly higher than those of group KS( P﹤0. 05). There was no case of illusion occured in the two groups. Conclusion Small dose of ketamine used for postoperative in-travenous analgesia can

  10. Anesthetic Routines: The Anesthesiologist's Role in GI Recovery and Postoperative Ileus

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    John B. Leslie

    2011-01-01

    Full Text Available All patients undergoing bowel resection experience postoperative ileus, a transient cessation of bowel motility that prevents effective transit of intestinal contents or tolerance of oral intake, to varying degrees. An anesthesiologist plays a critical role, not only in the initiation of surgical anesthesia, but also with the selection and transition to effective postoperative analgesia regimens. Attempts to reduce the duration of postoperative ileus have prompted the study of various preoperative, perioperative, and postoperative regimens to facilitate gastrointestinal recovery. These include modifiable variables such as epidural anesthesia and analgesia, opioid-sparing anesthesia and analgesia, fluid restriction, colloid versus crystalloid combinations, prokinetic drugs, and use of the new peripherally acting mu-opioid receptor (PAM-OR antagonists. Review and appropriate adaptation of these multiple modifiable interventions by anesthesiologists and their surgical colleagues will facilitate implementation of a best-practice management routine for bowel resection procedures that will benefit the patient and the healthcare system.

  11. Acute pain control and accelerated postoperative surgical recovery

    DEFF Research Database (Denmark)

    Kehlet, H

    1999-01-01

    Postoperative pain relief continues to demand our awareness, and surgeons should be fully aware of the potential physiologic benefits of effective dynamic pain relief regimens and the great potential to improve postoperative outcome if such analgesia is used for rehabilitation. To achieve...... to recent knowledge within surgical pathophysiology. Such efforts must be expected to lead to improved quality of care for patients, with less pain and reduced morbidity leading to cost efficiency....

  12. 地佐辛镇痛对老年骨科手术患者术后谵妄发生率的影响%Effect of dezocine analgesia on the incidence of the postoperative delirium in orthopedic patients

    Institute of Scientific and Technical Information of China (English)

    王会敏

    2014-01-01

    目的:观察地佐辛术后静脉镇痛对老年骨科患者术后谵妄发生率的影响。方法:择期行髋关节置换术患者70例,年龄>60岁,随机均分为地佐辛术后镇痛组( DA组)和吗啡术后镇痛组( MA组),各组35例。术后行患者静脉自控镇痛,并随访统计术后即刻(T1)、24 h(T2)和48 h(T3)3个时间点的谵妄发生率(CAM-CR法)、VAS评分以及术后不良反应。结果:DA组在T1的术后谵妄发生率与MA组差异无统计学意义(P>0.05);DA组患者术后恶心呕吐与呼吸抑制发生率与MA组的差异均无统计学意义(P>0.05)。2组患者在T1、T2和T3三个时间点VAS评分差异均无统计学意义(P>0.05)。结论:对于老年骨科手术患者而言,地佐辛术后静脉自控镇痛具有与吗啡相当的镇痛效果,并不增加术后谵妄的危险性,不良反应较少。%Objective:To investigate the effects of dezocine analgesia on the incidence of the postoperative delirium in orthopedic elderly patients. Methods:Seventy more than 60 years old patients,who were scheduled by knee and hip arthroplasty were randomly into the dezocine analgesia group ( DA group ) and morphine analgesia group ( MA group ) ( 35 cases each group ) . The incidence of the postoperative delirium,visual analog scale(VAS) and adverse reactions between two groups were compared after operation(T1),and at 24 and 48 hours after operation(T2 and T3). Results:The difference of the incidence of delirium at T1 between two groups was not statistically significant(P >0. 05). The differences of the incidences of nausea,vomiting and respiratory depression after operation between two groups were not statistically significant(P>0. 05). The differences of the VAS scores at T1,T2 and T3 between two groups were not statistically significant(P >0. 05). Conclusions:The effects of dezocine analgesia on the incidence of the postoperative delirium in orthopedic elderly patients are the same as that of morphine

  13. Dexmedetomidine combined with sufentanil for postoperative analgesia in patients undergoing pulmonary lobectomy%右美托咪定联合舒芬太尼应用于肺叶切除术后镇痛

    Institute of Scientific and Technical Information of China (English)

    田海涛; 李海鸥; 王士雷; 尤培军; 廉箫; 孟锋

    2015-01-01

    Objective To observe the effaciacy of patient-controlled intravenous analgesia (PCIA) using dexmedetomidine combined with sufentanil within postoperative 48 h in patients undergoing pulmonary lobectomy.Methods A total of eighty patients were enrolled in this study.The PCIA was set immediately after operation in group A (sufentanil 0.04 pg ·kg-1 ·h-1) and group B (sufentanil 0.03 μg· kg~· h~ combined with dexmedetomidine 0.07 μg· kg-1· h-1) (n=40).The preoperative and postoperative visual analogue scale (VAS) scores, Ramsay score and adverse events were recorded and analyzed.Results Both of group A and group B achieved targeted pain levels, with the VAS scores of less than 4 at all observed points.Compared with group A, the VAS score in group B was significantly reduced at 6 h after surgery[(0.8±0.9) vs (1.8±0.7), P<0.05] and 12 h after surgery [(0.7±0.7) vs (1.9±0.8), P<0.05].The Ramsay score in group B was significantly increased at 6 h after surgery [(2.2±0.5) vs (3.5±0.4), P<0.05] and 12 h after surgery [(2.3±0.3) vs (3.3±0.6), P<0.05).No severe sedation was found and the Ramsay score was below 4.The incidence of restlessness, chills, vomiting and dizziness was lower in group B (0, 0, 0, 0) than those in group A (5%, 5%, 25% and 10%, P<0.05).The numbers of positive and negative pain complains in group B were 34 and 0, while those in group A were 26 and 4.Conclusions In patients undergoing pulmonary lobectomy, dexmedetomidine combined with sufentanil for PCIA can achieve the better analgesic and sedate effects, reduce sufentanil consumption and improve satisfaction index compared with PCIA using sufentanil alone.%目的 观察右美托咪定联合舒芬太尼应用于肺叶切除患者术后48 h患者静脉自控镇痛(patient controlled intravenous analgesia,PCIA)的效果. 方法 80例患者采用随机数字表法分为两组,每组40例:对照组(A组)采用舒芬太尼0.04 μg· kg-1·h-1,观察组(B组)采用舒芬太尼0

  14. Exposure to time varying magnetic fields associated with magnetic resonance imaging reduces fentanyl-induced analgesia in mice

    Energy Technology Data Exchange (ETDEWEB)

    Teskey, G.C.; Prato, F.S.; Ossenkopp, K.P.; Kavaliers, M.

    1988-01-01

    The effects of exposure to clinical magnetic resonance imaging (MRI) on analgesia induced by the mu opiate agonist, fentanyl, was examined in mice. During the dark period, adult male mice were exposed for 23.2 min to the time-varying (0.6 T/sec) magnetic field (TVMF) component of the MRI procedure. Following this exposure, the analgesic potency of fentanyl citrate (0.1 mg/kg) was determined at 5, 10, 15, and 30 min post-injection, using a thermal test stimulus (hot-plate 50 degrees C). Exposure to the magnetic-field gradients attenuated the fentanyl-induced analgesia in a manner comparable to that previously observed with morphine. These results indicate that the time-varying magnetic fields associated with MRI have significant inhibitory effects on the analgesic effects of specific mu-opiate-directed ligands.

  15. Immediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Dahl, J B; Daugaard, J J; Rasmussen, B;

    1994-01-01

    Thirty-two patients scheduled for total knee arthroplasty were randomized to receive an identical epidural blockade initiated 30 min before surgical incision (N = 16), or at closure of the surgical wound (N = 16). Before induction of general anaesthesia the epidural catheter was tested...... with bupivacaine 7.5 mg.ml-1, 2 ml. General anaesthesia was induced with thiopentone, pancuronium or atracurium, and fentanyl 0.1-0.3 mg, and maintained with N2O/O2 and enflurane. The epidural regimen consisted of a bolus of 16 ml of bupivacaine 7.5 mg.ml-1 plus morphine 2 mg, and continuous infusion......, during or after cessation of the epidural regimen. These results do not suggest timing of analgesia with a conventional, continuous epidural regimen to be of major clinical importance in patients undergoing total knee arthroplasty....

  16. Analgesia controlada pelo paciente com fentanil e sufentanil no pós-operatório de reconstrução de ligamentos do joelho: estudo comparativo Analgesia controlada por el paciente con fentanil o sufentanil en el pós-operatorio de reconstrucción de ligamentos de la rodilla: estudio comparativo Patient controlled analgesia with fentanyl or sufentanil in the postoperative period of knee ligament reconstruction: comparative study

    Directory of Open Access Journals (Sweden)

    Marcelo Negrão Lutti

    2002-04-01

    bolus liberados. En el Grupo F fue mayor que el Grupo S. No hubo diferencia cuanto al volumen total de la solución infundida y tiempo de infusión total. No hubo bloqueo motor después de la institución de la analgesia controlada por el paciente (ACP. La incidencia de vómitos y retención urinaria fue mayor en el Grupo S y cuanto a la sedación y al prurito, no hubo diferencia entre los grupos. CONCLUSIONES: El fentanil y el sufentanil continuos y en bolus accionados por el paciente, por vía peridural, en las dosis utilizadas en este estudio, presentaron excelente analgesia pós-operatoria. No obstante, el sufentanil presentó efectos colaterales mas intensos que el fentanil.BACKGROUND AND OBJECTIVES: Epidural opioids, associated or not to local anesthetics, have been used for postoperative analgesia in continuous infusion and/or patient controlled boluses. The aim of this study was to compare postoperative analgesia provided by epidural fentanyl or sufentanil, in bolus or continuous infusion, in patients submitted to knee ligament reconstruction. METHODS: Seventy ASA I - II patients, aged 16 to 47 years, were randomly distributed in two groups. All patients were submitted to epidural anesthesia with 0.5% bupivacaine (100 mg with epinephrine 1:200,000 associated to fentanyl (100 mg. At the end of the procedure, patients received epidural fentanyl (Group F or sufentanil (Group S in continuous infusion plus patient controlled boluses. Group F infusion solution was made of saline (85 ml, 500 µg fentanyl (10 ml and 0.5% bupivacaine (5 ml. Group S solution was made of saline (92 ml, 150 µg sufentanil (3 ml and 0.5% plain bupivacaine (5 ml. Infusion pump´s flow was initially programmed to 5 ml.h-1, with 2 ml patient controlled bolus doses every 15 minutes at most, for both groups. The following parameters were compared: pain, number of patient controlled boluses, opioid consumption, motor block, sedation and side-effects. RESULTS: There have been no statistically

  17. Clinical nursing path after endoscopic submucosal dissection reduces the risk of postoperative complications

    Institute of Scientific and Technical Information of China (English)

    Xia Bai; Jun-Ping Wang; Lan Ming; Ya-Jie Xu; Xia Sun

    2016-01-01

    Objective: To investigate the effect of the nursing path on postoperative complications after endoscopic submucosal dissection (ESD). Method: Patients' nursing paths for ESD were established based on a systematic analysis of relevant literature, previous clinical procedures and consultation with chief physicians from a gastroenterology department. Forty patients were divided into the observation or control group and were assigned to follow the nursing path or the conventional path after an ESD, respectively. Next, the incidence of postoperative complications of these two groups was measured, primarily assessing the occurrences of bleeding, perforation, infection, and anxiety. Results: The incidence of complications after ESD in the observation group was remarkably lower than that of the control group (P Conclusion: The nursing path for ESD has a positive role in reducing certain frequent complications that occur after ESD, particularly infection and anxiety;in addition, the nursing path optimizes nursing care in patients with gastrointestinal stromal tumor.

  18. 舒芬太尼与丁丙诺啡对老年骨科患者术后镇痛效果比较%Comparison of postoperative analgesia effect between sufentanil and buprenorphine on elderly orthopedic patients

    Institute of Scientific and Technical Information of China (English)

    孟海; 王宁

    2014-01-01

    Objective To Compare effect of postoperative analgesia between equivalent dose of sufentanil and buprenor -phine on elderly orthopedic patients .Methods 60 cases of ASA Ⅱ-Ⅲ patients, aged 65~78 and ready for open reduction and internal fixation,were randomly divided into a sufentanil group (S) and a buprenorphine group (D),30 cases in each one.Both were treated with intravenous patient-controlled intravenous analgesia ( PCIA) administration ( group S sufentanil 100 μg;group D buprenorphine 1.2mg, total 100ml).After 5,10,20 and 40 hs respectively,VAS pain and Ramsay scores were graded .The number of effective PCA pressing and incidence of adverse reaction were accordingly recorded .Results The two groups had no significant statistic difference in terms of VAS pain score ,Ramsay score and PCA effective pressing number , but the incidence of adverse reactions in group D was significantly higher than that in group S (P<0.01).Conclusion Sufentanil and buprenorphine of equivalent dose ,if used after operation in elderly orthopedic patients ,have nearly equal analge-sia effect.But the adverse reaction rate of sufentanil is relatively lower .Thus it is more suitable for postoperative analgesia for elderly orthopedic patients .%目的:比较等效剂量舒芬太尼与丁丙诺啡对骨科老年病人患者术后镇痛的效果。方法选择60例ASAⅠ~Ⅱ级65~78岁的下肢骨折需行切开复位内固定术的患者,随机分为舒芬太尼组(S)和丁丙诺啡组(D),每组30例。2组均采用静脉自控镇痛(PCIA)给药,S组:舒芬太尼100μg,D组:丁丙诺啡1.2 mg,总量100 ml,术后5、10、20及40 h行VAS疼痛与Ramsay评分,记录PCA有效按压次数及不良反应发生率。结果2组VAS疼痛评分、Ramsay评分及PCA有效按压次数差异均无统计学意义,而不良反应发生率D组显著高于S组(P<0.01)。结论等效剂量舒芬太尼与丁丙诺啡用于骨科老年病人术后镇痛效

  19. An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay.

    Science.gov (United States)

    Robinson, Bryce R H; Mueller, Eric W; Henson, Kathyrn; Branson, Richard D; Barsoum, Samuel; Tsuei, Betty J

    2008-09-01

    Analgesics and sedatives are required to maintain a calm and comfortable mechanically ventilated injured patient. Continuous sedative infusions have been shown to lengthen mechanical ventilation and hospital length of stay. Daily interruption of sedative infusions may reduce both of these variables. Implementation of an Analgesia-Delirium-Sedation (ADS) Protocol using objective assessments with a goal of maintaining an awake and comfortable patient may obviate the need for daily interruption of infusions in critically ill trauma patients. We examined the effects of such a protocol on ventilator duration, intensive care unit (ICU) length of stay, hospital slength of stay, and medication requirements. A multidisciplinary team designed the protocol. Objective measures of pain (visual/objective pain assessment scale-VAS/OPAS), agitation (Richmond Agitation-Sedation Scale-RASS), and delirium [Confusion Assessment Method {CAM-ICU}] were used. Medications were titrated to a RASS of -1 to +1 and VAS/OPAS CAM-ICU positive patients. Retrospective review of the local Project IMPACT database for a 6-month period in 2004 was compared with the same seasonal period in 2006 in which the ADS protocol was used. All mechanically ventilated trauma patients receiving infusions of narcotic, propofol, or benzodiazepine were included. Age, APACHE II score, Injury Severity Score, ventilator days, ventilator-free days at day 28, ICU length of stay, and hospital length of stay are reported as median values (interquartile range). Medication usage is reported as mean values (+/-SD). Differences in data were analyzed using Wilcoxon's rank-sum test or t test, as appropriate. Gender, mortality, and mechanism of injury were analyzed using chi analysis. A total of 143 patients were included. Patients who died during their hospitalization were excluded except in the analysis of ventilator-free days at day 28. After exclusions, 61 patients were in the control group and 58 in the protocol group. The

  20. Postoperative pain management and proinflammatory cytokines: animal and human studies.

    Science.gov (United States)

    Shavit, Yehuda; Fridel, Keren; Beilin, Benzion

    2006-12-01

    The postoperative period is associated with neuroendocrine, metabolic, and immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. Limited evidence indicates that pain management in the postoperative period can affect the outcome of the surgery, reducing cardiac, pulmonary, and metabolic complications. Recent evidence indicates that pain and immune factors, especially proinflammatory cytokines, mutually interact and influence each other. A series of animal studies demonstrates that effective preemptive analgesia improved postoperative recovery, and this effect was enhanced by coadministration of IL-1ra together with the preemptive analgesics. Furthermore, preemptive analgesia attenuated surgery-induced PGE(2) production in the amygdala and the activation of the HPA axis. IL-1 signaling is required for the production of amygdala PGE(2) in response to surgical stress, and may thus affect the physiological and psychological aspects of surgical stress. These reports suggest that short-term effective analgesia can have long-lasting beneficial effects on surgery recovery. They further suggest that IL-1 blockade should be considered in the clinical management of pain associated with peripheral or nerve injury. Another series of human studies describes an interaction between the effectiveness of postoperative pain relief and surgery-associated immune alterations: In three separate studies, the more effective pain management technique was associated with diminished surgery-induced immune alterations, especially diminished elevation of IL-1. Reduced elevation of postoperative IL-1 and effective pain relief may both contribute to an attenuated illness response and a better surgery outcome.

  1. Reducing Postoperative Pain from Tonsillectomy Using Monopolar Electrocautery by Cooling the Oropharynx

    Science.gov (United States)

    Vieira, Lucas; Nissen, Leonardo; Sela, Gustavo; Amara, Yara; Fonseca, Vinicius

    2014-01-01

    Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS) for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05). There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications. PMID:25992083

  2. Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy.

    Science.gov (United States)

    Rodriguez-Larrad, Ana; Vellosillo-Ortega, Juan Manuel; Ruiz-Muneta, Carlos; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2016-07-01

    To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Quasi-experimental study. Tertiary referral academic hospital. 208 patients undergoing lobectomy by open thoracotomy. Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

  3. Reducing Postoperative Pain from Tonsillectomy Using Monopolar Electrocautery by Cooling the Oropharynx

    Directory of Open Access Journals (Sweden)

    Vieira, Lucas

    2014-01-01

    Full Text Available Objective Evaluate intraoperative cooling of the oropharynx to reduce postoperative pain in tonsillectomy using monopolar electrocautery. Methods Sixty-six patients, age 1 to 12 years, were selected for the study, 33 in the control group and 33 in the experimental group. After randomization, patients underwent subcapsular dissection and hemostasis with monopolar electrocautery. Patients in the experimental group had the oropharynx cooled after tonsil dissection and hemostasis for 10 minutes. The procedure was done through the oral cavity by irrigation with 500 mL of 0.9% saline, in temperatures between 5°C and 10°C, for 5 minutes. The evaluation of postoperative pain was made with the pain visual analog scale (VAS for 10 days. As complementary data on the evaluation of pain, we recorded daily use of ketoprofen for pain relief. Results Pain after tonsillectomy assessed by VAS was significantly lower in the experimental group at days 0, 5, and 6 (p < 0.05. There were no differences in the use of ketoprofen between the groups. Conclusion Cooling of the oropharynx after tonsillectomy promotes clinically significant reduction in postoperative pain, without additional complications.

  4. Preinductive use of clonidine and ketamine improves recovery and reduces postoperative pain after bariatric surgery.

    Science.gov (United States)

    Sollazzi, Liliana; Modesti, Cristina; Vitale, Francesca; Sacco, Teresa; Ciocchetti, Pierpaolo; Idra, Anna Sara; Tacchino, Roberto Maria; Perilli, Valter

    2009-01-01

    In obese patients, concomitant use of clonidine and ketamine might be suitable to reduce the doses and minimize the undesired side effects of anesthetic and analgesic drugs. In this study, we evaluated the perioperative effects of administration of clonidine and ketamine in morbidly obese patients undergoing weight loss surgery at a university hospital in Rome, Italy. A total of 50 morbidly obese patients undergoing open biliopancreatic diversion for weight loss surgery were enrolled. The patients were randomly allocated into a study group (n = 23) receiving a slow infusion of ketamine-clonidine before anesthesia induction and a control group (n = 27) who received standard anesthesia. The hemodynamic profile, intraoperative end-tidal sevoflurane and opioid consumption, tracheal extubation time, Aldrete score, postoperative pain assessment by visual analog scale, and analgesic requirements were recorded. The patients in the study group required less end-tidal sevoflurane, lower total doses of fentanyl (3.8 +/- 0.3 gamma/kg actual body weight versus 5.0 +/- 0.2 gamma/kg actual body weight, respectively; P postoperatively during the first 6 hours. The preoperative administration of low doses of ketamine and clonidine at induction appears to provide early extubation and diminished postoperative analgesic requirements in morbidly obese patients undergoing open bariatric surgery.

  5. Subcutaneously tunneled epidural catheters for postoperative analgesia in iabetes patients with tumor%经皮下放置硬膜外导管应用于糖尿病肿瘤患者的术后止痛

    Institute of Scientific and Technical Information of China (English)

    蒲斌

    2013-01-01

    Objective To investigate the effects of subcutaneously tunneled epidural catheters on epidural bacterial translocation in the management of postoperative analgesia for diabetes patients with tumor. Methods A total of 100 diabetes patients who were going to undergo Dixon operation were equally divided into two groups: tunneled epidural catheters group( group T )and control group( group C ). After the epidural puncture in an aseptic condition, the epidural catheters were placed between L1 and L2 spine clearance. Dilute local anesthetic and fentanyl infusions were used for postoperative analgesia. The epidural catheters were removed with aseptic technique and the tips( 2cm )were sent for microbiological culture after 3 days. Results In group C, bacteriological examination revealed the ratio of bacteria colonization was 26% ,mainly staphylococcus epidermidis( 61.5% ),followed by enterococcus( 15.4% ),gram-negative ba-cilli( 15.4% )and yeasts( 7. 7% ). In group T,the bacteria colonization only occurred in 8% of the patients, mainly staphylococcus epidermidis( 50% ),followed by enterococcus( 25% )and gram-negative ba-cilli( 25% ). Compare with the group C,the difference was significant(P <0. 01 ). Conclusion Subcutaneously tunneled epidural catheter can decrease the risk of bacteria colonization associated with postoperative epidural analgesia in diabetes patients with cancer.%目的 观察经皮下隧道头向放置硬膜外导管对伴有糖尿病的肿瘤患者行术后止痛时导管尖端细菌异生情况.方法 将100例伴有糖尿病拟行Dixon手术的直肠癌手术患者随机等分为经皮下隧道放置硬膜外导管组(T组)和对照组(C组),选取L1-2棘间隙在无菌条件下行硬膜外穿刺、置管,术后用0.75%布比卡因、恩丹西酮及芬太尼行硬膜外术后止痛,3d后在无菌条件下拔除硬膜外导管,剪取尖端2cm送细菌培养.结果 C组中硬膜外导管细菌异生发生率为26%,其中表皮葡萄球菌61.5%;肠球菌15

  6. 地佐辛超前镇痛对面肌痉挛术后麻醉苏醒期的影响%The effect of dezocine preemptive analgesia on hemifacial spasm postoperative anesthesia recovery period

    Institute of Scientific and Technical Information of China (English)

    王长明; 蔡长华; 张静; 刘辉; 庞庆贵; 王嵘巍; 刘艳芳; 尹美华; 马逸

    2014-01-01

    complications in recovery stage,such as respiratory depression,nausea and vomiting,chills and fever between the two groups.Conclusions Dezocine for preemptive analgesia can effectively relieve postoperative pain,reduce the incidence of pulling laryngeal mask immediately agitation and maintain hemodynamic stability in the recovery period of patients with MVD for hemifacial spasm.%目的 探讨地佐辛超前镇痛对显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛苏醒期的影响.方法 32例择期行MVD治疗面肌痉挛手术患者,按随机数字表法分为实验组(Ⅰ组)和对照组(Ⅱ组),每组16例:Ⅰ组术毕前30 min静注5 mg/2 ml地佐辛;Ⅱ组术毕前30 min静注2ml生理盐水.观察术后苏醒时间、拔出喉罩后10 min疼痛视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分及拔出喉罩即刻躁动评分(riker agitation-sedation scale,RSS)及麻醉前(T0,基础值)、拔出喉罩前5min(T1)、拔出喉罩即刻(T2)、拔出喉罩后10min(T3)时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2).结果 术后苏醒时间、Ramsay镇静评分,Ⅰ组与Ⅱ组之间差异无统计学意义(P>0.05);Ⅰ组与Ⅱ组之间在T2 RSS评分[(0.62±0.11),(2.83±0.24)分]及在T3VAS评分[(1.04±0.22),(3.30±0.41)分]之间比较差异有统计学意义(P<0.05);MAP、HR,Ⅰ组与Ⅱ组之间T0和T1差异无统计学意义(p>0.05),Ⅰ组T2和T3 MAP[(96.6±1.1),(94.7±1.1) mmHg(1 mmHg=0.133 kPa)]、HR[(81.4±1.7),(78.0±1.2)次/min]与Ⅱ组T2和T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9)次/min]比较,差异有统计学意义(P<0.05).Ⅱ组内T2和T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9) 次/min]与T0MAP[(95.5±2.0) mmHg]、HR[(81.8±2.6)次/min]比较,差异有统计学意义(P<0.05),Sp02两组比较差异无统计学意义(P>0.05).两组患者在苏醒期阶段均无发生呼

  7. 连续腰丛神经阻滞联合单次坐骨神经阻滞用于膝关节置换术后镇痛%Continuous Lumbar Plexus Block Combined with Single Sciatic Nerve Block for the Postoperative Analgesia after Knee Arthroplasty

    Institute of Scientific and Technical Information of China (English)

    李海华; 王春华

    2013-01-01

    that in control group ( P <0 .05) .The ratio of urinary retention and lower limb numbness occurred in the observation group was lower than that in control group( P<0 .05) .[Conclusion]Continuous lumbar plexus block combined with single sciatic nerve block for postoperative analgesia can reduce postoperative complications and is more conductive to postopera-tive functional exercise with the premise of effective analgesia .

  8. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

    Science.gov (United States)

    Asteriou, Christos; Lazopoulos, Achilleas; Rallis, Thomas; Gogakos, Apostolos S; Paliouras, Dimitrios; Tsakiridis, Kosmas; Zissimopoulos, Athanasios; Tsavlis, Drosos; Porpodis, Konstantinos; Hohenforst-Schmidt, Wolfgang; Kioumis, Ioannis; Organtzis, John; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Barbetakis, Nikolaos

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This

  9. Analgesia postoperatoria en la cirugía del pie y tobillo mediante bloqueo ciático poplíteo lateral con ropivacaína Postoperative analgesia in foot and ankle surgery through lateral popliteal sciatic blockade with ropivacaine

    Directory of Open Access Journals (Sweden)

    G. Valladares

    2004-03-01

    permitió realizar la técnica sin necesidad de modificar la posición de decúbito supino que mantenían todos los pacientes. Es de destacar la excelente calidad analgésica proporcionada por el bloqueo del nervio ciático en la fosa poplítea mediante abordaje lateral en la serie que presentamos, tanto en reposo como con el movimiento del pie. En conclusión, el bloqueo del nervio ciático en la fosa poplítea mediante abordaje lateral con 40 mL de ropivacaína 0,5% proporciona, en la cirugía del pie y tobillo, una analgesia postoperatoria eficaz, prolongada, sin efectos indeseables y con alto grado de satisfacción del paciente.Introduction: Popliteal sciatic nerve block provides efficacy and prolonged postoperative analgesia after foot and ankle surgery. The most important advantage of lateral approach is that it is not necessary to modify supine patient position, but posterior approach needs prone position of patient. It could be difficult in some situations: pregnancy, inestability haemodynamic and mechanical ventilation. Material and method: Physical status I-II patients, presented for foot and ankle surgery were included. A blockade of sciatic nerve at popliteal fossa level was realized using Vloka and Hadzic references with a 22G x 80 mm insulated needle. An adecuate motor response was considered when a foot movement was obseved at a stimulation intensity lower than 0.4 mA and higger than 0.1 mA. The dose of local anaesthetic administered was 0.5% ropivacaine, 40 ml. We registered postoperative repose and movement pain at 8, 16 and 24 hours after the blockade using VAS form 0 to 10 and patient satisfaction from 0 to 10, too. Results: Twenty-one ASA I-II patients were included. The medium repose postoperative pain registered was 1 at 8 hours and 3 at 16 and 24 hours after blockade. The medium movement postoperative pain registered was 2 at 8 hours and 4 at 16 and 24 hours after the blockade. The medium satisfaction of patient was 9. Discussion: Lateral approach

  10. Postoperative Ileus in the Elderly

    Directory of Open Access Journals (Sweden)

    Chih-Peng Tu

    2014-03-01

    Full Text Available Postoperative ileus is among the most common complications after surgery. Aging is associated with an increased colonic transit time, and anesthetic disturbance to colonic motility is often aggravated in the elderly. Postoperative ileus increases morbidity, prolongs the length of hospital stay, and constitutes a significant economic burden on the healthcare system. Multimodal enhanced recovery protocols, or fast-track surgeries, have been developed to improve postoperative recovery. Patient education, avoidance of perioperative fluid overload, selective use of nasogastric decompression, early ambulation, adopting a minimally invasive approach, early initiation of clear fluids, and gum chewing are all possible measures to reduce postoperative ileus. Thoracic epidural anesthesia is a well-established technique to hasten recovery, whereas insufficient data are available to ascertain the safety and efficacy of opioid-sparing analgesia in the elderly. The evidence is clear that traditional prokinetic medications are not helpful in the treatment or prevention of postoperative ileus. Early results suggest that alvimopan is a promising agent to reverse opioid-induced ileus. Since postoperative ileus is a multifactorial condition, a concerted effort is therefore necessary to prevent or decrease the duration of postoperative ileus using multimodal strategies.

