Sex- and Age-related Differences in Morphine Requirements for Postoperative Pain Relief

2005 ◽  
Vol 103 (1) ◽  
pp. 156-160 ◽  
Author(s):  
Frédéric Aubrun ◽  
Nadège Salvi ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Body Weight ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Period ◽  
Large Population ◽  
Clinical Model ◽  
Vas Score ◽  
Age Related ◽  
Significant Difference ◽  
Intravenous Morphine

Background Sex-related differences in the perception of pain and susceptibility to opioids remain a matter of debate. Intravenous morphine titration used to obtain pain relief in the immediate postoperative period is a unique clinical model for assessing the effect of sex on reported pain. Because of the wide variation in dose requirements for pain management, the authors conducted a prospective study in a large population and also assessed the effect of aging. Methods Intravenous morphine titration was administered as a bolus of 2 (body weight <or= 60 kg) or 3 mg (body weight > 60 kg) during the immediate postoperative period. The interval between each bolus was 5 min. The visual analog pain scale (VAS) threshold required to administer morphine was 30, and pain relief was defined as a VAS score of 30 or less. Data are expressed as mean +/- SD. Results Data from 4,317 patients were analyzed; 54% of the patients were male, and 46% were female. The mean morphine dose required to obtain pain relief was 11.9 +/- 6.8 mg or 0.173 +/- 0.103 mg/kg. Women had a higher initial VAS score (74 +/- 19 vs. 71 +/- 19; P < 0.001) and required a greater dose of morphine (0.183 +/- 0.111 vs. 0.165 +/- 0.095 mg/kg; P < 0.001). In contrast, no significant difference was noted in elderly (aged > 75 yr) patients (0.163 +/- 0.083 vs. 0.157 +/- 0.085 mg/kg). Conclusion Women experienced more severe postoperative pain and required a greater dose (+11%) of morphine than men in the immediate postoperative period. This sex-related difference disappeared in elderly patients.

Relationships between Measurement of Pain Using Visual Analog Score and Morphine Requirements during Postoperative Intravenous Morphine Titration

2003 ◽  
Vol 98 (6) ◽  
pp. 1415-1421 ◽  
Author(s):  
Frédéric Aubrun ◽  
Olivier Langeron ◽  
Christophe Quesnel ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Body Weight ◽  
Pain Relief ◽  
Analog Scale ◽  
Morphine Dose ◽  
Vas Score ◽  
Score Threshold ◽  
Intravenous Morphine ◽  
Sigmoid Curve ◽  
The Mean ◽  
The Relationship

Background Although intravenous morphine titration is widely used to obtain rapid and complete postoperative pain relief, the relationship between measurement of pain and morphine requirements varies, and the evolution of pain during titration is poorly understood. Methods Intravenous morphine titration was administered as a bolus of 2 (body weight < or = 60 kg) or 3 mg (body weight > 60 kg) during the immediate postoperative period in the PACU. The interval between each bolus was 5 min. The visual analog scale (VAS) score threshold required to administer morphine was 30, and pain relief was defined as a VAS score of 30 or less. Results Data from 3,045 patients were analyzed. The mean initial VAS score was 73 +/- 19 (mean +/- SD), and the mean morphine dose required to obtain pain relief was 0.17 +/- 0.10 mg/kg, i.e., a median of four boluses (range, 1-20). When patients were grouped according to several classes of initial VAS score (31-39, 40-49, 50-59, 60-69, 70-79, 80-89, 90-100), it seemed that the relationship between VAS score and morphine requirements was a sigmoid curve. A VAS score of 70 or greater predicted the need for a high (>0.15 mg/kg) morphine dose (sensitivity, 0.77; specificity, 0.54). During the pain relief process, the relationship between VAS score and time was depicted by a sigmoid curve. Conclusion A VAS score of 70 or greater should be considered indicative of severe pain. The relationship between the initial VAS score and morphine requirements is not linear, and the evolution of the VAS score during the pain relief process is described by a sigmoid curve.

scholarly journals Comparison of the Effects of a Bioceramic and Conventional Resin-Based Sealers on Postoperative Pain after Nonsurgical Root Canal Treatment: A Randomized Controlled Clinical Study

