scholarly journals Fentanyl-sparing Effect of Acetaminophen as a Mixture of Fentanyl in Intravenous Parent-/Nurse-controlled Analgesia after Pediatric Ureteroneocystostomy

2010 ◽  
Vol 113 (3) ◽  
pp. 672-677 ◽  
Author(s):  
Jeong-Yeon Hong ◽  
Won Oak Kim ◽  
Bon Nyeo Koo ◽  
Jin Sun Cho ◽  
Eun H. Suk ◽  
...  
Keyword(s):  
Side Effects ◽  
Infusion Rate ◽  
Loading Dose ◽  
Efficacy And Safety ◽  
Pediatric Pain ◽  
Pain Scores ◽  
Blinded Study ◽  
Sparing Effect ◽  
Double Blinded ◽  
Fentanyl Group

Background Although acetaminophen has been used widely and is well tolerated in children, its efficacy and safety have not been clarified when combined with an opioid in intravenous parent-/nurse-controlled postoperative analgesia. Methods Sixty-three children (aged 6-24 months) who had undergone elective ureteroneocystostomies were enrolled in this prospective, randomized, double-blinded study. After the surgery, an analgesic pump was programmed to deliver fentanyl at a basal infusion rate of 0.25 microg.kg(-1).h(-1) and 0.25 microg/kg bolus after a loading dose of 0.5 microg/kg(-1). In the fentanyl-acetaminophen group, acetaminophen was coadministered as a solution mixture at a basal infusion rate of 1.5 mg.kg(-1).h(-1) and 1.5 mg/kg bolus after a loading dose of 15 mg/kg, whereas saline was administered to the fentanyl group. Results Postoperative pain scores were similar between the two groups. The total dose (micrograms per kilogram per day, mean+/-SD) of fentanyl at postoperative days 1 (8.3+/-3.7 vs. 18.1+/-4.6, P=0.021) and 2 (7.0+/-2.4 vs. 16.6, P=0.042) was significantly less in the fentanyl-acetaminophen group compared with that in the fentanyl group. The incidences of vomiting (16.1 vs. 56.3%, P=0.011) and sedation (9.7 vs. 46.9%, P=0.019) were significantly lower in the fentanyl-acetaminophen group than those in the fentanyl group. Conclusions Acetaminophen has significant fentanyl-sparing effects and reduces side effects when combined with fentanyl in intravenous parent-/nurse-controlled analgesia for postoperative pediatric pain management.

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.

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

scholarly journals A prospective, randomized controlled, double-blinded study comparing dexmedetomidine and clonidine as an adjuvant to ropivacaine in femoral nerve block for postoperative analgesia in patients undergoing total knee arthroplasty

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Aathira Suresh ◽  
Gajanan Fultambkar ◽  
B. Vijayanand ◽  
Abhijit Nair
Keyword(s):  
Patient Satisfaction ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Blinded Study ◽  
Total Knee ◽  
Group 2 ◽  
Double Blinded ◽  
Group 1

Abstract Background Total knee arthroplasty (TKA) causes significant postoperative pain, imposing a limitation on postoperative mobilization crucial in regaining joint function. Ultrasound (US)-guided femoral nerve block (FNB) in complex knee surgeries is associated with better pain scores and fewer hospital admissions. Alpha-2 (α2) adrenoreceptor agonists have been the recent focus of interest as additives to local anesthetic. We aimed to compare the equivalent dose of dexmedetomidine and clonidine as an adjuvant to ropivacaine in US-guided FNB in TKA. A prospective, randomized, controlled, double-blinded study was conducted involving 80 American Society of Anesthesiologists’ physical status (ASA-PS) I, II, and III patients scheduled to undergo TKA under subarachnoid block. Group 1 (n = 40) patients received 1 μg/kg dexmedetomidine and group 2 (n = 40) patients with 1 μg/kg clonidine as adjuvants added to 20 ml of 0.75% ropivacaine. Duration of postoperative analgesia, pain scores, sedation scores, hemodynamics, rescue analgesia requirement, complications, and patient satisfaction were compared. Results The total duration of analgesia in group 1 was better compared to group 2 (p < 0.001). The patients were better sedated and the mean NRS scores were significantly lower (p < 0.05) in group 1 up to 24 h postoperatively. Total analgesic consumption was reduced in group 1, with a p value < 0.001. Patient satisfaction was significantly better (p < 0.001) in group 1 compared to group 2. Conclusion We conclude that dexmedetomidine added as an adjuvant in FNB increased the duration of analgesia when compared to clonidine with decreased NRS scores, reduced postoperative tramadol requirement, and better sedation and patient satisfaction. Trial registration Researchregistry6709, “Retrospectively registered” on 31 March 2021.

