Patient-controlled Regional Analgesia (PCRA) at Home

2002 ◽  
Vol 96 (6) ◽  
pp. 1290-1296 ◽  
Author(s):  
Narinder Rawal ◽  
Renée Allvin ◽  
Kjell Axelsson ◽  
Jan Hallén ◽  
Gustav Ekbäck ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Local Anesthetic ◽  
Analgesic Efficacy ◽  
Hand Surgery ◽  
Telephone Call ◽  
Analog Scale ◽  
Regional Analgesia ◽  
Blinded Study ◽  
Double Blinded

Background The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. Methods Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery. Results Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection. Conclusions This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.

Clinical Significance of Invasive Motor Cortex Stimulation for Trigeminal Facial Neuropathic Pain Syndromes

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 655-666 ◽  
Author(s):  
Dirk Rasche ◽  
Volker M. Tronnier
Keyword(s):  
Neuropathic Pain ◽  
Motor Cortex ◽  
Test Trial ◽  
Visual Analog Scale ◽  
False Positive ◽  
Motor Cortex Stimulation ◽  
Analog Scale ◽  
Pain Syndromes ◽  
Double Blinded

Abstract BACKGROUND: Invasive neuromodulation of the cortical surface for various chronic pain syndromes has been performed for >20 years. The significance of motor cortex stimulation (MCS) in chronic trigeminal neuropathic pain (TNP) syndromes remains unclear. Different techniques are performed worldwide in regard to operative procedure, stimulation parameters, test trials, and implanted materials. OBJECTIVE: To present the clinical experiences of a single center with MCS, surgical approach, complications, and follow-up as a prospective, noncontrolled clinical trial. METHODS: The implantation of epidural leads over the motor cortex was performed via a burr hole technique with neuronavigation and intraoperative neurostimulation. Special focus was placed on a standardized test trial with an external stimulation device and the implementation of a double-blinded or placebo test phase to identify false-positive responders. RESULTS: A total of 36 patients with TNP were operated on, and MCS was performed. In 26 of the 36 patients (72%), a significant pain reduction from a mean of 8.11 to 4.58 (on the visual analog scale) during the test trial was achieved (P <.05). Six patients were identified as false-positive responders (17%). At the last available follow-up of 26 patients (mean, 5.6 years), active MCS led to a significant pain reduction compared with the preoperative pain ratings (mean visual analog scale score, 5.01; P <.05). CONCLUSION: MCS is an additional therapeutic option for patients with refractory chronic TNP, and significant long-term pain suppression can be achieved. Placebo or double-blinded testing is mandatory.

scholarly journals Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Rie Ishikawa ◽  
Masako Iseki ◽  
Rie Koga ◽  
Eiichi Inada
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Pain Intensity ◽  
Visual Analog Scale ◽  
Analog Scale ◽  
Paindetect Questionnaire ◽  
Relationship Of ◽  
The Relationship ◽  
Over Time

Postherpetic itch (PHI), or herpes zoster itch, is an intractable and poorly understood disease. We targeted 94 herpes zoster patients to investigate their pain and itch intensities at three separate stages of the condition (acute, subacute, and chronic). We used painDETECT questionnaire (PDQ) scores to investigate the correlation between PHI and neuropathic pain. Seventy-six patients were able to complete follow-up surveys. The prevalence of PHI was 47/76 (62%), 28/76 (37%), and 34/76 (45%) at the acute, subacute, and chronic stages, respectively. PHI manifestation times and patterns varied. We investigated the relationship of PHI with neuropathic pain using the visual analog scale (VAS), which is a measure of pain intensity, and the PDQ, which is a questionnaire used to evaluate the elements of neuropathic pain. The VAS and PDQ scores did not differ significantly between PHI-positive and PHI-negative patients. A large neuropathic component was not found for herpes zoster itch, suggesting that neuropathic pain treatments may not able to adequately control the itch. Accordingly, we suggest that a more PHI-focused therapy is required to address this condition.

