Preemptive Analgesic Effects of Ketorolac in Ankle Fracture Surgery

2001 ◽  
Vol 94 (4) ◽  
pp. 599-603 ◽  
Author(s):  
Peter H. Norman ◽  
M. Denise Daley ◽  
Ronald W. Lindsey
Keyword(s):  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Ankle Fracture ◽  
Postoperative Bleeding ◽  
Patient Controlled Analgesia ◽  
Analog Scale ◽  
Analgesic Effects ◽  
Intergroup Comparison ◽  
Fracture Surgery ◽  
Tourniquet Inflation

Background Preemptive analgesia has been difficult to show in human experiments. If ketorolac has preemptive effects, then there may be an advantage to administering it at the beginning of surgery despite the potential for increased blood loss. Methods The authors performed a randomized, double-blind, controlled trial of 48 patients scheduled for ankle fracture surgery in a county trauma hospital. Anesthesia management was standardized and included adequate opioid analgesia (5 microg/kg fentanyl and 0.1 mg/kg morphine). Intravenous 30 mg ketorolac was administered to 23 patients before tourniquet inflation and to 25 patients after tourniquet inflation. Visual analog scale pain scores, morphine patient-controlled analgesia consumption, nausea-vomiting, and postoperative bleeding were measured. Results The 23 patients given ketorolac before tourniquet inflation had no increase in pain postoperatively compared with their preoperative baseline (P = 0.280). The 25 patients who received ketorolac minutes later after tourniquet inflation had significant increases in their postoperative pain compared with their preoperative baseline (P = 0.00116). This effect was short-lived, and by 6 h the pain score in this group was not significantly more than it was preoperatively. Intergroup comparison showed a lower visual analog scale score at 2 (P = 0.0203) and 4 h (P = 0.00549) in the preemptive group and lower nausea scores at hour 6 (P = 0.00704). There was no difference in patient-controlled analgesia consumption between groups. Conclusions Intravenous 30 mg ketorolac appears to have preemptive analgesic effects in patients undergoing ankle fracture repair. Ketorolac administered before tourniquet inflation prevents postoperative pain being perceived as more intense than preoperative pain.

scholarly journals Patients' Perceptions Regarding Microimplant as Anchorage in Orthodontics

2008 ◽  
Vol 78 (2) ◽  
pp. 228-233 ◽  
Author(s):  
Tony C. K. Lee ◽  
Colman P. J. McGrath ◽  
Ricky W. K. Wong ◽  
A. Bakr M. Rabie
Keyword(s):  
Postoperative Pain ◽  
Family Member ◽  
Visual Analog Scale ◽  
Orthodontic Treatment ◽  
Tooth Extraction ◽  
Area Under The Curve ◽  
Analog Scale ◽  
Structured Questionnaire

Abstract Objective: To determine patients' expectations, acceptance, and experience of pain with microimplant surgery compared to other orthodontic procedures. Materials and Methods: Seventy-eight microimplants were placed in 37 patients as an anchorage unit for orthodontic treatment. Patients were asked to rate anticipated pain and pain experienced with various orthodontic procedures (tooth extraction, insertion of separators, initial tooth alignment, and microimplant surgery) on a visual analog scale (VAS) over a 7-day period. One month after insertion of microimplants, patients were asked to rate their acceptance of the procedure using a structured questionnaire. Results: Unlike other orthodontic procedures, patients expected to experience a significantly higher level of pain with microimplant surgery than they experienced (P < .001). The postoperative pain experienced decreased continuously from day 1 to day 7 for all orthodontic procedures (P < .05). The total area under the curve (AUC) of pain experienced over the 7-day period was significantly larger for initial tooth alignment than for microimplant surgery (P < .05). Most patients were satisfied with the microimplant surgery (76%) and would recommend it to a friend or family member (78%). Conclusions: Patients tended to overestimate the pain anticipated with microimplant surgery. Patients were accepting of the surgery and would recommend it to others.