Materials ◽  
2021 ◽  
Vol 14 (10) ◽  
pp. 2661
Author(s):  
Kiche Shim ◽  
Young-Eun Jang ◽  
Yemi Kim
Keyword(s):  
Postoperative Pain ◽  
Postoperative Period ◽  
Root Canal ◽  
Continuous Wave ◽  
Root Canal Treatment ◽  
Root Canals ◽  
Anterior Teeth ◽  
Significant Difference ◽  
Ah Plus ◽  
Group 2

Background: This clinical trial aimed to compare the effects of bioceramic sealer and resin-based sealer on the incidence and intensity of postoperative pain. Methods: Patients with anterior teeth or premolars requiring root canal treatment were assigned to group 1 (n = 51). Those with molars requiring treatment were assigned to group 2 (n = 57). In groups 1En and 2En, root canals were obturated with Endoseal MTA using the single-cone technique. In groups 1AH and 2AH, the sealer used was AH Plus with the continuous wave technique. On the day of canal filling, each patient was instructed to indicate their pain intensity over the 7 day postoperative period, at rest and, while biting, using a visual analog scale. Results: There was no significant difference in the incidence or intensity of postoperative pain between the Endoseal MTA and AH Plus groups during the 7 day postoperative period (p > 0.05). Less time was needed to seal the root canals with Endoseal MTA, especially in group 2 (p < 0.05). Conclusions: Endoseal MTA and AH Plus had similar effects on the incidence and intensity of postoperative pain. The obturation time was shorter when using Endoseal MTA compared to AH Plus.

Evaluation of Postoperative Pain after Sinonasal Surgery

2005 ◽  
Vol 19 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Sarah K. Wise ◽  
Justin C. Wise ◽  
John M. DelGaudio
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Postoperative Period ◽  
Repeated Measures ◽  
Medication Use ◽  
Pain Rating ◽  
Pain Location ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Analgesic Use

Background Pain after sinonasal surgery concerns both patients and surgeons. Factors affecting sinonasal postoperative pain have not been examined extensively. Methods Using a prospective survey design, sinonasal surgery patients evaluated postoperative pain (on a scale of 0–10), pain location, and medication use. Results One hundred twenty-seven patients consented to participate. One hundred fifteen patients returned surveys, with 100 patients appropriate for analysis over the 6-day postoperative period. Pain score and medication use were evaluated with respect to sex, primary/revision case, nasal packing, and other factors. Repeated measures analysis of variance and chi-square analysis were conducted (p < 0.05). Pain ratings and analgesic use declined significantly over the postoperative period (p < 0.05). Mean pain score on postoperative day (POD) 1 was 3.61 and on POD 6 was 1.72. Mean medication use was 1.37 tablets on POD 1 and 0.55 tablets on POD 6. Additionally, a significant interaction existed, such that narcotic medication use declined from 1.91 tablets on POD 1 to 0.52 tablets on POD 6, whereas nonnarcotic medication use remained steady (p < 0.05). Periorbital pain was most frequent (46.3%), with unilateral facial pain reported least (4.1%). A significant difference existed for distribution of pain location (p < 0.05). Finally, the difference in pain rating between primary and revision procedure for women (0.65) was less than for men (1.12); this interaction was significant (p < 0.05). Conclusion Multiple patient and operative factors affect pain rating and medication use after sinonasal surgery. Generally, pain level should be low with little analgesic use postoperatively.

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

2021 ◽  
Vol 15 (10) ◽  
pp. 2622-2624
Author(s):  
Haq dad Durrani ◽  
Rafia Kousar ◽  
Ejaz Iqbal ◽  
Muhammad Abdul Aziz ◽  
Syed Aushtar Abbas Naqvi ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Subcutaneous Tissue ◽  
Difficult Problem ◽  
P Value ◽  
Trial Methodology ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Significant Difference

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

scholarly journals Epidural Morphine by the Thoracic or Lumbar Routes in Cholecystectomy. Effect on Postoperative Pain and Respiratory Variables

1989 ◽  
Vol 17 (2) ◽  
pp. 166-169 ◽  
Author(s):  
E. Hakanson ◽  
M. Bengtsson ◽  
H. Rutberg ◽  
A. M. Ulrick
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Analogue Scale ◽  
Epidural Morphine ◽  
Morphine Group ◽  
Thoracic Epidural ◽  
Respiratory Parameters ◽  
Significant Difference ◽  
Elective Cholecystectomy ◽  
Respiratory Variables