  11. Estudo comparativo entre fentanil por vias peridural e venosa para analgesia de operações ortopédicas Estudio comparativo entre fentanil por vías peridural y venosa para analgesia de operaciones ortopédicas Comparative study of epidural and intravenous fentanyl for postoperative analgesia of orthopedic surgeries

    Directory of Open Access Journals (Sweden)

    Marcelo Soares Privado

    2004-10-01

    miembro inferior. MÉTODO: El estudio fue aleatorio y duplamente encubierto. Cuando presentaban dolor pos-operatorio, los pacientes del G1 (n = 14 recibieron 5 ml de solución (100 µg de fentanil en solución fisiológica a 0,9% por vía peridural y 2 ml de solución fisiológica a 0,9% por vía venosa, los del G2 (n = 15 recibieron 5 ml de solución fisiológica a 0,9%, por vía peridural y 2 ml de fentanil (100 µg por vía venosa. Fue evaluada la necesidad de complementación analgésica con tenoxicam (40 mg por vía venosa y con bupivacaína a 0,25% (5 ml por vía peridural (cuando no había alivio con tenoxicam. La intensidad del dolor fue evaluada por las escalas numérica y verbal en los momentos M30, M120 y M240 minutos. RESULTADOS: El número de pacientes que necesitaron de complementación analgésica, tanto con el tenoxicam (G1 = 10 y G2 = 15 pacientes cuanto con la bupivacaína (G1 = 2 y G2 = 8 pacientes fue mayor en el G2. No hubo diferencia estadística en la intensidad del dolor entre los grupos en los tiempos evaluados. CONCLUSIONES: En las condiciones de este estudio el efecto analgésico del fentanil peridural es mejor que por vía venosa.BACKGROUND AND OBJECTIVES: There are controversies about the action site of lipophylic opioids after epidural injection. Some authors believe that these drugs act at supraspinal level, while others propose a spinal action. This comparative study aimed at answering this question by comparing epidural and intravenous fentanyl for postoperative analgesia of lower limb orthopedic procedures. METHODS: This was a randomized double-blind study. At postoperative pain complaint, G1 patients (n = 14 received 5 mL epidural solution (100 µg fentanyl in 0.9% saline and 2 mL of intravenous 0.9% saline; G2 patients (n = 15 received 5 mL epidural 0.9% saline and 2 mL intravenous fentanyl (100 µg. Analgesic complementation with intravenous tenoxicam (40 mg and epidural 0.25% bupivacaine (5 mL (when there was no relief with tenoxicam

  12. Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

    Science.gov (United States)

    Won, Young Ju; Lim, Byung Gun; Lee, So Hyun; Park, Sangwoo; Kim, Heezoo; Lee, Il Ok; Kong, Myoung Hoon

    2016-01-01

    Abstract Background: The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy. Methods: Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores. Results: Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit. Conclusions: SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy. PMID:27583920

  13. Femoral versus Multiple Nerve Blocks for Analgesia after Total Knee Arthroplasty

    Science.gov (United States)

    Stav, Anatoli; Reytman, Leonid; Sevi, Roger; Stav, Michael Yohay; Powell, Devorah; Dor, Yanai; Dudkiewicz, Mickey; Bayadse, Fuaz; Sternberg, Ahud; Soudry, Michael

    2017-01-01

    Background The PROSPECT (Procedure-Specific Postoperative Pain Management) Group recommended a single injection femoral nerve block in 2008 as a guideline for analgesia after total knee arthroplasty. Other authors have recommended the addition of sciatic and obturator nerve blocks. The lateral femoral cutaneous nerve is also involved in pain syndrome following total knee arthroplasty. We hypothesized that preoperative blocking of all four nerves would offer superior analgesia to femoral nerve block alone. Methods This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 107 patients were randomly assigned to one of three groups: a femoral nerve block group, a multiple nerve block group, and a control group. All patients were treated postoperatively using patient-controlled intravenous analgesia with morphine. Pain intensity at rest, during flexion and extension, and morphine consumption were compared between groups over three days. Results A total of 90 patients completed the study protocol. Patients who received multiple nerve blocks experienced superior analgesia and had reduced morphine consumption during the postoperative period compared to the other two groups. Pain intensity during flexion was significantly lower in the “blocks” groups versus the control group. Morphine consumption was significantly higher in the control group. Conclusions Pain relief after total knee arthroplasty immediately after surgery and on the first postoperative day was significantly superior in patients who received multiple blocks preoperatively, with morphine consumption significantly lower during this period. A preoperative femoral nerve block alone produced partial and insufficient analgesia immediately after surgery and on the first postoperative day. (Clinical trial registration number (NIH): NCT01303120) PMID:28178436

  14. No effect of continuous i.p. infusion of bupivacaine on postoperative analgesia, pulmonary function and the stress response to surgery

    DEFF Research Database (Denmark)

    Scott, N B; Mogensen, T; Greulich, A

    1988-01-01

    on entering the peritoneum. The following variables were measured before and at 2-h intervals during the infusion: serum glucose and cortisol concentrations, forced vital capacity, forced expiratory volume in the first second, peak expiratory flow rate and pain at rest, on mobilization and on coughing (visual...... was without effect in the management of pain, postoperative pulmonary dysfunction and the stress response in this group of patients....

  15. The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal

    Directory of Open Access Journals (Sweden)

    V. Benetello

    2007-08-01

    Full Text Available We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg or piroxicam (20 mg was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19. There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA. There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test. There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA. The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.

  16. Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína Comparación entre tres técnicas regionales de analgesia postoperatoria en niños con ropivacaina Comparison among three techniques of postoperative regional analgesia with ropivacaine in children

    Directory of Open Access Journals (Sweden)

    Ana Maria Menezes Caetano

    2006-12-01

    ropivacaína para la analgesia postoperatoria en niños. MÉTODO: Se estudiaron 87 niños del sexo masculino, con edad entre 1 y 5 años, sometidos a herniorrafias inguinales electivas unilaterales. Los niños recibieron aleatoriamente la PS, el BIHII o la IFO. Se investigó la necesidad de analgésico en el postoperatorio, el tiempo necesario para su primera dosis, la intensidad de dolor y el grado de bloqueo motor. RESULTADOS: En el grupo de la IFO se observó una mayor necesidad de analgésicos, y una mayor intensidad de dolor en las 1ª y 2ª horas, cuando se comparó con la PS y el BIHII. Apenas niños sometidos a PS presentaron bloqueo motor de grado moderado. El tiempo promedio de la necesidad de la primera dosis de analgésico fue similar entre los grupos. CONCLUSIONES: El BIHII presentó una superioridad sobre la IFO, especialmente en las primeras dos horas del postoperatorio. As tres técnicas anestésicas pueden ser utilizadas con seguridad y eficacia en el control de dolor postoperatorio de herniorrafia inguinal en niños.BACKGROUND AND OBJECTIVES: Postoperative pain increases cost and generates dissatisfaction among parents regarding to the analgesics prescribed to their children. Ropivacaine has a broad safety margin to be used for regional block in pediatric patients. The aim of this study was to compare caudal epidural block (CE with ilioinguinal/iliohypogastric nerve block (IINB and infiltration of surgical wound (ISW with ropivacaine for postoperative analgesia in children. METHODS: Eighty-seven children, all males, ages 1 to 5, who underwent elective unilateral inguinal herniorrhaphy participated in this study. Children were randomly assigned to receive CE, IINB, or ISW. The need for postoperative analgesia, length of time until the first dose, severity of pain, and degree of the motor blockade were evaluated. RESULTS: The need for analgesia and pain severity in the first two hours were greater for the ISW Group when compared with the CE and IINB Groups

  17. Use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischaemic complications.

    Science.gov (United States)

    Lai, Leon Tat; Morgan, Michael Kerin

    2014-01-01

    Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (paneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.

  18. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?

    Science.gov (United States)

    Kalogianni, Antonia; Almpani, Panagiota; Vastardis, Leonidas; Baltopoulos, George; Charitos, Christos; Brokalaki, Hero

    2016-10-01

    The effect of preoperative education on anxiety and postoperative outcomes of cardiac surgery patients remains unclear. The aim of the study was to estimate the effectiveness of a nurse-led preoperative education on anxiety and postoperative outcomes. A randomised controlled study was designed. All the patients who were admitted for elective cardiac surgery in a general hospital in Athens with knowledge of the Greek language were eligible to take part in the study. Patients in the intervention group received preoperative education by specially trained nurses. The control group received the standard information by the ward personnel. Measurements of anxiety were conducted on admission-A, before surgery-B and before discharge-C by the state-trait anxiety inventory. The sample consisted of 395 patients (intervention group: 205, control group: 190). The state anxiety on the day before surgery decreased only in the intervention group (34.0 (8.4) versus 36.9 (10.7); P=0.001). The mean decrease in state score during the follow-up period was greater in the intervention group (P=0.001). No significant difference was found in the length of stay or readmission. Lower proportions of chest infection were found in the intervention group (10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression revealed that education and score in trait anxiety scale on admission are independent predictors of a reduction in state anxiety. Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery, but it was not effective in reducing readmissions or length of stay. © The European Society of Cardiology 2015.

  19. Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery.

    Science.gov (United States)

    McTier, Lauren; Botti, Mari; Duke, Maxine

    2016-02-01

    Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation

  20. Effects of preoperative tramadol injection on postoperative analgesia in patients undergoing gynaecologiral laparoscopy%静脉应用不同剂量曲马多超前镇痛对妇产科腹腔镜手术后疼痛的影响

    Institute of Scientific and Technical Information of China (English)

    姚群

    2008-01-01

    postoperative dysphoria, dizziness, nausea and vomiting was higher in Group IV than that in other groups. Conclusion The study suggests that preoperative injection of 1.5 mg/kg-2 mg/kg tramadol provides satisfactory postoperative analgesia in patients undergoing gynaecological laparoscopy, reducing the use of analgesics and the incidence of side effects.

  1. Dextromethorphan Reduces Postoperative Pain of Post Partum Tubal Ligation under General Anesthesia

    Directory of Open Access Journals (Sweden)

    N. Manochehrian

    2009-04-01

    Full Text Available Introduction & Objective: Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. Materials & Methods: In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral. The patients induced general anesthesia with thiopental (5mg/kg, fentanyl 1.5 g/kg and succinylcholin(1-1.5 mg/kg and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. Results: There was no significant difference in age, education, . . . Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine in dextromethophan was less than placebo group.Conclusion: Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time , 2 and 4 hours after the surgery.

  2. Influence of preemptive analgesia on pulmonary function and complications for laparoscopic cholecystectomy.

    Science.gov (United States)

    Şen, Meral; Özol, Duygu; Bozer, Mikdat

    2009-12-01

    Pain and diaphragmatic dysfunction are the major reasons for postoperative pulmonary complications after upper abdominal surgery. Preoperative administration of analgesics helps to reduce and prevent pain. The objective of this study was first to research the rate of pulmonary complications for laparoscopic cholecystectomy (LC) and then analyze the influence of preemptive analgesia on pulmonary functions and complications. Seventy patients scheduled for elective LC were included in our double-blind, randomized, placebo-controlled, prospective study. Randomly, 35 patients received 1 g etofenamate (group 1) and 35 patients 0.9% saline (group 2) intramuscularly 1 h before surgery. All patients underwent physical examination, chest radiography, lung function tests, and pulse oxygen saturation measurements 2 h before surgery and postoperatively on day 2. Atelectasis was graded as micro, focal, segmental, or lobar. With preemptive analgesia, the need for postoperative analgesia decreased significantly in group 1. In both groups mean spirometric values were reduced significantly after the operation, but the difference and proportional change according to preoperative recordings were found to be similar [29.5 vs. 31.3% reduction in forced vital capacity (FVC) and 32.9 vs. 33.5% reduction in forced expiratory volume in 1 s (FEV(1)) for groups 1 and 2, respectively]. There was an insignificant drop in oxygen saturation rates for both groups. The overall incidence of atelectasia was similar for group 1 and 2 (30.2 vs. 29.2%). Although the degree of atelectesia was found to be more severe in the placebo group, the difference was not statistically significant. We concluded that although preemptive analgesia decreased the need for postoperative analgesia, this had no effect on pulmonary functions and pulmonary complications.

  3. 曲马多伍用小剂量纳洛酮在术后镇痛中的应用效果%The effect of application tramadol combined with low-dose naloxone on patients postoperative controlled intravenous analgesia

    Institute of Scientific and Technical Information of China (English)

    孟馥芬; 维拉; 杨峰

    2012-01-01

    目的 观察曲马多伍用小剂量纳洛酮在患者静脉自控镇痛(PCIA)中的疗效及不良反应.方法 选取全麻下行腹腔镜全子宫切除术患者90例,随机均分为三组,分别采用不同的PCIA镇痛液:N1组和N2组分别为曲马多1 000 mg加纳洛酮0.4 mg和1.5 mg,T组为曲马多1 000 mg.记录芬太尼总量,不同时点的NRS评分和曲马多总消耗量.结果 术后2、8h,N1组和T组静息时NRS评分显著低于N2组(P<0.05).术后2h,N1组咳嗽时NRS评分明显低于N2组和T组(P<0.05),且T组显著低于N2组(P<0.05).术后8h,N2组和T组咳嗽时NRS评分显著高于N1组(P<0.05).N1组术后24 h曲马多用量显著低于其余两组(P<0.05).术后N1组恶心、呕吐发生率较其他两组低( P<0.05).结论 曲马多伍用小剂量纳洛酮可以增强曲马多的镇痛作用,并减少不良反应.%Objective To observe the analgesia and adverse effects of postoperative controlled intravenous analgesia (PCIA) with tramadol combined with low-dose naloxone. Methods Ninety patients undergoing laparoscopic hysterectomy were randomly divided into 3 groups with 30 cases each. Group Nl: tramadol 1 000 mg combined with naloxone 0. 4 mg. Group N2: tramadol 1 000 mg combined with naloxone 1. 5 mg, group T: tramadol 1 000 mg. The numeric rating scale (NRS) was used in patients analgesia. Consumption of fentangl NRS of different time and consumption of tramadol were recorded. Results Patients in group N2 got higher NRS scores at rest compared with other groups at 2 and 8 hours postoperatively(P<0. 05). While coughing, patients in group Nl chose lower NRS than group T and N2 at 2 h postoperativly(P<0. 05) and NRS of group T were lower than group N2. Patients in group Nl chose lowest NRS compared with other groups (P<0. 05). Patients in group Nl consumed less tramadol in 24 h than in other groups (P<0. 05). The incidence of nausea and vomiting in group Nl was lower than in other groups ( P <. 0. 05). Conclusion Tramadol

  4. Bloqueio extraconal para facectomia com implante de lente intra-ocular: influência do fentanil associado ao anestésico local na qualidade do bloqueio e na analgesia pós-operatória Bloqueo extraconal para facectomia con implantación de lente intra-ocular: influencia del fentanil asociado al anestésico local en la calidad del bloqueo y en la analgesia pos-operatoria Extraconal block for cataract extraction surgery with implantation of intraocular lens: contribution of fentanyl associated to local anesthetics for quality of block and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Daniel Espada Lahoz

    2003-09-01

    de analgésicos con fentanil - 20,7%, en el uso de analgésicos con fentanil - 41,5%. CONCLUSIONES: En las condiciones de este estudio el fentanil mejoró la calidad del bloqueo cuanto a la motilidad del músculo recto medial y diminuyó la necesidad de analgésicos en el pos-operatorio.BACKGROUND AND OBJECTIVES: Loco-regional anesthesia for cataract extraction surgery offers as advantages minimum physiological changes, complete anesthesia, eye reflexes blockade, lower incidence of nausea and vomiting and shorter recovery time, in addition to postoperative analgesia. Continuous concern with blockade quality as well as with postoperative analgesia is responsibility of the anesthesiologist. This study aimed at evaluating whether fentanyl has contributed to blockade quality and postoperative analgesia in cataract extraction surgery with implantation of intraocular lens. METHODS: The association of fentanyl and 0.75% bupivacaine for eye blockade and postoperative analgesia was evaluated in 164 patients undergoing cataract extraction with implantation of intraocular lens (extracapsular technique. Patients were homogeneous in gender, demographics, operated eye, ASA physical status and Goldman’s cardiac risk index. Patients were randomly allocated in two groups (82 patients each: with or without fentanyl. Blockade quality was evaluated according to the following parameters: intraoperative pain; eyelid and/or eyeball movement; Bell’s reflex persistence; number of blocks needed to produce akinesia and surgeons evaluation of blockade. Postoperative analgesia was evaluated by patients’ request for additional postoperative analgesia. RESULTS: Results have shown that fentanyl has significantly improved medial rectus muscle blockade quality (with fentanyl - 17.1%; without fentanyl - 32.9% and has decreased postoperative analgesics consumption (analgesics with fentanyl - 20.7%; no analgesics with fentanyl - 41.5%. CONCLUSIONS: In the conditions of this study, fentanyl has

  5. Reducing Postoperative Fracture Displacement After Locked Plating of Proximal Humerus Fractures: Current Concepts.

    Science.gov (United States)

    Newman, Jared; Kahn, Mani; Gruson, Konrad I

    2015-07-01

    The incidence of proximal humerus fractures in the elderly has been rising. Concomitantly, operative fixation with use of locking plates has been increasing. Postoperative complications of locking plate fixation, particularly in the setting of osteoporotic bone, include screw penetration of the articular surface, progressive fracture displacement, and avascular necrosis. Intraoperative techniques to enhance the fixation construct and reduce complications include use of rotator cuff sutures, bone void fillers (fibular strut allograft, cancellous allograft, autograft, bone cement), appropriate placement of divergent and shorter locking screws, and medial calcar reduction and support. More recent clinical and biomechanical studies suggest that use of these strategies may reduce complications after locked plating of osteoporotic proximal humerus fractures. Furthermore, a multidisciplinary approach to the evaluation and treatment of osteoporosis may be beneficial in these patients.

  6. Bloqueio 3-em-1 prolongado versus analgesia sistêmica no tratamento da dor pós-operatória após a reconstrução do ligamento cruzado anterior do joelho Bloqueo 3 en 1 prolongado versus analgesia sistemica en el tratamiento del dolor postoperatorio después de la reconstrucción del ligamento cruzado anterior de la rodilla Extended three-in-one block versus intravenous analgesia for postoperative pain management after reconstruction of anterior cruciate ligament of the knee

    Directory of Open Access Journals (Sweden)

    Víctor A. Contreras-Domínguez

    2007-06-01

    = 30: bloqueo femoral continuo con infusión de bupivacaína y clonidina; y Grupo 2 (n =3 0: infusión intravenosa de cetoprofeno. La intervención quirúrgica se hizo bajo raquianestesia y sedación. El tratamiento del dolor postoperatorio se hizo con analgesia controlada por el paciente (PCA usando morfina. El dolor postoperatorio fue registrada 2, 4, 6, 24 y 36 horas después de la intervención quirúrgica usando la Escala Visual Analógica (VAS. El consumo de morfina, la satisfacción de los pacientes y las complicaciones también fueron registrados. RESULTADOS: En el Grupo 1, el VAS postoperatorio entre 4 y 48 horas trás de la intervención quirúrgica fue de 21 mm ± 2 y en el Grupo 2 fue de 45 mm ± 4 (p BACKGROUND AND OBJECTIVES: Continuous femoral block (three-in-one is used for postoperative analgesia in hip and knee replacements with good results, with advantages over other locoregional analgesic or intravenous techniques having low incidence of complications. The aim of this study was to clinically evaluate the utility of continuous femoral block compared with intravenous analgesia in reconstruction of anterior cruciate ligament. METHODS: Controlled prospective study of 60 patients ASA I. Patients were divided into two groups: Group 1 (n = 30: continuous femoral block with an infusion of bupivacaine and clonidine; and Group 2 (n = 30: intravenous ketoprofen infusion. Surgery was performed under spinal anesthesia and sedation. Postoperative pain management with morphine patient controlled analgesia (PCA. Postoperative pain recorded at 2, 4, 6, 24 and 36 hours after surgery using Visual Analog Scale (VAS. Morphine consumption, satisfaction's score and complications are registered. RESULTS: In Group 1 postoperative VAS between 4 and 48 hours was 21 mm ± 2 and in Group 2 was 45 mm ± 4 (p < 0.001. Morphine consumption between 4 and 48 hours in Group 1 was 4.5 mg ± 1.5 and in Group 2 was 25.5 mg ± 3 (p < 0.001. In Group 1, 6.7% of patients presented

  7. 美洛昔康对骨科术后的镇痛疗效及其安全性评价%Efficacy and safety evaluation of meloxicam for orthopedic patients with postopera-tive analgesia

    Institute of Scientific and Technical Information of China (English)

    章其益; 管四炎

    2014-01-01

    Objective To explore the efficacy and safety of meloxicam on orthopedics postoperative analgesi-a. Methods 78 patients with ulcerative colitis in our hospital from January 2011 to May 2012 were chosen,and all the patients were respectively injected with 15 mg meloxicam for analgesia at 1 h and 24 h after operation. Fentanyl analge-sia was added to the patients with incompletely analgesic. The extent of pain was assessed,and the change of blood rou-tine examination,liver and kidney function were recorded before and at 1 week after operation. The drug-related adverse events was observed. Results The VAS scores of patients with major surgery,moderate surgery and minor surgery be-fore treatment (1 h after surgery) were 9. 2,8. 1,7. 9;and the VAS score decreased significantly after medication (P<0. 05). The postoperative analgesia effect was satisfactory after using meloxicam. The analgesic effect of meloxicam on different types of operation were good. The analgesic effect of meloxicam in patients with minor surgery was better than those with major surgery and moderate surgery ( P <0. 05 ) . No abnormal phenomenon flow increase was observed when drainage tube was drawn out. During treatment,no severe bleeding in surgical incision,stomach pain,stomach ul-cers,nausea,vomit was observed. There was no arrhythmia,myocardial infarction and other adverse events. Conclusion Meloxicam can effectively relieve orthopedic postoperative pain without obvious adverse reaction,it is an effective orthopedic postoperative analgesics with good safety.%目的:探讨美洛昔康对骨科术后的阵痛疗效及其安全性。方法随机选择2011年1月至2012年5月来我院就诊的78例骨科手术患者,所有患者均在术后1 h、24 h肌注15 mg美洛昔康进行镇痛,对镇痛疗效不理想者给予芬太尼注射液进行补充镇痛。评估患者疼痛程度,记录患者术前和术后1周血常规、肝肾功能的变化情况,观察治疗时有无药物相

  8. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

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    Torsten Kluba

    2010-04-01

    Full Text Available This prospective study aimed to compare the efficacy of epidural (EDA versus intravenous (PCA application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal post-operative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

  9. Sufentanil versus Fentanyl for Postoperative Patient-Controlled Epidural Analgesia:A Systematic Review%舒芬太尼与芬太尼用于术后硬膜外自控镇痛的系统评价

    Institute of Scientific and Technical Information of China (English)

    唐轶洋; 张兴安; 阳婷婷; 徐波

    2012-01-01

    Objective To systematically evaluate effectiveness, dosage and adverse reaction of sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia (PCEA), so as to provide evidence for rational drug use in clinic. Methods Databases including The Cochrane Library, the special trials registered in the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by the end of 2012, and the relevant periodicals were also manually searched to collect the randomized controlled trials (RCTs) on sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia. According to the Cochrane Handbook 5.0, literature was screened, data were extracted, and quality of the included studies was critically assessed. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 25 RCTs involving 1 944 patients were included. The results of meta-analyses showed that: a) as for visual analog scale (VAS), compared with the fentanyl group, the postoperative VAS at 2-hour, 4-hour, 8-hour, 12-hour, 24-hour and 48-hour was decreased in the sufentanil group; b) as for sedation scale, the fentanyl group, the postoperative sedation at 12-hour and 24-hour was lower in the sufentanil group when adopting 0 to 3 points scoring method, but there were no significant differences at other time points; c) as for drug dosage, compared with the fentanyl group, the postoperative drug consumption at 24-hour and 48-hour was less in the sufentanil group; d) as for adverse reaction, the incidence of postoperative nausea, vomiting, dizziness and somnolence in the sufentanil group was lower than those in the fentanyl group. But there was no significant difference in other adverse reactions such as skin itching, limbs numbness and motor disturbance between the two groups; and e) as for the demands of additional analgesic drugs, compared with the fentanyl group, the incidence of demanding additional analgesic drugs was lower in the

  10. Mini-invasive surgical repair of the Achilles tendon--does it reduce post-operative morbidity?

    Science.gov (United States)

    Bhattacharyya, Mayukh; Gerber, Bruno

    2009-02-01

    The surgical benefit of minimally invasive tendo Achilles repair (n = 25) with early weight-bearing mobilisation after rupture of the tendo Achilles was compared with operative treatment using an open technique (n = 34) with full weight-bearing after 8 weeks of surgical repair. The minimally invasive technique provided no evidence of wound problems and a functional benefit from early weight-bearing mobilisation. However, we noted that increased post-operative morbidity in terms of wound infection (n = 7) leading to delayed wound healing and wound pain requiring opiate-based analgesia post-operatively in the open repair group may have an additional impact on the patients and health care providers. This study showed that the mini-invasive open surgical repair of the Achilles tendon with the Achillon instrument and early weight-bearing mobilisation in an orthosis for the accelerated rehabilitation may offer cost-effectiveness and less financial burden on the health care provider in terms of associated nursing and physiotherapy costs.

  11. Analgesia pós-operatória em pacientes pediátricos: estudo comparativo entre anestésico local, opióides e antiinflamatório não esteróide Analgesia pós-operatoria en pacientes pediátricos: estudio comparativo entre anestésico local, opioides y antiinflamatorio no esteróide Postoperative analgesia in pediatric patients: comparative study among local anesthetics, opioids and non-steroidal anti-inflammatory drugs

    Directory of Open Access Journals (Sweden)

    Miriam Seligman Menezes

    2002-04-01

    resultados de las 2 escalas de evaluación del dolor. CONCLUSIONES: Los opioides espinales se mostraran seguros y efectivos en la analgesia pós-operatoria en niños, más cuando comparados a la bupivacaína no presentaron diferencias relevantes y presentaron mayor incidencia de efectos colaterales. El diclofenaco por vía retal no se mostró efectivo como analgésico único cuando comparado a las otras técnicas.BACKGROUND AND OBJECTIVES: The treatment of postoperative pain in children has been given special attention in the last decades. This study aimed at analyzing postoperative analgesia in children, considering analgesia quality and duration, evaluation methods reliability and the incidence of side effects resulting from different analgesia techniques. METHODS: Participated in this study 100 children, aged 2 to 12 years, allocated in 5 groups of 20 children each, who received, right after anesthesia, the following analgesics: group B, 0.25% bupivacaine with epinephrine (1:400,000 0.5 to 1 ml.kg-1; group F, 1.5 µg.kg-1 fentanyl; group M, 30 µg.kg-1 morphine; group S, 0.3 µg.kg-1 sufentanil, all by epidural caudal block and group D, who received rectal diclofenac (1 mg.kg-1. Pain was evaluated by two different methods: one, predominantly behavioral and objective and the other subjective and self-evaluated, during the first 4 hours and then up to the 24th hour. Side effects were observed and treated. RESULTS: In the first 4 hours, groups B, F, M and S patients presented similar behavior, with a minimum need for complementary analgesia. In the remaining 20 hours, the longest analgesia duration was seen in group S, which did not differ from groups F and M, but was significantly longer than for groups B and D. Rectal diclofenac has not promoted effective pain relief. There has been a higher incidence of side-effects in group M, which did not differ from group S, but was significantly higher than for groups F, B and D. There has been a positive and significant correlation

  12. 小剂量氯胺酮复合芬太尼在小儿术后镇痛中的应用%The Usage of Small­dose Ketamin and Fentanyl for Postoperative Analgesia in children

    Institute of Scientific and Technical Information of China (English)

    王超平; 张继洛; 周旭

    2014-01-01

    Objective:To observe the effects of small­dose ketamin and fentanyl on postoperative analgesia in children underwent upper limb operations. Methods: Sixty patients (ASA I or Ⅱ), aged 6 to 9 years old, underwent upper limb operation were randomly divided into two groups. Patients controlled intravenous analgesia(PCIA)was started since skin suture with the following composition:fentanyl 0.02 mg·kg­1+ondansetron 0.1mg·kg­1 in 0.9%NS 100ml (group F); fentanyl 0.01mg·kg­1+ondansetron 0.1mg·kg­1+ ketamine 4mg·kg­1 in 0.9%NS 100ml(group KF).Visual analogue scale(VAS)pain scales and Ramsay sedation scores were recorded at 4、8、12、24 and 36 h after operation,and side effects were observed and recorded.Results: Ramsay score increased significantly in group F compared with that of group KF (P<0.05).Otherwise,the incidence of side effects was significantly decreased in group KF compared with group F (P<0.05).VAS value decreased in groups KF at 6­36h postoperatively compared with group K (P<0.05).Conclusion:Small dose of ketamine can improve the fentanyl postoperative analgesic efficacy in children with upper limb operation,without increasing the incidence of side effects.%目的:评价小剂量氯胺酮复合芬太尼在小儿上肢手术术后镇痛中的应用效果。方法:择期全麻下行上肢手术患儿60例,年龄3~9岁,随机分为两组,与手术封皮时经静脉连接镇痛泵,镇痛液配方:F组(芬太尼0.02mg·kg­1+昂单司琼0.1mg·kg­1+生理盐水=100mL);KF组(氯胺酮4mg·kg­1·d­1+芬太尼0.01mg·kg­1+昂单司琼0.1mg·kg­1+生理盐水=100mL)。记录术后4、8、12、24、36h的疼痛VAS评分和Ramsay镇静评分,观察和记录不良反应发生情况。结果:F组Ramsay评分明显低于KF组,且KF组恶心、呕吐、皮肤瘙痒发生率明显降低;术后8h后KF组VAS评分明显低于F组。结论:小剂量氯胺酮复合芬太尼用于小儿术后镇痛效果肯定,且不良反应发生率低。

  13. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    Directory of Open Access Journals (Sweden)

    Paulo V. M. Steagall

    2017-05-01

    Full Text Available This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect, perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique.

