Subarachnoid block with continuous TAP catheter analgesia produces less chronic pain and better functional outcome after inguinal hernioplasty: a randomized controlled observer-blinded study

Background and objectivesThe major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty.MethodsSeventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale.ResultsSix months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively.ConclusionsA subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia.Clinical trial registrationCTRI/2016/09/007238.

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POSTOPERATIVE ANALGESIA IN ONCOLOGIC HOSPITAL: CURRENT STATUS AND PROSPECTS

Problems in oncology ◽

10.37469/0507-3758-2017-63-1-95-98 ◽

2017 ◽

Vol 63 (1) ◽

pp. 95-98

Author(s):

Aleksandr Potapov ◽

Anna Boyarkina ◽

Igor Kostyuk ◽

Sergey Ivanov ◽

Vsevolod Galkin

Keyword(s):

Postoperative Analgesia ◽

Severe Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Current Status ◽

Regional Analgesia ◽

Surgical Pain ◽

Oncological Patients ◽

Maximum Pain ◽

Chronic Post Surgical Pain

Observational study of the postoperative analgesia efficacy with multimodal approach (acetaminophen, NSAIDs, opioids, regional analgesia) in 100 oncological patients has been conducted. On the first day after the surgery maximum pain level was 5 (3-7) points of numeric rating scale (NRS), 38% of patients experienced severe pain (NRS>6 points). After laparo-, thoracoscopic, videoassisted interventions and in cases of epidural analgesia NRS levels were 3 (1-6) and 3 (2-5) points respectively. After the surgeries with high risk of chronic post-surgical pain (thoracic, mammary gland interventions, Phan-nenstiel incision) NRS level was 6 (1-7) points. Patients in this group more often experienced severe pain than in the rest group - 56,7% vs. 32,5% (P.=0.037). Suggesting results of this study and data of current literature the perspectives of further improvement of postoperative analgesia in oncology have been formulated.

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Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2011.11015 ◽

2012 ◽

Vol 16 (2) ◽

pp. 101-106 ◽

Cited By ~ 5

Author(s):

Despoina Kakagia ◽

Theodosia Vogiatzaki ◽

Savvas Eleftheriadis ◽

Gregory Trypsiannis ◽

Christos Iatrou

Keyword(s):

Injection Site ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Demographic Data ◽

Randomized Study ◽

Cutaneous Lesions ◽

Double Blind ◽

Lidocaine Group ◽

Pain Scores

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

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Perioperative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-037879 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037879

Author(s):

Si Chen ◽

Zhonghuang Xu ◽

Hongju Liu ◽

Yuelun Zhang ◽

Jiao Zhang ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Depression Scale ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Regional Analgesia ◽

Transcutaneous Oxygen ◽

Group I ◽

Intravenous Analgesia ◽

T1 And T2

IntroductionBoth regional analgesia and intravenous analgesia are frequently used perioperatively for patients with critical limb ischaemia (CLI). Nevertheless, the comparison of perioperative effect of regional and intravenous analgesia has not yet been thoroughly illustrated. This study will comprehensively compare patient-controlled regional analgesia (PCRA) and patient-controlled intravenous analgesia (PCIA) as two different perioperative analgesia approaches for patients with CLI. It investigates their effects on analgesia, reperfusion and the quality of recovery perioperatively, also aims to provide clinical evidence to those non-surgical patients with non-reconstructable arteries.Methods and analysisThis trial is a randomised, single-centre, open-label, parallel trial with target sample size of 52 in total. Eligible participants will be randomly allocated to the PCRA group (group R) or the PCIA group (group I) after admission. Participants in group R will receive ultrasound-guided subgluteal sciatic catheterisation, followed by continuous PCRA infusion (0.2% ropivacaine 15 mL as loading dose, 8 mL/hour as background with a patient-controlled bolus of 6 mL). Participants in group I will receive PCIA (morphine is given in boluses of 1 mg as needed, background infusion at 1 mg/hour). Data will be collected at baseline (T0), 2 hours before revascularisation treatment (T1) and 2 hours before discharge (T2). The primary outcomes include the Numerical Rating Scale pain score at T1 and T2. The secondary outcomes include the perioperative transcutaneous oxygen pressure, the Tissue Haemoglobin Index, Hospital Anxiety and Depression Scale at T1 and T2; the Patient Global Impression of Change and patient satisfaction at T1 and T2; the perioperative cumulative morphine consumption, the length of postoperative hospital stay and adverse events.Ethics and disseminationThis study received authorisation from the Institutional Review Board of Peking Union Medical College Hospital on 21 March 2017 (approval no. ZS-1289X). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.Trial registration numberChinese Clinical Trial Registry (ChiCTR2000029298).Protocol versionV.4CP.B2 (15 June 2020).