Thirty-seven women undergoing elective cholecystectomy were randomised into two groups, receiving either lumbar epidural morphine (group L) or epidural morphine via the thoracic route (group T). The effect on pain relief was assessed by a visual analogue scale and included both resting pain and ‘provoked’ pain. Respiratory parameters (PEF, FEVI and FVC) were also studied. The patients were investigated preoperatively, and 4, 6, 12 and 24 hours after the start of surgery. No significant difference was observed between the groups concerning pain relief or respiratory performance. We conclude that after cholecystectomy lumbar epidural morphine is as effective as thoracic epidural morphine in relieving postoperative pain.

scholarly journals Dexamethasone for Morbidity After Subdural Electrode Insertion – A Randomized Controlled Trial

2003 ◽  
Vol 30 (4) ◽  
pp. 340-348 ◽  
Author(s):  
Ramesh L. Sahjpaul ◽  
Jeff Mahon ◽  
Samuel Wiebe
Keyword(s):  
Pain Relief ◽  
Postoperative Period ◽  
Controlled Trial ◽  
Intractable Epilepsy ◽  
Controlled Clinical Trial ◽  
Antiemetic Drug ◽  
Double Blind ◽  
Dexamethasone Group ◽  
Significant Difference ◽  
Limited Duration

Background:Invasive monitoring with subdural electrodes (SDE) for investigation of medically intractable epilepsy may be associated with undesirable immediate postoperative morbidity such as headache, nausea, vomiting, fever, and meningism. We undertook to evaluate the potential beneficial role of perioperative dexamethasone in reducing these symptoms.Methods:In a double-blind placebo controlled clinical trial 30 patients undergoing SDE insertion were randomized to receive either placebo or a course of dexamethasone beginning one hour prior to surgery and tapering to discontinue over 72 hours postoperatively. Pain, pain relief, nausea, nausea relief, temperature, and meningism were assessed regularly in the postoperative period, and analgesic, antipyretic, and antiemetic drug requirements were tabulated.Results:One patient was withdrawn from the dexamethasone group due to lack of data. With regards to postoperative pain, the direction of benefit favoured dexamethasone but a significant treatment by time interaction prevented further analysis of treatment effect. The dexamethasone group did have significantly lower temperatures and higher nausea relief scores. There was no statistically significant difference between the groups with regards to pain relief, nausea, and meningism scores. The beneficial effects of dexamethasone were delayed in onset, of limited duration, and not uniform over the observation period.Conclusion:Dexamethasone appears to have a role in reducing immediate morbidity following SDE insertion but its effect is not uniform in the postoperative period; it appears to be delayed in onset, and of limited duration. Further study is necessary to determine the ideal dosing schedule.

scholarly journals Using intravenous acetaminophen in the reduction of opioids in spinal cord surgeries by patient-controlled analgesia

2018 ◽  
Vol 5 (12) ◽  
pp. 3883
Author(s):  
Vadoud Nourouzi ◽  
Ali Mohammadian ◽  
Khatereh Isazadehfar ◽  
Sona Rasouli
Keyword(s):  
Spinal Cord ◽  
Placebo Group ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Pain Score ◽  
Postoperative Recovery ◽  
Opioid Use ◽  
Hospitalization Period ◽  
Significant Difference ◽  
Pain Pump

Background: Proper management of postoperative pain results in improved quality of patient's' life, early postoperative recovery, reduced hospitalization period and decreased treatment costs. Regarding significant efficacy and higher pain relief functions, opioids are amongst the best pain relief drugs. However, use of theses narcotics as pain killers is somehow controversial. Current study investigated the effects of IV acetaminophen in reduced use of opioids in surgeries of spinal cord by PCA method.Methods: Current double blinded clinical trial study performed upon 86 patients of 20-70 years of age who candidate for spinal CD implant with ASA class I or II. Patients randomly divided into two groups of IV Acetaminophen therapy (N=43) and placebo group (N=43) and each group were put equally under general anesthesia in which both received pain pump containing Fentanyl during recovery. Patients were examined regarding pain score, amount of opioid use and request for extra narcotics and the related complications including nausea, vomiting, dizziness, allergy, gastrointestinal bleeding and Ileus every 6 hours for 24 hours and the obtained results were recorded.Results: Regarding VAS, pain was significantly lower during 24 hours of study in IV Acetaminophen group (p<0.05). Mean use of opioid via pain pump was significantly lower in IV Acetaminophen group compared with placebo group (p=0.00). Request for extra doses of narcotics was higher in placebo group while regarding demand for extra pain relief, there was no significant difference between both groups. Regarding other results, no significant difference observed between both study groups.Conclusions: Results of the study indicated that use of a combination of IV acetaminophen along with opioids would be much more effective than use of narcotics alone in postoperative pain control of CD implant surgery of spinal cord and that leads to lower pain score and decreased use of opioids and its related complications.