  14. 腹横肌平面阻滞用于患儿腹股沟区术后镇痛的效果%Efficacy of transversus abdominis plane block for postoperative analgesia in pediatric patients undergoing operation on inguinal region

    Institute of Scientific and Technical Information of China (English)

    汪莉; 刘玉华; 冯春

    2015-01-01

    Objective To evaluate the efficacy of transversus abdominis plane (TAP) block for postoperative analgesia in the pediatric patients undergoing operation on the inguinal region.Methods Sixty-four pediatric patients of both sexes, aged 1-3 yr, weighing 8.5-23.6 kg, of American Society of Anesthesiologists physical status Ⅰ , undergoing elective unilateral high ligation of the hernia sac or high ligation of the processus vaginalis, were equally randomized into either intravenous analgesia group (group VA) or TAP block group (group TAP).In group TAP, after induction of anesthesia, the pediatric patients received ultrasound-guided TAP block with 0.2% ropivacaine 1 ml/kg injected locally.After the laryngeal mask airway was inserted, the pediatric patients were mechanically ventilated, and then inhaled 2%-3% sevoflurane for maintenance of anesthesia.In group VA, postoperative analgesia was performed with fentanyl 0.35 μg · kg-1 · h-1 until 24 h after operation.The level of pain was rated using the FLACC pain scale.When FLACC score>5, fentanyl 0.25 μg/kg was injected intravenously as rescue analgesic.The occurrence of TAP block-related adverse events, time for removal of laryngeal mask airway, and occurrence of fentanyl-related nausea and vomiting, respiratory depression, and emergence agitation were recorded.Results No TAP block-related adverse events were observed in group TAP, and no respiratory depression was found in the two groups.Compared with group VA, the time for removal of laryngeal mask airway was significantly shortened, and the requirement for rescue analgesics and incidence of vomiting and emergence agitation were decreased in group TAP (P< 0.05).Conclusion TAP block with 0.2% ropivacaine 1 ml/kg provides good efficacy for postoperative analgesia with good safety in the pediatric patients undergoing operation on the inguinal region.%目的 评价引导腹横肌平面阻滞用于患儿腹股沟区手术后的镇痛效果.方法 择期行单

  15. Analgesia pós-operatória com bloqueio bilateral do nervo pudendo com bupivacaína S75:R25 a 0,25%: estudo piloto em hemorroidectomia sob regime ambulatorial Analgesia pos-operatoria con bloqueo bilateral del nervio pudendo con bupivacaína S75:R25 a 0,25%: estudio piloto en hemorroidectomia bajo régimen ambulatorial Bilateral pudendal nerves block for postoperative analgesia with 0.25% S75:R25 bupivacaine: pilot study on outpatient hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2005-12-01

    , justificado por la anestesia en el pene. CONCLUSIONES: El bloqueo bilateral de los nervios pudendos, orientado por estimulador de nervios proporciona una analgesia de excelente calidad, con baja necesidad de opioides, sin complicaciones local o sistémica y sin retención urinaria. Estudios controlados permitirán demostrar si esta técnica debe ser la primera opción para la analgesia en hemorroidectomias. La permanencia de anestesia perineal por 20,21 horas deberá inducir nuevos trabajos con el bloqueo de los nervios pudendos orientado por estimulador para el acto quirúrgico.BACKGROUND AND OBJECTIVES: Hemorrhoidectomy may be performed under several anesthetic techniques and in outpatient regimen. Postoperative pain is severe and may delay discharge. This study aimed at evaluating bilateral pundendal nerves block for post- hemorrhoidectomy analgesia. METHODS: Bilateral pundendal nerves block with 0.25% S75:R25 bupivacaine was performed with nerve stimulator in 35 patients submitted to hemorrhoidectomy under spinal anesthesia. Evaluated parameters were pain severity, duration of analgesia, demand analgesia and possible technique-related complications. Data were evaluated 6, 12, 18, 24 and 30 hours after surgery completion. RESULTS: Successful pudendal nerves stimulation was achieved in all patients. There has been no severe pain in all evaluated moments. At 12 hours after blockade, all patients had perineal anesthesia; at 18 hours, 17 patients and at 24 hours, 10 patients still presented perineal anesthesia. Postoperative analgesia was optimal for 18 patients; satisfactory, for 5 patients; and unsatisfactory, for 7 patients. Mean analgesic duration was 23.77 hours. There were no changes in blood pressure, heart rate, no nausea and vomiting were observed. All patients had spontaneous micturition. No local anesthetic-related local or systemic complications were observed. Technique was considered excellent by 27 patients and only 3 male patients considered it satisfactory due

  16. 布托啡诺、曲马多及其复合应用在术后镇痛中的效果%Outcomes of butorphanol, tramadol, or their combination for postoperative analgesia

    Institute of Scientific and Technical Information of China (English)

    蒋金娣; 韩传宝; 周钦海; 钱燕宁; 桂波

    2013-01-01

    Objective To compare the outcomes of butorphanol,tramadol,and their combination in postoperative patient-controlled intravenous analgesia (PCIA).Methods Ninety patients scheduled for abdominal surgeries and undergoing PCIA were equally randomized into three groups of B(butorphanol),T (tramadol) and BT (butorphanol combined with tramadol).VAS pain score,Ramsay sedative score,Bruggrmann comfort scale score,the numbers of receiving rescue medication and PCA button pressing and analgesia-related adverse reaction were compared at 4,24 and 48 h after surgery among three groups.Results Compared with group BT,VAS pain scores were lower and Ramsay scores were higher at 4 h and 24 h,and PCA numbers were less within 4 h in group B(P<0.05).Compared with group BT,VAS pain score was lower in group T at 24 h after surgery(P<0.05).Conclusion The efficacy of combined use of butorphonal and tramadol has no better analgesic effect and less adverse reactions than that of butorphonal or tramadol alone for PCIA.%目的 比较布托啡诺、曲马多及两药联合应用在术后自控静脉镇痛(PCIA)中的临床效果.方法 拟行择期腹部手术患者90例随机均分为布托啡诺组(B组)、曲马多组(T组)和布托啡诺复合曲马多组(BT组),记录术后4、24、48h的VAS、Ramsay镇静评分、舒适度评分、追加镇痛药例数、镇痛泵按压次数和不良反应发生情况.结果 与BT组相比,B组术后4、24 h的VAS降低,Ramsay评分升高,术后4h镇痛泵按压次数减少(P<0.05),T组术后24 h的VAS降低(P<0.05).结论 复合应用布托啡诺与曲马多PCIA的镇痛效果不及各自单一药物,且未减少不良反应的发生.

  17. The effect comparison of different concentration dexmedetomidine with butorphanol on postoperative analgesia%不同剂量右美托咪定复合布托啡诺在术后镇痛中的效果比较

    Institute of Scientific and Technical Information of China (English)

    于颜锋; 刘文养; 覃勇华

    2013-01-01

    Objective Through the effect comprison of analgesic calm and side-effect on postoperative analgesia under different concentration dexmedetomidine with butorphanol,to research the best concentration of dexmedetomidine on postoperative analgesia.Methods Ninety patients with lower abdominal surgery with general anesthesia,ASA Ⅰ-Ⅱ grade,were divided into 3 groups by random digits table:group A,group B and group C,each group with 30 cases.The group A received 0.2 μg/ (kg·h) dexmedetomidine.The group B received 0.3 μg/ (kg ·h) dexmedetomidine,both added 0.15 mg/kg butorphanol and 8 mg ondansetron.The group C only received 0.15 mg/kg butorphanol and 8 mg ondansetron.Applied patient controlled intravenous analgesia (PCIA) pump continuous infusion gave total 100 ml,background infusion 2 ml/h,patient controlled analgesia (PCA) 2 ml,lock time 30 min,analgesia was continued 48 h.Below were recorded at 2,6,12,24 and 48 h after the beginning of PCIA:analgesia VAS score,ramsay sedation scale (RSS),adverse reaction.The total number of button pressing of PCA and the consumption of patient controlled liqnid analgesia (PCLA) solution were also recorded.Results There was no statistically significant difference in VAS score after each time point between group A and group B (P> 0.05).The VAS scores after each time point in group A and group B were significantly lower than those in group C [(2.7 ±0.8),(2.6 ± 0.8) scores vs.(3.2 ± 0.9) scores; (1.8 ± 0.6),(1.7 ± 0.6) scores vs.(2.5 ± 0.6) scores; (1.0 ±0.6),(0.9 ±0.7) scores vs.(1.8 ±0.6) scores; (1.0 ±0.5),(0.8 ±0.5) scores vs.(1.4 ±0.5) scores; (0.7 ±0.5),(0.7 ±0.4) scores vs.(1.0 ±0.5) scores,P <0.05].There was no statistically significant difference in RSS score among 3 groups (P > 0.05).The RSS scores after 6,12,24 and 48 h in group A and group B were significantly higher than those in group C [(2.6 ±0.5),(3.5 ±0.6) scores vs.(2.0 ±0.3) scores; (2.9 ± 0.6),(3.8 ± 1.2) scores vs.(2.4 ± 0.3) scores

  18. Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain.

    Science.gov (United States)

    Crawford, H J; Knebel, T; Kaplan, L; Vendemia, J M; Xie, M; Jamison, S; Pribram, K H

    1998-01-01

    Fifteen adults with chronic low back pain (M = 4 years), age 18 to 43 years (M = 29 years), participated. All but one were moderately to highly hypnotizable (M = 7.87; modified 11-point Stanford Hypnotic Susceptibility Scale, Form C [Weitzenhoffer & Hilgard, 1962]), and significantly reduced pain perception following hypnotic analgesia instructions during cold-pressor pain training. In Part 1, somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend and hypnotic analgesia (HA) conditions at anterior frontal (Fp1, Fp2), midfrontal (F3, F4), central (C3, C4), and parietal (P3, P4) regions. During HA, hypothesized inhibitory processing was evidenced by enhanced N140 in the anterior frontal region and by a prestimulus positive-ongoing contingent cortical potential at Fp1 only. During HA, decreased spatiotemporal perception was evidenced by reduced amplitudes of P200 (bilateral midfrontal and central, and left parietal) and P300 (right midfrontal and central). HA led to highly significant mean reductions in perceived sensory pain and distress. HA is an active process that requires inhibitory effort, dissociated from conscious awareness, where the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. In Part 2, the authors document the development of self-efficacy through the successful transfer by participants of newly learned skills of experimental pain reduction to reduction of their own chronic pain. Over three experimental sessions, participants reported chronic pain reduction, increased psychological well-being, and increased sleep quality. The development of "neurosignatures of pain" can influence subsequent pain experiences (Coderre, Katz, Vaccarino, & Melzack, 1993; Melzack, 1993) and may be expanded in size and easily reactivated (Flor & Birbaumer, 1994; Melzack, 1991, 1993). Therefore, hypnosis and

  19. Effects of preoperative sleep disturbance on efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery%术前睡眠紊乱对鼻内镜手术患者氟比洛芬酯术后镇痛效果的影响

    Institute of Scientific and Technical Information of China (English)

    王丽; 裴凌; 苏帆

    2014-01-01

    Objective To investigate the effects of preoperative sleep disturbance on the efficacy of flurbiprofen for postoperative analgesia in patients undergoing endoscopic nasal surgery.Methods Ninety-six ASA Ⅰ or Ⅱ patients of both sexes (aged 20-60 years and weighing 50-80 kg) undergoing endoscopic nasal surgery were enrolled in this study.Pittsburg sleep quality index was used to evaluate the long-term sleep quality before hospitalization and Athens sleep quality index was used to evaluate the short-term sleep quality in hospital.The patients were divided into four groups according to the types of preoperative sleep disturbance (n =24 each):no sleep disturbance (group Ⅰ),long-term sleep disturbance (group Ⅱ),acute short-term sleep disturbance (group Ⅲ),and long-term + acute short-term sleep disturbance (group Ⅳ).Anesthesia was induced with sufentanil,propofol and cis-atracurium and maintained with intravenous infusion of remifentanil and propofol.Then the patients received endotracheal intubation and mechanical ventilation.The end-tidal pressure of carbon dioxide was maintained at 30-35 mm Hg.Controlled hypotension was performed with nicardipine,and the mean arterial blood pressure was maintained at 50-70 mm Hg and heart rate at 60-90 bpm during operation.The patients received intravenous injection of flurbiprofen 50 mg 15 minutes before the end of operation for postoperative analgesia.When the visual analogue scale score was more than 3 during the first 6 hours after operation,flurbiprofen 50 mg was given intravenously as rescue analgesia.Results The incidence of rescue analgesia administered after operation was significantly greater in groups Ⅱ,Ⅲ and Ⅳ than in group Ⅰ,and greater in group Ⅳ than in groups Ⅱ and Ⅲ.There was no significant difference in the incidence of rescue analgesia administered during the first 6 hours after operation between groups Ⅱ and Ⅲ.Conclusion Preoperative sleep disturbance has adverse effects on the efficacy

  20. Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.

    Directory of Open Access Journals (Sweden)

    Dominik Herzog

    Full Text Available Endoscopic lung volume reduction (ELVR with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.Seventy-two (72 emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32 patients received standard post-implantation medical management (Standard Medical Care (SMC, and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC.The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02. Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02. Major clinical outcomes showed no significant differences between the two cohorts.In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.

  1. Peripheral morphine analgesia in dental surgery.

    Science.gov (United States)

    Likar, R; Sittl, R; Gragger, K; Pipam, W; Blatnig, H; Breschan, C; Schalk, H V; Stein, C; Schäfer, M

    1998-05-01

    The recent identification of opioid receptors on peripheral nerve endings of primary afferent neurons and the expression of their mRNA in dorsal root ganglia support earlier experimental data about peripheral analgesic effects of locally applied opioids. These effects are most prominent under localized inflammatory conditions. The clinical use of such peripheral analgesic effects of opioids was soon investigated in numerous controlled clinical trials. The majority of these have tested the local, intraarticular administration of morphine in knee surgery and have demonstrated potent and long-lasting postoperative analgesia. As the direct application of morphine into the pain-generating site of injury and inflammation appears most promising, we examined direct morphine infiltration of the surgical site in a unique clinical model of inflammatory tooth pain. Forty-four patients undergoing dental surgery entered into this prospective, randomized, double-blind study. Before surgery they received, together with a standard local anesthetic solution (articaine plus epinephrine) a submucous injection of either 1 mg of morphine (group A) or saline (group B). Postoperative pain intensity was assessed using the visual analog scale (VAS) and numeric rating scale (NRS) at 2, 4, 6, 8, 10, 12, 16, 20 and 24 h after surgery. In addition, patients recorded the occurrence of side effects and the supplemental consumption of diclofenac tablets. Results of 27 patients were analyzed (group A: n=14, group B: n=13). Pain scores which were moderate to severe preoperatively were reduced to a similar extent in both groups up to 8 h postoperatively. Thereafter, pain scores in group A were significantly lower than those in group B for up to 24 h, demonstrating the analgesic efficacy of additional morphine. The time to first analgesic intake and the total amount of supplemental diclofenac were less in group A than in group B. No serious side effects were reported. Our results show that 1 mg of

  2. AMPAkines and morphine provide complementary analgesia.

    Science.gov (United States)

    Sun, Yongjun; Liu, Kevin; Martinez, Erik; Dale, Jahrane; Huang, Dong; Wang, Jing

    2017-09-15

    Glutamate signaling in the central nervous system is known to play a key role in pain regulation. AMPAkines can enhance glutamate signaling through α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. previous studies have shown that AMPAkines are effective analgesic agents, and their site of action is likely in the brain. It is not known, however, if AMPAkines can provide complementary analgesia in combination with opioids, the most commonly used analgesics. Here, we show that the co-administration of an AMPAkine with morphine can provide additional analgesia, both in naïve rats and in rats that experience postoperative pain. Furthermore, we show that this AMPAkine can be administered directly into the prefrontal cortex to provide analgesia, and that prefrontal AMPAkine infusion, similar to systemic administration, can provide added pain relief to complement morphine analgesia. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. The effect of intravenous low dose ketamine for reducing postoperative sore throat.

    Science.gov (United States)

    Park, Sun Young; Kim, Sang Hyun; Noh, Jung Il; Lee, Su Myoung; Kim, Mun Gyu; Kim, Sang Ho; Ok, Si Young; Kim, Soon Im

    2010-07-01

    This study was performed to evaluate the effectiveness of intravenous low dose ketamine for reducing the incidence and severity of postoperative sore throat (POST). This was a prospective, randomized, double-blind clinical trial. The study population consisted of 70 patients between 20 and 70 years old who were classified as American Society of Anesthesiologists I-II and were scheduled for elective laparoscopic cholecystectomy. The patients were divided randomly into two groups. Patients in the ketamine group received an intravenous injection of 0.5 mg/kg of ketamine just before induction, followed by 10 microg/kg/min throughout the operation. Patients in the control group received intravenous saline instead of ketamine. The patients were interviewed 1, 6, and 24 h after the operation. The incidence and severity of POST were recorded. No significant differences in the incidence and severity of POST during the 24 h after the operation were found between the two groups (21/31 in the ketamine group vs. 26/34 in the control group, P = 0.398). Intravenous injection of low dose ketamine was not effective for reducing POST.

  4. Application of Dexmedetomidine Combined with Sulfentanyl in Postoperative Analgesia of Different Op-eration%右美托咪定复合舒芬太尼在不同手术术后镇痛中的应用

    Institute of Scientific and Technical Information of China (English)

    姜柳英; 郑辉利

    2014-01-01

    Objective To observe application of dexmedetomidine combined with sulfentanyl in postoperative analge -sia of different operation.Methods 90 cases patients (ASA I~II, Age 30~65) include gastric cancer radical correc-tion (group A), uterine cervix cancer radical correction (group B) and replacement of total hip (group C) with 30 cases each.Three groups were all administrated of 2 μg/kg of dexmedetomidine , 0.15 μg/kg of sulfentanyl and 6 mg of tropi-setron in the postoperative analgesia pumps which were adjusted in a standard of 100 mL volume, first dose of 4 mL, bo-lus dose of 2 mL,add dose of 0.5 mL and the lock time was 15 min.The visual analogue score (VAS),Ramsay calm score (6,12,24,and 48 h after operation) and adverse reaction were recorded.Results The VAS were lower than four at each time points both in group A and group B.The VAS of group C at each time points were higher than group A and B(P<0.05),the VAS were higher than four at 6h points, and lower than four at the other two time points.Ramsay calm score were well and the adverse reaction were low among every time points of all three groups .The sleep and conscious -sedation quality of group C were lower than group A and B ( P<0.05 ).Conclusions Dexmedetomidine combined with sulfentanyl in postoperative analgesia were deserve recommended which could offer well analgesia and conscious -seda-tion with few adverse effect , especially in the belly operation.%目的:探讨右美托咪定复合舒芬太尼在不同手术术后镇痛应用效果和临床意义。方法90例ASA分级Ⅰ~Ⅱ级、年龄30~65岁以下的择期手术患者使用右美托咪定复合舒芬太尼进行术后镇痛,其中包括30例胃癌根治术( A组),30例宫颈癌根治术( B组),30例全髋关节置换术( C组);三组均用右美托咪定2μg/kg+舒芬太尼0.15μg/kg+托烷司琼6 mg加入生理盐水稀释至100 mL,静脉镇痛泵首剂均为4 mL,背景输注速度2 m

  5. Postoperative Analgesia by Femoral Nerve Block after Total Knee Replacement: Randomized Controlled Trial%全膝关节置换术后股神经阻滞自控镇痛的随机对照研究

    Institute of Scientific and Technical Information of China (English)

    王宁; 戎玉兰; 魏越; 杨晓霞; 李民; 郭向阳

    2011-01-01

    目的 比较患者自控与恒速输注2种给药方案对全膝关节置换术后患者股神经阻滞镇痛的效果.方法 2010年3月~11月选择60例单侧全膝关节置换术,椎管内麻醉前在超声及神经刺激器引导下置入连续股神经阻滞导管,将阻滞效果完全的患者按随机数字表随机分为2组:恒速输注组(CI组)和患者自控镇痛组(PCA组).CI组经导管持续输注0.2%罗哌卡因5 ml/h,PCA组输注0.2%罗哌卡因背景量5 ml/h,单次注射5 ml/次,锁定时间60 min.记录2组患者静息痛及运动状态下疼痛评分、满意率以及不良反应发生情况.结果 3例在首次给药后30 min内没有达到完全阻滞而被排除.术后1~3 d静息及主动锻炼时疼痛评分2组无显著性差异(P>0.05).术后1~3 d被动锻炼时疼痛评分PCA组(4.7±1.3.4·5±1.0,4.5±1.0)显著低于CI组(6.5±1.6,6.1.4-1.6,5.9±1.6)(P<0.05=.患者满意度PCA组显著高于CI组[8(6~10)VS·7(4~9)](Z=16.957,P=0.031).2组患者均无耳鸣、口周麻木、眩晕等局麻药中毒症状同,均无因下肢无力而跌倒,无导管脱出.结论 与恒速输注相比,患者自控股神经阻滞能够提高术后康复运动时的镇痛效果.%Objective To compare the effects of patient-controlled and continuous-infusion femoral nerve block for postoperative analgesia after total knee replacement (TKR). Methods Sixty patients who underwent TKR in our hospital between March 2010 and November 2010 in our hospital were enrolled in this study. Before neuraxial block, the patients were scheduled to receive femoral nerve block catheter insertion under the guidance by ultrasonography and nerve stimulation. After confirmation of a successful block, the patients were randomly assigned to continuous infusion group (CI group) and patient controlled analgesia group (PCA group). 0.2% ropivacaine was infused through the femoral catheter, 5 ml/h for CI group, and 5 ml/h plus boluses of 5 ml with a lockout time of 60

  6. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  7. Post-surgical analgesia in rainbow trout: is reduced cardioventilatory activity a sign of improved animal welfare or the adverse effects of an opioid drug?

    Science.gov (United States)

    Gräns, Albin; Sandblom, Erik; Kiessling, Anders; Axelsson, Michael

    2014-01-01

    The use of fish models in biomedical research is increasing. Since behavioural and physiological consequences of surgical procedures may affect experimental results, these effects should be defined and, if possible, ameliorated. Thus, the use of post-surgical analgesia should be considered after invasive procedures also in fish, but presently, little information exists on the effects of analgesics in fish. This study assessed the effects of an opioid drug, buprenorphine (0.05 mg/kg IM), on resting ventilation and heart rates during 7 days of postsurgical recovery in rainbow trout (Oncorhynchus mykiss) at 10°C by non-invasively recording bioelectric potentials from the fish via electrodes in the water. Baseline ventilation and heart rates were considerably lower compared to previously reported values for rainbow trout at 10°C, possibly due to the non-invasive recording technique. Buprenorphine significantly decreased both ventilation and heart rates further, and the effects were most pronounced at 4-7 days after anaesthesia, surgical procedures and administration of the drug. Somewhat surprisingly, the same effects of buprenorphine were seen in the two control groups that had not been subject to surgery. These results indicate that the reductions in ventilation and heart rates are not caused by an analgesic effect of the drug, but may instead reflect a general sedative effect acting on both behaviour as well as e.g. central control of ventilation in fishes. This resembles what has previously been demonstrated in mammals, although the duration of the drug effect is considerably longer in this ectothermic animal. Thus, before using buprenorphine for postoperative analgesic treatment in fish, these potentially adverse effects need further characterisation.

  8. Post-surgical analgesia in rainbow trout: is reduced cardioventilatory activity a sign of improved animal welfare or the adverse effects of an opioid drug?

    Directory of Open Access Journals (Sweden)

    Albin Gräns

    Full Text Available The use of fish models in biomedical research is increasing. Since behavioural and physiological consequences of surgical procedures may affect experimental results, these effects should be defined and, if possible, ameliorated. Thus, the use of post-surgical analgesia should be considered after invasive procedures also in fish, but presently, little information exists on the effects of analgesics in fish. This study assessed the effects of an opioid drug, buprenorphine (0.05 mg/kg IM, on resting ventilation and heart rates during 7 days of postsurgical recovery in rainbow trout (Oncorhynchus mykiss at 10°C by non-invasively recording bioelectric potentials from the fish via electrodes in the water. Baseline ventilation and heart rates were considerably lower compared to previously reported values for rainbow trout at 10°C, possibly due to the non-invasive recording technique. Buprenorphine significantly decreased both ventilation and heart rates further, and the effects were most pronounced at 4-7 days after anaesthesia, surgical procedures and administration of the drug. Somewhat surprisingly, the same effects of buprenorphine were seen in the two control groups that had not been subject to surgery. These results indicate that the reductions in ventilation and heart rates are not caused by an analgesic effect of the drug, but may instead reflect a general sedative effect acting on both behaviour as well as e.g. central control of ventilation in fishes. This resembles what has previously been demonstrated in mammals, although the duration of the drug effect is considerably longer in this ectothermic animal. Thus, before using buprenorphine for postoperative analgesic treatment in fish, these potentially adverse effects need further characterisation.

  9. Postoperative upper airway problems

    African Journals Online (AJOL)

    QuickSilver

    2003-06-09

    Jun 9, 2003 ... REVIEW ARTICLE. Southern African Journal of Anaesthesia & Analgesia - May 2003. 12. Postoperative upper airway problems way. A number of factors, some avoidable, influence the incidence ... debilitating pain, inability to swallow and temporary voice changes, and are a ..... decrease airway resistance.

  10. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

    Directory of Open Access Journals (Sweden)

    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

  11. Gargling with sodium azulene sulfonate reduces the postoperative sore throat after intubation of the trachea.

    Science.gov (United States)

    Ogata, Junchi; Minami, Kouichiro; Horishita, Takafumi; Shiraishi, Munehiro; Okamoto, Takashi; Terada, Tadanori; Sata, Takeyoshi

    2005-07-01

    Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study, we investigated whether preoperative gargling with sodium 1,4-dimethyl-7-isopropylazulene-3-sulfonate monohydrate (sodium azulene sulfonate, Azunol) reduces POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anesthesia were randomized into Azunol and control groups. In the Azunol group, patients gargled with 4 mg Azunol diluted with 100 mL tap water (40 microg/mL). In the control group, patients gargled with 100 mL of tap water. After emergence from general anesthesia, the patients with POST were counted and POST was evaluated using a verbal analog pain scale. There were no significant differences between the two groups by age, height, body weight, gender distribution, or duration of anesthesia and surgery. In the control group, 13 patients (65%) complained of POST, which remained 24 h later in nine patients (45%). In the Azunol group, five patients (25%) also complained of POST, which completely disappeared by 24 h later. The incidence of POST and verbal analog pain scale scores in the Azunol group decreased significantly compared with the control group. We demonstrated that gargling with Azunol effectively attenuated POST with no adverse reactions.

