Combined spinal-epidural analgesia vs. intermittent bolus epidural analgesia for pain relief after major abdominal surgery. A prospective, randomised, double-blind clinical trial

2007 ◽  
Vol 62 (2) ◽  
pp. 255-262 ◽  
Author(s):  
D. M. Stamenkovic ◽  
V. Geric ◽  
Z. Slavkovic ◽  
J. Raskovic ◽  
M. Djordjevic
Keyword(s):  
Clinical Trial ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Major Abdominal Surgery ◽  
Double Blind ◽  
Intermittent Bolus ◽  
Combined Spinal Epidural ◽  
Double Blind Clinical Trial ◽  
Spinal Epidural

scholarly journals Subarachnoid Morphine, Bupivacaine and Fentanyl as Part of Combined Spinal-epidural Analgesia for Low Anterior Resection. A Prospective, Randomised, Double-blind Clinical Trial

2009 ◽  
Vol 37 (4) ◽  
pp. 552-560 ◽  
Author(s):  
D. Stamenkovic ◽  
V. Geric ◽  
M. Djordjevic ◽  
J. Raskovic ◽  
Z. Slavkovic ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Analogue Scale ◽  
Epidural Analgesia ◽  
Low Anterior Resection ◽  
Analogue Scale ◽  
Double Blind ◽  
Combined Spinal Epidural ◽  
Epidural Bupivacaine ◽  
Double Blind Clinical Trial ◽  
Spinal Epidural

This study was designed to compare the efficacy of subarachnoid morphine alone or in combination with bupivacaine and fentanyl for combined spinal-epidural analgesia in colorectal surgery. This is a prospective, randomised, double-blind clinical trial. Sixty patients undergoing low anterior resection were assigned to one of three groups: subarachnoid morphine, bupivacaine and fentanyl, subarachnoid morphine and bupivacaine or subarachnoid morphine only. Epidural catheter placement and subarachnoid injection were done via a combined spinal-epidural Epistar® needle at L2-3. The epidural catheter was used for scheduled intraoperative bupivacaine and intermittent postoperative bupivacaine and morphine administration. Intraoperative epidural bupivacaine, intraoperative intravenous fentanyl use, time to first analgesia request, postoperative visual analogue scale pain scores, tramadol requirements and side-effects were recorded for 72 hours. Postoperative analgesia was comparable in all groups. Intraoperative fentanyl and bupivacaine consumption was lowest in the morphine, bupivacaine and fentanyl group. Time to first analgesia request was longer in the morphine, bupivacaine and fentanyl compared to the morphine group (P=0.009). Tramadol use was lower in the morphine and bupivacaine group compared to morphine, bupivacaine and fentanyl (P=0.017) on postoperative day two. There were no significant adverse effects. All patients ambulated the morning after surgery. The addition of bupivacaine and fentanyl to subarachnoid morphine did not confer any advantage on postoperative visual analogue scale scores and tramadol use, but lowered the need for additional intraoperative intravenous fentanyl and epidural bupivacaine and prolonged the time to first analgesia request.

Analgesic Effect of Nebulized Versus Intravenous Fentanyl for Pain Relief of Limb Fracture: A Double-Blind Clinical Trial

2017 ◽  
Vol 11 (1) ◽  
pp. 101-106
Author(s):  
Mohammadreza Maleki Verki ◽  
Kambiz Masoumi ◽  
Hassan Motamed ◽  
Meisam Moezi ◽  
Arash Forouzan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Relief ◽  
Normal Saline ◽  
Pain Level ◽  
Fentanyl Citrate ◽  
Double Blind ◽  
Intravenous Fentanyl ◽  
Limb Fracture ◽  
Double Blind Clinical Trial ◽  
Fentanyl Group

Background:More than half of the patients attending emergency centers need analgesics. Injectable analgesics are currently the most common pain control strategy, but entail complications. Fentanyl is one of the most commonly used pain-relief opiates available in various forms.Objective:The present study aims to compare analgesic effects of nebulized against intravenous fentanyl for controlling pain due to limb fracture.Method:The present double-blind clinical trial recruited 213 patients presenting with fractured limbs to emergency departments. The first group of patients received 1 micg/kg of intravenous fentanyl citrate from a solution of 50 micg/ml and 5 ml of normal saline in nebulized form (group A), and the second group intravenously received 5 ml of normal saline and 4 micg/kg of 50 micg/ml solution of fentanyl citrate in nebulized form, whose volume reached 5 ml with the addition of normal saline (group B). Then, pain level was frequently measured and compared in the two groups for 20 minutes.Results:The results obtained showed reduced pain level in both the groups. However, point-by-point comparison of pain in the two groups revealed significantly greater pain reduction in intravenous fentanyl group (P<0.001). The need for adjuvant pain relief medication was 8.3% in intravenous fentanyl group and 24% in nebulized fentanyl group, with a significant difference between the two groups (P=0.002).Conclusion:According to the results, although nebulized fentanyl is effective in controlling pain due to limb fracture, it was less effective than intravenous type, and unable to control pain in many cases.

0.2% ropivacaine with or without Fentanyl for Patient-Controlled Epidural Analgesia after Major abdominal Surgery: a Double-Blind Study

2000 ◽  
Vol 12 (4) ◽  
pp. 292-297 ◽  
Author(s):  
Marco Berti ◽  
Andrea Casati ◽  
Guido Fanelli ◽  
Andrea Albertin ◽  
Sara Palmisano ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Epidural Analgesia ◽  
Blind Study ◽  
Major Abdominal Surgery ◽  
Double Blind Study ◽  
Double Blind

scholarly journals The Effect of Scheduled Intravenous Acetaminophen in an Enhanced Recovery Protocol Pathway in Patients Undergoing Major Abdominal Procedures: A Prospective, Randomized, and Placebo-Controlled Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Kathirvel Subramaniam ◽  
Stephen A Esper ◽  
Kushanth Mallikarjun ◽  
Alec Dickson ◽  
Kristin Ruppert ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Relief ◽  
Abdominal Surgery ◽  
Rating Scale ◽  
Enhanced Recovery ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Major Abdominal Surgery ◽  
Number Of Patients ◽  
Group A

Abstract Objective Enhanced recovery protocols (ERPs) utilize multi-modal analgesia regimens. Individual regimen components should be evaluated for their analgesic efficacy. We evaluated the effect of scheduled intravenous (IV) acetaminophen within an ERP on analgesia and recovery after a major abdominal surgery. Design This study is a prospective, randomized, double-blinded clinical trial. Setting The study setting was a tertiary care, academic medical center. Subjects Adult patients scheduled for elective major abdominal surgical procedures Methods Patients in group A received 1g IV acetaminophen, while patients in group P received IV placebo every six hours for 48 hours postoperatively within an ERP. Pain scores, opioid requirements, nausea and vomiting, time to oral intake and mobilization, length of stay, and patient satisfaction scores were measured and compared. Results From 412 patients screened, 154 patients completed the study (Group A: 76, Group P: 78). Primary outcome was the number of patients with unsatisfactory pain relief, defined as a composite of average Numeric Rating Scale (NRS) scores above 5 and requirement of IV patient-controlled analgesia for pain relief during the first 48 hours postoperatively, and was not significantly different between the two groups (33 (43.4%) in group A versus 42 (53.8%) patients in group P, p=0.20). Opioid consumption was comparable between two groups. Group A utilized significantly less postoperative rescue antiemetics compared to group P (41% vs. 58%, p= 0.02). Conclusions Scheduled administration of IV acetaminophen did not improve postoperative analgesia or characteristics of postoperative recovery in patients undergoing major abdominal surgery within an ERP pathway.

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