Efficacy of the Morphine-Adcon-L Compound in the Management of Postoperative Pain after Lumbar Microdiscectomy

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 518-525 ◽  
Author(s):  
Luciano Mastronardi ◽  
Marco Pappagallo ◽  
Fabrizio Puzzilli ◽  
Carlo Tatta
Keyword(s):  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Pain Control ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Analog Scale ◽  
Work Time ◽  
Long Term Outcome ◽  
Lumbar Microdiscectomy ◽  
Straight Leg Raising

Abstract OBJECTIVE: Epidural analgesia is a pharmacological technique for operative and postoperative pain control. It has been used with lumbar microdiscectomy to facilitate management of surgical pain, shorten patient recovery time, and increase patient satisfaction with the procedure and the hospital stay. Adcon-L (Gliatech, Inc., Cleveland, OH) (adhesion control in a barrier gel) has been demonstrated to act as a barrier to the development of epidural fibrosis after lumbar procedures, minimizing the formation of fibrotic scar and improving the long-term outcome. In this study, we used Adcon-L as a vehicle to administer 1 mg of morphine epidurally to patients who underwent lumbar microdiscectomy. Our objective was to evaluate the safety and analgesic efficacy of this compound . METHODS: A randomized, controlled, double-blind study was conducted in 100 patients. Patients were randomized to two groups: the morphine-Adcon-L (M-ADL) group (n = 51 patients) or the Adcon-L control group (n = 49 patients). Outcome measures included: 1) a visual analog scale to assess the intensity of spontaneous low back and radicular pain, 2) a straight leg-raising maneuver to assess the degree of leg elevation in relation to evoked sciatic pain, 3) postoperative time to comfortable walking, 4) duration of postoperative hospitalization, 5) required amount of postoperative analgesics, and 6) postoperative work time loss. RESULTS: No intraoperative or postoperative complications were observed. No clinically relevant adverse events, such as urinary retention, respiratory disturbances, or wound infections were reported in the M-ADL group. At the time of hospital discharge, results were as follows: 1) the M-ADL group had significantly lower pain intensity scores (mean value of postoperative visual analog scale, 12.3 mm ± 0.9 in the M-ADL group versus 24.7 mm ± 11.5 in the control group [P < 0.0001]); 2) the M-ADL group consumed significantly less analgesics: 57.4% of M-ADL patients versus 95.9% of controls received analgesics in the hospital, and 23.5% of M-ADL patients versus 55.1% of controls used analgesics at home (P < 0.0001); 3) the M-ADL group had significantly shorter hospital stays (1.37 ± 0.07 d versus 2.53 ± 0.12 d in the control group [P < 0.0001]); 4) the M-ADL group had a significantly higher degree of symptomatic leg elevation in the straight leg raising (mean postoperative straight leg-raising test, 64.41 degrees ± 1.59 versus 57.77 degrees ± 1.85 in the controls [P = 0.02]); and 5) the M-ADL group lost significantly less postoperative work time (21.67 ± 0.92 d versus 29.47 ± 1.18 d in the control group). In addition, at 1 year of follow-up, there was no clinical evidence of late-onset neurological complications. CONCLUSION: The epidural application of the compound M-ADL after lumbar microdiscectomy was found to be safe and effective, and it significantly improved postoperative pain control and return to function.

scholarly journals Electroacupuncture to alleviate postoperative pain after a laparoscopic appendectomy: study protocol for a three-arm, randomised, controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015286 ◽  
Author(s):  
Seunghoon Lee ◽  
Dongwoo Nam ◽  
Minsoo Kwon ◽  
Won Seo Park ◽  
Sun Jin Park
Keyword(s):  
Postoperative Pain ◽  
Laparoscopic Appendectomy ◽  
Pain Control ◽  
Rating Scale ◽  
Acupuncture Treatment ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Control Group ◽  
Acupuncture Points ◽  
Postoperative Pain Control