  12. 罗哌卡因局部浸润对妇科腹腔镜术后镇痛的影响研究%Local Infiltration of Ropivacaine for Postoperative Analgesia in Patients Undergoing Gynecologic Laparoscopy

    Institute of Scientific and Technical Information of China (English)

    王琳; 徐铭军

    2014-01-01

    Background Gynecological laparoscopic surgery has the characteristics of small trauma and less pain and has been widely used in clinic. Patient controlled intravenous analgesia(PCIA)is often used for post - operative analgesia after laparoscopic surgery. The analgesic effect is exact but it is a general analgesia with many adverse reactions. So it is of great signifi-cance to seek a perfect analgesic method with less adverse reactions. Objective To evaluate the effect of local infiltration of ropiv-acaine on postoperative analgesia in patients underwent gynecologic laparoscopy. Methods 60 patients with ovarian lesions admit-ted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from November 2011 to June 2012 were select-ed. All the patients were scheduled for gynecologic laparoscopy. The patients were randomly divided into research group and control group with each group 30 cases. In the research group,local infiltration of 0. 4% ropivacaine was performed,and 10 ml(40 mg)was injected on the navel incision while 5 ml(20 mg)was injected on the unilateral incision above the Mcburney′ s point. The two groups of patients both received PCIA with sufentanil after operation. The operation time and bleeding volume were recorded,and the score of visual analogue scale(VAS)at 2 h,4 h,6 h and 24 h,Ramsay sedation score and BCS comfort level were also recorded. The consumption of sufentanil within 24 h after operation,the number of successfully delivered doses (D1 )and the number of attempts(D2 )within 24 h after operation were recorded. The D1 / D2 was calculated. The patients′ satis-faction and the adverse reactions were also recorded. Results The operation time and bleeding volume between the two groups showed no statistically significant difference(P > 0. 05). VSA score at different time,Ramsay sedation score showed statistical-ly significant differences between the two groups(P 0. 05). Compared with the control group,the sufentanil used in PCIA

  13. Analgesia e sedação da associação da clonidina e ropivacaína a 0,75% por via peridural no pós-operatório de colecistectomia aberta Analgesia y sedación de la asociación de la clonidina y ropivacaína a 0,75% por vía peridural en el pos-operatorio de colecistectomia abierta Analgesia and sedation with epidural clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy

    Directory of Open Access Journals (Sweden)

    Antonio Mauro Vieira

    2003-09-01

    edades variando de 18 a 50 años, con peso entre 50 y 100 kg, estado físico ASA I y II, sometidos a colecistectomia, y que fueron distribuidos en dos grupos: Control (GC, en que fue administrada ropivacaína a 0,75% (20 ml, asociada al clorato de sodio a 0,9% (1 ml; Experimento (GE, en que fue inyectada ropivacaína a 0,75% (20 ml, asociada a la clonidina (1 ml = 150 µg. La analgesia y la sedación fueron observadas 2, 6 y 24 horas después del término del momento operatorio. RESULTADOS: La media de edad en el GC fue de 41 años y de 37 años en el GE. La media de peso fue de 67 kg en el GC y de 64 kg en el GE. La sedación en el pos-operatorio fue significativamente mayor en los pacientes a las 2 y 6 horas del grupo de experimento. La analgesia fue observada en mayor número de pacientes del grupo de experimento, cuando comparada al grupo control. CONCLUSIONES: La asociación de clonidina y ropivacaína produjo analgesia que dura más, y sedación en pacientes, en los horarios de observación de 2 y 6 horas.BACKGROUND AND OBJECTIVES: Epidural clonidine has analgesic properties and potentiates local anesthetic effects; there are, however, some side effects including: arterial hypotension, bradycardia and sedation. This study aimed at evaluating analgesia and sedation of clonidine associated to 0.75% ropivacaine in the postoperative period of open cholecystectomy. METHODS: Participated in this study 30 patients of both genders, aged 18 to 50 years, weighing 50 to 100 kg, physical status ASA I or II, submitted to cholecystectomy, who were distributed in two groups: Control Group (CG received 0.75% ropivacaine (20 ml with saline solution (1 ml; Experimental Group (EG received 0.75% ropivacaine (20 ml with clonidine (1 ml = 150 µg. Analgesia and sedation were observed at 2, 6 and 24 postoperative hours. RESULTS: Mean age was 41 yr in CG and 37 yr in EG. Mean weight was 67 kg in CG and 64 kg to EG. Postoperative sedation was significantly higher at 2 and 6 hours in the

  14. 音乐联合舒芬太尼术后静脉镇痛用于剖宫产术后患者的临床观察%Clinical Observation Of Musical Therapy Combined With Sufentanil For Postoperative Analgesia After Cesarean Section Patients

    Institute of Scientific and Technical Information of China (English)

    袁宏祥; 赵洁; 罗成才

    2015-01-01

    Objective To evaluate the effects of musical therapy combined with sufentanil for postoperative analgesia after cesarean section in patients with anxiety, pain and hemodynamic impact and the number of days of hospitalization.Methods200 cases of elective cesarean surgery( ASAⅠ-Ⅱ grade)using a random number table, divided into two groups (n = 100): Musical therapy group (M group) and control group (group C). The patients receiving preoperative music relaxation training 30min, 30min after 5,10,15,20,25,30h music intervention were carried out. Group C patients do not use any music therapy at the same time. M and C group after patients received intravenous sufentanil postoperative analgesia (postoperative paitent-controlled anaigesia, PCA). Recording patients 7,12,17,22,27,32h patient anxiety self-assessment scale (self rating anxiety scale, ASA) score, visual analogue scale (visual analogue scale, VAS), systolic blood pressure (systolic blood pressure, SBP), diastolic blood pressure (diastolic blood pressure, DBP) and heart rate (heart rate, HR ) change. Record after sufentanil dosage, PCA press times and adverse reactions; several days to discharge patients records.ResultsCompared with group C, group M patients at each time point of SAS score, VAS score, SBP, DBP, and HR were significantly lower (P <0.01), M group sufentanil dosage and PCA press times significantly reduced (P <0.01), and the adverse reactions and the number of days of hospitalization were significantly lower (P <0.01)ConclusionMusical therapy combined with sufentanil for postoperative analgesia after cesarean section patients can achieve better analgesic effect, and can alleviate patient anxiety, hemodynamic stability and reduce the amount of sufentanil effective in patients with stable; obviously shorten hospital stay.%目的:音乐治疗联合舒芬太尼术后静脉镇痛用于剖宫产术后患者的焦虑心理,镇痛和血流动力学及住院天数的影响。方法

  15. Serum therapeutic concentration of tramadol during intravenous analgesia for postoperative pain relief%曲马多用于术后静脉镇痛时的血清治疗浓度

    Institute of Scientific and Technical Information of China (English)

    徐惠芳; 朱永满; 江伟

    2001-01-01

    Objective To investigate the serum therapeutic concentration of tramadol during intravenous analgesia for postoperative pain relief. Methods Twenty adult patients ASA Ⅰ-Ⅱ (10 male, 10 female) undergoing elective radical operation for cancer of stomach were treated with intravenous tramadol for postoperative pain relief. Patients addicted to any drug or tolerant to opioid and patients with epilepsy or liver and/or renal dysfunction were excluded. All patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5mg. Anesthesia was induced with midazolam 0. 1mg/kg and fentanyl 5 μg/kg and intubation was facilitated with vecuronium 0.16mg/kg. Anesthesia was maintained with continuous intravenous infusion of propofol 4-6 mg@ kg 1 @ h 1, fentanyl 2-3 μg@ kg-1 @ h-1 and vecuronium 0.1mg@ kg-1@ h-1 combined with inhalation of 1% isoflurane. After surgery in ICU when patients felt slight pain (VAS 1-2), intravenous tramadol 1.5mg/kg was given as initial dose. Whenever patients felt slight pain (VAS 1-2) again, a bolus of tramadol 20 mg was given intravenously every 10 min until VAS was 0. The onset time (from the end of iv injection of initial dose of tramadol to VAS 0), the duration of action (from VAS 0 to VAS 1-2) and the time when accumulated dose of tramadol amounted to twice the initial dose were recorded. HR, MAP, respiratory rate (RR) and SpO2 were monitored and recorded before and 10, 20, 30 min after administration of tramadol. Venous blood samples were taken before each additional tramadol administration on demand for determination of serum tramadol concentration by high performance liquid chromatography. Results The mean serum therapeutic level of tramadol during period of analgesia was (370±148)ng/ml(248.6-615.7ng/ml). The mean onset time of the initial dose was (9.2± 2.1 )min. The mean duration of action was (2.3 ± 1.0)h. The time when accumulated dose of tramadol amounted to twice the initial dose was (6.4 ± 2.7)h on average

  16. Effectiveness of ketamine gargle in reducing postoperative sore throat in patients undergoing airway instrumentation: a systematic review.

    Science.gov (United States)

    Mayhood, Jillian; Cress, Kayla

    2015-09-01

    Postoperative sore throat is a common, minor adverse event, second to postoperative nausea and vomiting, occurring in individuals undergoing general anesthesia. Postoperative sore throat has the potential to not only diminish patient satisfaction, but also increase the need for adjunct pain therapy in the post anesthesia care unit. Many techniques are utilized to reduce postoperative sore throat; however no one intervention has proven to be completely effective. The use of ketamine gargle is a novel intervention but the effectiveness of administering it prior to induction of general anesthesia is still uncertain. Therefore, further evaluation of current evidence is needed to determine the effectiveness of ketamine gargle in reducing the incidence of postoperative sore throat. The objective of this review was to determine the effectiveness of ketamine gargle in comparison to placebo or another intervention in reducing the incidence of postoperative sore throat in patients undergoing airway instrumentation. The participants in this review were adult patients who received ketamine gargle or placebo prior to induction of general anesthesia for a variety of surgical procedures requiring endotracheal intubation.This review examined studies that evaluated the effectiveness of ketamine gargle compared to placebo or another intervention in reducing the incidence of postoperative sore throat.This review considered studies that measured the incidence of postoperative sore throat using a direct question survey with a four-point scale (0 = no sore throat; 1,2,3 = presence of sore throat).This review included randomized controlled trials only; no other types of articles were discovered upon searching. The comprehensive search strategy aimed to find both English language studies prior to August 2014.Databases used were: EMBASE, CINAHL, MEDLINE, ProQuest, Web of Science and Cochrane Central Register of Controlled Trials. Google Scholar, MEDNAR, New York Academy of Medicine Grey

  17. Efficacy of Opioid-free Anesthesia in Reducing Postoperative Respiratory Depression in Children Undergoing Tonsillectomy

    Science.gov (United States)

    2016-12-08

    Anesthesia; General Anesthesia; Analgesics, Opioid; Postoperative Complications; Pathologic Processes; Physiologic Effects of Drugs; Narcotics; Analgesics; Sleep Disordered Breathing; Obstructive Sleep Apnea of Child; Tonsillectomy; Respiratory Depression; Dexmedetomidine; Ketamine; Lidocaine; Gabapentin; Pulse Oximetry

  18. Reduced complement activation during cardiopulmonary bypass does not affect the postoperative acute phase response

    NARCIS (Netherlands)

    van den Goor, J.; Nieuwland, R.; van den Brink, A.; van Oeveren, W.; Rutten, 27818; Tijssen, J.; Eijsman, L.; Rutten, P

    2004-01-01

    Objective: In the present study the relationship was evaluated between perioperative inflammation and the postoperative acute phase response in patients undergoing elective coronary artery bypass grafting (CABG) assisted by cardiopulmonary bypass (CPB). CPB circuits contained either non-coated-

  19. 剖宫产及硬膜外吗啡术后镇痛对产妇泌乳的影响及其护理干预%The Cesarean section and epidural morphine for postoperative analgesia maternal lactation and the influence of nursing intervention

    Institute of Scientific and Technical Information of China (English)

    李彩霞

    2013-01-01

    objective:To observe the cesarean section, epidural morphine postoperative analgesia maternity lactation status and serum prolactin (PRL) change. Methods:The 240 cases of maternal term are divided into four groups: Ⅰ group operation BiHang epidural morphine analgesia; Ⅱ group operation BiHang epidural morphine analgesia, 24 h after additional one time. Ⅲ group do not postoperative analgesia;Vaginal natural childbirth sixty cases of Ⅳ group. 240 cases were performed antenatal, postpartum nursing intervention, scientific propaganda, the maternal and child inmates and pure breastfeeding. Results:Postpartum 5 min, 24 h and h and start within lactation and 72 h lactation hyposecretion incidence and cesarean section group compared with indifference. Conclusion:Due to the nursing intervention, and cesarean section and epidural morphine postoperative analgesia does not affect maternal breastfeeding success rate.%目的:观察剖宫产、硬膜外吗啡术后镇痛产妇的泌乳状况及血清泌乳素(PRL)变化.方法:足月产妇240例均分为四组:Ⅰ组术毕行硬膜外吗啡镇痛;Ⅱ组术毕行硬膜外吗啡镇痛,24h后追加一次;Ⅲ组未行术后镇痛;阴道自然分娩60例为Ⅳ组.240例产妇产前、产后均进行护理干预、科学宣传,实行母婴同室和纯母乳喂养.结果:产后5min、24h及48h内开始泌乳及72h泌乳分泌不足发生率与剖宫产组相比无差异.结论:由于护理干预,剖宫产及硬膜外吗啡术后镇痛不影响产妇母乳喂养的成功率.

  20. Technique of ICP monitored stepwise intracranial decompression effectively reduces postoperative complications of severe bifrontal contusion

    Directory of Open Access Journals (Sweden)

    Guan eSun

    2016-04-01

    Full Text Available Background Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of ICP monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. Method A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an intracranial pressure (ICP monitored stepwise intracranial decompression group (68 patients each, to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs 6 months after the surgery were compared between the two groups.Results (1 The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05; (2 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05; the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05.Conclusions The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of intracranial pressure and was beneficial to the prognosis of

  1. Analgesia pós-operatória em correção cirúrgica de pé torto congênito: comparação entre bloqueio nervoso periférico e bloqueio peridural caudal Analgesia postoperatoria en corrección quirúrgica de pie jorobado congénito: comparación entre bloqueo nervioso periférico y bloqueo epidural caudal Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block

    Directory of Open Access Journals (Sweden)

    Monica Rossi Rodrigues

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O procedimento de correção de pé torto congênito (PTC cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças. MÉTODO: Estudo randômico, encoberto, em crianças submetidas à intervenção cirúrgica para liberação póstero-medial de PTC, alocadas em 4 grupos conforme a técnica anestésica: Caudal (ACa; Bloqueios isquiático e femoral (IF; Bloqueios isquiático e safeno (IS; Bloqueio isquiático e anestesia local (IL, associados à anestesia geral. Nas primeiras 24 horas os pacientes receberam dipirona e paracetamol via oral e foram avaliados por anestesiologista que desconhecia a técnica empregada. Conforme escores da escala CHIPPS (Children's and infants postoperative pain scale era administrada morfina via oral (0,19 mg.kg-1 por dia. RESULTADOS: Foram estudadas 118 crianças distribuídas nos grupos ACa (30, IF (32, IS (28 IL (28. O tempo médio entre o bloqueio e a primeira dose de morfina foi 6,16 horas no grupo ACa, 7,05 horas no IF, 7,58 horas no IS e 8,18 horas no IL. O consumo de morfina foi 0,3 mg.kg-1 por dia nos quatro grupos. Não houve diferença significativa entre os grupos. CONCLUSÕES: Os bloqueios nervosos periféricos não promoveram maior tempo de analgesia, tampouco redução no consumo de morfina nas primeiras 24 horas em crianças submetidas à correção de PTC quando comparados ao bloqueio peridural caudal.JUSTIFICATIVA Y OBJETIVOS: El procedimiento de corrección de pie jorobado congénito (PJC, debuta

  2. Bloqueio do plexo lombar pela via posterior para analgesia pós-operatória em artroplastia total do quadril: estudo comparativo entre Bupivacaína a 0,5% com Epinefrina e Ropivacaína a 0,5% Bloqueo del plexo lumbar por la vía posterior para analgesia postoperatoria en artroplastia total de la cadera: estudio comparativo entre Bupivacaína a 0,5% con Epinefrina y Ropivacaína a 0,5% Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty: a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-06-01

    diferentes bloqueos de nervios periféricos. El objetivo de este estudio, fue comparar la eficacia de la analgesia postoperatoria, resultante de la administración en dosis única de la bupivacaína a 0,5% o de la ropivacaína a 0,5% en el bloqueo del plexo lumbar por la vía posterior en la artroplastia total de la cadera. MÉTODO: Treinta y siete pacientes fueron ubicados aleatoriamente en dos grupos según el anestésico local utilizado en el bloqueo: Grupo B - bupivacaína a 0,5% con epinefrina 1:200.000 o Grupo R - ropivacaína a 0,5%. Durante el período postoperatorio, los puntajes de dolor y el consumo de morfina en la analgesia controlada por el paciente, fueron comparados entre los grupos. El sangramiento durante la operación y la incidencia de efectos adversos y de complicaciones también fueron comparados. RESULTADOS: Pese a que los puntajes de dolor hayan sido menores en el Grupo R 8 horas, 12 horas y 24 horas después del bloqueo, esas diferencias no fueron clínicamente significativas. La regresión lineal múltiple no identificó el anestésico local como una variable independiente. No hubo diferencia en el consumo de morfina, en el sangramiento intraoperatorio y en la incidencia de complicaciones y efectos adversos entre los dos grupos. CONCLUSIONES: La bupivacaína a 0,5% y la ropivacaína a 0,5%, ofrecieron un alivio eficaz y prolongado del dolor postoperatorio después de la artroplastia total de la cadera, sin diferencia clínica, cuando dosis equivalentes fueron administradas en el bloqueo del plexo lumbar por la vía posteriorBACKGROUND AND OBJECTIVES: Posterior lumbar plexus block promotes effective postoperative analgesia in total knee arthroplasty. Ropivacaine and bupivacaine do not show differences in analgesic efficacy when used in different peripheral nerve blocks. The objective of this study was to compare the efficacy of postoperative analgesia resulting from the administration of a single dose of 0.5% bupivacaine or 0.5% ropivacaine in

  3. Preoperative Preparation for Cardiac Surgery Facilitates Recovery, Reduces Psychological Distress, and Reduces the Incidence of Acute Postoperative Hypertension.

    Science.gov (United States)

    Anderson, Erling A.

    1987-01-01

    Cardiac surgery patients were assigned to information-only, information-plus-coping, or control preoperative preparation groups. Preoperatively, both experimental groups were significantly less anxious than were controls. Both experimental groups increased patients' belief in control over recovery. Postoperatively, experimental patients were less…

  4. Preoperative Preparation for Cardiac Surgery Facilitates Recovery, Reduces Psychological Distress, and Reduces the Incidence of Acute Postoperative Hypertension.

    Science.gov (United States)

    Anderson, Erling A.

    1987-01-01

    Cardiac surgery patients were assigned to information-only, information-plus-coping, or control preoperative preparation groups. Preoperatively, both experimental groups were significantly less anxious than were controls. Both experimental groups increased patients' belief in control over recovery. Postoperatively, experimental patients were less…

  5. Efficacy analysis of continuous lumbar p elxus blocks on postoperative analgesia in total knee arthroplasty%连续腰丛神经阻滞在全膝关节置换术中的应用

    Institute of Scientific and Technical Information of China (English)

    付乐荣; 黄文斌; 冯卫荣; 陈艳梅; 李宁

    2014-01-01

    Objective To investigate the efficacy of continuous lumbar plexus blocks on postoperative analgesia in total knee arthroplasty .Methods Sixty patients after total knee arthroplasty were divided into two groups .The continuous femoral nerve blocks were used in the control group and the continuous lumbar plexus blocks were used in the observation group .The pain level,complica-tion rates,knee joint function and the life quality were compared between the two groups .Results 6 h,12 h,and 24 h after the opera-tion, the pain level and complication rates of the observation group were lower than that of the control group ( P <0.05 or P <0.01), and knee joint function and the life quality of the observation group were better than that of the control group ( P <0.01).Conclusion The method of continuous lumbar plexus blocks has valuable significance in total knee arthroplasty with less pain and lower complica -tion rate,and with improved knee joint function and quality of life .%目的:探讨连续腰丛神经阻滞在全膝关节置换术中的应用效果。方法将60例行全膝关节置换术患者随机分为两组,各30例。术后观察组采用连续腰丛神经阻滞镇痛,对照组采用股神经阻滞镇痛,比较两组患者术后疼痛水平、副作用发生率、膝关节功能评分及生活质量的差异。结果观察组患者术后6 h、12 h和24 h疼痛水平和副作用发生率均低于对照组( P <0.05或P <0.01),膝关节功能评分和生活质量评分均高于对照组( P <0.01)。结论连续腰丛神经阻滞可在全膝关节置换术中发挥积极作用,其可降低患者疼痛水平及并发症发生率,提高患者膝关节功能恢复程度和生活质量。

  6. Cement technique for reducing post-operative bursitis after trochanteric fixation.

    Science.gov (United States)

    Derman, Peter B; Horneff, John G; Kamath, Atul F; Garino, Jonathan

    2013-02-01

    Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy. We present a simple technique for use with a bolt-washer system or grip plate in which trochanteric components are covered in bone wax followed by a layer of cement to decrease friction and to diminish the risk of post-operative bursitis.

  7. Time to onset of analgesia and analgesic efficacy of effervescent acetaminophen 1000 mg compared to tablet acetaminophen 1000 mg in postoperative dental pain: a single-dose, double-blind, randomized, placebo-controlled study.

    Science.gov (United States)

    Møller, P L; Nørholt, S E; Ganry, H E; Insuasty, J H; Vincent, F G; Skoglund, L A; Sindet-Pedersen, S

    2000-04-01

    This randomized, double-blind, placebo-controlled study compared the time to onset of analgesia and the analgesic efficacy of two formulations of acetaminophen 1000 mg--an effervescent solution and tablet--in 242 patients with moderate or severe pain following dental surgery. Onset of analgesia was determined using a two-stopwatch procedure. Analgesia was assessed over a 4-hour period. Treatments were compared using standard indexes of pain intensity and pain relief and summary measures. Both acetaminophen formulations were significantly more effective than their corresponding placebo for all efficacy assessments. The median time to onset of analgesia was significantly shorter with effervescent acetaminophen (20 minutes) compared to tablet acetaminophen (45 minutes). During the first 45 minutes after administration, effervescent acetaminophen was significantly more effective at each scheduled assessment time than tablet acetaminophen. The median time to meaningful pain relief was significantly shorter with effervescent acetaminophen (45 minutes) compared to tablet acetaminophen (60 minutes). At 4 hours after administration, the pain relief was significantly better with tablet acetaminophen than with effervescent acetaminophen. No other significant differences were observed between the active treatments. In conclusion, effervescent acetaminophen produces a significantly faster onset of analgesia than tablet acetaminophen.

  8. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Leonhardt, Jane Schwartz; Revald, Peter

    2011-01-01

    Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged...

  9. Effect of musical therapy combined with sufentanil postoperative intravenous analgesia on hemodynamic changes in patient accepted lung cancer operation%音乐治疗联合舒芬太尼术后静脉镇痛对肺癌术后患者血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    唐灏珂; 王懿春; 刘景诗; 朱咏北; 刘晓红; 杨文茜

    2013-01-01

    Objective To evaluate musical therapy combined with sufentanil postoperative intravenous analgesia on hemodynamic changes in patient accepted lung cancer operation.Methods Sixty lung cancer surgery patients (ASA Ⅰ-Ⅱ grade) were selected and divided randomly into musical therapy (group M; n =30) and control (group C; n =30).In group M,patients accepted music relaxation training for fifteen minutes before surgery,and music intervention for one hour at 3,7,15,19 hour after surgery.Whereas,in Group C,patients did not listen to any music during the same period.In the intensive care unit,patients were connected to a patient controlled analgesia (PCA) device.The PCA device (sufentanil 2 μg/kg,100 ml saline) was set to deliver a bolus of 2 ml,with a lockout interval of 10 min and background infusion volume of 0.5 ml/h.Hemodynamic changes,the visual analog scale (VAS) and consumption of sufentanil were recorded at the 4th,8th,12th,16th,20th and 24th hour after operation.Results SBP,DBP,HR and VAS of group M were significantly decreased compared to the group C,respectively (P <0.05),and significant difference was found in the PCA delivery frequency [group C (30.96 ± 4.00),group M (19.06 ± 3.49),t =12.39,P < 0.01] and postoperative sufentanil consumption[group C (82.65±6.19)μg,group M (52.68 ±7.07)μg,t =20.00,P <0.01].Conclusions Musical therapy combined with sufentanil postoperative intravenous analgesia was able to produce better analgesic effect in the treatment of patient accepted lung cancer operation,which decreased postoperative sufentanil consumption and effectively reduced SBP,DBP and HR,and relieved the patient's anxiety.%目的 观察音乐治疗联合舒芬太尼静脉自控镇痛对肺癌手术后患者血液动力学和镇痛效果的影响.方法 择期肺癌手术患者60例,按随机数字表法分为二组(n=30):音乐治疗组(M组)和对照组(C组).M组入手术室后,术前接受音乐放松训练15 min,术后3、7、15、19 h

  10. Administration of perioperative penicillin reduces postoperative serum amyloid A response in horses being castrated standing

    DEFF Research Database (Denmark)

    Busk, Peter; Jacobsen, Stine; Martinussen, Torben

    2010-01-01

    Objectives: To compare postoperative inflammatory responses in horses administered perioperative procaine penicillin and those not administered penicillin using acute phase protein serum amyloid A (SAA) as a marker of inflammation. Study Design: Randomized clinical trial. Animals: Stallions (n = 50...

  11. A Rat Model of Full Thickness Thermal Injury Characterized by Thermal Hyperalgesia, Mechanical Allodynia, Pronociceptive Peptide Release and Tramadol Analgesia

    Science.gov (United States)

    2014-01-01

    hyperalgesia, mechanical allodynia, pronociceptive peptide release and tramadol analgesia 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...therapeutic tramadol combines opioid receptor activation and 5HT/NE reuptake inhibition [9 11]. Both preclinical and clinical research has reported that... tramadol reduces acute, postoperative, neuropathic and cancer pain [9,10,12 14] and may have a lower propensity to induce addiction [15] with little to

  12. The Effect of Test Dose Fentanyl on Predicting Postoperative Respiratory Depression in Patients with Continuous Intravenous Morphine Analgesia%试验剂量芬太尼在预测术后持续吗啡静脉镇痛患者发生呼吸抑制的可能性

    Institute of Scientific and Technical Information of China (English)

    丁正年; 王忠云; 惠宁宁

    2003-01-01

    目的:评估试验剂量芬太尼所致低氧血症在预测术后吗啡静脉镇痛患者镇痛效果及发生呼吸抑制可能性中的作用.方法:在35例准备术后使用吗啡持续静脉镇痛(12 μg@kg-1@h-1)的患者术前静脉注射2μg/kg的芬太尼.结果:在吸空气状态下芬太尼注入后,有19人血氧饱和度(SpO2)降至95%以下,16人SpO2仍维持在95%或以上.在SpO2降至95%以下的19例患者,术后使用吗啡持续静脉镇痛时,有8人在术后24或40 h清醒状态下发生呼吸抑制(SpO2<95%),而在使用芬太尼后SpO2大于或等于95%的患者中,无一人发生呼吸抑制(P<0.01).术前使用芬太尼后最低的SpO2与术后24和40h的最低SpO2显著相关(P<0.01),但与术后8、16、24和40 h时的镇痛效果无关(P>0.05).结论:术前静脉注射芬太尼易致脱氧的患者,术后使用吗啡持续静脉镇痛时易于发生呼吸抑制,但其镇痛效果不一定好.%Objective: To evaluate the effect of test dose fentanyl on predicting postoperative analgesia and respiratory depression. Methods: Preoperatively the lowest pulse oximeter saturation ( SpO2 ) under room air breathing was measured after 2μg/kg of fentanyl given intravenously in 35 patients who were scheduled with continuous intravenous morphine analgesia(12μg@kg-1@h-1) postoperatively. Results: The test dose fentanyl resulted in respiratory depression in 19 of 35 cases, while 8 (42.1%) of the 19 cases developed respiratory depression postoperatively. However in the rest 16 patients, no patient (0) developed respiratory depression(P<0.01 ). The fentanyl-induced lowest SpO2 significantly correlated with the lowest SpO2 postoperatively (P<0.01). The analgesia effect in terms of verbal analogue scale was correlated neither with the fentanyl-induced lowest SpO2 nor with the lowest SpO2 postoperatively ( P>0.05). Conclusion: The patient who was sensitive to fentanyl-induced respiratory depression would take a high risk to develop

  13. Stellate ganglion blockade for analgesia following upper limb surgery.

    LENUS (Irish Health Repository)

    McDonnell, J G

    2012-01-31

    We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

  14. Effects of flurbiprofen axetil combined with sufentanil analgesia on the incidence of postoperative delirium in orthopedic patients%氟比洛芬酯复合舒芬太尼镇痛对骨科患者术后谵妄发生率的影响

    Institute of Scientific and Technical Information of China (English)

    王晓山; 刘沛; 王东信; 李世忠; 丁婷; 贾茜茜

    2012-01-01

    Objective To investigate the efficacy of flurbiprofen axetil combined with sufentanil analgesia on prevent postoperative delirium in orthopedic patients. Methods Three hundred and seventy patients who were aged 60 years or older and underwent elective orthopedic surgery were randomized into flurbiprofen axetil plus sufentanil group (group FS) or fat emulsion plus sufentanil group (group S). After surgery, patients were given 3 days PCI A according two groups. The presence of delirium, the visual analog scale (VAS) and the consumptions of sufentanil were recorded. Results The incidence of delirium was significantly lower in the group FS than that in the group S (16. 3% versus 26. 2%, RR=0. 62, 95% CI 0. 41-0. 93) (P<0. 05). The point prevalence of delirium in the group FS was also lower compared with group S, and the risk of suffering delirium for group FS was 0. 57 times as great as that for group S (95% CI 0. 34-0. 96) (P<0. 05). The VAS scores were significantly low, the sufentanil consumptions were remarkably less in group FS than in group S. Conclusion Compare sufentanil group, group FS postoperative analgesia significantly reduce the incidence and the prevalence of delirium in orthopedic patients.%目的 观察氟比洛芬酯复合舒芬太尼镇痛对骨科患者术后谵妄发生率的影响.方法 拟行择期骨科手术患者370例,年龄≥60岁,随机均分为氟比洛芬酯复合舒芬太尼组(FS组)和脂肪乳复合舒芬太尼组(S组),术后连续3d行PCIA,并随访谵妄的发生(CAM-ICU法)、VAS评分和舒芬太尼使用量.结果 FS组术后谵妄发生率明显低于S组(16.3% vs.26.2%,RR=0.62,95% CI 0.41~0.93) (P<0.05).FS组罹患谵妄的风险是S组的0.57倍(95% CI 0.34~0.96)(P<0.05).FS组术后VAS评分及舒芬太尼用量均明显低于S组(P<0.01).结论 与单纯应用舒芬太尼相比,氟比洛芬酯复合舒芬太尼镇痛能够减少骨科患者术后谵妄的发生率.

