OP07 On the effectiveness and costs of inhaled methoxyflurane versus usual analgesia for prehospital injury and trauma

2021 ◽  
Vol 38 (9) ◽  
pp. A4.1-A4
Author(s):  
Murray D Smith ◽  
Aloysius Niroshan Siriwardena ◽  
Robert Spaight ◽  
Elise Rowan
Keyword(s):  
Severe Pain ◽  
Traumatic Injury ◽  
Clinical Effectiveness ◽  
Severe Trauma ◽  
Control Group ◽  
Limited Evidence ◽  
P Values ◽  
Scenario Analyses ◽  
Pain Scores ◽  
Maximum Pain

BackgroundAcute pain is often inadequately treated in adults with traumatic injury. Inhaled methoxyflurane, newly licensed in Europe for this indication, has limited evidence of clinical effectiveness in the prehospital setting. We aimed to investigate clinical effectiveness and costs of methoxyflurane administered by ambulance staff compared with usual analgesic practice (UAP) for patients with trauma.MethodsWe used a non-randomised control group pragmatic design comparing methoxyflurane versus Entonox® and parenteral analgesics. Verbal numerical pain scores (VNPS) were gathered over time in adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Comparator VNPS were obtained from database records of UAP in similar patients. Clinical efficacy was tested using an Ordered Probit panel regression model of pain linked by observational rules to VNPS. Scenario analyses were used to compare durations under analgesia spent in severe pain, and costs.ResultsOver 12 months, 96 trained paramedics and technicians prepared 510 doses of methoxyflurane for administration to 483 patients. 32 patients reported side-effects, 19 of whom discontinued early. 13 patients, 10 aged over 75 years, were nonadherent to inhaler use instructions.Modelling results showed statistically significant clinical effectiveness of methoxyflurane over each comparator (all p-values<0.001). Methoxyflurane’s time to achieve maximum pain relief was significantly faster (all p-values<0.001): 26.4 mins (95%CI 25.0-27.8) versus Entonox® 44.4 (39.5-49.3); 26.5 (25.0-27.9) versus IV morphine sulfate 41.8 (38.9-44.7); 26.5 (25.1-28.0) versus IV paracetamol 40.8 (34.7-46.9).Scenario analyses of durations spent in severe pain were significantly less for methoxyflurane to comparators. Benefits of methoxyflurane were achieved at higher cost to comparators.ConclusionsMethoxyflurane reduced pain more rapidly and to a greater extent than Entonox® and more quickly than parenteral analgesics in adults with moderate or severe pain due to trauma attended by ambulance clinicians. Methoxyflurane provides a useful addition to prehospital analgesia.

scholarly journals Clinical effectiveness and costs of pre-hospital inhaled methoxyflurane for acute pain in trauma in adults: non-randomised control group study

2021 ◽  
Vol 5 (4) ◽  
pp. 66-67
Author(s):  
A. Niroshan Siriwardena ◽  
Murray D. Smith ◽  
Elise Rowan ◽  
Rob Spaight
Keyword(s):  
Severe Pain ◽  
Treated Patient ◽  
Hospital Setting ◽  
Clinical Effectiveness ◽  
Morphine Sulfate ◽  
List Price ◽  
Control Group ◽  
Control Group Design ◽  
P Values ◽  
Scenario Analyses