The Visual Analog Scale for Pain

2001 ◽  
Vol 95 (6) ◽  
pp. 1356-1361 ◽  
Author(s):  
Carol A. Bodian ◽  
Gordon Freedman ◽  
Sabera Hossain ◽  
James B. Eisenkraft ◽  
Yaakov Beilin
Keyword(s):  
Visual Analog Scale ◽  
Outcome Measure ◽  
Patient Controlled Analgesia ◽  
Analog Scale ◽  
Full Spectrum ◽  
Vas Score ◽  
Vas Scores ◽  
Relevant Outcome ◽  
Apparent Influence ◽  
Research Studies

Background The visual analog scale is widely used in research studies, but its connection with clinical experience outside the research setting and the best way to administer the VAS forms are not well established. This study defines changes in dosing of intravenous patient-controlled analgesia as a clinically relevant outcome and compares it with VAS measures of postoperative pain. Methods Visual analog scale measurements were obtained from 150 patients on the morning after intraabdominal surgery. On the same afternoon, 50 of the patients provided a VAS score on the same form used in the morning, 50 on a new form, and 50 were not asked for a second VAS measurement. Results Visual analog scale values and changes in value were similar for patients who were given a new VAS form in the afternoon and those who used the form that showed the morning value. The proportions of patients requesting additional analgesia were 4, 43, and 80%, corresponding to afternoon VAS scores of 30 or less, 31-70, and greater than 70, respectively. Change from morning VAS score had no apparent influence on patient-controlled analgesic dosing for patients with afternoon values of 30 or less or greater than 70, but changes in VAS scores of at least 10 did discriminate among patients whose afternoon values were between 31 and 70. Conclusions When pain is an outcome measure in research studies, grouping final VAS scores into a small number of categories provides greater clinical relevance for comparisons than using the full spectrum of measured values or changes in value. Seeing an earlier VAS form has no apparent influence on later values.

scholarly journals Effect of Addition of Dexamethasone or Clonidine to Ropivacaine on Postoperative Analgesia in Ultrasonography Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair: A Prospective Double Blind Randomized Control Trial

2020 ◽  
Vol 5 (1) ◽  
pp. 74-77
Author(s):  
Sweta Bharadiya ◽  
Neelam Meena ◽  
Ram Nivas ◽  
R.K. Solanki
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Visual Analog Scale ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Analog Scale ◽  
Rescue Analgesia

Background: A hernia repair surgery commonly induces moderate to severe postoperative pain for 48 hours. Aim of the study was to compare 0.5% Ropivacaine with dexamethasone and 0.5% Ropivacaine with clonidine for ultrasonography guided transversus abdominis plane (TAP) block as post-operative analgesia in patients undergoing Inguinal hernia repair surgery.Subjects and Methods:A randomized prospective controlled clinical study was conducted in 64 patients undergoing Inguinal Herneoplasty. Participants were divided into two groups in which group RD (n=32) received 0.5% Ropivavacaine with Dexamethasone 8mg and those in group RC (n=32) received 0.5% Ropivacaine with Clonidine 75mcg as USG guided TAP block at the end of surgery. The postoperative pain was evaluated by visual analog scale (VAS) for pain scoring at every 2 hours for 24 hours postoperatively. Subjective assessment of duration of analgesia was done.Results:Time to first rescue analgesia was significantly less in group RC (424.53±34.13) compared to group RD (616.09±31.36min) (P < 0.001). Total tramadol consumed in 24 h was significantly higher in group RC than group RD (P < 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group RC than group RD at 6h, 8 h and 12 h postoperatively.Conclusion:TAP block is a safe and effective way of relieving postoperative pain in inguinal herneoplasty patients. Addition of dexamethasone to Ropivacaine significantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine addition.

scholarly journals Harmonic scalpel® hemorrhoidectomy: A painless procedure?