  15. 右美托咪啶复合丁丙诺啡用于术后静脉自控镇痛的临床研究%Clinical study of buprenorphine be used for postoperative patient-control ed venous analgesia

    Institute of Scientific and Technical Information of China (English)

    王警卫; 张蓬勃; 蒋敢

    2013-01-01

    目的:探讨右美托咪啶复合丁丙诺啡用于术后静脉P C A的安全性及效果。方法60例择期大手术后患者随机分为右美托咪啶组和丁丙诺啡组两组(n=30),术后右美托咪啶组以右美托咪啶2μg/kg和丁丙诺啡6μg/kg加盐水至100ml行术后静脉PCA,丁丙诺啡组以丁丙诺啡12μg/kg加盐水至100ml行术后静脉PCA。观察并记录两组的镇痛效果及副作用并进行统计学分析。结果右美托咪啶组较单纯丁丙诺啡组镇痛效果更好,副作用少。结论右美托咪啶组复合丁丙诺啡用于术后静脉PCA效果确切,可减少丁丙诺啡用量和并发症。%Objective To study the security and efficacy of postoperative patient-control ed venous analgesia with dexmedetomidine al ying buprenorphine. Methods 60 patients undergoing a elective capital operation were randomly divided into tow groups: dexmedetomidine group (Group D) and buprenorphine group (Group B ) (n=30). Al the patients received either dexmedetomidine2μg/kg and buprenorphine 6μg/kg (Group D)or buprenorphine 12μg/kg (Group B) adding sodium chloride injection to 100ml used to postoperative patient-control ed venous analgesia. The effects on the pain and the side-effects were recorded to make a statistical analysis of. Results The analgesia effect in dexmedetomidine group was significant better than in buprenorphine group and the incidence of side-effects lower. Conclusion Dexmedetomidine al yingbuprenorphine can be used effectively and safely to postoperative patient-control ed venous analgesia. And it could decrease the dose of buprenorphine.

  16. [Assessment of pain relief in patients receiving different variants of multimodal analgesia after major gynecological surgery].

    Science.gov (United States)

    Timerbaev, V H; Smimova, O V; Genov, P G; Olejnikova, O N; Rebrova, O Yu

    2014-01-01

    The major gynecology surgery generally results in severe postoperative pain. Currently multimodal analgesia concept is widely used for the aim of postoperative pain relief optimization. According to this theory it is worth using the medication with different mechanism in order to increase analgesia qualify, decrease analgesic consumption and avoid adverse reaction. Unfortunately the surveys recently conducted have been pointed out the postoperative analgesia quality is still insufficient despite of using the concept mentioned above. One way to solve the problem is appearing in daily practice nefopam--centrally acting non-opioid analgesic that inhibits reuptake of serotonin, norepinephrine, and dopamine and also mitigates glutamatergic neurotransmission. In this trial we tried to assess the postoperative daily used analgesia quality and potency of preemptive multimodal analgesia model consisted of nefopam, ketoprofen, paracetamol and morphine.

  17. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  18. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    Directory of Open Access Journals (Sweden)

    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods 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. Results 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 2 = 20.6; P = 0.006. Conclusion 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.

  19. Postoperative ileus - an update on preventive techniques

    DEFF Research Database (Denmark)

    Kehlet, H.

    2008-01-01

    institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open......This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number...... of techniques have been demonstrated to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess. Early...

  20. Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery

    Science.gov (United States)

    Jarstad, Allison R.; Chung, Gary W.; Tester, Robert A.; Day, Linda E.

    2017-01-01

    Purpose To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). Setting Ambulatory surgical center. Methods Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. Results Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. Synopsis Immediate postoperative IOP adjustment

  1. 氟比洛芬酯复合芬太尼镇痛对老年骨科患者术后谵妄发生率的影响%Impact of Flurbiprofen Fentanyl Analgesia on Postoperative Delirium in Elderly Orthopedic Incidence

    Institute of Scientific and Technical Information of China (English)

    赵伟

    2014-01-01

    目的探讨氟比洛芬酯复合芬太尼镇痛对老年骨科患者术后谵妄发生率的影响。方法选取我院骨科自2012年1月~2014年1月收治的拟行择期手术的60岁以上的老年骨折患者88例,随机分为实验组和对照组各44例,实验组给予氟比洛芬酯复合芬太尼镇痛,对照组仅给予芬太尼镇痛,术后连续行术后自控静脉镇痛(PCIA)2 d。比较两组患者术后谵妄发生率、VAS评分。结果实验组患者术后谵妄发生率11.4%(5/44)显著低于对照组患者术后谵妄发生率27.3%(12/44),有统计学意义(<0.05);两组患者VAS疼痛评分差异不显著,无统计学意义(<0.05)。结论采用氟比洛芬酯复合芬太尼对老年骨科患者术后镇痛与单独采用芬太尼镇痛效果相似,但患者术后谵妄发生率明显低于单独采用芬太尼镇痛时谵妄发生率。%Objective Study the impact of flurbiprofen fentanyl analgesia on postoperative delirium in elderly orthopedic incidence. Methods Selected 60 years or older fracture patients 88 cases, admit ed in our hospital orthopedic from January 2012 to January 2014, who was undergoing elective surgery. Divided them randomly into Experimental group and control group ,each group had 44 cases,. Experimental group received fentanyl analgesia with flurbiprofen, control group were given fentanyl, and took continuous postoperative control ed intravenous analgesia (PCIA) for two days. Compared the incidence of postoperative delirium and the VAS score between the two group. Results The incidence of postoperative delirium in experimental group was 11.4% (5/44) ,significantly lower than the control group, the incidence of postoperative delirium was 27.3% (12/44), which had statistical y significance ( <0.05); The VAS pain scores between the two groups were not significant, which had no statistical significance ( <0.05).Conclusion The ef icacy of take the Fentanyl for postoperative analgesia in elderly orthopedic

  2. Partial reinforcement, extinction, and placebo analgesia.

    Science.gov (United States)

    Au Yeung, Siu Tsin; Colagiuri, Ben; Lovibond, Peter F; Colloca, Luana

    2014-06-01

    Numerous studies indicate that placebo analgesia can be established via conditioning procedures. However, these studies have exclusively involved conditioning under continuous reinforcement. Thus, it is currently unknown whether placebo analgesia can be established under partial reinforcement and how durable any such effect would be. We tested this possibility using electrocutaneous pain in healthy volunteers. Sixty undergraduates received placebo treatment (activation of a sham electrode) under the guise of an analgesic trial. The participants were randomly allocated to different conditioning schedules, namely continuous reinforcement (CRF), partial reinforcement (PRF), or control (no conditioning). Conditioning was achieved by surreptitiously reducing pain intensity during training when the placebo was activated compared with when it was inactive. For the CRF group, the placebo was always followed by a surreptitious reduction in pain during training. For the PRF group, the placebo was followed by a reduction in pain stimulation on 62.5% of trials only. In the test phase, pain stimulation was equivalent across placebo and no placebo trials. Both CRF and PRF produced placebo analgesia, with the magnitude of initial analgesia being larger after CRF. However, although the placebo analgesia established under CRF extinguished during test phase, the placebo analgesia established under PRF did not. These findings indicate that PRF can induce placebo analgesia and that these effects are more resistant to extinction than those established via CRF. PRF may therefore reflect a novel way of enhancing clinical outcomes via the placebo effect.

  3. Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy.

    Science.gov (United States)

    Crociolli, Giulianne Carla; Cassu, Renata Navarro; Barbero, Rafael Cabral; Rocha, Thalita Leone A; Gomes, Denis Robson; Nicácio, Gabriel Montoro

    2015-08-01

    This study aimed to evaluate the analgesic efficacy of gabapentin as an adjuvant for postoperative pain management in dogs. Twenty dogs undergoing mastectomy were randomized to receive perioperative oral placebo or gabapentin (10 mg/kg). All dogs were premedicated with intramuscular acepromazine (0.03 mg/kg) and morphine (0.3 mg/ kg). Anesthesia was induced with propofol (4 mg/kg) intravenously and maintained with isoflurane. Intravenous meloxicam (0.2 mg/kg) was administered preoperatively. Postoperative analgesia was evaluated for 72 hr. Rescue analgesia was provided with intramuscular morphine (0.5 mg/kg). Dogs in the Placebo group received significantly more morphine doses than the Gabapentin group (P=0.021), despite no significant differences in pain scores. Perioperative gabapentin reduced the postoperative morphine requirements in dogs after mastectomy.

  4. Epidural and opioid analgesia following the Nuss procedure

    Science.gov (United States)

    Walaszczyk, Malgorzata; Knapik, Piotr; Misiolek, Hanna; Korlacki, Wojciech

    2011-01-01

    Summary Background Parents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure. Material/Methods The study subjects were 61 adolescents aged 11–18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents’ consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted “butterfly” cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects. Results Heart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group. Conclusions Denial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures. PMID:22037752

  5. 氢吗啡酮联合芬太尼用于颌面部手术后镇痛效果观察%ANALGESIC EFFECTS OF HYDROMORPHONE COMBINED FENTANYL ON POSTOPERATIVE ANALGESIA OF MAXILLOFACIAL SURGERY

    Institute of Scientific and Technical Information of China (English)

    王平; 陈喜波; 李汝泓; 李艳; 杨玲

    2015-01-01

    目的::评价氢吗啡酮联合芬太尼用于颌面部手术患者术后自控静脉镇痛的效果。方法:40例择期行颌面部手术的患者随机分为氢吗啡酮+芬太尼(H)组和芬太尼(F)组,每组20例。两组术后均采用患者静脉自控镇痛的方式,F组芬太尼1.0mg;H组氢吗啡酮1.6mg+芬太尼0.5mg,记录术后2h、4h、8h、12h、24h的疼痛评分(VAS评分)和Ramsay镇静评分(RSS评分),观察恶心、呕吐、眩晕等不良反应的发生情况。结果:两组患者术后各时间点VAS评分、RSS评分比较差异无统计学意义(P>0.05)。镇痛治疗期间H组患者恶心呕吐、眩晕的发生率明显低于F组(P<0.05)。结论:氢吗啡酮联合芬太尼与单用芬太尼用于颌面部手术术后镇痛的效果相当,但不良反应发生率明显较低,更适用于颌面部手术术后镇痛。%[ABSTRACT]Objective:To evaluate the effects of hydromorphone combined fentanyl on postoperative patient control intravenous analgesia (PCIA) of maxillofacial surgery patients. Methods:40 cases selective maxillofacial surgery patients were randomly divided into hydromorphone combined fentanyl (H) group and fentanyl (F) group (n=20). These 2 groups all used PCIA:patients in H group used hydromorphone (1.6mg) combined fentanyl (0.5mg);patients in F group only used fentanyl(1.0mg). The VAS score and RSS score of patients in 2 groups were recorded 2h, 4h, 8h, 12h, 24h after operation respectively;as well as adverse effects. Results:There had no statistical signiifcance about VAS score and RSS score of 2 groups at each time point after operation (P>0.05). The incidence rate of adverse effects (nausea, vomiting and dizziness) of H group were obviously lower than that of F group (P<0.05). Conclusions:The analgesic effects of hydromorphone combined fentanyl is same as fentanyl after maxillofacial surgery, but adverse effects are fairly lower. So hydromorphone combined fentanyl is more comfortable and

  6. A COMPARATIVE STUDY SHOWING EFFICACY OF PREEMPTIVE INTRAVENOUS PARACETAMOL IN REDUCING POSTOPERATIVE PAIN AND ANALGESIC REQUIREMENT IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Aftab Ahmad

    2015-07-01

    Full Text Available A double blind, prospective, randomized study was conducted on 60 patients of ASA I and II undergoing laparoscopic cholecystectomy to evaluate the efficacy of pre - emptive IV paracetamol [PCM] in reducing postoperative pain and analgesic requirement. Patien ts were randomly assigned in two groups, group A and group B of which group A received pre - emptive IV PCM 10 minutes before skin incision. It was observed that time to first analgesic required was significantly longer in group A as compared to group B and group A had significantly lower total analgesic consumption and visual analogue scores (VAS as compared to group B. We concluded that pre - emptive use of IV PCM (Paracetamol in laparoscopic cholecystectomy significantly decreases postoperative pain and a nalgesic requirement.

  7. Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

    Science.gov (United States)

    Zarpelon, Camila Stuchi; Netto, Miguel Chomiski; Jorge, José Carlos Moura; Fabris, Cátia Carolina; Desengrini, Dieli; Jardim, Mariana da Silva; da Silva, Diego Guedes

    2016-01-01

    Background The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). Conclusion The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr. PMID:27223641

  8. Analgesia and sedation after pediatric cardiac surgery.

    Science.gov (United States)

    Wolf, Andrew R; Jackman, Lara

    2011-05-01

    In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric intensive care unit (PICU). This reflects perceived priorities of the primary disease process over the supporting structure of PICU, with a generic approach to sedation and analgesia that can result in additional morbidities and delayed recovery. Management of the marginal patient requires optimisation of not only cardiac and other attendant pathophysiology, but also every aspect of supportive care. Individualized sedation and analgesia strategies, starting in the operating theater and continuing through to hospital discharge, need to be regarded as an important aspect of perioperative care, to speed the process of recovery. © 2010 Blackwell Publishing Ltd.

  9. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade.

    Science.gov (United States)

    Parrington, Simon J; O'Donnell, Dermot; Chan, Vincent W S; Brown-Shreves, Danielle; Subramanyam, Rajeev; Qu, Melody; Brull, Richard

    2010-01-01

    Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

  10. Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2008-01-01

    Full Text Available Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway. Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD. Defined goals are (1 ambulation and liquid diet on the evening of the operative day; (2 out of bed (OOB at least 4 times on POD 1; (3 removal of Foley catheter on the morning of POD 2; (4 removal of Jackson Pratt drain on the afternoon of POD 2; (4 discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway. Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61% out of 36 fast track patients and 4 (16% out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days; P = .012. Age (median, 55 versus 57 years, tumor size (median, 2.5 versus 2.5 cm, readmission within 30 days (5.5% versus 5.1%, and complications (10.2% versus 13.8% were similar in the fast track patients and control, respectively. Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

  11. 阿扎司琼不同给药时间对患者术后自控镇痛所致恶心呕吐的预防%Effects of Different Administration Time of Azasetron on Prevention of Nausea and Vomiting in Postoperative Patient-controlled Analgesia

    Institute of Scientific and Technical Information of China (English)

    耿吉青

    2012-01-01

    目的:探讨阿扎司琼不同时机给药对术后静脉自控镇痛恶心、呕吐的预防效果.方法:120例全麻行腹部手术后接受静脉自控镇痛的患者,随机分为预防组、术后给药组和对照组(n=40).预防组于麻醉诱导前静脉注射阿扎司琼10 mg;术后给药组于手术结束、接镇痛泵前静脉注射阿扎司琼10 mg;对照组不使用阿扎司琼.3组镇痛泵药物配方及使用参数相同.分别于术后4、12、24、48 h观察并记录患者的疼痛视觉模拟评分(VAS)、Ramsay镇静状态评分、恶心呕吐发生率及评分.结果:各组患者镇痛后12~48 h的VAS与4h内比较,差异有统计学意义(P<0.05或P<0.01);均无嗜睡或镇静过深.镇痛后预防组各时段恶心呕吐发生率低于对照组,(P<0.05或P<0.01);术后给药组仅4~12 h明显低于对照组(P<0.01).结论:全麻诱导前静脉预注阿扎司琼能有效预防患者术后静脉自控镇痛所致恶心、呕吐的发生.%Objective To explore the effects of Azasetron at different timing of administration on the prevention of nausea and vomiting in postoperative patient-controlled analgesia. Methods Total 120 patients of general anesthesia undergone abdominal surgery were accepted self-controlled analgesia after operation. All patients were randomly divided into prevention group, postoperative administration group and control group ( n =40). Azasetron were intravenous injection with a dose of 10 mg before induction of anesthesia in prevention group,and azasetron was given in postoperation but before the access of analgesia pump by the same dosage regimen in postoperative administration group. No azasetron was given in control group. The drug components and parameters of analgesia pump in three groups were the same. The visual analog scale of pain, Ramsay sedation score, incidence and score of nausea and vomiting in three groups were recorded at4,12,24,48 h in postoperation, respectively. Results Compared with4

  12. Prevention of postoperative ileus

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammatory...... mediators. We update evidence on the advances in the prevention and treatment on PI. As single interventions, continuous thoracic epidural analgesia with local anesthetics and minimally invasive surgery are the most efficient interventions in the reduction of PI. The effects of pharmacological agents have...... generally been disappointing with the exception of cisapride and the introduction of the new selective peripherally acting m-opioid antagonists. Presently, introduction of a multi-modal rehabilitation programme (including continuous epidural analgesia with local anesthetics, early oral feeding and enforced...

  13. 帕瑞昔布钠镇痛对老年急诊股骨头置换术患者神经系统的影响%Effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head

    Institute of Scientific and Technical Information of China (English)

    李井柱; 李晓征; 王晓敏; 王明山; 于海芳; 时飞; 苗丹; 毕燕琳

    2013-01-01

    重并发症发生.结论 帕瑞昔布钠围手术期镇痛减轻中枢神经系统损伤,改善老年患者术后认知功能,利于患者康复.%Objective To explore the effects of parecoxib sodium analgesia on serum concentrations of neuron-specific enolase (NSE) and S-100β and postoperative cognitive function of elderly patients undergoing acute replacement of femoral head.Methods After the approval of institutional review board and the provision of informed consent,80 patients over 70 years old,undergoing acute replacement of femoral head under combined spinal and epidural anesthesia and midazolam sedation at Qingdao Municipal Hospital and Qingdao Hiser Medical Center from January 2011 to May 2012,were randomly assigned into control group (group C,n =40) and parecoxib group (group P,n =40).In group P,parecoxib sodium 20/ 40 mg (based on weight 50 kg) was administered via an intravenous injection after admission with 12 hours intervals for six times.In group C,morphine 2/4 mg was given initially.Additional morphine 2 mg was given to maintain the pain visual analog scale (VAS) of 3 points or less in both groups.Primary observation indices:(1) postoperative time and additional amount of morphine; (2) rate of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at 3 days,1 week,3 months and 6 months postoperation (T1-T4) ; (3) serum levels of NSE and S-1005 were measured at the timepoints of before analgesia (t0),before anesthesia (t1),end of surgery (t2) and 6 hours,24 hours,48 hours postoperation (t3-t5); (4) other serious complications.Results Compared with group C,the additional amount of morphine,postoperative time,rate of POD and POCD at T1-T4,the level of NSE at t2-t5 and S-100 β at t1-t5 were lower in group P (P <0.05).No other serious complications were observed.Conclusions Parecoxib sodium analgesia reduces the rate of POD and POCD in elderly patients with neuroprotective effects.

  14. Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

    Directory of Open Access Journals (Sweden)

    R. Azarfarin

    2006-05-01

    Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

  15. Bioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV®

    Directory of Open Access Journals (Sweden)

    Martin Haensig

    2011-01-01

    Full Text Available Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian RastanDepartment of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, GermanyAbstract: Treatment of a number of congenital heart defects often necessitates staged surgical intervention. In addition, substantial improvements in postoperative cardiac care and more liberal use of biological valve substitutes have resulted in many adult patients surviving to become potential candidates for reoperations to repair or replace valves or to undergo additional revascularization procedures. In all these scenarios, surgeons are confronted with cardiac adhesions, leading to an increased surgical risk. Thus, bioresorbable adhesion barriers had become of increasing interest because they are easy to use, and safe and effective. This review focuses on the mechanisms by which REPEL-CV® prevents adhesive processes, as well as the development, design, and materials used, and also summarizes efficacy studies, clinical data, safety, and current role in therapy.Keywords: adhesion prevention, bioresorbable copolymer, cardiac reoperation

  16. ROLE OF TRANEXAMIC ACID IN REDUCING POSTOPERATIVE BLOOD LOSS AND TRANSFUSION REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERIES

    Directory of Open Access Journals (Sweden)

    Yashwant

    2014-09-01

    Full Text Available AIM: Aim of our study to assess the effects of tranexamic acid (TA in patients undergoing lower limb orthopedic surgeries. OBJECTIVE: Assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major lower limb orthopedic surgeries. MATERIAL AND METHOD: 90 patients ASA grade I & II undergoing elective surgery for femoral fracture like open reduction internal fixation, hemiarthroplasty, total hip replacement (THR under anaesthesia were taken. Patients were classified randomly into 2 groups (forty five patients in each group. Group T: Patients received inj. TA 10 mg/kg body weight. Group P: Patients received normal saline 1 ml/kg body weight 15 min before surgery. Postoperative hemoglobin concentration (on day 0 and day 2 and volume of blood in the drain were measured. The number of units of packed red cells transfused during the hospital stay was recorded and any thromboembolic and other complications were documented. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery and preoperative mean hemoglobin concentration. Neither heart rate nor MABP has statistically significant difference or results (P>0.05. The drains were removed in the evening of the first postoperative day. Mean volume of blood in the drain compared to placebo group showing a highly significant reduction in postoperative blood loss (P=0.01. Mean fall in hemoglobin at day 0 and day 2 was 2 less in the study group as compared to the placebo that has P value 0.01 making it significant finding. CONCLUSION: the present paired study demonstrated that the administration of TA given preoperatively reduces the blood loss in the first 24 h by a highly significant degree as well it causes a significant reduction in postoperative anemia and need for transfusion among these patients.

  17. Convalescence and hospital stay after colonic surgery with balanced analgesia, early oral feeding, and enforced mobilisation

    DEFF Research Database (Denmark)

    Møiniche, S; Bülow, Steffen; Hesselfeldt, Peter;

    1995-01-01

    OBJECTIVE: To evaluate the combined effects of pain relief by continuous epidural analgesia, early oral feeding and enforced mobilisation on convalescence and hospital stay after colonic resection. DESIGN: Uncontrolled pilot investigation. SETTING: University hospital, Denmark. SUBJECTS: 17....../daily. No patient had a nasogastric tube, and oral feeding with normal food and protein enriched solutions (1000 Kcal (4180 KJ/day) was instituted 24 hours postoperatively together with intensive mobilisation. RESULTS: Median visual analogue pain scores were zero at rest and minimal during coughing and mobilisation...... weight loss. CONCLUSION: These results suggest that a combined approach of optimal pain relief with balanced analgesia, enforced early mobilisation, and oral feeding, may reduce the length of convalescence and hospital stay after colonic operations....

  18. Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial

    OpenAIRE

    Tikuišis, R.; Miliauskas, P.; Samalavičius, N. E.; Žurauskas, A.; Samalavičius, R.; Zabulis, V.

    2013-01-01

    Background Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery. Methods Sixty four patients with colon cancer scheduled for elective colon r...

  19. Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas Post-surgical analgesia in hip surgery: A comparison of three techniques

    Directory of Open Access Journals (Sweden)

    M.I. Segado Jiménez

    2010-09-01

    Full Text Available Introducción: Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos: Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, inicio de rehabilitación y costes económicos en cada grupo. Pacientes y método: Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en 3 grupos aleatorios: A: solo analgesia intravenosa, B: bloqueo iliofascial y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y satisfacción analgésica, tiempo transcurrido hasta el inicio de la sedestación, necesidad de analgésicos postoperatorios, efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados: La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (EVA medio 2,14±1,24, satisfacción 3,75±0,8 que en los que solo recibieron analgesia intravenosa (EVA medio 5,57±0,64, satisfacción 2,83±0,7 (pIntroduction: The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives: Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods: Prospective study of 90 patients undergoing hip surgery

  20. Clinical Observation of Lappaconitine Combined With Butorphanol in Post-operative Intravenous Analgesia in Elderly Patients With Rectal Cancer%高乌甲素联合布托啡诺在老年直肠癌患者术后静脉镇痛中的临床分析

    Institute of Scientific and Technical Information of China (English)

    王雪叶; 张同军

    2015-01-01

    Objective to study the analgesic effect of lappaconitine combined with butorphanol in elderly patients after rectal can-cer operation with patient-controlled intravenous analgesia. Methods 60 patients with rectal cancer operation under general anes-thesia were randomly divided into 3 groups .The patients who received butorphanol 10mg and tropisetron 5 mg were divided into group A.Butorphanol 8 mg combined with lappaconitine 20 mg and tropisetron 5 mg were group B. Butorphanol 10mg combined with lappaconitine 20 mg and tropisetron 5 mg were group C.Observe and record the pain score、sedation score at the time 6 h、12 h、24 h、48 h after surgery. Also record the incidence of postoperative adverse reaction and pressing times of PCIA within 48h. Results Compared with group A , group B and group C have a lower VAS score at 12~48 h after surgery(P<0.05),and decrease the effective pressing numbers of PCIA pump at 6~48 h(P<0.05).At the time 6~24 h, group B and group C decrease the Ramsey seda-tion score compared with group A (P<0.05),and group C has a more lower Ramsey sedation score compared with group B (P<0.05). All of the three groups have no obvious adverse reactions. Conclusion The method can reduce the incidence of adverse reaction and has a good analgesic effect of lappaconitine combined with butorphanol in elderly patients after rectal cancer operation with patient-controlled intravenous analgesia .%目的:探讨高乌甲素联合布托啡诺用于老年直肠癌患者术后静脉自控镇痛(PCIA)中的效果。方法60例择期在全身麻醉下行直肠癌根治术的患者随机分为三组:A组布托啡诺10 mg+托烷司琼5mg;B组,布托啡诺8 mg+高乌甲素20mg+托烷司琼5mg,C组,布托啡诺10 mg+高乌甲素20 mg+托烷司琼5 mg。观察并记录患者术后6 h.12 h.24 h.48 h疼痛。镇静评分、术后48 h内PCIA有效按压次数和术后不良反应的发生情况。结果与A 组比较12~48 h 时B.C 组 VAS 评分降低(P<0

  1. Comparison of the Effects of General Anesthesia and Epidural Combined Anesthesia on Postoperative Early Cognitive Function in Elderly Patients with Postoperative Epidural Analgesia%全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响比较

    Institute of Scientific and Technical Information of China (English)

    隋金玲; 邓蓉蓉

    2015-01-01

    Objective To probe into the effect of general anesthesia and epidural combined anesthesia on postoperative early cognitive function in elderly patients with postoperative epidural analgesia. Methods 115 patients who accepted heart operation treatments in our hospital from January, 2011 to December, 2014 and these patients were randomly divided into the control group and the observation group.In the observation group of 60 patients were received general anesthesia and epidural combined anesthesia and postoperative epidural analgesia while in the control group of 55 patients were received general anesthesia and intravenous analgesia after surgery. Then, the postoperative neurological and mental function and other indicators of two groups of patients were observed and the early postoperative cognitive function of patients was comparative analyzed.Results The incidence of cognitive dysfunction seven days after surgery in the observation group and control group was 51.67% (31/60) and 49.09% (27/55).Conclusion After non cardiac surgery, the elderly patient wil have some early cognitive dysfunction due to surgical operation and education, while the effect of epidural anesthesia and epidural anesthesia on early cognitive function in elderly patients is not obvious.%目的:探讨全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响。方法选择2011年01月~2014年12月在我院进行非心脏手术的老年患者115例分为对照组和观察组,观察组60例患者接受全身麻醉与硬膜外复合麻醉和术后硬膜外镇痛,对照组55例患者仅接受全身麻醉和术后静脉镇痛。观察两组患者术后神经及精神功能等各项指标,就患者术后早期认知功能情况作对比分析。结果观察组和对照组患者在术后七天的认知功能障碍发生率为51.67%(31/60)、49.09%(27/55)。结论在进行非心脏手术后,老年患者会因外科手

  2. Postoperative Intravenous Analgesia with Flurbiprofen Axeyil Injection Combined with Low Dose Fentanyl in Patients Undergoing Breast Tumor Resection%氟比洛芬酯复合小剂量芬太尼用于乳腺肿块切除术后静脉镇痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    陈莉丽; 熊平

    2013-01-01

    Objective:To observe analgesic influence flurbiprofen axeyil injection combined with low dose of fentanyl for postoperative analgesia (PCIA)in patients undergoing breast tumor resection. Method:60 patients undergoing general anexthesia were randomly divided into two groups(n=30), observation group and control group. Observation group was applied flurbiprofen axeyil injection 1 ml/kg through slow intravenous injection before and during surgery. Observation group wes applied Fentanyl 0.5 mg and flurbitrofen axeyil 50 mg till 100 ml in analgesia pump after surgery.Control group wes applied Fentanyl 1.0mg till 100 ml in analgesia pump after surgery. Visual simulation scale(VAS)(at 4,8,12 and 24 hours),adverse effects and the amount of Fentanyl after surgery were recorded. Result:The VAS score 4 and 8 hours after surgery in observation group was significantly lower than that in control group(P0.05). The consumption of fentanyl in observation group was significantly less than that in control group(P0.05),芬太尼的用药量情况,观察组明显少于对照组(P<0.05),不良反应恶心呕吐发生率的情况,观察组明显少于对照组(P<0.05)。结论:氟比洛芬酯复合小剂量芬太尼用于乳腺肿块切除术后镇痛效果良好,可明显减少芬太尼用量,不良反应发生率减少。

  3. Intercostals Nerve Freezing Technique for Analgesia on Post-operative Chest: A Randomized Controlled Trial%改良肋间神经冷冻术在胸部术后镇痛中应用的随机对照研究

    Institute of Scientific and Technical Information of China (English)

    何建冰; 段红兵; 康健乐; 柯孙葵; 吴朝辉; 何泽锋; 李敏杰

    2016-01-01

    Objective To discuss the clinical effects of intercostals nerve freezing technique for analgesia on postoperative chest.Methods We included 80 patients with thoracotomy in Zhongshan Hospital in Xiamen University between June 2013 and June 2014.The patients were divided into a trial group (30 males and 10 females at average age of 59.90±10.62 years) and a control groups (28 males and 12 females at average age of 59.85±10.52 years) by random digital table.The patients in the trial group were treated with frozen the intercostals nerve roots located in the incision and next intercostals before closing the chest by cryotherapy therapy apparatus (K520 type,Beijing Kulan Company).The patients in the control group were treated with self-control intravenous analgesia pump post-operation.We compared the postoperative incision pain and cough,sputum reflection score,and pulmonary complications between the two groups.Results The pain degree in the trial group was significantly weaker than that in the control group on the first day,the second day and the seventh day after operation (t=-6.45,-4.95,-3.14,P<0.05).Cough,sputum reflection score were significantly higher than those in the control group (P<0.0 1).Pulmonary complications were significantly lower (t=3.023,P<0.05).There were 4 patients with pneumonia and no pulmonary atelectasis in the trial group.While there were 8 patients with pneumonia in the control group and 1 patient with pulmonary atelectasis.Conclusion Intercostals nerve freezing technique can drastically reduce postoperative pain in the patients with open thoracic operation,effectively promote patient cough and expectoration,and reduce pulmonary complications rate.%目的 探讨肋间神经冷冻在胸部术后切口镇痛的临床疗效.方法 选取2013年6月到2014年6月在我院胸外科行开胸手术的患者80例,按照随机数字表法分为试验组,40例,男30例、女10例,年龄(59.90±10.62)岁;对照组,40例,男28例、女12

  4. Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones.

