scholarly journals The ALOHA trial: (intra-articular local anaesthetic in hip arthroscopy)—a three-arm randomized trial comparing pre-emptive, high- and low-dose intra-articular local anaesthetic in hip arthroscopy

2021 ◽  
Author(s):  
Chong O Tan ◽  
Phong Tran ◽  
Yew Ming Chong ◽  
William Howard ◽  
Laurence Weinberg
Keyword(s):  
Local Anaesthetic ◽  
Hip Arthroscopy ◽  
Recovery Room ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Multimodal Analgesia ◽  
Visual Analogue Scale Pain ◽  
Optimum Dose ◽  
High Dose ◽  
Pain Scores

Abstract Pain after hip arthroscopy is variable and can be severe despite multimodal analgesia. Intra-articular local anaesthetic (IALA) may reduce acute postoperative pain after hip arthroscopy. However, neither its optimum dose nor timing of administration have been systematically evaluated. In 132 patients, a double-blinded, three-arm randomized controlled trial comparing IALA used during hip arthroscopy was conducted comparing 100 mg ropivacaine given at the end of the procedure (Group L, lose dose), 200 mg ropivacaine at the end of the procedure (Group H, high dose) and 100 mg of ropivacaine given at the beginning and end of the procedure (Group P, pre-emptive). There were no statistically significant differences between the three groups for Numerical Rating Scale-11 pain scores in the recovery room [mean (standard deviation): Group L—2.2 (1.9); Group H—2.3 (2.1); Group P—2.7 (2.5); lowest P = 0.6], or post-recovery room Visual Analogue Scale pain scores at 2, 4 and 6 h. There were also no significant differences in antiemetic usage and requirement for rescue fascia iliaca blockade between the three groups. Compared to a single 100 mg dose of ropivacaine at the end of the procedure, we were unable to demonstrate any advantage of either a higher dose IALA or a pre-emptive dose IALA when multimodal analgesia is used.

scholarly journals The ALOHA Trial: (Intra-Articular Local Anaesthetic in Hip Arthroscopy) – A Double-Blinded, 3-Arm Randomised Controlled Clinical Trial Comparing Pre-Emptive, High- and Low-Dose Intra-Articular Local Anaesthetic in Hip Arthroscopy

2019 ◽  
Author(s):  
Chong Oon Tan ◽  
Phong Tran ◽  
YewMing Chong ◽  
William Howard ◽  
Laurence Weinberg
Keyword(s):  
Local Anaesthetic ◽  
Hip Arthroscopy ◽  
Low Dose ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Multimodal Analgesia ◽  
Optimum Dose ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
Pain Scores

Abstract Background Pain after hip arthroscopy is variable but can be severe [11-point Numerical Rating Scale (NRS-11) pain scores of 10] despite multimodal analgesia. Although postoperative rescue regional analgesia is useful in these cases its efficacy may be limited by the maximum safe dose of local anaesthetic (LA) permissible when high-dose intra-articular local anaesthetic (IALA) has already been used. IALA may reduce acute postoperative pain after hip arthroscopy, however neither its optimum dose nor timing of administration have been systematically evaluated. Methods In 132 randomly assigned adult patients scheduled for therapeutic hip arthroscopy we compared the effects of two different doses of IALA given at procedure end (Group L [low-dose]: 100mg ropivacaine; Group H [high-dose]: 200mg ropivacaine). We also investigated the effect of an additional pre-emptive dose at the beginning of the procedure (Group P [pre-emptive]: 100mg ropivacaine at procedure start and end). Results There were no statistically significant differences between groups for NRS-11 pain scores in recovery (mean[SD]: Group L – 2.2[1.9]; Group H – 2.3[2.1]; Group P – 2.7[2.5]; lowest p = 0.6), or post recovery Visual Analogue Scale (VAS) pain scores [largest mean difference VAS 1.5 hours: 5mm (p = 0.32); VAS 2 hours: 5mm (p = 0.35); VAS 4 hours: 2mm (p = 0.7); VAS 6 hours: 3mm (p = 0.7)]. There were also no significant differences in antiemetic usage and requirement for rescue fascia iliaca block (FIB) between groups. Conclusions Compared to a single 100 mg dose of ropivacaine at the end of the procedure, we were unable to demonstrate any advantage of either a higher dose IALA or a pre-emptive dose IALA when multimodal analgesia is used. Lower-dose IALA could reduce total systemic LA absorption if a given rescue regional analgesic LA dose is used postoperatively.