<sec id="s1"> Aims: Inhaled methoxyflurane, newly licensed in Europe for acute trauma pain in adults, has limited evidence of effectiveness in the pre-hospital setting. We aimed to investigate the clinical effectiveness and costs of methoxyflurane delivered when administered by ambulance staff compared with usual analgesic practice (UAP) for adults with trauma. </sec> <sec id="s2"> Methods: A non-randomised control group design was used to compare methoxyflurane versus Entonox® or parenteral analgesics. Verbal numerical pain scores (VNPS) were gathered over time in adults with moderate to severe trauma pain attended by ambulance staff trained in administering and supplied with methoxyflurane. Comparator VNPS were obtained from database records of UAP in similar patients. Clinical efficacy was tested using an Ordered Probit panel regression model of pain intensity linked by observational rules to VNPS. Scenario analyses were used to compare durations under analgesia spent in severe pain, and costs. </sec> <sec id="s3"> Results: Over the 12-month evaluation period, 96 trained paramedics and technicians prepared 510 doses of methoxyflurane for administration to a grand total of 483 patients. Thirty-two patients reported side effects, 19 of whom discontinued early. Thirteen patients, 10 aged over 75 years, were nonadherent to instructions given on inhaler use. Modelling results included demonstration of statistically significant clinical effectiveness of methoxyflurane over each comparator (all p-values <0.001). Methoxyflurane’s time to achieve maximum pain relief was significantly faster (all p-values <0.001): 25.7 mins (95%CI 24.4‐27.0) versus Entonox® 44.4 (39.5‐49.3); 25.8 (24.5‐27.1) versus IV paracetamol 40.7 (34.6‐46.9); 25.7 (24.4‐27.0) versus IV morphine sulfate 41.9 (38.9‐44.8). Scenario analyses of time spent in severe pain (VNPS on administration just scoring 10 reducing to a score of 7) were significantly less for methoxyflurane (all difference p-values <0.001): 7.6 mins (95%CI 6.5‐8.7) versus Entonox® 24.6 (20.1‐29.0); 6.7 (5.6‐7.7) versus IV paracetamol 23.0 (17.9‐28.0); 6.9 (5.9‐7.9) versus IV morphine sulfate 14.9 (13.3‐16.6). Costing scenarios compared single-dose use of methoxyflurane versus Entonox® and versus parenteral analgesics (80‐20% weighted episode mix of morphine sulfate and paracetamol). In both scenarios, the benefits of methoxyflurane were achieved at higher cost: the additional cost per treated patient was £8.77 versus Entonox® and £9.69 versus parenteral analgesics. The BNF list price for one vial containing a 3 mL dose of methoxyflurane for vaporisation in a Penthrox® inhaler is £17.89 per pack. </sec> <sec id="s4"> Conclusion: Methoxyflurane administered by ambulance clinicians reduced moderate or severe pain due to trauma in adults more rapidly compared to Entonox® or parenteral drugs. Methoxyflurane provides a useful addition to pre-hospital analgesia. </sec>

scholarly journals Efficacy of ketamine for postoperative pain following robotic thyroidectomy: A prospective randomised study

2017 ◽  
Vol 46 (3) ◽  
pp. 1109-1120 ◽  
Author(s):  
Jiwon Lee ◽  
Hee-Pyoung Park ◽  
Mu-Hui Jeong ◽  
Je-Do Son ◽  
Hyun-Chang Kim
Keyword(s):  
Postoperative Pain ◽  
Severe Pain ◽  
Analogue Scale ◽  
Postoperative Pain Management ◽  
Robotic Thyroidectomy ◽  
Control Group ◽  
Randomised Study ◽  
Pain Scores ◽  
Vas Scores ◽  
Induction Of Anaesthesia

Objective Although robotic thyroidectomy (RoT) is a minimally invasive surgery, percutaneous tunneling causes moderate to severe pain immediately postoperatively. We evaluated the efficacy of ketamine for postoperative pain management in patients following RoT. Methods Sixty-four patients scheduled for RoT were randomly divided into two groups. In the ketamine group (n = 32), ketamine was infused from induction of anaesthesia until the end of the procedure (0.15-mg/kg bolus with continuous infusion at 2 µg/kg/min). In the control group (n = 32), the same volume of saline was infused. Visual analogue scale (VAS) scores for acute and chronic pain, the incidence of hypoesthesia, postoperative analgesic requirements, and complications related to opioids or ketamine were compared between the two groups. Results The VAS pain scores were significantly lower in the ketamine group up to 24 h postoperatively. The VAS pain score when coughing was significantly higher in the control group than in the ketamine group at 24 h postoperatively. A significantly greater proportion of patients in the control group required rescue analgesics. Complications were comparable in both groups. Conclusions Ketamine infusion decreased pain scores for 24 h postoperatively and reduced analgesic requirements without serious complications in patients following RoT. Trial Registration: Clinicaltrials.gov Identifier: NCT01997801

scholarly journals Effect of live oud music on physiological and psychological parameters in patients undergoing cardiac surgery

