The use of Preoperative Lidocaine to Prevent Stridor and Laryngospasm after Tonsillectomy and Adenoidectomy

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group. (Otolaryngol Head Neck Surg 1998;118:880–2.)

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Analgesic Effects of Gabapentin after Spinal Surgery

Anesthesiology ◽

10.1097/00000542-200404000-00025 ◽

2004 ◽

Vol 100 (4) ◽

pp. 935-938 ◽

Cited By ~ 152

Author(s):

Alparslan Turan ◽

Beyhan Karamanlıoğlu ◽

Dilek Memiş ◽

Mustafa Kemal Hamamcıoglu ◽

Barış Tükenmez ◽

...

Keyword(s):

Placebo Group ◽

Side Effects ◽

Spinal Surgery ◽

Early Postoperative Period ◽

Morphine Consumption ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Pain Scores ◽

Incremental Dose

Background A combination of opioid and nonopioid analgesic drugs may improve the quality of postoperative analgesia as well as reduce opioid requirements and their associated side effects. Studies have shown synergism between gabapentin and morphine in animal and human experiments and in the treatment of incisional pain. Therefore, the authors investigated, in a randomized, placebo-controlled, double-blind study, the effects of gabapentin on acute postoperative pain and morphine consumption in patients undergoing spinal surgery. Methods After standard premedication, 25 patients in the control group received oral placebo, and 25 patients in the gabapentin group received 1,200 mg of gabapentin, 1 h before surgery in a randomized fashion. Anesthesia was induced with propofol and cisatracurium and was maintained with sevoflurane and remifentanil. The total intraoperative remifentanil consumption by each patient was noted. All patients postoperatively received patient-controlled analgesia with morphine (1 mg/ml) with an incremental dose of 2 mg, a lockout interval of 10 min, and a 4-h limit of 40 mg. The incremental dose was increased to 3 mg, and the 4-h limit to 50 mg, if analgesia was inadequate after 1 h. Patients were questioned for the first 1 h in the PACU and were later evaluated in the ward at 1, 2, 4, 6, 12, and 24 h. Pain scores, heart rate, oxygen saturation measured by pulse oximetry, mean blood pressure, respiratory rate, sedation, morphine use, and total dose of morphine were recorded. Results Overall, pain scores at 1, 2, and 4 h were significantly lower in the gabapentin group when compared with the placebo group. Total morphine consumption in the gabapentin group was 16.3 +/- 8.9 mg (mean +/- SD) versus 42.8 +/- 10.9 mg in the placebo patients. The incidence of vomiting and urinary retention was significantly (P < 0.05) higher in the placebo group, but there was no difference in incidence of other adverse effects between the groups. Conclusions Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.

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The Effect of Oral Pregabalin on Epidural-Induced Shivering and Epidural Characteristics in Gynecological Surgeries, a Prospective Randomized Double-Blind Study

10.21203/rs.2.76/v1 ◽

2018 ◽

Author(s):

Tarek Al Menesy ◽

Ghada Adel ◽

Ahmed A. Badawy ◽

Samaa A. Kasem ◽

Ashraf Abd Elmawgoud ◽

...

Keyword(s):

Side Effects ◽

Epidural Anesthesia ◽

Side Effect ◽

Epidural Block ◽

Control Group ◽

Double Blind Study ◽

Single Shot ◽

Double Blind ◽

Sedation Scores ◽

And Control

Abstract Purpose: The previous reports tried to reduce shivering and improve neuraxial anesthesia characteristics by the systemic use of different drugs. This study was directed to evaluate the effect of pregabalin premedication on both shivering and epidural characteristics following single shot loading. Patients and Methods: Eighty female patients, ASA grade I and II, scheduled for gynecological surgeries under epidural anesthesia were studied. The patients were divided into two groups: Pregabalin (P) group and Control (C) group in which the patients received 150 mg of pregabalin and placebo capsules respectively sixty minutes prior to surgery. Following epidural loading, the onset and degree of shivering were compared between the two groups. Also, the epidural onset, level and duration were compared. The perioperative hemodynamics, sedation scores, meperidine consumption and side effects were followed up and registered. Results: The onset of shivering was significantly prolonged and the degree of shivering was less in pregabalin group compared to Control group. The duration of epidural shot was shorter in the control group in relation to the pregabalin treated patients. Regarding both onset and level of block, no significant changes were detected. The patients were more sedated with less meperidine consumption in the pregabalin group. The two groups were similar as regards the perioperative hemodynamics and occurrence of side effect. Conclusion: The premedication with pregabalin reduced onset and degree of shivering and prolonged the duration of single shot epidural block.