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

2013 ◽  
Vol 118 (2) ◽  
pp. 337-343 ◽  
Author(s):  
Sung-Hoon Kim ◽  
Min H. Lee ◽  
Hyungseok Seo ◽  
In-Gyu Lee ◽  
Jeong-Yeon Hong ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Young Children ◽  
Primary Outcome ◽  
Acute Tolerance ◽  
Opioid Tolerance ◽  
Pain Scores ◽  
Blinded Study ◽  
Secondary Outcomes ◽  
Double Blinded ◽  
Remifentanil Group

Abstract Background: Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, double-blinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children. Methods: We enrolled 60 children (aged 1–5 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 µg·kg−1·min−1 remifentanil. Postoperative pain was managed by a parent/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects. Results: The children who received 0.6 and 0.9 µg·kg−1·min−1 remifentanil required more postoperative fentanyl than the children who received saline or 0.3 µg·kg−1·min−1 remifentanil (all P &lt; 0.001) for 24 h after surgery. The children who received 0.3–0.9 µg·kg−1·min−1 intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (P = 0.002, P = 0.023, and P = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 µg·kg−1·min−1 remifentanil group than in the other groups (P = 0.027). Conclusions: The intraoperative use of 0.3 µg·kg−1·min−1 remifentanil for approximately 3 h (range: 140–265 min) did not induce acute tolerance, but the administration of 0.6 and 0.9 µg·kg−1·min−1 remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.

Nitrous oxide analgesia for bone marrow aspiration and biopsy – A randomized, controlled and patient blinded study

2015 ◽  
Vol 7 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Anna-Maria Kuivalainen ◽  
Freja Ebeling ◽  
Eira Poikonen ◽  
Per H. Rosenberg
Keyword(s):  
Bone Marrow ◽  
Nitrous Oxide ◽  
Cognitive Function ◽  
Side Effects ◽  
Bone Marrow Aspiration ◽  
Bone Marrow Examination ◽  
Procedural Pain ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Blinded Study