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Merna Luis ◽  
Ramy Doss ◽  
Basel Zayed ◽  
Magdi Yacoub
Keyword(s):  
Cardiac Surgery ◽  
Music Therapy ◽  
Pain Perception ◽  
Intervention Group ◽  
Surrogate Marker ◽  
Control Group ◽  
P Values ◽  
Positive Effects ◽  
Pain Scores ◽  
Psychological Parameters

Background. Music therapy has emerged as a promising evidence-based adjuvant method of intervention. This study aims to assess the effect of live oud music on physiological and psychological parameters in patients undergoing cardiac surgery, pre- and post-operatively.Methods. Twelve patients undergoing cardiac operations were randomly allocated into either intervention group or control group, six patients in each group. Patients in the intervention group listened to 20 minutes of improvised and personally customized live oud music before and after surgery while patients in the control group heard the normal hospital sounds. While anxiety scores were assessed preoperatively, vital signs and pain scores were assessed postoperatively together with serum levels of cortisol, which was used as a surrogate marker of the stress response.Results. In the intervention group, pain scores and respiratory rates showed statistically significant reduction after listening to music (P values of 0.043 and 0.034 respectively). Additionally, heart rates, anxiety scores and serum cortisol levels showed borderline significant reduction in patients who listened to music with P values, 0.063, 0.066 and 0.068 respectively. These changes were not found in the control group.Conclusions. This preliminary study suggests a role of live oud music therapy in decreasing stress response of the patients undergoing cardiac surgery, in addition to its positive effects on pain perception and anxiety scores.

scholarly journals Comparative evaluation of various analgesics in irreversible pulpitis to reduce pain

2021 ◽  
Vol 17 (2) ◽  
pp. 313-319
Author(s):  
Pradeep Solete ◽  
Keyword(s):  
Clinical Trial ◽  
Single Dose ◽  
Comparative Evaluation ◽  
Severe Pain ◽  
Statistical Significance ◽  
Control Group ◽  
Time Intervals ◽  
Root Canals ◽  
Pain Scores ◽  
Irreversible Pulpitis

It is of interest to evaluate a single dose of three different analgesics compared to placebo in patients with symptomatic irreversible pulpitis. 120 patients were enrolled with severe pain in this prospective clinical trial. Patients were randomly divided into four groups after shaping and cleaning of root canals. This includes placebo, piroxicam 20mg, acetaminophen 325mg with aceclofenac sodium 100mg and acetaminophen 650mg. Participants were given a questionnaire to note the pain scores at various time intervals (6 hrs, 12 hrs, and 24 hrs) along with the respective tablets in a concealed manner. Data thus collected was analyzed for statistical significance. The severity of pain decreased in all the three interventional groups compared to the control group (p <0.01) at 6 hours. Zerodol-P and dolonex showed better pain reduction in comparison to the placebo and dolo 650 group (p <0.05) at 12 and 24 hours. Data shows that both zerodol-P and dolonex groups had similar effects at all time intervals. Thus, a single dose of analgesic such as Zerodol-P and Dolonex following shaping and cleaning of root canals relieved pain at all time intervals of the treatment. However, Dolo 650 performed better during the initial 6hrs after completion of the shaping and cleaning of root canals compared to the placebo.

scholarly journals Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Fei Xing ◽  
LiXin An ◽  
FuShan Xue ◽  
ChunMei Zhao ◽  
YaFan Bai
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Pediatric Patients ◽  
Group Versus ◽  
Pediatric Neurosurgery ◽  
Control Group ◽  
Morphine Group ◽  
Pain Scores ◽  
Background Infusion ◽  
Lower Pain

Abstract Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1-0.2 μg/k·h, bolus 0.1-0.2 μg/kg; Morphine group was used with a background infusion of 10-20 μg/kg·h, bolus 10-20 μg/kg; while Tramadol group was used with a background infusion of 100-400 μg/kg·h, bolus 100-200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In comparison of all groups with each other, lower pain scores were shown at 1 hour and 8 hour after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P<0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P<0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 hours of PCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI=0.000-0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), and morphine treatment (OR=0.077, 0.021-0.281, P<0.001) are the relevant factors. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn.

