Diclofenac Is Superior to Paracetamol in Postoperative Pain Scores and Analgesic Consumption in Supratentorial Craniotomy With No Difference in Platelet and Clot Function

OBJECTIVE The aim of this study was to assess in-hospital (immediate) postoperative pain scores and analgesic consumption (primary goals) and preoperative anxiety and sleep quality (secondary goals) in patients who underwent craniotomy and were treated with pregabalin (PGL). Whenever possible, out-of-hospital pain scores and analgesics usage data were obtained as well. METHODS This prospective, randomized, double-blind and controlled study was conducted in consenting patients who underwent elective craniotomy for brain tumor resection at Tel Aviv Medical Center between 2012 and 2014. Patients received either 150 mg PGL (n = 50) or 500 mg starch (placebo; n = 50) on the evening before surgery, 1.5 hours before surgery, and twice daily for 72 hours following surgery. All patients spent the night before surgery in the hospital, and no other premedication was administered. Opioids and nonsteroidal antiinflammatory drugs were used for pain, which was self-rated by means of a numerical rating scale (score range 0–10). RESULTS Eighty-eight patients completed the study. Data on the American Society of Anesthesiologists class, age, body weight, duration of surgery, and intraoperative drugs were similar for both groups. The pain scores during postoperative Days 0 to 2 were significantly lower in the PGL group than in the placebo group (p < 0.01). Analgesic consumption was also lower in the PGL group, both immediately and 1 month after surgery. There were fewer requests for antiemetics in the PGL group, and the rate of postoperative nausea and vomiting was lower. The preoperative anxiety level and the quality of sleep were significantly better in the PGL group (p < 0.01). There were no PGL-associated major adverse events. CONCLUSIONS Perioperative use of twice-daily 150 mg pregabalin attenuates preoperative anxiety, improves sleep quality, and reduces postoperative pain scores and analgesic usage without increasing the rate of adverse effects. Clinical trial registration no.: NCT01612832 (clinicaltrials.gov)

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Intercostal Nerve Block and Peritubal Infiltration with Bupivacaine for Postoperative Analgesia after Percutaneous Nephrolithotomy: A Randomised Clinical Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49105.14828 ◽

2021 ◽

Author(s):

Karunakaran Binil ◽

Kaniyil Suvarna ◽

Kannammadathy Poulose Biji

Keyword(s):

Postoperative Pain ◽

Nerve Block ◽

Percutaneous Nephrolithotomy ◽

Postoperative Analgesia ◽

Intercostal Nerve ◽

Categorical Variables ◽

P Value ◽

Intercostal Nerve Block ◽

Analgesic Consumption ◽

Pain Scores

Introduction: Percutaneous Nephrolithotomy (PCNL), a common endourologic procedure for removal of renal stones is associated with significant pain. Regional blocks are being used for postoperative analgesia after PCNL. Aim: To compare the analgesic efficacy of intercostal nerve block and fluoroscopic guided peritubal infiltration in terms of duration of analgesia, postoperative pain scores and total analgesic consumption in first 24 hours. Materials and Methods: This was a randomised clinical trial conducted from May 2018 to October 2018 on total of eighty patients, randomly allocated to two groups of 40 each. Group IC received intercostal nerve block and group IF received fluoroscopy guided peritubal infiltration with 0.25% bupivacaine. Duration of analgesia was assessed from postoperative pain scores (Numerical Rating Scale (NRS) during rest and coughing). Total analgesic consumption for 24 hours was also noted. Data was analysed using Chi-square test for categorical variables and independent Student’s t-test for quantitative variables. Results: The duration of analgesia was 702.00±140.022 minutes in Group IC and 346.50±129.566 minutes in group IF which was significant statistically with a p-value of <0.001. Resting and dynamic NRS were lower upto 12 hours postoperatively in group IC (p-value less than 0.05). Both tramadol (50.00±11.32 mg vs 82.50±24.15 mg) and paracetamol (100±303.82mg vs 850±622.23mg) requirements were lower in group IC as compared to group IF with p-values less than 0.001. Total consumption of first rescue analgesic tramadol as well as second analgesic Paracetamol both were significantly lesser(p-value<0.001) in group IC than group IF. Conclusion: Intercostal Nerve Block (INB) provided superior analgesia compared to fluoroscopic guided peritubal infiltration after PCNL.