Burst Spinal Cord Stimulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 986-990 ◽  
Author(s):  
Dirk De Ridder ◽  
Sven Vanneste ◽  
Mark Plazier ◽  
Elsa van der Loo ◽  
Tomas Menovsky
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Visual Analog Scale ◽  
Spinal Cord Stimulation ◽  
Short Form ◽  
Burst Stimulation ◽  
Analog Scale ◽  
Tonic Stimulation ◽  
Better Than

Abstract INTRODUCTION Spinal cord stimulation is commonly used for neuropathic pain modulation. The major side effect is the onset of paresthesia. The authors describe a new stimulation design that suppresses pain as well as, or even better than, the currently used stimulation, but without creating paresthesia. METHODS A spinal cord electrode (Lamitrode) for neuropathic pain was implanted in 12 patients via laminectomy: 4 at the C2 level and 7 at the T8–T9 level for cervicobrachialgia and lumboischialgia, respectively (1 at T11 at another center). During external stimulation, the patients received the classic tonic stimulation (40 or 50 Hz) and the new burst stimulation (40-Hz burst with 5 spikes at 500 Hz per burst). RESULTS Pain scores were measured using a visual analog scale and the McGill Short Form preoperatively and during tonic and burst stimulation. Paresthesia was scored as present or not present. Burst stimulation was significantly better for pain suppression, by both the visual analog scale score and the McGill Short Form score. Paresthesia was present in 92% of patients during tonic stimulation, and in only 17% during burst stimulation. Average follow-up was 20.5 months. CONCLUSION The authors present a new method of spinal cord stimulation using bursts that suppress neuropathic pain without the mandatory paresthesia. Pain suppression seems as good as or potentially better than that achieved with the currently used stimulation. Average follow-up after nearly 2 years (20.5 months) suggests that this stimulation design is stable.

In Revision Hip Arthroscopy, Labral Reconstruction Can Address a Deficient Labrum, but Labral Repair Retains Its Role for the Reparable Labrum: A Matched Control Study

2018 ◽  
Vol 46 (14) ◽  
pp. 3437-3445 ◽  
Author(s):  
Itay Perets ◽  
Danil Rybalko ◽  
Brian H. Mu ◽  
David R. Maldonado ◽  
Gary Edwards ◽  
...  
Keyword(s):  
Decision Making ◽  
Total Hip Arthroplasty ◽  
Visual Analog Scale ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Acetabular Labrum ◽  
Analog Scale ◽  
Total Hip

Background: Revision hip arthroscopy is increasingly common and often addresses acetabular labrum pathology. There is a lack of consensus on indications or outcomes of revision labral repair versus reconstruction. Purpose: To report clinical outcomes of labral reconstruction during revision hip arthroscopy at minimum 2-year follow-up as compared with pair-matched labral repair during revision hip arthroscopy (control group) and to suggest a decision-making algorithm for labral treatment in revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent revision hip arthroscopy with labral reconstruction were matched 1:2 with patients who underwent revision arthroscopic labral repair. Patients were matched according to age, sex, and body mass index. Outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score–Sport-Specific Subscale, and a visual analog scale for pain, were collected preoperatively and at minimum 2-year follow-up. At latest follow-up, patient satisfaction on a 0-10 scale and the abbreviated International Hip Outcome Tool (iHOT-12) were collected. Complications, subsequent arthroscopies, and conversion to total hip arthroplasty were collected as well. Results: A total of 15 revision labral reconstructions were pair matched to 30 revision labral repairs. The reconstructions had fewer isolated Seldes type I detachments ( P = .008) and lower postoperative lateral center-edge angle, but there were otherwise no significant differences in demographics, radiographics, intraoperative findings, or procedures. Both groups demonstrated significant improvements in all outcomes and visual analog scale at minimum 2-year follow-up. The revision repairs trended toward better preoperative scores: mHHS (mean ± SD: 59.3 ± 16.5 vs 54.2 ± 16.0), Non-Arthritic Hip Score (61.0 ± 16.7 vs 51.2 ± 17.6), Hip Outcome Score–Sport-Specific Subscale (39.6 ± 25.1 vs 30.5 ± 22.1), and visual analog scale (5.8 ± 1.8 vs 6.2 ± 2.2). At follow-up, the revision repair group had significantly higher mHHS (84.1 ± 14.8 vs 72.0 ± 18.3, P = .043) and iHOT-12 (72.2 ± 23.3 vs 49.0 ± 27.6, P = .023) scores than the reconstruction group. The magnitudes of pre- to postoperative improvement between the groups were comparable. The groups also had comparable rates of complications: 1 case of numbness in each group ( P > .999), subsequent arthroscopies (repair: n = 2, 6.5%; revision: n = 3, 20%; P = .150), and conversion to total hip arthroplasty (1 patient in each group, P > .999). Conclusion: Labral reconstruction safely and effectively treats irreparable labra in revision hip arthroscopy. However, labral repair is another treatment option for reparable labra, yielding similar magnitude of improvement. A proposed algorithm may assist in surgical decision making to achieve optimal outcomes based on the condition and history of each patient’s acetabular labrum.