scholarly journals Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Fei Xing ◽  
LiXin An ◽  
FuShan Xue ◽  
ChunMei Zhao ◽  
YaFan Bai
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Pediatric Neurosurgery ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Pain Scores ◽  
Significant Difference ◽  
Lower Pain

Abstract Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia (PCIA or NCIA). Postoperative pain scores at different time point after surgery and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In all groups, significantly lower pain scores were observed at one to 8 hours in the morphine group (P<0.05). There was no significant difference in pain scores between the fentanyl and tramadol groups (P>0.05), both of which had lower pain scores than the placebo group (P<0.05). However, a higher incidence of nausea and vomiting occurred in the tramadol group during the 48 hours of NCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in control group (CI=0.000-0.019). No consciousness change and respiratory depression was observed in all groups. There were 56 children experienced moderate-severe pain(17.5%), younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), morphine treatment, were relevant factors of moderate-severe pain in pediatric patients. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn. Keywords: Pain, Postoperative, Child, Craniotomy

scholarly journals Comparative evaluation of various analgesics in irreversible pulpitis to reduce pain

2021 ◽  
Vol 17 (2) ◽  
pp. 313-319
Author(s):  
Pradeep Solete ◽  
Keyword(s):  
Clinical Trial ◽  
Single Dose ◽  
Comparative Evaluation ◽  
Severe Pain ◽  
Statistical Significance ◽  
Control Group ◽  
Time Intervals ◽  
Root Canals ◽  
Pain Scores ◽  
Irreversible Pulpitis

It is of interest to evaluate a single dose of three different analgesics compared to placebo in patients with symptomatic irreversible pulpitis. 120 patients were enrolled with severe pain in this prospective clinical trial. Patients were randomly divided into four groups after shaping and cleaning of root canals. This includes placebo, piroxicam 20mg, acetaminophen 325mg with aceclofenac sodium 100mg and acetaminophen 650mg. Participants were given a questionnaire to note the pain scores at various time intervals (6 hrs, 12 hrs, and 24 hrs) along with the respective tablets in a concealed manner. Data thus collected was analyzed for statistical significance. The severity of pain decreased in all the three interventional groups compared to the control group (p <0.01) at 6 hours. Zerodol-P and dolonex showed better pain reduction in comparison to the placebo and dolo 650 group (p <0.05) at 12 and 24 hours. Data shows that both zerodol-P and dolonex groups had similar effects at all time intervals. Thus, a single dose of analgesic such as Zerodol-P and Dolonex following shaping and cleaning of root canals relieved pain at all time intervals of the treatment. However, Dolo 650 performed better during the initial 6hrs after completion of the shaping and cleaning of root canals compared to the placebo.

scholarly journals Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

2019 ◽  
Author(s):  
Fei Xing ◽  
LiXin An ◽  
FuShan Xue ◽  
ChunMei Zhao ◽  
YaFan Bai
Keyword(s):  
Postoperative Analgesia ◽  
Severe Pain ◽  
Pediatric Patients ◽  
Group Versus ◽  
Pediatric Neurosurgery ◽  
Control Group ◽  
Morphine Group ◽  
Pain Scores ◽  
Background Infusion ◽  
Lower Pain

Abstract Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia. The formulas used were as follows: Control group included normal saline 100 ml, with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group was used with a background infusion of 0.1-0.2 μg/k·h, bolus 0.1-0.2 μg/kg; Morphine group was used with a background infusion of 10-20 μg/kg·h, bolus 10-20 μg/kg; while Tramadol group was used with a background infusion of 100-400 μg/kg·h, bolus 100-200 μg/kg. Postoperative pain scores and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In comparison of all groups with each other, lower pain scores were shown at 1 hour and 8 hour after surgery in Morphine group versus Tramadol, Fentanyl and Control groups (P<0.05). Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P<0.05). Nausea and vomiting were observed more in Tramadol group in comparison to all other groups during the 48 hours of PCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in Control group (CI=0.000-0.019). Changes in consciousness and respiratory depression were not observed in study groups. Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that, younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), and morphine treatment (OR=0.077, 0.021-0.281, P<0.001) are the relevant factors. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn.