2007 ◽  
Vol 60 (9-10) ◽  
pp. 421-426 ◽  
Author(s):  
Dejan Ivanov ◽  
Sinisa Babovic ◽  
Dora Selesi ◽  
Mirjana Ivanov ◽  
Radovan Cvijanovic
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Surgical Approach ◽  
Surgical Procedure ◽  
Thermal Damage ◽  
Harmonic Scalpel ◽  
Hemorrhoidal Disease ◽  
Disease Stage ◽  
Analog Scale

Since the surgical treatment of hemorrhoidal disease has been characterized by intense postoperative pain, recent studies have tried to modify the standard Milligan-Morgans technique. The up-to-date literature, in the experience of authors, has confirmed that the new method of Harmonic Scalpel? hemorrhoidectomy reduces postoperative pain. The aim of our study was to statistically evaluate, based on our experience, the efficacy of this surgical approach in terms of reducing postoperative pain and establishing a stable hemostasis. Seventy-seven (77) patients suffering from hemorrhoid disease, stage III and IV, underwent surgery in our clinic during the last five years. The postoperative pain was determined using the visual analog scale on the 1st, 2nd and 7th postoperative days. Patients were divided into two groups in regard to the surgical procedure applied. The data were statistically processed using the Statistica 7.0 software. We concluded that Harmonic Scalpel? hemorrhoidectomy, due to less thermal damage, statistically significantly reduced postoperative pain with better hemostasis, compared with Milligan-Morgan's method of treating hemorrhoidal disease. .

Pharmacokinetics and Analgesic Effect of Ropivacaine during Continuous Epidural Infusion for Postoperative Pain Relief

1996 ◽  
Vol 84 (4) ◽  
pp. 834-842. ◽  
Author(s):  
Carl-Johan Erichsen ◽  
Jan Sjovall ◽  
Henrik Kehlet ◽  
Cecilia Hedlund ◽  
Torbjorn Arvidsson
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Epidural Infusion ◽  
Postoperative Pain Relief ◽  
Total Plasma ◽  
Analog Scale ◽  
Continuous Epidural Infusion ◽  
Unbound Fraction

Background The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. Methods Through an epidural catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion was followed up to the end of infusion. Postoperative pain at rest, on coughing, and at mobilization was assessed by means of a visual analog scale 2,4,6,8,12, and 24 h after the end of surgery. Sensory (pinprick) and motor block (modified Bromage scale) were assessed at the same intervals. Results The total plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional to the infusion rate. The total and unbound plasma clearance was independent of dose. Total mean clearance decreased on average by 21% (P &lt; 0.001) during the last 12 h of epidural infusion, i.e., from 539 +/- 191 ml/min to 418 +/- 138 ml/min, indicating time-dependent kinetics. The unbound clearance also varied between estimates after 8 h of infusion and the end of treatment, i.e., a 5.3% decrease from 10.4 +/- 5.3 l/min to 9.5 +/- 3.9 l/min (P &lt; 0.05). The unbound fraction of ropivacaine in plasma decreased during treatment, and this was related to the increase in alpha1-acid glycoprotein concentration. Pain was generally well controlled, and median visual analog scale scores during mobilization were less than 30 mm in patients receiving ropivacaine at 20 mg/h. Conclusions The pharmacokinetics of ropivacaine were independent of dose, but total clearance decreased with time over 24 h. The consistent increase in total plasma concentration during the postoperative epidural infusion contrasted to much less variation in the unbound plasma concentrations of ropivacaine.

Continuous Interscalene Analgesia with Ropivacaine 2 mg/ml after Major Shoulder Surgery

2003 ◽  
Vol 98 (1) ◽  
pp. 143-150 ◽  
Author(s):  
Georgios Ekatodramis ◽  
Alain Borgeat ◽  
Gunilla Huledal ◽  
Lennart Jeppsson ◽  
Lars Westman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Plasma Concentrations ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Postoperative Pain Relief ◽  
Analog Scale ◽  
Threshold Levels ◽  
Continuous Interscalene