    Science.gov (United States)

    Cepeda, M S; Diaz, J E; Hernandez, V; Daza, E; Carr, D B

    1998-12-01

    To evaluate the impact of music on opioid requirements and pain levels during renal lithotripsy using alfentanil patient-controlled analgesia (PCA), we conducted a prospective, blinded, randomized controlled trial. Patients undergoing lithotripsy were instructed in PCA use and asked to rate their anxiety and select their preferred type of music. They were then premedicated with morphine and ketorolac and randomly allocated into two groups. Group 1 (n = 97) had music started 10 min before the procedure and maintained until 10 min after its conclusion. Group 2 (n = 96) had music begun at the conclusion of lithotripsy and continued for 10 min. Pain intensity, alfentanil requirement, side effects, quality of analgesia, patient satisfaction, and acceptance of the technique were evaluated. Demographics, alfentanil requirement, pain levels, side effects, quality of analgesia, and patient satisfaction were similar in both groups. The addition of music did not provide any benefit. This result raises the possibility that some nonpharmacologic therapies have minimal impact in settings where the painful stimulus is moderate to severe and adequate pharmacotherapy is available.

  5. COMPARATIVE EVALUATION OF POSTOPERATIVE ANALGESIC EFFECTS OF WOUND INFILTRATION WITH TRAMADOL, LEVOBUPIVACAINE AND COMBINATION OF THE TWO IN CHILDREN UNDERGOING INGUINAL HERNIA AND UNDESCENDED TESTIS SURGERY

    Directory of Open Access Journals (Sweden)

    Aftab Ahmad

    2016-04-01

    Full Text Available BACKGROUND Wound infiltration with local anaesthetics may improve postoperative analgesia and has become increasingly common. It has the ability to reduce the need for opioids, additional complications, duration of hospital stay and its provision of effective postoperative analgesia. Tramadol infiltration of wound has been shown to have effects similar to those of local anaesthetics. AIMS AND OBJECTIVES To investigate the effects of wound infiltration with levobupivacaine and tramadol on postoperative analgesia in children undergoing elective unilateral inguinal hernia and undescended testis surgery. METHODS Ninety children (Age Group 1 to 7 years who were scheduled to undergo elective unilateral inguinal hernia and undescended testis surgery were included in the study. Patients were allocated to 3 groups of 30 each: Group A received wound infiltration with 2 mg/kg Tramadol in 0.2 mL/kg saline, Group B received wound infiltration with 0.2 mL/kg of 0.25% Levobupivacaine and Group C received wound infiltration with 2 mg/kg Tramadol plus 0.25% Levobupivacaine (total volume of solution as 0.2 mL/kg. Pain score was assessed using FACES pain scale at 1, 4, 8, 12 and 24 hours postoperatively. Patients with pain score of ≥4 were treated with paracetamol suppository (20 mg/kg body weight as rescue analgesia. Respiratory rate and pulse rate were also recorded at 1, 4, 8, 12 and 24 hours postoperatively. The frequency of side effects and rescue analgesic used were also recorded during the 24-hour postoperative period. RESULTS Average pain scores, respiratory rate and pulse rate were lowest in Group C compared to Group A and Group B at 1, 4, 8, 12 and 24 hours postoperatively (P value of 0.05. CONCLUSION Infiltration of the wound site with combined Levobupivacaine and Tramadol provides significantly better analgesia compared with Levobupivacaine or Tramadol alone.

  6. Effect of hydromorphone hydrochloride combined with ropivacaine for orthopedic postoperative PCEA on serum pain mediators and stress response

    Institute of Scientific and Technical Information of China (English)

    Ran Chen; Yuan-Hui Liu; Yan Yan; De-Xing Luo

    2016-01-01

    Objective:To study the effect of hydromorphone hydrochloride combined with ropivacaine for orthopedic postoperative patient-controlled epidural analgesia (PCEA) on serum pain mediators and stress response.Methods: A total of 84 patients who received fracture surgery under combined spinal epidural anesthesia and required postoperative analgesia in our hospital from May 2012 to December 2015 were randomly divided into two groups, the observation group received ropivacaine combined with hydromorphone hydrochloride for postoperative PCEA, and the control group accepted ropivacaine combined with morphine hydrochloride for postoperative PCEA. PCEA, serum pain mediator levels and the degree of stress response were compared between two groups.Results: The number of additional pressing on analgesia pump and the dosage of anesthetics of observation group within 24 h after operation were significantly lower than those of control group; 1 d, 3 d and 5 d after operation, serum 5-HT, NO and PGE2 as well as Cor, GH and PRL levels of observation group were significantly lower than those of control group; 1 d, 3 d, 5 d and 7 d after operation, REE levels of observation group were significantly lower than those of control group.Conclusions:Hydromorphone hydrochloride combined with ropivacaine for orthopedic postoperative PCEA can enhance analgesic effect, reduce the dosage of anesthetics, suppress the generation of pain mediators and reduce stress response.

  7. Evidence summary: which dental liners under amalgam restorations are more effective in reducing postoperative sensitivity?

    Science.gov (United States)

    Nasser, Mona

    2011-06-10

    Since August 2009, members of the Primary Care Dentistry Research Forum (www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question that receives the most votes each month forms the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website. The paper below details a summary of the findings of the ninth critical appraisal. In order to address the question raised by dentistry research forum, first a search was conducted for systematic reviews on the topic. There was one systematic review retrieved comparing bonded amalgam restorations versus non-bonded amalgam restorations. However, there was no other systematic review identified assessing the effectiveness of dental liners under amalgam restorations in general. Therefore, a search was conducted for any randomised controlled trial (RCT) comparing use of a lining under amalgam restorations versus no lining or RCTs comparing differing lining materials under amalgam against each other. There were eight relevant RCTs identified. Due to the low quality, small sample sizes or lack of adequate reporting of the outcome data, the evidence is inadequate to claim or refute a difference in postoperative sensitivity between different dental liners. Further well-conducted RCTs are needed to answer this question. These RCTs would be preferably included and synthesised in a systematic review.

  8. 罗哌卡因与咪唑安定复合芬太尼用于妇产科术后镇痛效果观察%Effect Comparison Between Ropivacaine and Midazolam Combined With Fentanyl in Gynaecology and Obstetrics Patients With Postoperative Analgesia

    Institute of Scientific and Technical Information of China (English)

    王宏丽

    2015-01-01

    目的:探讨罗哌卡因与咪唑安定复合芬太尼用于妇产科术后镇痛的临床效果对比。方法180例妇产科手术患者随机分为罗哌卡因组和咪唑安定复合芬太尼组,每组各90例,观察和比较两组的术后镇痛情况。结果罗哌卡因组的VAS评分高于咪唑安定复合芬太尼组(P<0.05);两组运动神经阻滞差异具有统计学意义,P<0.05。结论针对妇产科术后镇痛,采用罗哌卡因的麻醉效果优于咪唑安定复合芬太尼。%Objective To discuss the clinical effect of ropivacaine and midazolam combined with fentanyl on gynaecology and obstetrics patients with postoperative analgesia.Methods180 cases of caesarean section patients were randomly divided into ropivacaine group and midazolam combined with fentanyl group with 90 cases each. To observe and compare two groups of postoperative analgesia.ResultsVAS score of ropivacaine group was significantly higher than that of midazolam combined with fentanyl group(P<0.05). Motor nerve block situation of two groups had statistical significance(P<0.05). Conclusion During implementing clinical anesthesia on caesarean section,the use of ropivacaine is better than midazolam combined with fentanyl.

  9. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    Directory of Open Access Journals (Sweden)

    R.S.R Murthy

    2010-06-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  10. Clinical aspects of acute post-operative pain management & its assessment

    Directory of Open Access Journals (Sweden)

    Anuj Gupta

    2010-01-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  11. A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol

    Institute of Scientific and Technical Information of China (English)

    JIA Dong-lin; NI Cheng; XU Ting; ZHANG Li-ping; GUO Xiang-yang

    2010-01-01

    Background Early studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration. Methods Eighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mgkg-1·h-1 tramadol with no naloxone (group I, n=20), 0.05 μg-kg-1·h-1 naloxone (group II, n=20), 0.1 μg·kg-1·h-1 naloxone (group III, n=20) and 0.2 μg·kg-1·h-1 naloxone (group IV, n=20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6,12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers. Results Seventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P <0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P <0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P<0.01). Conclusion A small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

  12. Mouse anesthesia and analgesia.

    Science.gov (United States)

    Adams, Sean; Pacharinsak, Cholawat

    2015-03-02

    Providing anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. These practices are necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging for instance), and providing intra- and post-procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical outlines for the investigator covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, and considerations for administering preventative analgesia. Copyright © 2015 John Wiley & Sons, Inc.

  13. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

    Directory of Open Access Journals (Sweden)

    Elham M. El-Feky

    2015-04-01

    Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

  14. 消炎痛栓不同时间给药对腹腔镜胆囊切除术后镇痛效果的影响%INFLUENCE ON ANALGESIA EFFECT OF INDOMETHACIN SUPPOSITORY IN DIFFERENT TIME FOR THE LC POSTOPERATIVE PATIENTS

    Institute of Scientific and Technical Information of China (English)

    张玉珍; 魏万梅; 刘惠勤; 王宇

    2015-01-01

    Objective To observe the effect of indomethacin suppository via rectal for postoperative patients with laparoscopic cholecystectomy (LC) in different time on analgesia and rehabilitation .Methods Totally 79 patients underwent elective LC surgery ,were randomly divided into group A ,group B and group C ,a‐mong them ,11 cases were excluded out of intravenous or postoperative epidural analgesia pump patients . Group A (24 cases) accepted indomethacin suppository 100 mg via rectal pre - operation1 hour ,group B (22 cases) for indomethacin suppository 100 mg via rectal 2 hours after operation ,group C (22 cases) was treated with indomethacin suppository 100 mg via rectal when postoperative pain and asked for analgesia . The pain degree of patients in postoperative 2 ,4 ,6 ,8 ,12 and 24 hours was evaluated by using visual ana‐logue scale (VAS) ,and the number of using other painkillers was recorded .The comfort degree on opera‐tion day ,first and second day after operation by WHO pain classification standard was judged ,the anus ex‐haust time was recorded .Results The postoperative pain VAS scores of different time postoperatively at the same point were of significant difference among three groups( P 0 .05) .On postoperative comfort de‐gree on the day and after day was in proper order top of group A ,group B and group C ,and with signifi‐cant difference(P< 0 .01) .On postoperative anal exhaust time ,there were statistical significance between group A and group C ,group Band group C ,besides group A and group B(P < 0 .01) .Conclusions The effect of postoperative analgesia for indomethacin suppository rectal medication at preoperative 1 hour is ob‐viously better than LC surgery 2 hours after surgery and/or postoperative pain ,and on the day and after day ,comfort level increases significantly ,anal exhaust time significantly shorten ,it can promote the pa‐tient recover soon .%目的:观察消炎痛栓不同时间直肠给药对腹腔镜胆囊切除术

  15. Preemptive analgesia I: physiological pathways and pharmacological modalities.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: The physiological basis of preemptive analgesia is complex and involves modification of the pain pathways. The pharmacological modalities available may modify the physiological responses at various levels. Effective preemptive analgesic techniques require multi-modal interception of nociceptive input, increasing threshold for nociception, and blocking or decreasing nociceptor receptor activation. Although the literature is controversial regarding the effectiveness of preemptive analgesia, some general recommendations can be helpful in guiding clinical care. Regional anesthesia induced prior to surgical trauma and continued well into the postoperative period is effective in attenuating peripheral and central sensitization. Pharmacologic agents such as NSAIDs (non-steroidal anti-inflammatory drugs) opioids, and NMDA (N-methyl-D-aspartate) - and alpha-2-receptor antagonists, especially when used in combination, act synergistically to decrease postoperative pain. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input requires individualization of the technique(s) chosen. Multi-modal analgesic techniques appear most effective.

  16. Influence of adrenergic and cholinergic mechanisms in baclofen induced analgesia.

    Science.gov (United States)

    Tamayo, L; Rifo, J; Contreras, E

    1988-01-01

    1. Baclofen induced analgesia was confirmed by means of the mouse hot plate test. 2. Physostigmine significantly increased the response to baclofen whilst neostigmine was ineffective. Baclofen analgesia was reduced by atropine. 3. The response to baclofen was increased by the administration of tolazoline, propranolol and nadolol. In contrast, the analgesic response to morphine was attenuated by the antiadrenergic drugs phenoxybenzamine, tolazoline and nadolol.

  17. 布托啡诺、芬太尼联合治疗术后患者自控静脉镇痛的临床疗效观察%Clincal Effect of Butorphanol Combined with Fentanyl on Postoperative Pain Relief with Intravenous Patient Controlled Analgesia

    Institute of Scientific and Technical Information of China (English)

    江海霞; 杨文燕; 苏彦伊

    2012-01-01

    Objective To compare the analgesic effects of butorphanol, fentanyl and butorphanol combined with fentanyl for postoperative patient-controlled intravenous analgesia (PCIA). Methods Sixty ASA class I or Ⅱ patients undergoing abdominal operations were randomly assigned into three groups with 20 cases each. The patients in group B received butorphanol (0.2mg/mL, in group F fentanyl ( 10 ug/mL) , and in group BF butorphanol (0.1 mg/mL) with fentanyl (5 ug/mL) for PCIA. The PC A model for all groups was set with background infusion 2 mL/h, bolus of lml with lock time 15 min. The visual analogue scale (VAS) analgesic score, Ramsay sedation score and side effects were recorded and compared among three groups at 2, 4, 8, 18, 24, 48 h after the operations. Results Adequate analgesia was achieved in all three groups. VAS score of group BF was significantly lower than that of group B at 8, 18, 24 h after the operation (P < 0.05). Ramsay sedation score of group B was significantly higher than that of group F at 4, 8, 18, 24h after the operation (P<0.05) . The incidence of dizziness of group B was significantly higher than that of group F (P < 0.05) . The incidence of postoperative vomiting of group BF was significantly lower than that of group F (P <0.05). Conclusion Butorphanol combined with fentanyl for postoperative intravenous analgesia shows effective analgesia with fewer side effects, which is good mixture for PCIA.%目的 比较布托啡诺、芬太尼、布托啡诺联合芬太尼用于术后患者自控静脉镇痛(PCIA)的临床效果.方法 60例ASAⅠ~Ⅱ级的腹部手术患者,随机均分为布托啡诺组(B组)、芬太尼组(F组)、布托啡诺联合芬太尼组(BF组),术毕按3种方案实行PCIA.记录并比较术后2、4、8、18、24、48 h的疼痛视觉模拟评分(VAS)、Ramsay镇静评分及不良反应.结果 3组患者均达到了良好的镇痛效果,但术后8 h、18 h、24 h,BF组的VAS评分明显低于B组(P<0.05).B组术后4、8、18

  18. Dezocine combined with sufentanil versus sufentanil for postoperative patient-controlled intravenous analgesia: a systematic review%地佐辛联合舒芬太尼用于全麻术后患者静脉自控镇痛的临床效果及安全性:Meta分析

    Institute of Scientific and Technical Information of China (English)

    夏中元; 唐哨群; 刘菊英

    2015-01-01

    Objective To evaluate the clinical efficacy and adverse effect of a combination of and sufentanil versus sufentanil for postoperative patient-controlled intravenous analgesia (PCIA).Methods The relevant randomized controlled trials were searched in the Cochrane Library,PubMed,Embase,CBM,Ovid,ScienceDirect,ProQuest,Springer,CNKI,WanFang Data and VIP databases (updated to June 2014).The quality of the included studies was evaluated after data extraction according to the inclusion and exclusion criteria by two reviewers independently.The Meta-analysis was performed by using RevMan 5.1 software.Results Six trials with a total of 477 patients were included.The results showed that there were no significant differences of visual analog scale(VAS) at 4,8,12 h,and 24 h between groups(P>0.05).However the VAS at 48 h was decreased in dezocine combined with sufentanil group[weighted mean difference(WMD)=-0.36,95% confidence interval(CI) (-0.69,-0.04)] (P<0.05).There were significant differences in adverse effects[odds ratio(OR)=0.36,95%CI (0.26,0.50)] (P<0.05).There were significant differences of interleukin (IL)-6 and IL-10 at 24 h and 48 h postoperatively (P<0.05).Conclusions Dezocine combined with sufentanil provide sufficient analgesia effect but with fewer adverse effects and seemed to improve the systematic immune function for postoperative patient-controlled intravenous analgesia.%目的 系统评价地佐辛联合舒芬太尼与单独舒芬太尼用于术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)的临床效果及副作用.方法 计算机检索Cochrane Library、PubMed、Embase、CBM、Ovid、ScienceDirect、ProQuest、Springer、CNKI、万方和维普等数据库从建库至2014年6月文献,在按纳入和排除标准进行资料提取和文献质量评价后,采用RevMan 5.1版软件进行Meta分析.结果 共纳入6个随机对照实验,共计患者477例.Meta分析结果显示:地佐辛联合舒芬太尼与单独舒

  19. Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty

    DEFF Research Database (Denmark)

    Lunn, Troels H; Gaarn-Larsen, Lissi; Kehlet, Henrik

    2013-01-01

    postoperative pain after total knee arthroplasty (TKA). Patients scheduled for elective, unilateral, primary TKA under spinal anesthesia were consecutively included in this prospective, observational study. Perioperative analgesia was standardized for all patients. Outcomes were postoperative pain during walk...

  20. Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain?

    Science.gov (United States)

    Staud, Roland

    2007-12-01

    Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.

  1. Pain relief and clinical outcome: from opioids to balanced analgesia

    DEFF Research Database (Denmark)

    Kehlet, H

    1996-01-01

    If it is generally accepted that adequate postoperative pain relief will improve outcome from surgery, several controlled trials demonstrated this only for lower body surgical procedures with epidural and spinal anesthetics. Important effects on outcome were not shown when postoperative opioids...... were administered with patient controlled (PCA) or epidural techniques. However, the most optimal pain relief seems to be best achieved with balanced analgesia techniques using combinations of epidural opioids and local anesthetics and systemic non-steroidal antiinflammatory drugs. Future efforts...

  2. CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 李勇; 叶铁虎; 任洪智; 黄宇光; 罗爱伦

    2003-01-01

    Objective.To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia(PCEA)after pulmonary lobectomy. Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group(22 patients)or ropivacaine group(21 patients). In the tetracaine group,0.15% tetracaine was used for postoperative PCEA,while 0.3% ropivacaine was used in the ropiva-caine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale(VAS). Forced expired volume at the 1st second(FEV1.0),forced vital capacity(FVC),FEV1.0/ FVC and peak expired flow(PEF)were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study. Results. VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation,pulmonary function was reduced in both groups. However,there were no significant differences between the percentage of the changes of FEV1.0,FEV1.0/FVC and PEF in the two groups. There were also no significant differences between the percentage of the changes of heart rate,mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.Conclusions. The analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in pa-tient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

  3. The saving effect of preemptive analgesia with dezocine on fentanyl use of esophageal cancer postoperative%地佐辛超前镇痛对食管癌切除术患者术后芬太尼的节俭效果

    Institute of Scientific and Technical Information of China (English)

    杨红燕; 向勇

    2014-01-01

    Objective To study the saving effect of preemptive analgesia with dezocine on fentanyl use of radical resec-tion of esophageal carcinoma postoperative. Methods Eighty patients(the ASAⅠ~II)who underwent the general anes-thesia downlink esophageal cancer radical operation were randomly divided into two groupsthe control group (group C) and pholcodine group (group D),40 cases in each group.Patients in group D were given 10mg dezocine through intra-venous injection 15 min before skin incision,patients in group C were given the same capacity of saline. After opera-tion,two groups were given fentanyl for postoperative patient-controlled intravenous analgesia (PCIA),keeping the Vi-sual Analog Scale(VAS) lower than 3 scores. The tracheal extubation time,waking time,Ramsay sedation scores at 2 h、6 h、12 h、24 h、48 h, dosage of fentanyl and the occurrence of adverse reactions within 48 h of postoperative were compared. Results The tracheal extubation time and waking time had no significant difference between the two groups(P>0.05). The Ramsay sedation scores at 2 h、6 h、12 h of group D were lower than those in group C (P0.05),dosage of fentanyl and the occurrence of restlessness,vomiting,respiratory depression and dizziness were lower than those in group C(P0.05);与C组比较,D组术后2 h、6 h、12 h时Ramsay镇静评分降低(P0.05),D组术后芬太尼用量、躁动、呕吐、呼吸抑制和头晕的发生率降低(P<0.05)。结论静脉注射地佐辛超前镇痛对食管癌切除术患者术后芬太尼有节俭效果,降低了术后头晕、呕吐、呼吸抑制、躁动等不良反应的发生率,值得临床推广使用。

  4. 地佐辛、芬太尼及芬太尼联合曲马多用于全子宫切除术后镇痛的临床效果比较%Clinical Efficiency of Postoperative Analgesia with Dezocine, Fentanyl and Fentanyl Combined with Tramdol after Hysterectomy

    Institute of Scientific and Technical Information of China (English)

    潘蓓

    2011-01-01

    Objective To compare the efficiency and side effects of postoperative analgesia with dezocine, fentanyl and fentanyl combined with tramdol. Methods Sixty patients underwent hysterectomy under general anesthesia were randomly assigned into 3 groups with 20 cases each. For postoperative intravenous analgesia, dezocine 0.8 mg/kg was given in group D, fentanyl 0.016 mg/ kg in group F and fentanyl 0. 008 mg/kg combined with Tramadol 6.5 mg/kg in group FT. The VAS analgesic score, Ramsay sedative score were recorded within 48 hours after operations. The side effects were evaluated as well. Results There were no significant differences in VAS scores among 3 groups. The VAS scores of group D were much lower than those of group FT at 6 h and 12 h after operation( P <0.05). The Ramsay scores of group D were higher than those of group F at 0.5,6 and 12 h after operation ( P < 0. 05 ). The incidence of postoperative nausea and vomiting of group D was lower than that of group FT ( P < 0. 05 ). Conclusion Derocine 0.8 mg/kg is better than fentanyl 0.016 mg/kg and fentanyl 0. 008 mg/kg combined with tramadol 6.5 mg/kg for postoperative intravenous analgesia with fewer side effects in patients underwent hysterectomy.%目的 比较地佐辛、芬太尼、芬太尼联合曲马多用于全子宫切除术后静脉镇痛的效果及不良反应.方法 将60例择期行全子宫切除全麻患者,随机分为地佐辛组(D组)、芬太尼组(F组)及芬太尼联合曲马多组(FT组)三组.分别以地佐辛0.8 ms/kg,芬太尼0.016 mg/kg,芬太尼0.008 me,/kg联合曲马多6.5 mg/kg持续静脉镇痛.记录并比较术后48 h内视觉模拟疼痛(VAS)评分、Ramsay评分及不良反应.结果 三组术后镇痛效果VAS组内比较差异无统计学意义.术后6 h、12 h D组VAS评分均明显低于FT组(P<0.05).术后0.5 h、6 h、12 h D组Ramsay评分均明显高于F组(P<0.05).术后D组恶心呕吐发生率明显低于FT组(P<0.05).结论 地佐辛0.8 mr,/kg术后静

  5. Nurse titrated analgesia and sedation in intensive care increases the frequency of comfort assessment and reduces midazolam use in paediatric patients following cardiac surgery.