AbstractBackground and aims Bone marrow aspiration and/or biopsy (BMAB), performed under local anaesthesia in adults, is a common and often painful procedure. Anxiety is known to intensify pain during the procedure. Nitrous oxide (N2O), known for its sedative and analgesic benefit in various short medical procedures and labour pain, could be advantageous also for pain relief during bone marrow examination. N2O acts rapidly and is eliminated in a couple of minutes once the inhalation is stopped, and occasional side effects (e.g. dizziness and nausea) are mild. The aim of this study was to compare the analgesic effects of inhaled 50% mixture of nitrous oxide and oxygen to 50% oxygen during bone marrow examination.MethodsIn this randomized, controlled, patient and observer blinded study patients received either 50% mixture of nitrous oxide and oxygen or 50% mixture of oxygen in air during bone marrow examination, in addition to local analgesia. Both patient groups comprised 35 adult patients. Pre-procedural anxiety and procedural pain were rated on the Numeral Rating Scale (NRS 0‒10). Cognitive function was measured before and 30 min after the procedure. Possible side effects were recorded. A telephone interview was performed 24 h later.ResultsThere were no statistically significant differences in pain scores of the procedural steps (median NRS ranging 3.0‒4.0) between the study groups. High pain scores of 8‒10 comprised 0% vs. 8.6% of the scores during infiltration, 2.9% vs. 5.7% during puncture, 11.4% vs. 14.3% during aspiration and 2.9% vs. 2.9% during biopsy in N2O and 50% O2 groups, respectively (NS). Pre-procedural anxiety (median NRS 3.5 in both groups), measured in the outpatient clinic just prior to procedure, correlated with pain intensity during bone marrow aspiration (P = 0.045). There were no significant differences between side effects. During the BMAB four patients (3 in N2O group, 1 in 50% O2 group) reported dizziness and one patient in the N2O group reported nausea. Gas inhalation did not affect the cognitive function of the participants. In both groups the majority (>80%) of the patients was satisfied with the inhalation technique. During the 24 h interview, most of the participants were pain free and they did not report any serious adverse effects.ConclusionsIn spite of similar moderate to strong procedural pain in both groups and no benefit of N2O, most patients were satisfied with the inhalational techniques. We assume that the bedside presence of an anaesthesiologist and the distraction caused by the inhalational arrangements introduced positive context-sensitive therapeutic effect independent of the gas used. Pre-procedural anxiety predicted pain associated with bone marrow aspiration.ImplicationsInhaled 50% nitrous oxide was not an effective analgesic during bone marrow examination in our unselected outpatient population. Further studies should concentrate on its use with patients predicted to be at increased risk of suffering intense pain during the procedure, such as very anxious patients or those who have a painful history of previous bone marrow examinations.

The Effect of Adding a Minidose of Clonidine to Intrathecal Sufentanil for Labor Analgesia

1998 ◽  
Vol 89 (3) ◽  
pp. 594-601. ◽  
Author(s):  
Frederic J. Mercier ◽  
Mokhtar Dounas ◽  
Herve Bouaziz ◽  
Veronique Des Mesnards-Smaja ◽  
Christine Foiret ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Outcome ◽  
Intrathecal Injection ◽  
Labor Analgesia ◽  
Motor Blockade ◽  
Pain Scores ◽  
Nulliparous Women ◽  
Blinded Study ◽  
Double Blinded ◽  
Effective Analgesia

Background Preliminary studies have suggested that the addition of clonidine to intrathecal sufentanil prolongs analgesia without producing motor blockade. Methods Fifty-three nulliparous women in painful labor were included in this prospective, randomized, double-blinded study. Parturients at 2- to 5-cm cervical dilation received either 5 microg sufentanil plus 30 microg clonidine or 5 microg sufentanil intrathecally, followed by 5 mg bupivacaine epidurally. The primary outcome was time until first request for additional analgesia. Visual analog pain scores, sensory changes, blood pressure, heart rate, ephedrine requirements, motor blockade, sedation, pruritus, and nausea were also recorded. Results All parturients but one had effective analgesia in both groups, with similar sensory levels never exceeding T2. The duration (mean +/- SD) of analgesia was longer in the sufentanil-clonidine group: 125+/-46 versus 97+/-30 min (P = 0.007). The incidence of hypotension and the ephedrine requirements (median with range) were higher in the sufentanil-clonidine group: 63% versus 12% (P &lt; 0.001) and 7.5 mg [range, 0-25.5 mg] versus 0 mg [range, 0-6 mg] (P &lt; 0.0001). The incidence of fetal heart rate abnormalities during the first 30 min after intrathecal injection was similar in both groups (17% vs. 19%). No parturient had motor blockade. Conclusions The addition of 30 microg clonidine to 5 microg intrathecal sufentanil extended the duration of labor analgesia without producing motor blockade. However, as previously reported with 100-200 microg clonidine, the incidence of hypotension and the ephedrine requirements were also increased, even when 30 microg clonidine only was added.

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