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Assessment of postoperative analgesic effect of rectus sheath block for patients who had emergency midline laparatomy, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia: an observational prospective cohort study.

10.21203/rs.2.15888/v1 ◽

2019 ◽

Author(s):

Wubie Birlie Chekol ◽

Hailu Yimer Tawuye ◽

zewuditu abdissa denu ◽

Abatneh Feleke agegnehu

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Prospective Cohort Study ◽

Analgesic Effect ◽

Prospective Cohort ◽

Rectus Sheath ◽

Exposed Group ◽

Analgesic Consumption ◽

Pain Scores ◽

Rectus Sheath Block

Abstract Background : Postoperative pain is a major concern after midline abdominal surgeries. Rectus sheath block (RSB) has been indicated after midline laparatomy ; however, the analgesic effect of landmark technique on postoperative pain was not well investigated. Objectives: we tested the hypothesis that RSB reduces pain scores, decreased total analgesic consumption and prolong first analgesic request time after emergency midline laparatomy . Methods : Prospective cohort study was done from February 1 to May 10, 2018. Eighty eight patients were observed in this study, 44 in the RSB group and 44 in the non exposed group. Pain severity was assessed in first 24 hours postoperative period in terms of total analgesic consumption, first analgesic request time and visual analogue scale (VAS) score at 1 hour , 2 hours , 4 hours , 6 hours , 8 hours , 10 hours, 12 hours and 24 hours. Results : The RSB group had significantly reduced VAS score at rest and on movement at (1, 2, 4, 6 and 8 hours), but not at (10, 12 and 24 hours) point assessed. Patients in RSB group had reduced tramadol requirement compared to non exposed group in 24 hours (255.68±80.13) VS (314.77±97.40), P=0.003). The 24 hours diclofenac consumption was significantly lowered in RSB group (75 ( 75-150) than non exposed group (150 ( 75-150), P=0.031.Mean time to first analgesic request was significantly longer in RSB group (372.95±131.41) than non exposed group (50.34±14.12), p≤0 . 001). Conclusions : The RSB group resulted in less pain scores, reduced total analgesic utilization and stayed for longer time for first analgesic request. Therefore we recommend RSB as part of multimodal analgesia after emergency midline laparatomy. Keywords: midline abdominal surgery, rectus sheath block, abdominal field block

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Postoperative around-the-clock administration of intravenous acetaminophen for pain control following robot-assisted radical prostatectomy

Scientific Reports ◽

10.1038/s41598-021-84866-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shogo Inoue ◽

Hirotsugu Miyoshi ◽

Keisuke Hieda ◽

Tetsutaro Hayashi ◽

Yasuo M. Tsutsumi ◽

...

Keyword(s):

Postoperative Pain ◽

Radical Prostatectomy ◽

Additional Dose ◽

Robot Assisted ◽

Rescue Analgesia ◽

Analgesic Drugs ◽

Analgesic Consumption ◽

Pain Scores ◽

Intravenous Acetaminophen ◽

The Impact

AbstractThe objective of this study was to examine the impact of around-the-clock (ATC) administration of intravenous (IV) acetaminophen following robot-assisted radical prostatectomy (RARP). Intravenous infusion of acetaminophen was started on the day of the operation at 1000 mg/dose every 6 h, and the infusion was continued on a fixed schedule until postoperative day 2 a.m. In a retrospective observational study, we compared 127 patients who were administered IV acetaminophen on a fixed schedule (ATC group) with 485 patients who were administered analgesic drugs only as needed (PRN group). We investigated postoperative pain intensity and additional analgesic consumption on postoperative day 0, 1, 2, 3, and 5 between the two groups. Postoperative pain scores were significantly lower in the ATC group than in the PRN group at 1 and 2 days, and this period matched the duration of ATC administration of IV acetaminophen. Postoperative frequency of rescue analgesia was significantly lower in the ATC group than in the PRN group at postoperative 0, 1, and 2 days. ATC administration of IV acetaminophen has the potential to be a very versatile and valuable additional dose to achieve appropriate postoperative analgesia in patients with RARP.