    Science.gov (United States)

    Larson, Grace E; McKeever, Stephen

    2017-03-08

    Pain and sedation protocols are suggested to improve the outcomes of patients within paediatric intensive care. However, it is not clear how protocols will influence practice within individual units. Evaluate a nurse led pain and sedation protocols impact on pain scoring and analgesic and sedative administration for post-operative cardiac patients within a paediatric intensive care unit. A retrospective chart review was performed on 100 patients admitted to a tertiary paediatric intensive care unit pre and post introduction of an analgesic and sedative protocol. Stata12 was used to perform Chi 2 or student t tests to compare data between the groups. Post protocol introduction documentation of pain assessments increased (pre protocol 3/24h vs post protocol 5/24h, p=0.006). Along with a reduction in administration of midazolam (57.6mcg/kg/min pre protocol vs 24.5mcg/kg/min post protocol, p=0.0001). Children's pain scores remained unchanged despite this change, with a trend towards more scores in the optimal range in the post protocol group (5 pre protocol vs 12 post protocol, p=0.06). Introducing a pain and sedation protocol changed bedside nurse practice in pain and sedation management. The protocol has enabled nurses to provide pain and sedation management in a consistent and timely manner and reduced the dose of midazolam required to maintain comfort according to the patients COMFORT B scores. Individual evaluation of practice change is recommended to units who implement nurse led analgesic and sedative protocols to monitor changes in practice. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

  6. Intrapleural analgesia after endoscopic thoracic sympathectomy Analgesia intrapleural após simpatectomia videotoracoscópica

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    Patrícia Gomes da Silva

    2011-12-01

    Full Text Available PURPOSE: To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS: Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS: In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION: Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS

  7. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

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    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  8. Administração intraperitoneal da mistura com excesso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia pós-operatória em colecistectomias videolaparoscópicas Administración intraperitoneal de la mezcla con exceso enantiomérico de 50% de bupivacaína (S75-R25 para analgesia postoperatoria en colecistectomías videolaparoscópicas Intraperitoneal administration of 50% enantiomeric excess (S75-R25 bupivacaine in postoperative analgesia of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    João Batista Santos Garcia

    2007-08-01

    40 pacientes sometidos a colecistectomía videolaparoscópica divididos en dos grupos: GI (n = 20 que recibió 80 mL de solución de bupivacaína S75-R25 a 0,125% intraperitoneal al final de la operación; y GII (n = 20 que recibió 80 mL de solución fisiológica a 0,9%. Los dos grupos recibieron 40 mg de tenoxican y 30 mg.kg-1 de dipirona, por vía venosa, poco antes del final de la operación. La analgesia en el postoperatorio (PO se hizo con tramadol. Se evaluaron las puntuaciones de dolor en reposo, al sentarse y en la maniobra de Valsalva, según la escala numérica al despertar y 2, 4, 8, 12 y 24 horas en el PO; la presencia de dolor en el hombro; el tiempo para la primera solicitación del analgésico y su consumo acumulativo. RESULTADOS: Hubo una diferencia estadística significativa entre los puntajes de dolor a las 12 horas en el PO con el paciente en reposo (GI BACKGROUND AND OBJECTIVES: The analgesic effect of intraperitoneal administration of local anesthetics after laparoscopic cholecystectomy is a controversial issue, and the results described vary from considerable pain relief to little reduction in pain. The objective of this study was to evaluate the efficacy of the intraperitoneal administration of 50% enantiomeric excess bupivacaine (S75-R25 for the postoperative pain relief of laparoscopic cholecystectomy. METHODS: A randomized, double blind, placebo controlled study was conducted with 40 patients undergoing laparoscopic cholecystectomy, who were divided in two groups: GI (n = 20 received 80 mL of intraperitoneal 0,125% S75-R25 bupivacaine at the end of the procedure; and GII (n = 20 received 80 mL of intraperitoneal normal saline. Both groups received 40 mg of tenoxicam and 30 mg.kg-1 of intravenous dypirone shortly before the end of the surgery. Tramadol was used for postoperative analgesia (PO. Pain scores were evaluated at rest, sitting up, and during the Valsalva maneuver, according to a numeric scale upon waking up and 2, 4, 8, 12, and 24

  9. Thermal balance during transurethral resection of the prostate. A comparison of general anaesthesia and epidural analgesia

    DEFF Research Database (Denmark)

    Stjernström, H; Henneberg, S; Eklund, A;

    1985-01-01

    anaesthesia (G.A.) or epidural analgesia (E.A.). Oxygen uptake, catecholamines, peripheral and central temperatures were followed in the per- and postoperative period. Heat production and total body heat were calculated from oxygen uptake and temperature measurements, respectively. Transurethral resection......Heat loss during anaesthesia and surgery is a common problem. In patients with restricted cardio-pulmonary reserves this may endanger the postoperative outcome. In order to compare thermal balance we studied 25 men undergoing transurethral resection of the prostate (TURP), using either general...... of the prostate resulted in a peroperative heat loss which was not influenced by the anaesthetic technique used and averaged 370 kJ during the first hour of surgery. G.A. reduced heat production while this was uninfluenced by E.A. After termination of general anaesthesia, oxygen uptake and plasma catecholamines...

  10. Analgesia adjuvante e alternativa Analgesia adyuvante y alternativa Adjuvant and alternative analgesia

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    Nilton Bezerra do Vale

    2006-10-01

    álgicos actúan a través de la vía espinal de control de la compuerta de Melzack y Wall y/o a través de la transducción de la señal en los sistemas de neurotransmisión y neuromodulación central relacionados con la analgesia, relajamiento y el humor: peptidérgico, monaminérgico, gabaérgico, colinérgico y canabinoide. La Analgesia Adyuvante Complementaria es habitualmente utilizada en los tratamientos fisiátricos, ortopédicos, reumatológicos, obstétricos y con acupuntura. La Analgesia Alternativa Complementaria puede potenciar los métodos analgésicos convencionales, la exposición al del sol del alba, luz y colores bajo la luz artificial, el tiempo (T - anestésicos generales más potentes por la noche, opioides por la mañana y anestésicos locales a la tarde, dieta, buen humor y la risa, espiritualidad, religión, meditación, musicoterapia, hipnosis y efecto placebo. CONCLUSIONES: Si el dolor agudo es un mecanismo de defensa, el dolor crónico es un estado patológico desagradable relacionado con la depresión endógena y con una baja calidad de vida. Es importante establecer relaciones interdisciplinarias entre la Medicina adyuvante y alternativa en las terapias analgésicas y antiinflamatorias clásicas.BACKGROUND AND OBJECTIVES: Although acute and chronic pain are usually controlled with pharmacological interventions, 14 complementary methods of adjuvant and alternative analgesia (AAA may reduce the abusive prescription of analgesics and the side effects that eventually compromise the patient's physiological status. CONTENTS: The action of every analgesic mechanism is through the spinal gate of Melzack and Wall and/or through signal transduction in the central neurotransmission and neuromodulation systems related to analgesia, relaxation, and mood: peptidergic, monoaminergic, gabaergic, cholinergic, and cannabinoid. Complementary adjuvant analgesia is normally used in physiatric, orthopedic, rheumatologic, and obstetric treatments and acupuncture. It can

  11. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    E S Adarsh

    2012-01-01

    Full Text Available Background: Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect. Objective: To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements. Study Design: A randomized clinical trial. Methods: After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group and group C (Conventional group. Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted. Results: We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002. There was no evidence of any increased perioperative bleeding in the diclofenac group. Conclusion: Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.

  12. 无痛护理模式用于椎间盘突出症术后疼痛的疗效观察%Painless nursing mode used in intervertebral disc herniation curative effect observation of postoperative pain

    Institute of Scientific and Technical Information of China (English)

    廖化敏

    2013-01-01

    Objective: Discusses different patterns of nursing intervention, leading to use analgesic drugs on intervertebral disc hemiation in patients with pain after the operation effect.Methods:Choose to hold bachelor degree of 90 cases of intervertebral disc hemiation surgery patients, randomly divided into A, B, C three groups, A group with normal care + serious pain medicine analgesia, group B with normal care + psychological intervention and health education + serious pain medicine analgesia, the group C painless nursing mode, namely the routine nursing + psychological intervention and health education + advance using drugs analgesia. Observe and record three groups of patients postoperative pain relief degree. Result:Painless nursing mode pain level best, 3 sets of data analysis showed that the difference was statistically significant (P < 0.05). Conclusion: Painless nursing mode on the intervertebral disc disease can significantly reduce postoperative pain, is worth popularizing use.

  13. The optimal dose of sufentanil combined with ketamine for postoperative patient-controlled intravenous analgesia%苏芬太尼复合氯胺酮用于静脉自控镇痛最佳剂量的研究

    Institute of Scientific and Technical Information of China (English)

    陈华艳; 仲吉英; 杨承祥

    2010-01-01

    Objective To observe the effect of gynecologic surgery patient-controlled intravenous analgesia (PCIA) with different-dose sufentanil combined with ketamine for obtaining a better medicine compatibility. Methods Ninety patients, ASA I~II ,30~50 years old,scheduled for hysterectomy under general anesthesia,were randomly divided into three groups;A,B and C;30 adults were included in each group. (sufentanil 1.5μg·kg~(-1) + ketamine 4mg·kg~(-1))/100ml, ( sufentanil 2.0μg·kg~(-1) + ketamine 4mg·kg~(-1))/100ml, ( sufentanil 2.5μg·kg~(-1)+ ketamine 4mg·kg~(-1))/100ml,was used in A,B,C group respectively. Tropisetron 4mg was added in every patient. VAS, sedative scores,respiratory depression,nausea and vomiting,delire,dizzy and pruritus were recorded at the time points of 4,12,24 and 48h after operation. Results VAS scores in group A was significantly higher than those in group B and group C at all three time points (P 0.05).结论 B组配伍在妇科术后静脉自控镇痛具有较好效果,不良反应少.

  14. Ethanol-induced analgesia

    Energy Technology Data Exchange (ETDEWEB)

    Pohorecky, L.A.; Shah, P.

    1987-09-07

    The effect of ethanol (ET) on nociceptive sensitivity was evaluated using a new tail deflection response (TDR) method. The IP injection of ET (0.5 - 1.5 g/kg) produced raid dose-dependent analgesia. Near maximal effect (97% decrease in TDR) was produced with the 1.5 g/kg dose of ET ten minutes after injection. At ninety minutes post-injection there was still significant analgesia. Depression of ET-induced nociceptive sensitivity was partially reversed by a 1 mg/kg dose of naloxone. On the other hand, morphine (0.5 or 5.0 mg/kg IP) did not modify ET-induced analgesia, while 3.0 minutes of cold water swim (known to produce non-opioid mediated analgesia) potentiated ET-induced analgesic effect. The 0.5 g/kg dose of ET by itself did not depress motor activity in an open field test, but prevented partially the depression in motor activity produced by cold water swim (CWS). Thus, the potentiation by ET of the depression of the TDR produced by CWS cannot be ascribed to the depressant effects of ET on motor activity. 21 references, 4 figures, 1 table.

  15. Effect of sufentanil combined with different concentrations of ropivacaine for labor analgesia on maternal

    Institute of Scientific and Technical Information of China (English)

    Han-He Wang; Min-Jia Jiang; Wan-Dong Liao

    2016-01-01

    Objective:To study the effect of sufentanil combined with different concentration of ropivacaine for stepped analgesia on stage of labor, stress indexes and blood coagulation function.Methods:A total of 178 cases of full-term singleton primiparas who awaited delivery and received epidural labor analgesia in our hospital from January 2015 to June 2016 were selected and randomly divided into stepped analgesia group and routine analgesia group, and the stage of labor, levels of stress hormones and pain mediators during childbirth and blood coagulation function indexes after childbirth were observed between two groups.Results: The duration of latent phase of labor of stepped analgesia group was shorter than that of routine analgesia group while the duration of active phase of labor, the duration of second stage of labor and the duration of third stage of labor were not significantly different from those of routine analgesia group; serum PRL level of stepped analgesia group was significantly higher than that of routine analgesia group while PA, NE, E, DYN,β-EP, SP, PGE2, 5-HT, TF, TFPI, FPA, AT-III and DD levels were not significantly different from those of routine analgesia group.Conclusions: Sufentanil combined with different concentration of ropivacaine for stepped analgesia is with equivalent effect to routine analgesia, and can shorten the latent phase of labor and reduce the inhibitory effect of pain on prolactin without affecting the degree of stress during childbirth and the blood coagulation function after childbirth.

  16. A COMPARISON OF ANALGESIA AND FOETAL OUTCOME IN TERM PARTURIENTS WITH AND WITHOUT LOW DOSE COMBINED SPINAL EPIDURAL LABOUR ANALGESIA

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    Manjunath

    2015-11-01

    Full Text Available : STUDY OBJECTIVE: We aimed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus using combined ‘low dose’ spinal and epidural (CSE. DESIGN: prospective case control study. SETTING: Labour suite of a tertiary care hospital. PATIENTS: study population included 120 pregnant women of ASA physical status I and II parturients in active labor who requested analgesia, 60 of these patients were given labour analgesia - ‘GROUP T’ and 60 of who underwent a delivery without labour analgesia -‘GROUP C’. MEASUREMENTS AND MAIN RESULTS: Maternal hemodynamics, degree of pain relief, duration of labour, fetal heart rate, Apgar scores, mode of delivery, intervention to relieve pain, Adverse effects because of procedure and drugs used were also noted. Low dose epidural analgesia does not prolong labour and does not increase the incidence of instrumental deliveries when compared to parturients undergoing delivery without labour analgesia. Even with the reduced dose of fentanyl the parturients had acceptable pain relief and a decreased incidence of intervention for pain. It does not cause more fetal depression when compared to normally laboring term parturients. ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome. CONCLUSION: ‘Low dose’ labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.

  17. Protons Offer Reduced Normal-Tissue Exposure for Patients Receiving Postoperative Radiotherapy for Resected Pancreatic Head Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, Romaine C., E-mail: rnichols@floridaproton.org [University of Florida Proton Therapy Institute, Jacksonsville, FL (United States); Huh, Soon N. [University of Florida Proton Therapy Institute, Jacksonsville, FL (United States); Prado, Karl L.; Yi, Byong Y.; Sharma, Navesh K. [Department of Radiation Oncology, University of Maryland, Baltimore, MD (United States); Ho, Meng W.; Hoppe, Bradford S.; Mendenhall, Nancy P.; Li, Zuofeng [University of Florida Proton Therapy Institute, Jacksonsville, FL (United States); Regine, William F. [Department of Radiation Oncology, University of Maryland, Baltimore, MD (United States)

    2012-05-01

    Purpose: To determine the potential role for adjuvant proton-based radiotherapy (PT) for resected pancreatic head cancer. Methods and Materials: Between June 2008 and November 2008, 8 consecutive patients with resected pancreatic head cancers underwent optimized intensity-modulated radiotherapy (IMRT) treatment planning. IMRT plans used between 10 and 18 fields and delivered 45 Gy to the initial planning target volume (PTV) and a 5.4 Gy boost to a reduced PTV. PTVs were defined according to the Radiation Therapy Oncology Group 9704 radiotherapy guidelines. Ninety-five percent of PTVs received 100% of the target dose and 100% of the PTVs received 95% of the target dose. Normal tissue constraints were as follows: right kidney V18 Gy to <70%; left kidney V18 Gy to <30%; small bowel/stomach V20 Gy to <50%, V45 Gy to <15%, V50 Gy to <10%, and V54 Gy to <5%; liver V30 Gy to <60%; and spinal cord maximum to 46 Gy. Optimized two- to three-field three-dimensional conformal proton plans were retrospectively generated on the same patients. The team generating the proton plans was blinded to the dose distributions achieved by the IMRT plans. The IMRT and proton plans were then compared. A Wilcoxon paired t-test was performed to compare various dosimetric points between the two plans for each patient. Results: All proton plans met all normal tissue constraints and were isoeffective with the corresponding IMRT plans in terms of PTV coverage. The proton plans offered significantly reduced normal-tissue exposure over the IMRT plans with respect to the following: median small bowel V20 Gy, 15.4% with protons versus 47.0% with IMRT (p = 0.0156); median gastric V20 Gy, 2.3% with protons versus 20.0% with IMRT (p = 0.0313); and median right kidney V18 Gy, 27.3% with protons versus 50.5% with IMRT (p = 0.0156). Conclusions: By reducing small bowel and stomach exposure, protons have the potential to reduce the acute and late toxicities of postoperative chemoradiation in this setting.

  18. The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12 hours after surgery.

    Science.gov (United States)

    Abad Torrent, A; Rodríguez Bustamante, V; Carrasco Fons, N; Roca Tutusaus, F J; Blanco Vargas, D; González García, C

    2016-05-01

    .43-2.17) compared with group H-2 (5.66 [1.58]; medium 6, 95% confidence interval 5.05-6.26). Monitoring of the intraoperative analgesia by pupillometry was able to reduce the intensity of the acute postoperative pain and analgesic consumption in the first 12h in the hospital room after major gynecological surgery. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

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    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  20. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report

    Directory of Open Access Journals (Sweden)

    Ranger Cavalcante da Silva

    2006-04-01

    drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural.BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who, in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be

  1. Improvement of dexmedetomidine to postoperative intravenous analgesia by fentanyl in patients with large-area burn%右美托咪定可改善大面积烧伤患者术后芬太尼静脉镇痛效果

    Institute of Scientific and Technical Information of China (English)

    黄东晓; 丁娴; 高洁; 陈肖

    2014-01-01

    目的 观察右美托咪定(dexmedetomidine,Dex)用于大面积烧伤患者术后镇痛的有效性和安全性. 方法 择期全身麻醉下首次行四肢切痂术烧伤患者40例,采用随机数字表法分为2组(每组20例):Ⅰ组采用芬太尼静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),Ⅱ组采用芬太尼+Dex PCIA.分别在术后4、8、24、48 h时记录视觉模拟评分(visual analogue scales,VAS)、Ramsay评分,并记录恶心呕吐、嗜睡、心动过缓、呼吸抑制等副作用发生率,在术后48 h记录患者对镇痛效果的满意度. 结果 Ⅱ组各时点VAS评分都明显低于Ⅰ组,Ⅱ组恶心、呕吐的发生率(5%)明显低于Ⅰ组(35%,P<0.05).两组各时间点Ramsay评分差异无统计学意义.Ⅱ组患者镇痛满意度(95%)明显高于Ⅰ组(65%,P<0.05). 结论 Dex可显著改善大面积烧伤患者术后芬太尼的镇痛效果,并减少副作用发生.%Objective To evaluate the efficacy and safety of dexmedetomidine (Dex) used for postoperative intravenous analgesia in patients with large-area burn.Methods Forty 18-60 years old patients,undergoing escharectomy were randomly assigned into two groups with 20 cases each.Group Ⅰ received patient-controlled intravenous analgesia(PCIA) with fenmnyl,Group Ⅱ received PCIA with Dex and fentanyl.Visual analogue scales (VAS) scores and Ramsay scores at 4,8,24 h and 48 h after operation and the incidence of nausea and vomit,somnolence,bradycardia and respiratory depression were recorded.The satisfactory degree of patients was recorded at 48 h.Results Compared with Group Ⅰ,the VAS score of Group Ⅱ at any time point and the incidence of nausea and vomit in Group Ⅱ were significantly decreased.There was no significant difference in the incidence of somnolence,bradycardia,respiratory depression and Ramsay score between the two groups.The satisfactory degree of patients in Group Ⅱ (95%) was obviously higher than that in Group Ⅰ (65

  2. Comparison of patient controlled intravenous analgesia with tramadol or morphine for postoperative pain relief%曲马多和吗啡用于术后PCIA的观察与比较

    Institute of Scientific and Technical Information of China (English)

    刘怀萍; 王忱; 李莉; 邱树彬

    2004-01-01

    目的通过对开胸术后剧痛病人行曲马多病人自控镇痛(patient controlled intravenous analgesia,PCIA)并与吗啡PCIA比较,评定曲马多对病人镇痛程度和恶心、呕吐等不良反应的发生率以及在呼吸系统和心血管系统方面的安全性.方法择期开胸手术病人60例随机分为曲马多组和吗啡组,每组30例,两组病人全麻诱导术中麻醉维持用药相同,术毕清醒拔管后与外周输液静脉连接PCA泵.镇痛治疗时间48h.PCIA选择负荷剂量+维持剂量+PCIA给药模式.术后4,8,12,24和48h随访并记录BP,P,R及药物用量、疼痛评分、恶心呕吐、皮肤骚痒等情况.结果两组镇痛效果无显著性差异;曲马多组不良反应低于吗啡组.结论曲马多用于术后PCIA与传统的吗啡相比:镇痛效果较好,曲马多用于术后PCIA是一种有效、安全的方法.

  3. Tramadol and Fentanyl and fentanyl Anesthesia Intravenous Postoperative Analgesia%曲马多复合芬太尼与芬太尼全麻术后静脉镇痛的比较

    Institute of Scientific and Technical Information of China (English)

    木也塞尔•艾买提; 热汗姑丽•台外库力

    2012-01-01

      目的探讨曲马多符合芬太尼治疗全麻术后静脉镇痛疗效。方法随机选择我院全麻手术,ASA 麻醉分级为1~2级患者87名,分成 A、B 两组,A 组31例,为对照组,行单独芬太尼注射;B 组56例,为治疗组,行曲马多复合芬太尼注射。结果 B 组3h、5h、11h、21h 呼吸频率高于 A 组,舒适评分高于 A 组,Ramsay 镇静评分高于 B 组,恶心、呕吐等不良反应发生率低于 B 组。结论曲马多复合芬太尼进行全麻术后静脉镇痛,具有较好的效果,不良反应发生率低。%  Objective Explore the tramadol in line with the intravenous analgesic effect of fentanyl treatment after general anesthesia. Methods Randomly selected hospital surgery under general anesthesia, the ASA anesthesia grade 1 to 2 patients of 87, divided into two groups (A, B),31 cases of group A, the control group, the line alone fentanyl injection; Group B 56 cases, in order totreatment group, the line tramadol fentanyl injection. Results Group B 3h,5h,11h,21h respiratory rate higher than Group A, the comfortable score higher than Group A, pain intensity was lower than group B, incidence of nausea, vomiting and other adverse reactions was lower than that in B group. Conclusion Tramadol fentanyl intravenous analgesia after general anesthesia, with good results and fewer adverse reactions.

  4. Multimodal analgesia and regional anaesthesia.

    Science.gov (United States)

    Tornero Tornero, C; Fernández Rodríguez, L E; Orduña Valls, J

    Multimodal analgesia provides quality analgesia, with fewer side effects due to the use of combined analgesics or analgesic techniques. Regional anaesthesia plays a fundamental role in achieving this goal. The different techniques of regional anaesthesia that include both peripheral and central blocks in either a single dose or in continuous infusion help to modulate the nociceptive stimuli that access the central level. The emergence of the ultrasound as an effective system to perform regional anaesthesia techniques has allowed the development of new regional anaesthesia techniques that formerly could not be carried out since only neurostimulation or skin references were used. It is essential to take into account that even with effective blocking it is advisable to associate other drugs by other routes, in this way we will be able to reduce the required doses individually and attempt to achieve a synergistic, not purely additive, effect. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

    LENUS (Irish Health Repository)

    Carney, John

    2010-10-01

    The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.

  6. Evaluation of dezocine combined with flurbiprofen axetil or fentanyl for postoperative analgesia in patients undergoing thoracic surgery%地佐辛复合氟比洛芬酯或芬太尼用于开胸手术术后镇痛的比较

    Institute of Scientific and Technical Information of China (English)

    贺克强; 柴小青; 陈昆洲; 王瑞婷

    2012-01-01

    Objective To evaluate the efficacy and safety of dezocine combined with flurhiprofen axetil or fentanyl for postoperative patient-control led intravenous analgesia (PCIA) in patients undergoing thoracic surgery. Methods One hundred and twenty ASA T or H patients scheduled for clcctive thoracic surgery were randomly divided into three groups according to different PCIA formula; group A received fentanyl 0. 5 mg plus dezocine 30 mg;group B received dezocine 30 mg plus flnrbiprofen axetil 200 mg; group C received fentanyl 0.5mg plus flurbiprofen axetii 200 mg. Tropisetron 6mg was also added identically in all groups. Total PCIA volume was 100 saline with loading volume 2 ml,background volume 2 ml/h,bolus dose 0. 5 ml,and lockout time was set 15 mia The VAS, Prince-Henry and Ramsay sedation scale were recorded 2,4,8,24,48 h after surgery. Total pressing times 24 h postoperatively and the adverse effects were also recorded. Results Prince-Henry scale and VAS score 2h,4h after surgery and total PCIA pressing times were higher in group A than group B and C without difference between group B and C(P<0. 05). The Ramsay sedation scale was lower 2h postoperatively but higher 4,8, and 24 hours after surgery in group A than in group B and C (P<0. 05). Conclusion Dezocine combined with flurbiprofen axetil for postoperative patient-controlled intravenous analgesia (PCIA)is effective and safe than dezocine combined with fentanyl in palients undergoing thoracic surgery%目的 比较地佐辛复合氟比洛芬酯或芬太尼用于开胸手术患者术后自控静脉镇痛(PCIA)的效果.方法 择期行开胸手术患者120例,随机均分为三组,术后均行PCIA,镇痛药配方分别为地佐辛30 mg+芬太尼0.5 mg(A组),地佐辛30 mg+氟比洛芬酯200 mg(B组),芬太尼0.5mg+氟比洛芬酯200 mg(C组),均加入托烷司琼6mg,且用生理盐水稀释至100 ml,初始负荷剂量2 ml,背景剂量2ml/h,单次PCA剂量0.5ml,锁定时间15 min.观察并记录患者术后2、4、8

  7. Effects of preoperative parecoxib on interleukin 6 and postoperative analgesia for mastectomy%帕瑞昔布钠术前用药对乳腺切除术患者血清 IL-6及术后镇痛的影响

    Institute of Scientific and Technical Information of China (English)

    滕培兰; 徐德荣; 杨洁; 李奉通; 江晨

    2014-01-01

    Objective To investigate the effects of preoperative parecoxib on the levels of inter-leukin 6 (IL-6)and postoperative analgesia for breast surgery.Methods Sixty breast cancer patients undergoing mastectomy were randomly divided into two groups:parecoxib group (group P)and con-trol group (group C),n=30 in each group.All patients received sevoflurane and fentanyl anesthesia. Group P was injected parecoxib 40 mg at 10 minutes before induction of anesthesia,meanwhile group C was injected saline 5 ml.All patients received postoperative patient-controlled intravenous analgesia (PCIA)with fentanyl.VAS scores for pain were assessed at postoperative 2,4,8,12,24 hours. The serum levels of IL-6 were measured by ELISA at 10 minutes before induction,4 h,8 h,and 24 h after surgery.Results Group P had lower VAS scores than group C at 2-12 h after surgery (P <0.05).Compared with 10 minutes before induction,the levels of IL-6 increased significantly at post-operative 4,8,24 h in two groups (P<0.01),while group P had lower levels of IL-6 than group C (P <0.01).Conclusion Preoperative administration of parecoxib has a stronger analgesic effect in breast cancer patients after mastectomy,and decreases the levels of IL-6.%目的:观察帕瑞昔布钠术前用药对乳腺切除术患者血清 IL-6及术后镇痛的影响。方法选择乳腺癌行乳腺切除手术患者60例,随机分为帕瑞昔布钠(P 组)和对照组(C 组),每组30例。所有患者均行静吸复合全身麻醉。P 组于麻醉诱导前10 min 静注帕瑞昔布钠40 mg,C 组静注生理盐水5 ml。术后两组均行静脉自控镇痛(PCIA)。记录术后2、4、8、12、24 h 的疼痛 VAS 评分。采用 ELISA 法测定诱导前10 min、术后4、8和24 h 的血清 IL-6浓度。结果术后2~12 h P 组VAS 评分均明显低于 C 组(P<0.05)。与诱导前10 min 比较,术后4~24 h 两组血清 IL-6浓度均明显升高(P<0.01),但 P 组明显低于 C 组(P<0.01)。

  8. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    Directory of Open Access Journals (Sweden)

    Gaonkar V

    2004-01-01

    Full Text Available In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25 or peri-incisional infiltration (n=25 pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively. We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

  9. Postoperative astigmatism.

    Science.gov (United States)

    Swinger, C A

    1987-01-01

    With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.

  10. COMPARISON OF INTRAVENOUS MAGNESIUM AND PLACEBO ADMINISTRATION ON POSTOPERATIVE PAIN AND ANALGESIC CONSUMPTION DURING SPINAL ANESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Olapour A

    2013-06-01

    Full Text Available Previous studies have suggested that magnesium may be a useful adjuvant to postoperative analgesia. We investigated efficacy of intravenous infusion of magnesium sulfate during spinal anesthesia to reduce post-operative pain and opioid consumption in patients undergoing inguinal hernia surgery.We randomly divided one hundred patients’ age 18-55 years old and ASA class I-II undergoing inguinal surgery into two groups. The magnesium group (Group M received magnesium sulfate 50 mg/kg in 100 ml normal saline intravenously within 10 minutes and 15 mg/kg/h by continuous infusion during the operation in one hour. The control group (Group S received the same amount of normal saline without magnesium sulfate. All patients received spinal anesthesia. Postoperative pain scores, meperidine consumption, and motor block were evaluated during 24 hours after surgery.Postoperative pain scores were significantly lower in Group M at 2, 3, 4 and 6 hours after surgery (P<0.05. Motor block was longer in Group M (P<0.05. Cumulative postoperative meperidine consumptions were also significantly lower in Group M at 24 h after surgery (P<0.05. 12% nausea and 26% flashing have been reported in Group M. A bolus and intravenous infusion of magnesium sulfate administration during spinal anesthesia improves postoperative analgesia. IRCT201201088645N1.

  11. Inhibition of Inactive States of Tetrodotoxin-Sensitive Sodium Channels Reduces Spontaneous Firing of C-Fiber Nociceptors and Produces Analgesia in Formalin and Complete Freund's Adjuvant Models of Pain.