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The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6691459 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Dongdong Liang ◽

ShenHui Jin ◽

LeDan Huang ◽

YeLong Ren ◽

ZhongHeng Du ◽

...

Keyword(s):

General Anesthesia ◽

Transurethral Resection ◽

Early Postoperative Period ◽

Control Group ◽

Urinary Catheterization ◽

Double Blind Study ◽

Early Recovery ◽

Analgesic Requirement ◽

Double Blind ◽

Acupoint Stimulation

Background. Catheter-related bladder discomfort (CRBD), an extremely distressing complication secondary to an indwelling urinary catheterization, is frequently reported in patients with transurethral resection of the prostate (TURP), postoperatively. A prospective, randomized, controlled, double-blind study was designed to assess the efficacy of transcutaneous electrical acupoint stimulation (TEAS) as a treatment for CRBD in patients undergoing TURP. Methods. Seventy benign prostatic hyperplasia male patients undergoing TURP under general anesthesia requiring intraoperative urinary catheterization were enrolled for the trial. An experienced acupuncturist performed TEAS for 30 minutes before general anesthesia with acupoints RN7, RN6, RN5, RN4, and RN3 and bilateral BL32, BL33, and BL34. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO2), body temperature (T), and blood samples were collected during the surgery. A series of assessments included the incidence and severity of CRBD, postoperative pain, nausea and vomiting, and physical and mental state measurements. Results. The incidence of CRBD was significantly lower in TEAS group than in control group at the time T5 [9(26%) vs. 28(80%), P < 0.001 ], T9 [20(57%) vs. 28(80%), P = 0.039 ], T11 [7(20%) vs. 31(89%), P < 0.001 ], and T12 [4(11%) vs. 7(20%), P = 0.003 ]. The severity of CRBD was significantly lower in TEAS group than in control group at the time T5 [0 vs. 10 (29%), P < 0.001 ], T9 [2(6%) vs. 10(29%), P = 0.011 ], and T11 [0 vs .9(26%), P = 0.002 ]. The QoR-40 total score was higher in TEAS group at time T11 [191.7(4.4) vs. 189.1(4.3), P = 0.007 ] and T12 [195.3(1.9) vs. 193.3(3.0), P < 0.001 ]. The postoperative analgesia requirement was higher in control group [5.0(2.9) vs. 3.8(1.9), P = 0.045 ]. Conclusions. TEAS could significantly prevent the incidence and severity of CRBD, reduce the postoperative analgesic requirement in the early postoperative period, and promote the quality of early recovery in patients undergoing TURP.

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Topical Lidocaine Patch for Postthoracotomy and Poststernotomy Pain in Cardiothoracic Intensive Care Unit Adult Patients

Critical Care Nurse ◽

10.4037/ccn2019849 ◽

2019 ◽

Vol 39 (5) ◽

pp. 51-57 ◽

Cited By ~ 1

Author(s):

Michael Liu ◽

Mabel Wai ◽

James Nunez

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Standard Care ◽

Academic Medical Center ◽

Adult Patients ◽

Control Group ◽

Lidocaine Group ◽

Lengths Of Stay ◽

Topical Lidocaine

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.

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Comparative Evaluation of 0.1% Octenidine Mouthwash with 0.2% Chlorhexidine Mouthwash in Prevention of Plaque and Gingivitis – A Clinicomicrobiological Study

RGUHS Journal of Dental Sciences ◽

10.26715/rjds.13_3_9 ◽

2021 ◽

Vol 13 (3) ◽

pp. 202-210

Author(s):

Sowmya Sadanandan ◽

Suhas S ◽

Sanjay Venugopal ◽

Kavitha Karur

Keyword(s):