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Effect of intravenous infusion of magnesium sulphate on postoperative analgesia in patients undergoing arthroscopic knee surgeries under spinal anaesthesia

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20170046 ◽

2017 ◽

Vol 6 (2) ◽

pp. 291

Author(s):

Revi N ◽

Mithun Raju P ◽

Mohsin Mohammed Ali

Keyword(s):

Postoperative Pain ◽

Spinal Anaesthesia ◽

Magnesium Sulphate ◽

Intravenous Infusion ◽

Study Cohort ◽

Control Cohort ◽

Analgesic Effects ◽

Analgesic Consumption ◽

Pain Scores ◽

Arthroscopic Knee

Background: Magnesium sulphate is being used for postoperative pain relief intravenously, intrathecally and epidurally. Currently, it is also gaining popularity as an adjuvant in blocks. The objective of the study was aimed at the postoperative analgesic effects of magnesium sulphate when given as intravenous infusion in patients undergoing arthroscopic knee surgeries under spinal anaesthesia and to compare the postoperative analgesic effects of magnesium sulphate infusion in a study cohort who received magnesium sulphate with the control cohort who were not given magnesium sulphate and underwent arthroscopic knee surgeries under spinal anaesthesia.Methods: After obtaining ethical committee clearance and consent from the patients, 31 patients each were placed in study cohort and control cohort. Spinal anaesthesia was administered in the lateral decubitus position through the L3–4 or L4–5 interspace. Hyperbaric bupivacaine 0.5% solution with fentanyl 20 μg was injected intrathecally. After spinal anaesthesia, patients received magnesium sulphate 50 mg/kg for 15 min and then 15 mg/kg/hr by continuous intravenous infusion until the end of surgery. The other group did not receive magnesium sulphate infusion. Postoperative pain scores and postoperative analgesic consumption were the primary end points.Results: The results of the study reveal the efficacy of perioperative intravenous infusion of magnesium sulphate in prolonging the spinal block as well as reducing the postoperative pain scores without hemodynamic variability or side effects.Conclusions: Post-operative pain and analgesic consumption was reduced with the use of intravenous magnesium following spinal anaesthesia.

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Impact of dexamethasone added to intra-articular morphine and bupivacaine for postoperative analgesia after knee arthroscopy

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00193-z ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Heba Fouad Toulan ◽

Raafat Abdel-Azim Hammad ◽

Amr Mohammed Talaat ◽

Ahmed Abd El-Daeem Abd El-Haq

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Postoperative Analgesia ◽

Knee Arthroscopy ◽

Control Group ◽

Study Group ◽

Early Recovery ◽

Analgesic Consumption ◽

Pain Scores ◽

Arthroscopic Knee

Abstract Background Pain relief after knee arthroscopy is very important for early recovery and rehabilitation. The study was conducted to evaluate the effects of adding dexamethasone (8 mg) to intra-articular morphine (10 mg) and bupivacaine (25 mg) combination on postoperative pain after knee arthroscopy. Results We enrolled 40 patients, 18–65 years-old of both sexes, ASA I and II scheduled for minor arthroscopic knee surgeries. The study group showed a lower visual analog score at rest and movement, prolonged postoperative analgesia, and decreased total analgesic consumption compared with the control group (P value < 0.05). Conclusions Adding dexamethasone to intra-articular combination of morphine and bupivacaine after knee arthroscopy prolongs the duration of analgesia, lowers pain scores, and decreases total analgesic consumption with no detected adverse effects.

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Fascia Iliaca Block for Postoperative Pain Control After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials

The American Journal of Sports Medicine ◽

10.1177/0363546521996713 ◽

2021 ◽

pp. 036354652199671

Author(s):

John-Rudolph H. Smith ◽

Matthew J. Kraeutler ◽

Laura E. Keeling ◽

Anthony J. Scillia ◽

Eric C. McCarty ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Hip Arthroscopy ◽