    Directory of Open Access Journals (Sweden)

    David J Matson

    Full Text Available While genetic evidence shows that the Nav1.7 voltage-gated sodium ion channel is a key regulator of pain, it is unclear exactly how Nav1.7 governs neuronal firing and what biophysical, physiological, and distribution properties of a pharmacological Nav1.7 inhibitor are required to produce analgesia. Here we characterize a series of aminotriazine inhibitors of Nav1.7 in vitro and in rodent models of pain and test the effects of the previously reported "compound 52" aminotriazine inhibitor on the spiking properties of nociceptors in vivo. Multiple aminotriazines, including some with low terminal brain to plasma concentration ratios, showed analgesic efficacy in the formalin model of pain. Effective concentrations were consistent with the in vitro potency as measured on partially-inactivated Nav1.7 but were far below concentrations required to inhibit non-inactivated Nav1.7. Compound 52 also reversed thermal hyperalgesia in the complete Freund's adjuvant (CFA model of pain. To study neuronal mechanisms, electrophysiological recordings were made in vivo from single nociceptive fibers from the rat tibial nerve one day after CFA injection. Compound 52 reduced the spontaneous firing of C-fiber nociceptors from approximately 0.7 Hz to 0.2 Hz and decreased the number of action potentials evoked by suprathreshold tactile and heat stimuli. It did not, however, appreciably alter the C-fiber thresholds for response to tactile or thermal stimuli. Surprisingly, compound 52 did not affect spontaneous activity or evoked responses of Aδ-fiber nociceptors. Results suggest that inhibition of inactivated states of TTX-S channels, mostly likely Nav1.7, in the peripheral nervous system produces analgesia by regulating the spontaneous discharge of C-fiber nociceptors.

  12. Postoperative spine; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Schlaeger, R. [Universitaetsspital Basel, Neurologische Klinik und Poliklinik, Basel (Switzerland); Lieb, J.M. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Shariat, K. [Neurochirurgie Koeln-Merheim, Koeln (Germany); Ahlhelm, F.J. [Kantonsspital Baden AG, Abteilung Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland)

    2014-11-15

    Approximately 15-30 % of surgical procedures involving the lumbar spine are associated with complications that require further diagnostic work-up. The choice of imaging modality for postoperative complications depends on the extent, pattern and temporal evolution of the postoperative neurological signs and symptoms as well as on the preoperative clinical status, the surgical procedure itself and the underlying pathology. The interpretation of imaging findings, in particular the distinction between postoperative complications and normally expected nonspecific postoperative imaging alterations can be challenging and requires the integration of clinical neurological information and the results of laboratory tests. The combination of different imaging techniques might help in cases of equivocal imaging results. (orig.) [German] Etwa 15-30 % der operativen Eingriffe im Bereich der lumbalen Wirbelsaeule verlaufen nicht komplikationsfrei und erfordern weiterfuehrende Abklaerungen. Die Auswahl des bildgebenden Verfahrens im Rahmen postoperativer Komplikationen haengt dabei wesentlich von der zeitlichen Entwicklung, dem Ausmass und Verteilungsmuster der neuaufgetretenen klinisch-neurologischen bzw. orthopaedischen Symptome sowie von den Ausfaellen vor dem Eingriff, der zugrundeliegenden Pathologie und der Lokalisation und Art des Eingriffs ab. Die Interpretation der bildgebenden Befunde, insbesondere die Abgrenzung postoperativer Komplikationen von natuerlicherweise zu erwartenden postoperativen Veraenderungen kann dabei eine Herausforderung darstellen. Bei unklaren Befunden kann ergaenzend zur eingehend klinisch-neurologischen und laborchemischen Bestandsaufnahme auch der kombinierte Einsatz mehrerer bildgebender Modalitaeten diagnostisch weiterhelfen. (orig.)

  13. A randomized, double-blind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen [paracetamol] in reducing headache following electroconvulsive therapy [ECT].

    Science.gov (United States)

    Isuru, Amila; Rodrigo, Asiri; Wijesinghe, Chamara; Ediriweera, Dileepa; Premadasa, Shan; Wijesekara, Carmel; Kuruppuarachchi, Lalith

    2017-07-28

    Electroconvulsive therapy (ECT) is a safe and efficient treatment for several severe psychiatric disorders, but its use is limited by side effects. Post-ECT headache is one of the commonest side effects. Preemptive analgesia is effective in post-surgical pain management. The most commonly used analgesic is acetaminophen (paracetamol). However, acetaminophen as a preemptive analgesic for post-ECT headache has not been studied adequately. This study was conducted to compare the incidence and severity of post-ECT headache in patients who were administered acetaminophen pre-ECT with a placebo group. This study was a randomised, double-blind, placebo-controlled trial. Sixty-three patients received 1 g acetaminophen and 63 patients received a placebo identical to acetaminophen. The incidence and severity of headache 2 h before and after ECT were compared between placebo and acetaminophen groups. The severity was measured using a visual analog scale. Generalised linear models were used to evaluate variables associated with post ECT headache. Demographic and clinical variables of placebo and acetaminophen groups were comparable except for the energy level used to induce a seizure. Higher proportion of the placebo group (71.4%) experienced post-ECT headache when compared to the acetaminophen group (p acetaminophen group whereas the score was 2 (IQR: 0-4) in placebo group (P acetaminophen is associated with less post-ECT headache (odds ratio = 0.23, 95% CI: 0.11-0.48, P acetaminophen. Ethical approval was granted by an Ethic review committee, University of Kelaniya, Sri Lanka (P/166/10/2015) and the trial was registered in the Sri Lanka Clinical Trials Registry ( SLCTR/2015/27 ).

  14. 两种冷疗方法用于儿童术后镇痛的对比研究%Comparison of two cold therapy methods for post-operative analgesia for children

    Institute of Scientific and Technical Information of China (English)

    蒋小平; 蒋林峻; 郑显兰

    2015-01-01

    目的探讨普通冰袋冷敷和加压冷敷疗法在儿童骨折术后镇痛的效果。方法将435例符合纳入标准的上肢骨折术后患儿随机分为两组,观察组217例患儿采用加压冷敷治疗,对照组218例患儿采用普通冰袋冷敷治疗,冷疗时间均为术后1~3 d ,每天3次,每次30 min。冷敷治疗结束后30 min及2 h ,采用疼痛评分量表各行疼痛评分一次,比较两组间有无差异。结果两组患儿冷敷治疗30 min及2 h评分有明显差异,观察组疼痛评分明显低于对照组,χ2分别为62.7和81.82,P<0.001。结论加压冷敷疗法可有效减轻儿童骨折术后疼痛,镇痛效果优于普通冰袋冷敷。%Objective To study the effect post‐operative analgesia by common cold packs and pressurized cold therapy for child patients with fracture .Method 435 child patients meet the inclusion criteria of upper limb fracture was randomly divided into control group and observation group .217 child patients in observation group was given pressurized cold treatment .218 child patients in the control group were treated with ordinary ice cold treatment . The cold therapy time was three days after surgery ,three times a day and 30 minutes for each treatment .Wong‐Banker FACES Pain Rating Scale and Visual Analogue Scale were used to assess the pain level in all children in 30 minutes and 2 hours after cold therapy .The differnce between the two group was compared .Result The scores of 30 minutes and two hours after children cold treatment for two group were significantly different .The pain score in ob‐servation group was less than that of control group .2 for 30minute was 62 .7 ,2 for 2 hours was 81 .82 ,P<0 .001 . Conclusion Cold compression therapy had a better pain control effect than that of ice bag therapy for child patients .

  15. Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery

    Science.gov (United States)

    Asad, Muhammad Vaiz; Khan, Fauzia Anis

    2015-01-01

    Background and Aims: Opioids are commonly used to provide perioperative analgesia, but have many side-effects. Addition of co-analgesics results in reducing the dosage and hence the side-effects of opioids. The objective of this study was to compare the analgesic efficacy of fentanyl (1 micro/kg−1) administered alone, with fentanyl (0.75 micro/kg−1) and dexamethasone (8 mg) combination, in patients undergoing day care unilateral inguinal hernia repair. Material and Methods: Patients scheduled for the day care unilateral inguinal hernia repair were randomized to receive either saline and fentanyl 1 micro/kg−1 (control group) or 8 mg dexamethasone with fentanyl 0.75 micro/kg−1 (study group) immediately before induction of anesthesia in a double-blind clinical trial. Anesthesia technique and rescue analgesia regimen were standardized. Intraoperatively, pain was assessed based on hemodynamic variability and postoperatively by visual analog scale. Results: The mean heart rate, systolic and the diastolic blood pressure at 1, 5, 20 and at 30 min after incision, were significantly higher in the control group (P ≤ 0.001) when compared to the study group. Intra-operative rescue analgesia was required in 32 (100%) and 19 (59.4%) patients in control group and study group respectively (P = 0.0002). Mean pain scores measured at fixed time periods postoperatively were significantly higher in the control group when compared to study group (P ≤ 0.001). Postoperative rescue analgesia was needed in 32 (100%) versus 24 (75%) patients in the control group and study group respectively, but this difference was not statistically significant (P = 0.285). Conclusion: We conclude that the addition of 8 mg of preoperative intravenous dexamethasone to 0.75 micro/kg−1 fentanyl was effective in reducing intraoperative and postoperative pain in the 1st h after unilateral inguinal hernia surgery. PMID:26330712

  16. Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery

    Directory of Open Access Journals (Sweden)

    Muhammad Vaiz Asad

    2015-01-01

    Full Text Available Background and Aims: Opioids are commonly used to provide perioperative analgesia, but have many side-effects. Addition of co-analgesics results in reducing the dosage and hence the side-effects of opioids. The objective of this study was to compare the analgesic efficacy of fentanyl (1 micro/kg−1 administered alone, with fentanyl (0.75 micro/kg−1 and dexamethasone (8 mg combination, in patients undergoing day care unilateral inguinal hernia repair. Material and Methods: Patients scheduled for the day care unilateral inguinal hernia repair were randomized to receive either saline and fentanyl 1 micro/kg−1 (control group or 8 mg dexamethasone with fentanyl 0.75 micro/kg−1 (study group immediately before induction of anesthesia in a double-blind clinical trial. Anesthesia technique and rescue analgesia regimen were standardized. Intraoperatively, pain was assessed based on hemodynamic variability and postoperatively by visual analog scale. Results: The mean heart rate, systolic and the diastolic blood pressure at 1, 5, 20 and at 30 min after incision, were significantly higher in the control group (P ≤ 0.001 when compared to the study group. Intra-operative rescue analgesia was required in 32 (100% and 19 (59.4% patients in control group and study group respectively (P = 0.0002. Mean pain scores measured at fixed time periods postoperatively were significantly higher in the control group when compared to study group (P ≤ 0.001. Postoperative rescue analgesia was needed in 32 (100% versus 24 (75% patients in the control group and study group respectively, but this difference was not statistically significant (P = 0.285. Conclusion: We conclude that the addition of 8 mg of preoperative intravenous dexamethasone to 0.75 micro/kg−1 fentanyl was effective in reducing intraoperative and postoperative pain in the 1 st h after unilateral inguinal hernia surgery.

  17. Assessment of a short hypnosis in a paediatric operating room in reducing postoperative pain and anxiety: A randomised study.

    Science.gov (United States)

    Duparc-Alegria, Nathalie; Tiberghien, Karine; Abdoul, Hendy; Dahmani, Souhayl; Alberti, Corinne; Thiollier, Anne-Francoise

    2017-04-12

    To assess the impact of a short hypnotic session on postoperative anxiety and pain in major orthopaedic surgery. Despite specific information given before a scheduled paediatric surgery, perioperative anxiety can become important. Randomised Clinical Study. The study is an open single-centre randomised clinical study comparing a "control" group versus a "hypnosis" group receiving a short hypnosis pre-induction session as additional experimental analgesic procedure. The primary endpoint was the postoperative anxiety, blindly assessed using a visual analogue scale. The study involved 120 children (age 10-18 years). The results showed no difference between control group versus hypnosis group. Twenty-four hours after surgery (Day+1), the patient's anxiety score was not different between control and hypnosis groups (median [Q1-Q3]: 1 [0; 3] vs. 0 [0; 3], respectively, p = .17). Each group experienced a significant decrease in anxiety level between the day before surgery (Day-1) and the day after surgery (Day+1) (median ([Q1-Q3]) difference of the anxiety score: 2 [4; 0] and 2 [4; 0], respectively, p < .0001 in each group). The postoperative pain scores were low and not different between groups (median [Q1-Q3]: 2 [0; 3] in control group vs. 3 [1; 3] in hypnosis group, p = .57). This randomised study on a short hypnosis session performed in the operating room prior to a major surgery showed no difference in postoperative anxiety and pain levels. The decrease in anxiety and pain levels may be due to the addition of nurse pre-operative interviews and optimisation in communication in the operating room. As postoperative anxiety level was low in both control and hypnosis groups, nurse pre-operative interviews and nurse training in hypnosis may contribute to the optimisation of global management and decrease the postoperative anxiety level. © 2017 John Wiley & Sons Ltd.

  18. 曲马多复合不同剂量舒芬太尼用于胃肠外科患者术后静脉自控镇痛效果比较%Postoperative patient controlled intravenous analgesia with tramadol combined with different doses of sufen-tanil after gastrointestinal surgery

    Institute of Scientific and Technical Information of China (English)

    黄君书

    2015-01-01

    Objective To evaluate the efficacy of postoperative patient controlled intravenous analgesia ( PCIA) with tramadol combined with different doses of sufentanil after gastrointestinal surgery .Methods According to admission date , 60 patients undergoing gastrointestinal surgery were randomly divided into three groups with 20 pa-tients in each group .Group A received tramadol 300 mg and sufentanil 50 μg.Group B received sufentanil 100 μg and tramadol 300 mg.Group C received tramadol 300 mg and sufentanil 150μg.Analgesia drugs in each group were added droperidol 2.5 mg and diluted with normal saline to 100 ml.Patient controlled analgesia(PCA) pumps were connected before the end of operations .The mode of analgesia: the load dose was 2 ml, the maintenance dose was 1.2 ml/h, PCA was 2 ml and the locking time was 20 min.The whole observing course was 24 h.Visual analogue scale( VAS) , Ramsay sedation score and side effects were recorded at 2~4 h,8~10 h,12~20 h and 22~24 h re-spectively after the operation .Results The VAS scores in group B and group C at each stage after the operation were lower than that in group A ( P=0.000 ) .The VAS score in group C at each stage was lower than that in group B after the operation ( P=0.000 ) .There was no significant difference in Ramsay sedation score at each stage after the opera -tion among the three groups .Conclusion Tramadol 300 mg combined with sufentanil 150 μg is effective and safe for postoperative PCIA in patients undergoing gastrointestinal surgery .%目的:评价曲马多复合不同剂量舒芬太尼用于胃肠外科患者术后静脉自控镇痛( patient con-trolled intravenous analgesia ,PCIA)的效果。方法选择ASAⅠ或Ⅱ级择期行胃肠外科手术患者60例,按入院先后分为三组。 A组:曲马多300 mg+舒芬太尼50μg;B组:曲马多300 mg+舒芬太尼100μg;C组:曲马多300 mg+舒芬太尼150μg。三组镇痛药物均加入氟哌啶2.5 mg

  19. Effects of Postoperative Analgesia with Buprenorphine on Cell Immunity in Patients with Gastric Cancer%丁丙诺啡术后镇痛对胃癌患者细胞免疫的影响

    Institute of Scientific and Technical Information of China (English)

    杨少勇; 张广华; 李锦成

    2011-01-01

    Objective: Surgical stress, including pain, may induce cell immunodepression and can even affect postoperative recurrence of cancer. The influence of the postoperative analgesic buprenorphine and fentanyl on the perioperative cell immunity of gastric cancer patients was compared. Methods: A total of 40 patients umdergoing surgery for gastric cancer were randomly divided into group B ( n = 20 ) with postoperative buprenorphine 0.3 μg·kg-1·h-1 as the experiment group and group F ( n = 20 ) with fentanyl 0.3 μg·kg-1·h-1 as the controls. Blood samples were collected before the surgery and at one day and three days after the surgery. T-cell subgroups CD3+, CD4+, CD8+, CD4+/CD8+, and NK cell were analyzed by flow cytometry, and the levels of cytokines INF-γ and IL-10 were determined using ELISA. Results: The surgical procedure and analgesic effects were similar between the two groups. There were reductions in the number of T cells and NK cells, and increased immunologic derangement, such as inflammatory cytokines, after the surgery. Compared with fentany 1, buprenorphine was beneficial to the recovery of inmnume indices. Conclusion: Surgical stress can induce changes in T lymphocyte subsets, NK cells, and cytokines. Buprenorphine is more beneficial to immune recovery than fentanyl when used as a postoperative analgesic.%目的:外科手术应激(包括疼痛)可抑制细胞免疫甚至促进恶性肿瘤术后转移复发.本研究比较丁丙诺啡与芬太尼术后镇痛对胃癌手术患者围术期细胞介导免疫功能的影响.方法:选取天津医科大学附属肿瘤医院2009年3月至2010年5月间40例胃癌切除术患者,随机分为丁丙诺啡组(A组20例)和芬太尼组(B组20例).A组使用丁丙诺啡背景输注剂量为0.3μg/(kg·h)行术后镇痛,追加剂量为0.3 μg/kg;B组使用芬太尼0.3 μg/(kg·h)行术后镇痛,追加剂量0.3 μg/kg.分别在术前、术后24 h、术后72 h取血进行T细胞亚群、NK细胞

  20. Epidural analgesia during labor vs no analgesia: A comparative study

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    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  1. Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery-- a randomized double blind clinical study.

    Science.gov (United States)

    Kreisler, M B; Haj, H Al; Noroozi, N; Willershausen, B d'Hoedt

    2004-01-01

    The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

  2. Moderate evidence to recommend submucosal injection of dexamethasone in reducing post-operative oedema and pain after third molar extraction.

    Science.gov (United States)

    Freda, Nicolas M; Keenan, Analia Veitz

    2016-06-01

    Data sourcesThe electronic databases searched included: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (Central) and Web of Science until June 2015. There was no restriction to language and the reference lists from relevant studies were searched for further articles.Study selectionRandomised and prospective controlled trials that compared the effect of submucosal injection of dexamethasone with that of placebo after impacted third molar surgery in humans. Studies involving volunteers with decompensated metabolic disease were excluded.Data extraction and synthesisStudy selection, data extraction and quality assessment (risk of bias) were assessed by two reviewers. All disagreements were resolved through discussion. A meta-analysis was performed for all continuous variables (oedema, pain and trismus) when at least two of the studies analysed the same data type.ResultsEight studies involving a total of 476 patients of which six were included in the meta-analysis. All of the surgical procedures were performed on the lower molars, submucosal injections of dexamethasone were used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a control. Antibiotic medications were administered prophylactically before surgery or by continuous use after the procedure. Seven of the eight studies identified the impactions according to the Pell and Gregory Classification. Oedema was measured using facial contours of pre-established reference points. The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70 to -1.70), with a statistically significant difference favouring dexamethasone (Pincluding a VAS were used for meta-analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and showed a statistically significant difference favouring dexamethasone.ConclusionsThe review found moderate quality evidence that submucosal injections of dexamethasone reduced post-operative oedema and pain compared to a placebo following impacted third

  3. PRE-EMPTIVE ORAL CLONIDINE FOR IMMEDIATE POSTOPERATIVE PAIN IN SURGERIES UNDER SUB-ARACHNOID BLOCK

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    Priti

    2014-10-01

    Full Text Available : BACKGROUND: Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce sensitization of central and peripheral pain pathways produced by pain signals evoked by tissue damage. Clonidine has demonstrated efficacy in clinical trials as pre-emptive analgesic in postoperative pain management. OBJECTIVE: The present study was conducted to evaluate postoperative analgesic benefit in patients administered clonidine or placebo for below umbilical surgeries to be performed under subarachnoid block (SAB using 3ml 0.5%bupivacaine & to compare their postoperative efficacy with respect to duration of analgesia, 24hrs postoperative requirements of total analgesics and study side effects. MATERIAL & METHODS: Sixty patients of either sex (30 per group, 20-65yrs, ASA class I-II received either oral placebo (group PC or clonidine 150µg (group CL one hr preoperatively. The postoperative Visual Analogue Scale (VAS score was assessed for 24hrs every 2hrly. The patients were given iv Diclofenac75mg as rescue analgesic at VAS ≥4.The time at which patient demanded rescue analgesic for first time & total requirement of 24 hrs postoperative analgesics was noted. STATISTICAL ANALYSIS: Software used in the analysis was EPI info software (3.4.3. Data was reported as mean value ± SD, P-value of < 0.05 was considered statistically significant. Unpaired T – test was used to find out significance between two samples. The comparison of normally distributed continuous variables between the groups was performed by means of one-way analysis of variance (ANOVA and, if appropriate, followed by Dunnett multiple comparison tests. Nominal categorical data among study groups were compared using the chi-square test. Results: Total duration of analgesia in Group-CL was significantly more than Group-PC. (492.66 ±78.29 min. Group-CL, 264.83 ±13.67 min. Group-PC, p=0.000, lower rescue analgesic requirement in Group-CL than in Group-PC (2

  4. Proinflammatory cytokines oppose opioid induced acute and chronic analgesia

    OpenAIRE

    Hutchinson, Mark R.; Coats, Benjamen D; Lewis, Susannah S.; Zhang, Yingning; Sprunger, David B.; Rezvani, Niloofar; Baker, Eric M.; Jekich, Brian M.; Wieseler, Julie L.; Somogyi, Andrew A; Martin, David; Poole, Stephen; Judd, Charles M.; Steven F. Maier; Watkins, Linda R.

    2008-01-01

    Spinal proinflammatory cytokines are powerful pain-enhancing signals that contribute to pain following peripheral nerve injury (neuropathic pain). Recently, one proinflammatory cytokine, interleukin-1, was also implicated in the loss of analgesia upon repeated morphine exposure (tolerance). In contrast to prior literature, we demonstrate that the action of several spinal proinflammatory cytokines oppose systemic and intrathecal opioid analgesia, causing reduced pain suppression. In vitro morp...

  5. Preemptive analgesia II: recent advances and current trends.

    LENUS (Irish Health Repository)

    Kelly, D J

    2012-02-03

    PURPOSE: This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. SOURCE: Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents. Principal findings: In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multi-modal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy. CONCLUSION: The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.

  6. Mechanisms of acupuncture analgesia for clinical and experimental pain.

    Science.gov (United States)

    Staud, Roland; Price, Donald D

    2006-05-01

    There is convincing evidence that acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting, as well as postoperative dental pain. Less convincing data support AP's efficacy for chronic pain conditions, including headache, fibromyalgia and low back pain. There is no evidence that AP is effective in treating addiction, insomnia, obesity, asthma or stroke deficits. AP seems to be efficacious for alleviating experimental pain by increasing pain thresholds in human subjects and it appears to activate analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes some time to develop and to resolve. Furthermore, repetitive use of AP analgesia can result in tolerance that demonstrates cross-tolerance with morphine. However, it appears that not all forms of AP are equally effective for providing analgesia. In particular, electro-AP seems to best deliver stimuli that activate powerful opioid and nonopioid analgesic mechanisms. Thus, future carefully controlled clinical trials using adequate electro-AP may be able to provide the necessary evidence for relevant analgesia in chronic pain conditions, such as headache, fibromyalgia, irritable bowel syndrome and low back pain.

  7. Management of pain in the postoperative neonate.

    Science.gov (United States)

    Truog, R; Anand, K J

    1989-03-01

    Only recently has the use of anesthesia and analgesia become widely accepted in the newborn infant. This is largely a result of the overwhelming evidence that neonates have the neurologic substrate for the perception of pain and display characteristic behavioral, physiologic, metabolic, and hormonal responses to noxious stimuli. The management of postoperative pain in the surgical neonate begins in the operating room, where techniques can be chosen that will ease the transition into the postoperative period. For postoperative analgesia, the most widely used and effective agents are the narcotics morphine and fentanyl. They may be administered either intermittently or continuously, and with proper precautions may be given to both intubated and nonintubated newborns. Other medications for analgesia and sedation are not as well studied in the newborn, but chloral hydrate and the benzodiazepines are useful for sedation, and acetaminophen may be used for analgesia alone or for potentiating the effect of narcotics. In addition, a number of creative nonpharmacologic techniques are being developed and promise to further decrease the discomfort experienced by postoperative neonates.

  8. Efficacy of ropivacaine by the concentration of 0.25%, 0.5%, and 0.75% on surgical performance, postoperative analgesia, and patient’s satisfaction in inguinal hernioplasty: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Su YL

    2015-09-01

    Full Text Available Yinglan Su, Zhongjun Zhang, Yaoxian Zhang, Hanwei Li, Wei Shi Anesthesia Department, The Shenzhen People’s Hospital, The Secondary Clinical Medical College of Jinan University, Shenzhen, Guangdong, People’s Republic of China Background: The purpose of this study was to evaluate the use of different concentrations of ropivacaine in ultrasound-guided regional anesthesia with regard to postoperative analgesic and patient’s satisfaction in elderly patients undergoing inguinal hernioplasty in the People’s Republic of China. Methods: A total of 60 patients (>75 years of age who scheduled inguinal hernioplasty at the Shenzhen People’s Hospital from December 2013 to March 2015 were randomly assigned to three groups: 0.25% ropivacaine (n=20, 0.5% ropivacaine (n=20, and 0.75% ropivacaine (n=20. Ultrasound-guided regional anesthesia was performed before every surgery. Non-invasive blood pressure and heart rate were recorded before the operation, during the first 5 minutes of the surgical procedure, and 5 minutes after the operation of the patients, and compared between the groups. Incidence of adverse reactions, postoperative Visual Analog Scale score, and analgesic effect were also recorded and analyzed. Results: The surgical procedure and anesthesia was performed successfully in all patients. Patients with high-dose ropivacaine (0.5% and 0.75% in ultrasound-guided regional anesthesia exhibited lower arterial pressure and lower heart rate during the operation when compared to low-dose group. The interquartile range of Visual Analog Scale scores in both group C (0.75% ropivacaine and group B (0.5% ropivacaine were significantly lower (P<0.05 than in group A (0.25% ropivacaine. Accordingly, the interquartile range of satisfactory scores in both group C (0.75% ropivacaine and group B (0.5% ropivacaine were significantly higher (P<0.05 than in group A (0.25% ropivacaine. More cases in high-dose groups reported abnormal skin sensation; however, it

  9. Does Fibrin Glue Sealant Used During Pancreaticoduodenectomy Reduce Post-Operative Complication? Audit of 100 Consecutive Patients Undergoing Whipple's Procedure by a Single Surgeon

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    Shafiq Rehman

    2016-03-01

    Full Text Available Introduction This study evaluated the effect of fibrin glue applied as a sandwich film between a two layer pancreatico-jejunostomy anastomosis following pancreaticoduodenectomy. Primary end-points were post-operative pancreatic fistulae, overall complication rates and post-operative length of stay. Methods Pancreaticoduodenectomy was performed by fashioning a two layer pancreatico-jejunostomy with or without a glue sealant which when applied, formed a thin film external to the ductal anastomosis but internal to the seromuscularpancreatic parenchymal layer. Results Following audit of 100 consecutive patients undergoing pancreaticoduodenectomy, patients were separated into two groups; those with glue augmented anastomosis [Glue (G N=50] or those without [No Glue (NG, N=50]. Each group was matched with regard to age [median, G=68 years vs. NG=66 years, (P=0.19] and sex (P=0.84. There were no statistically significant differences between the two groups with respect to overall POPF [G N=7(14% vs. NG N=11(22%, (P=0.42], significant complications (Clavien Grade 3 or more, [G N=4(8% vs. NG N=2(4% (P=0.40], or post-operative length of stay [G 13 days vs. NG 14 days, (P=0.90]. In those patients with the highest fistulae risk score, there were significantly more post-operative pancreatic fistulae in the no glue cohort. There was no mortality in either group. Conclusion This study shows that application of sealant glue significantly reduces post-operative pancreatic fistulae in high-risk patients, but does not reduce overall complications or hospital stay following pancreaticoduodenectomy.

  10. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery.

    Science.gov (United States)

    Kranke, Peter; Jokinen, Johanna; Pace, Nathan Leon; Schnabel, Alexander; Hollmann, Markus W; Hahnenkamp, Klaus; Eberhart, Leopold H J; Poepping, Daniel M; Weibel, Stephanie

    2015-07-16

    The management of postoperative pain and recovery is still unsatisfactory in clinical practice. Opioids used for postoperative analgesia are frequently associated with adverse effects including nausea and constipation. These adverse effects prevent smooth postoperative recovery. On the other hand not all patients may be suited to, and take benefit from, epidural analgesia used to enhance postoperative recovery. The non-opioid lidocaine was investigated in several studies for its use in multi-modal management strategies to reduce postoperative pain and enhance recovery. The aim of this review was to assess the effects (benefits and risks) of perioperative intravenous lidocaine infusion compared to placebo/no treatment or compared to epidural analgesia on postoperative pain and recovery in adults undergoing various surgical procedures. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 5 2014), MEDLINE (January 1966 to May 2014), EMBASE (1980 to May 2014), CINAHL (1982 to May 2014), and reference lists of articles. We searched the trial registry database ClinicalTrials.gov, contacted researchers in the field, and handsearched journals and congress proceedings. We did not apply any language restrictions. We included randomized controlled trials comparing the effect of continuous perioperative intravenous lidocaine infusion either with placebo, or no treatment, or with epidural analgesia in adults undergoing elective or urgent surgery under general anaesthesia. The intravenous lidocaine infusion must have been started intraoperatively prior to incision and continued at least until the end of surgery. Trial quality was independently assessed by two authors according to the methodological procedures specified by the Cochrane Collaboration. Data were extracted by two independent authors. W