Antibacterial Properties ◽

Chlorhexidine Gluconate ◽

Control Group ◽

Double Blind Study ◽

Gingival Inflammation ◽

Patient Acceptability ◽

Double Blind ◽

Microbiological Parameters ◽

Group B ◽

The Impact

Background: Our study aimed to assess the efficacy of 0.1% Octenidine mouthwash as an anti-plaque agent and to assess its effect on gingival inflammation and staining of teeth when compared to 0.2% chlorhexidine gluconate by evaluating the impact on plaque and gingival inflammation as well as on microbial load. Materials and Methods: A three week double blind study was conducted on 69 subjects, aged 20-50 years, with moderate to severe gingivitis. The study population was divided into three groups with 23 subjects in each group: Group A - control subjects received only scaling, Group B received 0.2% chlorhexidine gluconate in addition to scaling and Group C received 0.1% Octenidine mouthwash along with scaling. Clinical and microbiological parameters were recorded at baseline, on 14th day and on 21st day. Subjective and objective criteria were assessed on the 14th day and 21st day. Results: There was a statistically significant reduction in all the tested parameters within all the three groups and between the groups from baseline to 21st day. The highest mean reduction in all the parameters was seen in subjects using 0.1% Octenidine. On comparison with the control group, subjects using the mouthwashes (Group B and Group C) had better improvement in clinical and microbiological parameters from baseline to 21st day. On comparison with chlorhexidine, Octenidine mouthwash significantly reduced plaque (p<0.05) and showed better patient acceptability. However, it was comparable to chlorhexidine in other two tested parameters. Conclusion: Owing to Octenidine’s pronounced and comparable antibacterial properties, it can be a promising candidate for the use in antiseptic mouthwashes.

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The Effectiveness of Group Acceptance and Commitment Therapy and Cognitive Therapy on Alexithymia and Marital Boredom, Case study: Women Affected by Marital Infidelity in Mashhad, Iran

Journal of Community Health Research ◽

10.18502/jchr.v10i4.8337 ◽

2022 ◽

Author(s):

Maryam Sadeghi ◽

Naeimeh Moheb ◽

Marziyeh Alivandi Vafa

Keyword(s):

Cognitive Therapy ◽

Analysis Of Covariance ◽

Control Group ◽

Double Blind Study ◽

University Counseling Center ◽

Double Blind ◽

University Counseling ◽

Acceptance And Commitment ◽

Marital Infidelity ◽

The Mean

Introduction: The aim of current paper was to compare the effectiveness of acceptance and commitment group therapy (ACT) and group cognitive therapy (GCT) on Alexithymia and marital boredom (MB) among women affected by marital infidelity in Mashhad. Method: This clinical trial was a double- blind study with a pretest-posttest design in which two intervention groups and one control group were investigated. The study performed on women who realized their spouse infidelity and referred to Azad University Counseling Center in Mashhad in 2018. The sample consisted of 30 women who were selected by purposive sampling and were randomly assigned to two intervention groups and a control group (n=10 per group). The intervention groups were put under ACT training (twelve 90-minute sessions) and GCT training (twelve 90-minute sessions), but the control group did not receive any intervention. Data was obtained by the Toronto Alexithymia Scale-20 and Pines Marital Boredom Scale and was analyzed by multivariate analysis of covariance with SPSS (version 22) software. Results: The results showed a significant reduction in the mean score of MB in the ACT group, also there was a significant reduction in the mean score of Alexithymia in the GCT group (P <0.05). So comparing both therapies, ACT was more influential on reducing marital boredom whereas GCT was more effective on reducing alexithymia. Conclusion: Although both intervention methods were effective on Alexithymia and Marital Boredom in women affected by marital infidelity, it was demonstrated that ACT and GCT have more effect on Marital Boredom and Alexithymia, respectively.