scholarly journals OPRM1 and ABCB1 Polymorphisms and Their Effect on Postoperative Pain Relief With Piritramide

2015 ◽  
pp. S521-S527 ◽  
Author(s):  
O. BARTOŠOVÁ ◽  
O. POLANECKÝ ◽  
F. PERLÍK ◽  
S. ADÁMEK ◽  
O. SLANAŘ
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Adverse Effects ◽  
Postoperative Period ◽  
Receptor Gene ◽  
Early Postoperative Period ◽  
Postoperative Pain Relief ◽  
Intensity Difference ◽  
Pain Intensity Difference ◽  
118G Allele

Genetic factors may contribute to the differential response to opioids. The aim of this study was to evaluate the association between polymorphisms of µ1-opioid receptor gene OPRM1 (rs1799971), and P-glycoprotein transporter gene ABCB1 (rs1045642, rs2032582), and piritramide efficacy under postoperative patient-controlled analgesia (PCA). In 51 patients, OPRM1 variant was associated with decreased efficacy in early postoperative period evidenced by sum of pain intensity difference in the 0-6 h postoperative period (SPID0-6), (F=3.27, p=0.029). Mean (SD) SPID0-6 was observed in the 118AA genotype 22.9 (6.1) mm, which was significantly higher from the 118GG genotype 10.0 (4.4) mm, p=0.006. The lowest cumulative dose was recorded in 118AA genotype 19.1 (9.8) mg, which was significantly less than in the 118GG genotype group 36.6 (6.1) mg, p=0.017. Opioid–induced adverse effects were observed in 11, 30, and 100 % of patients in 118AA, 118AG, and 118GG genotype groups, respectively (p<0.05). Piritramide efficacy and safety was not significantly affected by ABCB1 (rs1045642, rs2032582) polymorphisms. Variant OPRM1 118G allele is associated with decreased acute postoperative pain relief after piritramide. Decreased efficacy leads to higher drug consumption under PCA settings, which however, does not fully compensate insufficient pain relief, but increases incidence of adverse effects.

scholarly journals A Randomised Controlled Study to Evaluate Efficacy of the Landmark Guided Erector Spinae Plane Block for Postoperative Pain in Percutaneous Nephrolithotomy Surgeries in Kolhapur District in Western Maharashtra

2021 ◽  
Vol 8 (20) ◽  
pp. 1559-1564
Author(s):  
Rashmee Vijay Chavan ◽  
Archita Rajaram Patil ◽  
Anupama Deepak Sahasrabudhe ◽  
Aarati Bhaskar Jadhav ◽  
Prithiv Rishardhan Prabhakaran
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
General Anaesthesia ◽  
Percutaneous Nephrolithotomy ◽  
Erector Spinae ◽  
Control Group ◽  
Study Group ◽  
Vas Score ◽  
Erector Spinae Plane Block ◽  
Post Operative Pain

BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P < 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery

2020 ◽  
pp. 019459982095280
Author(s):  
Amarbir S. Gill ◽  
Farrukh R. Virani ◽  
Joshua C. Hwang ◽  
Machelle D. Wilson ◽  
Angela M. Beliveau ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Wilcoxon Test ◽  
Opioid Use ◽  
Chi Square ◽  
Vas Score ◽  
Significant Difference ◽  
Patient Reported ◽  
Chi Square Test ◽  
Sinonasal Outcome Test ◽  
The Mean

Objective To determine the efficacy of preoperative gabapentin on patient-reported pain levels and postoperative opioid requirements following sinonasal surgery. Study Design Retrospective review. Setting Academic institution. Methods Patients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi-square test and Wilcoxon test were used for data analysis. Results Fifty-seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test–22 scores between the groups. The total MED, postoperative day (POD) 1-2 MED, POD 3-4 MED, and POD 5-6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups ( P = .98, .25, .16, .44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups ( P = .81). The mean daily VAS score decreased significantly in both groups with each successive POD ( P = .004). Conclusion Preoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.

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