scholarly journals Saddle Block for Transrectal Prostate Biopsy: A Comparison of the Analgesic Efficacy of 0.25% Bupivacaine and 0.375% Ropivacaine

2021 ◽  
Vol 7 (3) ◽  
pp. 292-301
Author(s):  
JO Bamigboye ◽  
SO Olateju ◽  
AF Faponle ◽  
AA Salako
Keyword(s):  
Prostate Biopsy ◽  
Statistical Significance ◽  
Analgesic Efficacy ◽  
Sensory Block ◽  
Hyperbaric Bupivacaine ◽  
Pain Scores ◽  
Blinded Study ◽  
Transrectal Prostate Biopsy ◽  
Group B ◽  
Double Blinded

Background: Prostate biopsy is a painful procedure, and the degree of pain is related to the number of core biopsies taken. Objective: To compare the analgesic properties of hyperbaric bupivacaine 0.25% with 0.375% ropivacaine for saddle block in transrectal prostate biopsy. Methods: This was a randomised double-blinded study. Eighty patients with indications for prostate biopsy presenting at the Day-Case Theatre in a Nigerian tertiary facility were randomised into two equal groups: B (Bupivacaine) and R (Ropivacaine). Group B received 1ml of 0.25% bupivacaine, while Group R received 1ml of 0.375% ropivacaine for saddle block, respectively. Pain assessment, home readiness, patients' satisfaction, and time to first analgesic request were assessed and compared between the two groups. Results: The Bupivacaine group had an earlier onset of sensory block (11.90±4.10 minutes vs 23.70±8.65 minutes, p = 0.000), slower sensory block regression (48.73±9.32 minutes vs 24.88±4.21 minutes, p = 0.000), but delayed home readiness (47.23±15.93 minutes vs 29.88±8.58 minutes, p = 0.000), than patients in the Ropivacaine group. The pain scores during, immediately after and 30 minutes post-biopsy were lower in the Bupivacaine group: p = 0.010, p = 0.028 and p = 0.023 respectively. The time to first analgesic request was also longer in the Bupivacaine group (48.73±9.33 minutes) than for those in the Ropivacaine group (24.88±4.21 minutes) with statistical significance (p = 0.000). Conclusion: Intraoperative analgesic properties were better in the Bupivacaine group than in the Ropivacaine group. However, home readiness was earlier in the Ropivacaine group.

scholarly journals Analgesic Efficacy of Paracetamol in Children Using Tonsillectomy as a Pain Model

1996 ◽  
Vol 24 (6) ◽  
pp. 669-673 ◽  
Author(s):  
B. Anderson ◽  
S. Kanagasundarum ◽  
G. Woollard
Keyword(s):  
Pain Score ◽  
Venous Blood ◽  
Analgesic Efficacy ◽  
Temperature Plasma ◽  
Paracetamol Concentration ◽  
Blinded Study ◽  
Group A ◽  
Group B ◽  
Double Blinded ◽  
Induction Of Anaesthesia

The analgesic efficacy of paracetamol was assessed in a prospective, randomized, double-blinded study of 100 children undergoing tonsillectomy with or without adenoidectomy. Fifty children were given paracetamol elixir 40 mg/kg 40 minutes preoperatively (Group A); the remaining 50 children were given an oral placebo 40 minutes pre-operatively and paracetamol suppositories 40 mg/kg after induction of anaesthesia (Group B). Paracetamol was the only analgesic given and was given either orally or rectally in order to produce high variations in plasma paracetamol concentrations postoperatively. At 30 minutes after the end of surgery a pain score (0–10) was obtained and a venous blood sample was taken for serum paracetamol concentration analysis. Children given paracetamol elixir had a higher mean paracetamol concentration (0.15 [SD 0.06] mmol/l vs 0.05 [SD 0.03] mmol/l, P < 0.001) and a lower median pain score (5 vs 7, P < 0.02) than those who were given suppositories. The use of rescue morphine was higher (10 vs 23, P < 0.001) in the latter group. The incidence of nausea and vomiting was the same in both groups (20%) during the 24 hour postoperative period. Plasma paracetamol concentrations of 0.066–0.132 mmol/l are known to reduce temperature; plasma paracetamol concentrations which provide analgesia are unknown. Children with plasma paracetamol concentrations above 0.07 mmol/l had superior analgesia to those with concentrations below this level (P < 0.05).