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Addition of Epinephrine to Intrathecal Bupivacaine and Sufentanil for Ambulatory Labor Analgesia

Anesthesiology ◽

10.1097/00000542-199703000-00003 ◽

1997 ◽

Vol 86 (3) ◽

pp. 525-531 ◽

Cited By ~ 59

Author(s):

David C. Campbell ◽

Robert Banner ◽

Lesley-Ann Crone ◽

Wendy Gore-Hickman ◽

Ray W. Yip

Keyword(s):

Labor Analgesia ◽

Saline Control ◽

Control Group ◽

Double Blind Study ◽

Saline Control Group ◽

Double Blind ◽

Prolonged Labor ◽

Intrathecal Analgesia ◽

Limited Duration ◽

Effective Analgesia

Background The intrathecal combination of sufentanil and bupivacaine provides rapid, effective analgesia for labor with a limited duration. Many anesthesiologists have concerns that the use of intrathecal local anesthetics precludes maternal ambulation. This prospective, randomized, double-blind study was designed to determine whether the addition of epinephrine to the combination of sufentanil and bupivacaine would prolong intrathecal analgesia for labor. Patients' ability to ambulate was also assessed. Methods Thirty-nine patients received either an intrathecal control dose of 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml normal saline (control group); or 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml (0.2 mg) of epinephrine (EPI group). Results Seven patients (3 control, 4 EPI) delivered vaginally and two (1 control, 1 EPI) required cesarean delivery before requesting epidural analgesia. The duration (mean +/- SD) of intrathecal labor analgesia was prolonged significantly by the addition of epinephrine: control (n = 15): 145 +/- 23 min; EPI (n = 15): 188 +/- 25 min (P < 0.0001). Maternal ambulation was demonstrated in 100% (19 of 19) of the control group and in 80% (16 of 20) of the EPI group (P = NS). Conclusions The addition of 0.2 mg epinephrine to the intrathecal combination of sufentanil and bupivacaine significantly prolonged labor analgesia without causing adverse effects to the mother or fetus. The intrathecal combination of sufentanil and bupivacaine, with or without epinephrine, provided rapid, profound labor analgesia and allowed most patients to ambulate.

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Intracavitary anaesthesia for medical thoracoscopy procedural pain: the CAMP randomised trial

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00091-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ahmed Mohamed Abdelhady ◽

Mohamed Gadallah ◽

Moustafa Shaheen ◽

Sahar Mourad ◽

Maged Hassan

Keyword(s):

Pain Score ◽

Chest Tube ◽

Randomised Trial ◽

Study Groups ◽

Procedural Pain ◽

Control Group ◽

Clinical Trial Registry ◽

Double Blind ◽

Lidocaine Group ◽

Medical Thoracoscopy

Abstract Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot study reported reduction in procedural pain with lidocaine application via chest tube before procedure. This study aimed at assessing the extent of effect of intrapleural lidocaine on pain during MT in a double-blind randomised trial. Results Thirty patients (mean age 48.3 years) were recruited, 14 randomised to the lidocaine group and 16 to the saline group. In four patients (two from each group), chest tube insertion prior to MT failed, and they were excluded from the final analysis. The mean (SD) visual analogue scale (VAS) pain score during procedure was 49 ± 33.2 for the lidocaine group and 57.4 ± 27.6 for the control group (mean difference − 8.4 points, p = 0.49). The VAS pain score as assessed by operator was 45.6 ± 19.8 for the lidocaine group and 46.6 ± 29.8 for the control group (p = 0.97). There was no difference in the VAS pain score at 120 min post MT or in the doses of sedatives used during procedure between the study groups. Conclusion ICA for MT does not seem to improve procedural pain as suggested by previous studies. Trial registration The study has been registered with the Pan African Clinical Trial Registry (PACTR202008762D159889).

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Prophylactic Intramuscular Ephedrine Prior to Caesarean Section

Anaesthesia and Intensive Care ◽

10.1177/0310057x9202000408 ◽

1992 ◽

Vol 20 (4) ◽

pp. 448-452 ◽

Cited By ~ 29

Author(s):

C. C. Rout ◽

D. A. Rocke ◽

R. Brijball ◽

R. V. Koovarjee

Keyword(s):

Caesarean Section ◽

General Anaesthesia ◽

Control Group ◽

Double Blind Study ◽

Double Blind ◽

Maximum Increase ◽

Arterial Ph ◽

Maternal Hypertension ◽

Acid Base Status ◽

Umbilical Arterial Ph

Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4–38.3%). Maternal pH was significantly lower (P = 0.03) in the ephedrine 50 mg group. Neonatal acid base status was significantly impaired in the ephedrine 50 mg group with umbilical venous pH (P = 0.0001) and umbilical arterial pH (P = 0.001) being significantly lower than the control group. The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.

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