Background In this open, randomized study, the pharmacokinetics, clinical efficacy, and safety of a 48-h continuous interscalene infusion of 2 mg/ml ropivacaine for postoperative pain relief were investigated in patients undergoing open major shoulder surgery. Methods An initial interscalene block with 30 ml ropivacaine, 7.5 mg/ml (225 mg), was performed. After completion of interscalene block, all patients (n = 24) received general anesthesia, and 6 h after interscalene block, a 48-h continuous interscalene infusion of 12 or 18 mg/h using 2 mg/ml ropivacaine was started. Total and unbound plasma concentrations of ropivacaine and 2.6-pipecoloxylidide (PPX; a major active metabolite) were determined during and up to 6 h after the interscalene infusion. Postoperative pain at rest was assessed by a visual analog scale. Supplementary analgesics and adverse events were recorded. Results Plasma concentrations of total and unbound ropivacaine were proportional to the total dose. At the end of the interscalene infusion of 9 ml/h, the mean +/- SD plasma concentrations of total and unbound ropivacaine were 1.40 +/- 0.54 and 0.03 +/- 0.01 mg/l, respectively, and of total and unbound PPX were 0.70 +/- 0.38 and 0.30 +/- 0.20 mg/l, respectively. Plasma concentrations of unbound ropivacaine and unbound PPX, added together, remained well below threshold levels for systemic central nervous system toxicity. There were no significant differences between the groups for postoperative pain (median maximum of about 20 mm on the visual analog scale in both groups), analgesic consumption, or quality of pain relief assessed by the patient. No signs or symptoms of systemic local anesthetic toxicity were observed. Conclusion A 48-h continuous interscalene infusion of 6 or 9 ml/h ropivacaine, 2 mg/ml, started 6 h after an initial interscalene block of 30 ml ropivacaine, 7.5 mg/ml, provided satisfactory postoperative pain relief after major shoulder surgery and was well tolerated. Unbound plasma concentrations of ropivacaine and PPX remained well below threshold levels for systemic central nervous toxicity.

scholarly journals Local Infiltration Analgesia with Ropivacaine Improves Postoperative Pain Control in Ankle Fracture Patients: A Retrospective Cohort Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Bao-Liang Li ◽  
Xizhe Liu ◽  
Lihua Cui ◽  
Wenqian Zhang ◽  
Hui Pang ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Ankle Fracture ◽  
Retrospective Cohort ◽  
Wound Complications ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Superficial Wound ◽  
Vas Scores ◽  
Fracture Surgery ◽  
Infiltration Analgesia

Purpose. The study aimed at investigating the effect of local infiltration analgesia (LIA) with ropivacaine on postoperative analgesia for patients undergoing ankle fracture surgery. Methods. Consecutive patients were retrospectively included and analysed according to their medical records from July 2014 to August 2018 in a tertiary hospital. Inclusion criteria were patients undergoing open reduction and internal fixation (ORIF) for ankle fractures under general anaesthesia. Moreover, patients should have received intravenous patient-controlled analgesia (iPCA) or LIA + iPCA for postoperative pain relief. The primary outcome indicator was visual analogue scale (VAS) from 8 hours to 48 hours after surgery. Secondary outcomes included postoperative opioid requirement, need for rescue medication, opioid-related adverse effects, and wound complications. Results. In total, 89 consecutive patients were included in the study. There were 48 males and 41 females. The average age was 44.6 ± 7.0 years, and VAS scores were significantly lower in the LIA + iPCA group at 8 hours after surgery (1.51 ± 0.58 cm vs 4.77 ± 1.83 cm, p<0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p<0.001), and the number of patients who need tramadol was lower in the LIA + iPCA group (18 vs 26, p=0.04). There was a statistically significant reduction in morphine consumption (25.1 ± 6.3 mg vs 73.4 ± 8.2 mg, p<0.001) and opioid-related side effects in the LIA + iPCA group (4 vs 10, p=0.023). No major wound complications were noted in either group. However, there were 2 cases with superficial wound necrosis in group LIA + iPCA and 3 patients with superficial wound necrosis in group iPCA, and all cured by local wound care. Conclusions. The retrospective cohort study indicates that LIA with ropivacaine can provide better early postoperative pain management with a reduction of VAS scores for ankle fracture surgery. Patients receiving wound infiltration also experience decreased opioid consumption, a lower rate of analgesia-related side effects, and comparable wound complication rate.

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