scholarly journals Mid Term 5-Year Follow Up of a Novel Algorithm for Non-Operative Weber B Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Edward M Rooney ◽  
Fred T Finney ◽  
Paul Talusan ◽  
James R Holmes ◽  
David Walton
Keyword(s):  
Pain Score ◽  
Visual Analog Scale ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Ankle Arthritis ◽  
Analog Scale ◽  
Post Traumatic ◽  
Grading Scale ◽  
Novel Algorithm

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: It is important to understand which isolated fibular fractures require surgical intervention. Several different radiographic guidelines have been used to interpret and predict stability of the injured ankle. Holmes et al previously described a novel algorithm used to assess stability and the ability to treat the stable injuries non-operatively. The one year results demonstrated favorable outcomes of these non-operative patients, however there is a question about the durability of these results and whether these patients developed post-traumatic degenerative changes over mid to long term follow up. Methods: An observational study based on a previous cohort of 51 patients studied from 2010 to 2013 with isolated Weber B ankle fractures was performed. These were defined as stable at the time of injury when the medial clear space (MCS) was less than 7 mm on the initial gravity stress radiographs along with a normal mortise relationship on weight bearing radiographs. 27 patients that were treated non-surgically, were brought back for a mid-term follow up with a mean of 6.8 years. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot scores, Olerud-Molander Ankle (OMA) Score, and visual analog scale (VAS) pain score were collected in accordance with the prior study. Patient Reported Outcome Measurement Information System (PROMIS) scores were also collected including lower extremity, physical function, depression, and pain interference. Standing bilateral ankle radiographs were obtained, and assessed for MCS widening, and ankle arthritis using the Kellgren-Lawrence grading scale. Results: Average functional score results were (in comparison to 1-year outcomes): AOFAS Hindfoot, 95.7 (93.2); OMA Score, 95.2 (91.0); and visual analog scale pain score, 0.24 (0.57). Using a Wilcox Signed Ranks Test, there was a statistically significant increase in 5-year AOFAS Hindfoot scores as compared to 1-year scores in those same patients (p=0.005) There was no evidence of significant post-traumatic osteoarthritis based on the Kellgren-Lawrence grading scale. Conclusion: The previously described, novel at the time, algorithm for assessing stability of isolated Weber B ankle fractures and nonsurgical treatment with protected weight bearing has shown to produce excellent results for mid-term follow up with an average of 6.8 years. Additionally, these patients are not at increased risk for rapid progression of post-traumatic osteoarthritis. This further supports initial weight bearing radiographs as a reasonable assessment of ankle stability and validates the aforementioned algorithm as a safe and cost-effective functional treatment regimen.

Tramadol vs nalbuphine: analgesic efficacy and side effects. A prospective, randomized, double-blinded study in children.

2007 ◽  
Vol 24 (Supplement 39) ◽  
pp. 138-139 ◽  
Author(s):  
J. Ouaki ◽  
A. Rochette ◽  
O. Raux ◽  
Ch. Dadure ◽  
X. Capdevila
Keyword(s):  
Side Effects ◽  
Analgesic Efficacy ◽  
Blinded Study ◽  
Double Blinded

Total subaxial reconstruction

2010 ◽  
Vol 13 (4) ◽  
pp. 424-434 ◽  
Author(s):  
Vincent C. Traynelis
Keyword(s):  
Cervical Spine ◽  
Visual Analog Scale ◽  
Anterior Decompression ◽  
Analog Scale ◽  
Excellent Outcome ◽  
Arm Pain ◽  
Subaxial Cervical Spine ◽  
Pain Scores ◽  
The Mean

Object Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery. Methods The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression. Results There were 16 men and 11 women whose mean age was 59 years (range 35–86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2–7 surgery, and in all others the procedure crossed the cervicothoracic junction. Following surgery patients remained intubated for an average of 3.3 days (range 1–22 days). The mean hospital length of stay was 11 days (range 3–45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002). Conclusions Segmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.

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