Pain Control ◽

Control Group ◽

Controlled Trials ◽

Analgesic Consumption ◽

Randomized Controlled ◽

Pain Scores ◽

Fascia Iliaca Block

Background: Various analgesic modalities have been used to improve postoperative pain in patients undergoing hip arthroscopy. Purpose: To systematically review the literature to compare the efficacy of the fascia iliaca block (FIB) with that of other analgesic modalities after hip arthroscopy in terms of postoperative pain scores and analgesic consumption. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase up to April 2020 to identify randomized controlled trials that compared postoperative pain and analgesic consumption in patients after hip arthroscopy with FIB versus other pain control modalities. The search phrase used was “hip arthroscopy fascia iliaca randomized.” Patients were evaluated based on postoperative pain scores and total postoperative analgesic consumption. Results: Five studies (3 level 1, 2 level 2) were identified that met inclusion criteria, including 157 patients undergoing hip arthroscopy with FIB (mean age, 38.3 years; 44.6% men) and 159 patients among the following comparison groups: lumbar plexus block (LPB), intra-articular ropivacaine (IAR), local anesthetic infiltration (LAI), saline placebo, and a no-block control group (overall mean age, 36.2 years; 36.5% men). No significant differences in pain scores were reported in the postanesthesia care unit (PACU) between the FIB and LPB (3.4 vs 2.9; P = .054), IAR (7.7 vs 7.9; P = .72), control group (no FIB: 4.1 vs 3.8; P = .76); or saline placebo (difference, –0.2 [95% CI, –1.1 to 0.7]). One study reported significantly higher pain scores at 1 hour postoperation in the FIB group compared with the LAI group (5.5 vs 3.4; P = .02). Another study reported significantly greater total analgesic consumption (in morphine equivalent dosing) in the PACU among the FIB group compared with the LPB group (20.8 vs 17.0; P = .02). No significant differences were observed in total PACU analgesic consumption between FIB and other analgesic modalities. Conclusion: In patients undergoing hip arthroscopy, the FIB does not appear to demonstrate superiority to other forms of analgesics in the immediate postoperative period. Therefore, it is not recommended as a routine form of pain control for these procedures.

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Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children

World Journal of Surgery ◽

10.1007/s00268-021-06295-x ◽

2021 ◽

Author(s):

Eilidh S. Bruce ◽

Sesi A. Hotonu ◽

Merrill McHoney

Keyword(s):

Postoperative Pain ◽

Hernia Repair ◽

Postoperative Analgesia ◽

Local Anaesthetic ◽

Laparoscopic Group ◽

Analgesic Consumption ◽

Pain Scores ◽

The Impact ◽

Open Hernia Repair ◽

Caudal Blockade

Abstract Background This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. Method A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups. Results 155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption. Conclusions Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.

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Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade

Hip International ◽

10.1177/1120700020950247 ◽

2020 ◽

pp. 112070002095024

Author(s):

Efi Kazum ◽

Ehud Rath ◽

Amir Shlaifer ◽

Zachary T Sharfman ◽

Hal D Martin ◽

...

Keyword(s):

Postoperative Pain ◽

Hip Arthroscopy ◽

Pain Control ◽

Recovery Room ◽

Postoperative Pain Management ◽

Control Group ◽

Analgesic Consumption ◽

Pain Scores ◽

Group 2 ◽

Group 1

Introduction: Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. Methods: 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. Results: Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. Conclusions: This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.

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The Effect of Preoperative Administration of Duloxetine on Postoperative Pain After Laparoscopic Myomectomy

ACTA MEDICA IRANICA ◽

10.18502/acta.v58i3.3775 ◽

2020 ◽

Author(s):

Maryam Hatami ◽

Arezoo Kheirati ◽

Shekoufeh Behdad ◽

Atiye Javaheri ◽

Sedighe Vaziribozorg

Keyword(s):

Postoperative Pain ◽

Laparoscopic Myomectomy ◽

Control Group ◽

Case Group ◽

Hemodynamic Changes ◽

Double Blind ◽

Analgesic Consumption ◽

Pain Scores ◽

Preoperative Administration ◽

Double Blind Clinical Trial

The purpose of this study was to evaluate the effect of preoperative administration of duloxetine on postoperative pain after laparoscopic myomectomy. In this double-blind clinical trial study, 57 patients aged 18-55 years with ASA I or II undergoing laparoscopic myomectomy involved. The case group received oral duloxetine 60 mg, and the control group received placebo 2 hours before the surgery. Pain scores, total analgesic consumption during 24 hours, recovery discharging time, nausea, vomiting, dizziness, and hemodynamic changes were recorded and compared between two groups. The pain severity was significantly lower in the case group at 2, 12, and 24 hours after the operation (P<0.05). There were no significant differences in dizziness, nausea, vomiting, systolic and diastolic blood pressure, and heart rate of patients between two groups before the surgery, 5 and 30 minutes after the induction, and after the recovery. Duloxetine administration prior to laparoscopic surgery myomectomy can reduce postoperative pain without inducing side effects in patients.

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