BackgroundThe purpose of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for postoperative pain after laparoscopic appendectomy compared with sham electroacupuncture (SEA) and no acupuncture treatment.Methods and analysisThis study is a protocol for a three-arm, randomised, patient-assessor-blinded (to the type of acupuncture treatment), controlled, parallel trial. 138 participants diagnosed with appendicitis and scheduled for laparoscopic appendectomy will be randomly assigned to the EA group (n=46), SEA group (n=46) or control group (n=46). The EA group will receive acupuncture treatment at both regional and distal acupuncture points with electrostimulation. The SEA group will receive sham acupuncture treatment with mock electrostimulation. Both EA and SEA groups will receive a total of four treatments 1 hour preoperative, 1 hour postoperative and during the morning and afternoon the day after surgery with the same routine postoperative pain control. The control group will receive only routine postoperative pain control. The primary outcome is the 11-point Pain Intensity Numerical Rating Scale (PI-NRS) at 24 hours after surgery. The secondary outcomes are the PI-NRS, analgesic consumption, opioid-related side effects, time to first passing flatus, quality of life and adverse events evaluated 6, 12, 24 and 36 hours and 7 days after surgery.Ethics and disseminationThe study was planned in accordance with the Helsinki Declaration and the Korean Good Clinical Practice Guidelines to protect the participants and was approved by the institutional review board (IRB) of Kyung Hee University Medical Center (KMC IRB-1427–02). The results will be disseminated in peer-reviewed journals and presented at international conferences.Trial registration numberClinical Research Information Service (KCT0001328).

scholarly journals Use of Intraoperative Analgesic and Anesthetic Substances by Intramuscular Infiltrations during Hip Surgery for Postoperative Pain Monitoring

2019 ◽  
Vol 69 (12) ◽  
pp. 3530-3532
Author(s):  
Bogdan Hogea ◽  
Bogdan Corneliu Andor ◽  
Alina Totorean ◽  
Lavinia Maria Hogea ◽  
Laura Alexandra Nussbaum ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Hip Surgery ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Pain Scores ◽  
Important Benefit ◽  
Active Mobilization ◽  
Management Techniques ◽  
Arthroplasty Surgery

The authors present their intraoperative and postoperative experience in using intramuscular infiltrations with analgesic and anesthetic substances as pain control methods in patients that undergo hip surgery: arthroplasty or hemiarthroplasty. A total of 30 patients that have undergone either an elective total hip arthroplasty surgery or hemiarthroplasty of the hip following a hip fracture, since May 2018 until August 2018. The patients were divided in two equal groups, one group that followed through the protocol and one control group. The intramuscular infiltrations were administered intraoperatively at the timeline of the muscle suture and contained: Bupivacaine 10 mL + Morphine 1 mL + Methylprednisolone 40mg. Postoperative protocol used the visual analogue scale (VAS) pain scores on days 1, 2, 3, 4, 5, 6 and 7 for measuring the postoperative pain control. Intraoperative intramuscular infiltrations, with an analgesic and anesthetic cocktail consisting of Bupivacaine, Morphine and Methylprednisolone, for patients that are going through hip surgery are safe to use with very good results in terms of postoperative pain control. We reduced the consumption of opioids and analgesic drugs, which indirectly leads to decreased direct cost per patient. Another important benefit was an early active mobilization of the patient, with shorter hospitalization time. All things considered, using regional anesthesia and multimodal pain management techniques may lead to a nearly painless hip surgery.

Efficacy of Curcuminoids in managing postoperative pain after total laparoscopic hysterectomy: A randomized controlled, open-label trial.

2022 ◽  
Author(s):  
Chai Ariyasriwatana ◽  
Natacha Phoolcharoen ◽  
Shina Oranratanaphan ◽  
Pongkasem Worasethsin
Keyword(s):  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Curcuma Longa ◽  
Laparoscopic Hysterectomy ◽  
Control Group ◽  
Analog Scale ◽  
Open Label ◽  
Vas Scores ◽  
The Mean ◽  
Experimental Group

Background and aims: Curcuminoids, which are substances extracted from turmeric (Curcuma longa), have anti-inflammatory and analgesic effects and a good safety profile. This study aimed to evaluate the clinical efficacy of curcuminoid extracts on reducing pain among patients who underwent laparoscopic hysterectomy. Experimental procedure: From November 2016 to December 2017, 98 participants were included in this clinical trial, and they were randomly assigned to the experimental and control arms according to blocks of four. The intraoperative findings did not significantly differ between the two groups. The experimental group received one tablet of curcuminoid extract 250 mg four times a day on postoperative days 1–3. Pain was evaluated at 24 and 72 h postoperatively using a 10-point visual analog scale (VAS). Results and conclusion: The mean visual analog scale (VAS) scores at 24 h after surgery were 4.9 in the experimental group and 4.3 in the control group. Hence, the results did not significantly differ (p = 0.129). The mean VAS scores at 72 h after surgery were 1.8 in the experimental group and 2.8 in the control group (p = 0.001). The side effects in both groups were similar. Hence, curcuminoids can be an effective supplement for reducing pain after laparoscopic hysterectomy. The conclusion from this study is, that curcuminoids may be an effective supplement to reduce postoperative pain following laparoscopic hysterectomy.