scholarly journals Intrathecal Morphine versus Intrathecal Hydromorphone for Analgesia after Cesarean Delivery

2020 ◽  
Vol 132 (6) ◽  
pp. 1382-1391 ◽  
Author(s):  
Emily E. Sharpe ◽  
Rochelle J. Molitor ◽  
Katherine W. Arendt ◽  
Vanessa E. Torbenson ◽  
David A. Olsen ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intrathecal Morphine ◽  
Oral Morphine ◽  
Multimodal Analgesia ◽  
Rank Test ◽  
Pain Scores ◽  
Analgesic Regimen ◽  
Significant Difference

Abstract Background Intrathecal opioids are routinely administered during spinal anesthesia for postcesarean analgesia. The effectiveness of intrathecal morphine for postcesarean analgesia is well established, and the use of intrathecal hydromorphone is growing. No prospective studies have compared the effectiveness of equipotent doses of intrathecal morphine versus intrathecal hydromorphone as part of a multimodal analgesic regimen for postcesarean analgesia. The authors hypothesized that intrathecal morphine would result in superior analgesia compared with intrathecal hydromorphone 24 h after delivery. Methods In this single-center, double-blinded, randomized trial, 138 parturients undergoing scheduled cesarean delivery were randomized to receive 150 µg of intrathecal morphine or 75 µg of intrathecal hydromorphone as part of a primary spinal anesthetic and multimodal analgesic regimen; 134 parturients were included in the analysis. The primary outcome was the numerical rating scale score for pain with movement 24 h after delivery. Static and dynamic pain scores, nausea, pruritus, degree of sedation, and patient satisfaction were assessed every 6 h for 36 h postpartum. Total opioid consumption was recorded. Results There was no significant difference in pain scores with movement at 24 h (intrathecal hydromorphone median [25th, 75th] 4 [3, 5] and intrathecal morphine 3 [2, 4.5]) or at any time point (estimated difference, 0.5; 95% CI, 0 to 1; P = 0.139). Opioid received in the first 24 h did not differ between groups (median [25th, 75th] oral morphine milligram equivalents for intrathecal hydromorphone 30 [7.5, 45.06] vs. intrathecal morphine 22.5 [14.0, 37.5], P = 0.769). From Kaplan–Meier analysis, the median time to first opioid request was 5.4 h for hydromorphone and 12.1 h for morphine (log-rank test P = 0.200). Conclusions Although the hypothesis was that intrathecal morphine would provide superior analgesia to intrathecal hydromorphone, the results did not confirm this. At the doses studied, both intrathecal morphine and intrathecal hydromorphone provide effective postcesarean analgesia when combined with a multimodal analgesia regimen. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

2015 ◽  
Vol 41 (3) ◽  
pp. 322-327 ◽  
Author(s):  
J. K. Thillemann ◽  
T. M. Thillemann ◽  
B. Munk ◽  
K. Krøner
Keyword(s):  
Rating Scale ◽  
Revision Rate ◽  
Numerical Rating Scale ◽  
Elevated Serum ◽  
Consecutive Series ◽  
Dash Score ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

scholarly journals Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Richard Mwase ◽  
Tonny Stone Luggya ◽  
John Mark Kasumba ◽  
Humphrey Wanzira ◽  
Andrew Kintu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Mulago Hospital ◽  
Clinical Trial Registry ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Intravenous Ketamine

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects.Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.”Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group.Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry numberPACTR201404000807178.

Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness

2018 ◽  
Vol 129 (3) ◽  
pp. 536-543 ◽  
Author(s):  
Matthias Behrends ◽  
Edward N. Yap ◽  
Alan L. Zhang ◽  
Kerstin Kolodzie ◽  
Sakura Kinjo ◽  
...  
Keyword(s):  
Placebo Group ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Recovery Room ◽  
Study Endpoint ◽  
Block Group ◽  
Opioid Use ◽  
Quadriceps Weakness ◽  
Pain Scores ◽  
Fascia Iliaca Block

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Ambulatory hip arthroscopy is associated with postoperative pain routinely requiring opioid analgesia. The potential role of peripheral nerve blocks for pain control after hip arthroscopy is controversial. This trial investigated whether a preoperative fascia iliaca block improves postoperative analgesia. Methods In a prospective, double-blinded trial, 80 patients scheduled for hip arthroscopy were randomized to receive a preoperative fascia iliaca block with 40 ml ropivacaine 0.2% or saline. Patients also received an intraarticular injection of 10-ml ropivacaine 0.2% at procedure end. Primary study endpoint was highest pain score reported in the recovery room; other study endpoints were pain scores and opioid use 24 h after surgery. Additionally, quadriceps strength was measured to identify leg weakness. Results The analysis included 78 patients. Highest pain scores in the recovery room were similar in the block group (6 ± 2) versus placebo group (7 ± 2), difference: −0.2 (95% CI, −1.1 to 0.7), as was opioid use (intravenous morphine equivalent dose: 15 ± 7mg [block] vs. 16 ± 9 mg [placebo]). Once discharged home, patients experienced similar pain and opioid use (13 ± 7 mg [block] vs. 12 ± 8 mg [placebo]) in the 24 h after surgery. The fascia iliaca block resulted in noticeable quadriceps weakness. There were four postoperative falls in the block group versus one fall in the placebo group. Conclusions Preoperative fascia iliaca blockade in addition to intraarticular local anesthetic injection did not improve pain control after hip arthroscopy but did result in quadriceps weakness, which may contribute to an increased fall risk. Routine use of this block cannot be recommended in this patient population.

Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study

2012 ◽  
Vol 16 (2) ◽  
pp. 101-106 ◽  
Author(s):  
Despoina Kakagia ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
Gregory Trypsiannis ◽  
Christos Iatrou
Keyword(s):  
Injection Site ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Demographic Data ◽  
Randomized Study ◽  
Cutaneous Lesions ◽  
Double Blind ◽  
Lidocaine Group ◽  
Pain Scores

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

scholarly journals Evaluation of Pain Management after Surgery: An Observational Study

Medicina ◽  
2020 ◽  
Vol 56 (2) ◽  
pp. 65
Author(s):  
Regina Sierżantowicz ◽  
Jolanta Lewko ◽  
Dorota Bitiucka ◽  
Karolina Lewko ◽  
Bianka Misiak ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Perception ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Multimodal Analgesia ◽  
World Health ◽  
Endocrine Surgery ◽  
Who Analgesic Ladder ◽  
Frequent Use ◽  
Health Organization

Background and Objectives: Choosing a pain management strategy is essential for improving recovery after surgery. Effective pain management reduces the stress response, facilitates mobilization, and improves the quality of the postoperative period. The aim of the study was to assess the effectiveness of pain management in patients after surgery. Materials and Methods: The study included 216 patients operated on in the following surgical wards: the Department of Cardiosurgery and the Department of General and Endocrine Surgery. Patients were hospitalized on average for 6 ± 4.5 days. Patients were randomly selected for the study using a questionnaire technique with a numerical rating scale. Results: Immediately after surgery, pre-emptive analgesia, multimodal analgesia, and analgosedation were used significantly more frequently than other methods (p < 0.001). In the subsequent postoperative days, the method of administering drugs on demand was used most often. Patients with confirmed complications during postoperative wound healing required significantly more frequent use of drugs from Steps 2 and 3 of the World Health Organization (WHO) analgesic ladder compared with patients without complications. Conclusion: The mode of patient admission for surgery significantly affected the level of pain perception. Different pain management methods were used and not every method was effective.

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