scholarly journals The effect of warm contrast medium and other factors in pain assessment of infertile patients during HSG procedure

2021 ◽  
Author(s):  
Burak Ersak ◽  
Yasemin Tasci ◽  
Rahime Bedir Findik ◽  
Duygu Tugrul ◽  
Aytekin Tokmak ◽  
...  
Keyword(s):  
Body Temperature ◽  
Contrast Medium ◽  
Severe Pain ◽  
Randomized Study ◽  
Control Group ◽  
Previous Surgery ◽  
Related Factors ◽  
Pain Scores ◽  
History Of ◽  
Infertile Patients

Abstract Purpose To compare pain scores of infertile patients during and after hysterosalpingography (HSG) procedure using visual analoge scale (VAS) between cold and warm contrast medium and to investigate whether using warm contrast can alter spontaneous pregnancy rate. Methods Prospective randomized study between March-September 2017. Primary infertile patients undergoing HSG procedure. Patients’ age, body mass index(BMI), history of previous surgery, duration of infertility and pain levels during the most painful menstrual period were recorded. The pain severity was questioned during and at the 30th minute after the procedure using VAS. While patients who underwent HSG using a contrast medium at body temperature 37°C were defined as warm group(n:55), patients who underwent HSG using a contrast medium at room temperature 23°C were defined as cold group(n:55). Results There were no significant differences between the groups in terms of age, BMI, duration of infertility, previous surgery and VAS during menstruation. The mean duration of HSG of warm group patients was significantly lower(p = 0.001). Warm group patients’ mean VAS score during and 30 minutes after HSG were significantly lower than in the control group ( 5.3 ± 4.2 vs 7.5 ± 2.0), (1.1 ± 0.9 vs 2.4 ± 1.4), respectively. While severe pain percentage during HSG in warm group was %25.5, it was %66.7 in the control group. In logistic regression analysis, warm and cold groups were only found as significant related factors for severe pain felt during procedure(p < 0.001, OR = 0.19, 95% CI = 0.08–0.46). Conclusion The use of contrast media at body temperature during HSG procedure reduces the pain associated with the procedure.

scholarly journals SPSS Analysis of Pain Factors in Rotator Cuff Repair

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yi Zhou ◽  
Huali Chen ◽  
Jing Wang ◽  
Hui Wu ◽  
Yuanjie Zeng ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Hospital Stay ◽  
Rotator Cuff Repair ◽  
Severe Pain ◽  
Postoperative Hospital Stay ◽  
Control Group ◽  
Observation Group ◽  
Maximum Pain ◽  
The Impact ◽  
Cuff Repair

In this study, the matched case-control study was used. Nineteen cases of severe pain in the early postoperative period among 55 patients were set as the observation group, and 57 cases of simultaneous rotator cuff repair without severe pain were matched in a 1 : 3 ratio as the control group. Patients’ general information, disease characteristics, anesthesia and analgesia scheme, and operation information were collected. Frequency statistics, Wilcoxon signed rank sum test, regulatory effect analysis, and Poisson regression analysis were performed on these data. Some findings are included in the analysis. (1) There was a markable difference of 0.01 between the preoperative 48 h maximum pain value and the postoperative 48 h maximum pain value in the observation group. (2) There was a markable difference of 0.01 between the size and shape of the wound tear and the maximum pain value at 48 h after operation in the observation group. (3) When the number of opioid use affected the maximum pain value at 48 h after operation, the regulatory variables (type, quantity, and number of days of postoperative analgesics) were at different levels, and the impact amplitude had markable differences. (4) Age has a markable negative impact on the postoperative hospital stay. (5) The operation duration has a markable positive relationship with the postoperative hospital stay. (6) The analgesic pump had a markable positive impact on the postoperative hospital stay. (7) The location of injury did not affect the postoperative hospital stay.

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