scholarly journals Preemptive effect of amantadine as adjuvant in postoperative analgesia of ovaryhisterectomy in dogs

2020 ◽  
Vol 9 (11) ◽  
pp. e68091110128
Author(s):  
Raquel Vieira Niella ◽  
Aline Silva Sena ◽  
Janaína Maria Xavier Corrêa ◽  
Priscila Carvalho Lima Rocha Soares ◽  
Taísa Miranda Pinto ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Control Group ◽  
Nociceptive Threshold ◽  
Postoperative Pain Control ◽  
Analog Scale ◽  
Analgesic Requirement ◽  
Preoperative Administration ◽  
Significant Difference ◽  
Mechanical Nociceptive Threshold ◽  
Preemptive Effect

This study aimed to evaluate the preemptive analgesic effect of amantadine on postoperative pain control in female dogs that underwent ovariohysterectomy. Twenty female dog were randomly assigned to two groups of ten. The control group (CONTROL) received oral placebo capsules, while the amantadine (AMANT) group received 5 mg/kg of oral amantadine one hour before sedation. All the animals were premedicated with 3 mg/kg (IM) meperidine, induced with propofol and maintained with isofluorane. The transanesthetic physiological parameters were recorded, and postoperative pain was evaluated every hour after extubation for six hours with the Dynamic Interactive Visual Analog Scale (DIVAS) and mechanical nociceptive threshold (MNT) and when the necessary analgesic rescue was administered (morphine, 0.2 mg/kg (IM)). During the surgical procedure, there was no significant difference in the variables measured between the two groups. Regarding postoperative pain assessment, there was a significant difference in the DIVAS score (p = 0.004) between the groups, in which AMANT required fewer rescues than did CONTROL (p = 0.03). The MNT was significantly higher ​​in AMANT than in CONTROL (p = 0.03). The results suggested that the preoperative administration of amantadine decreased analgesic requirement in female dogs that underwent elective ovariohysterectomy.

scholarly journals Intra-Articular Bupivacaine Injection is An Ideal Method for Postoperative Pain Control in Children with Supracondylar Humeral Fracture

2021 ◽  
Author(s):  
Qian Wang ◽  
Jingxin Zhao ◽  
Yu Wang ◽  
Man He
Keyword(s):  
Treatment Group ◽  
Postoperative Pain ◽  
Pain Control ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

Abstract Objective: Supracondylar humeral fracture is the most common fracture in children. Currently there are a large number of studies on supracondylar humeral fractures addressing the epidemiology of supracondylar fractures, injury mechanisms, treatments and complications, however there are few studies on how to control the pain in children after fractures and operation. Therefore, we retrospectively analyzed the effectiveness of an intra-articular injection of 0.25% bupivacaine on pain control after CRPP of supracondylar humeral fractures in children. To our knowledge, this is the largest study on the use of an intra-articular injection for pain control after surgery for supracondylar humeral fractures.Methods: This clinical trial was designed to evaluate the efficacy of intra-articular injection of 0.25% bupivacaine as a postoperative pain control in children with supracondylar humeral fractures who underwent closed reduction and percutaneous pinning (CRPP).Subjects (n = 120) were randomized to treatment with 0.25% bupivacaine (treatment group) (n = 60) or no injection (control group) (n =71). After surgery, all patients were prescribed Ibuprofen for analgesia. The Ibuprofen doses and the times of administration were recorded. The Faces Pain Scale-Revised (FPS-R) scores were blindly recorded during postoperative day 1.Results: The results suggested that the use of intra-articular injection of 0.25% bupivacaine improved pain control and decreased the need for Ibuprofen on postoperative day 1. FPS-R scores were also significantly lower in the treatment group as compared with those of the control group. No intra-articular injection-associated complications were reported. Conclusion: Therefore, the intra-articular injection of bupivacaine significantly improves postoperative pain control following CRPP of supracondylar humeral fractures in children.

Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

2020 ◽  
Author(s):  
Daniel J. Lynch ◽  
James S. Lin ◽  
Kanu S. Goyal
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Control ◽  
Over The Counter ◽  
Unequal Variance ◽  
Pain Medications ◽  
Medication Consumption

Abstract Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery (n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone (n = 66) or soft tissue (n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t-tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients’ postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.

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