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Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413488494 ◽

2013 ◽

Vol 38 (8) ◽

pp. 866-874 ◽

Cited By ~ 29

Author(s):

J. F. Goubau ◽

C. K. Goorens ◽

P. Van Hoonacker ◽

B. Berghs ◽

D. Kerckhove ◽

...

Keyword(s):

Functional Outcome ◽

Rating Scale ◽

Numerical Rating Scale ◽

Survival Rates ◽

Trapeziometacarpal Joint ◽

Term Survival ◽

Numerical Rating ◽

Trapeziometacarpal Joint Osteoarthritis ◽

The Mean

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54–78) years. The mean follow-up period was 67 (range 60–77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

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COMPARISON OF ULTRASOUND-GUIDED THORACIC PARAVERTEBRAL AND PECTORALIS INTERFASCIAL PLANE BLOCK FOR MODIFIED RADICAL MASTECTOMY

International Journal of Advanced Research ◽

10.21474/ijar01/13714 ◽

2021 ◽

Vol 9 (11) ◽

pp. 73-79

Author(s):

Kalyani Nilesh Patil ◽

◽

Shalini Pravin Sardesai ◽

Poonam Ghodki ◽

Rajlaxmi Menghal ◽

...

Keyword(s):

Patient Satisfaction ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Randomized Study ◽

Radical Mastectomy ◽

Categorical Variables ◽

Continuous Variables ◽

Modified Radical Mastectomy ◽

Ultrasound Guided

Aims and Objectives : To compare the efficacy of ultrasound-guided thoracic paravertebral block(TPVB) and ultrasound-guided pectoralis interfascial plane (PECS) block for Modified Radical Mastectomy (MRM). The primary objectives were to compare duration of post-operative analgesia and total post-operative analgesic consumption while the secondary objectives were to compare dermatomal spread, intraoperative anaesthesia requirement and patient satisfaction. Materials And Methods: Sixty female patients of American Society of Anaesthesiologists (ASA) physical status I and II, undergoing MRM under general anaesthesia, were randomly recruited to receive ultrasound-guided TPVB (Group T) or ultrasound-guided PECS block (Group P) with 25ml of 0.25% bupivacaine, in a prospective, observer-blinded, randomized study. Data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Categorical variables were compared using the Chi-square test or Fishers exact probability test continuous variables compared using unpaired t-test or Mann-Whitney U test. Results: All demographic variables were comparable. Intraoperative fentanyl consumption was lower in patients who received PECS block (72.50+27.35) than those who received TPVB (104.17+46.92) (p=0.0023). NRS was comparable in both groups till 2 hours post operatively. However, from 4 hours onwards, till 18 hours the Numerical Rating Scale (NRS) was significantly higher in TPVB group. Dermatomal spread was more extensive and postoperative analgesia requirement was lower in Group P. Patient satisfaction was comparable in both groups. Conclusion: PECS block is associated with superior postoperative analgesia and reduced analgesic requirement. The cranial dermatomal spread was better and intraoperative opioid requirement was less with PECS block.

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Effect of 3 Different Doses of Intrathecal Dexmedetomidine (2.5µg, 5µg, and 10 µg) on Subarachnoid Block Characteristics: A Prospective Randomized Double Blind DoseResponse Trial

January 2018 - Pain Physician ◽

10.36076/ppj/2019.19.e411 ◽

2016 ◽

Vol 3;19 (3;3) ◽

pp. E411-E420 ◽

Cited By ~ 8

Author(s):

Dr Mayank Gupta

Keyword(s):

Adverse Effects ◽

Motor Block ◽

Rating Scale ◽

Numerical Rating Scale ◽

College Teaching ◽

Sensory Block ◽

Motor Blockade ◽

Analgesic Requirement ◽

Double Blind ◽

Subarachnoid Block

Background: The extended analgesic efficacy of intrathecal dexmedetomidine (ITD) has been investigated in a few clinical trials; however, there is a lack of conclusive evidence upon its ideal dosage. Objectives: To elucidate the dose-response relationship between ITD and subarachnoid block characteristics, particularly the duration of analgesia and differential analgesia (DA: defined as time difference from the offset of motor blockade to the first analgesic requirement on numerical rating scale ≥ 4.0). Study Design: Prospective, randomized double blind active control trial. Setting: Medical college teaching hospital. Methods: Ninety adult (18 – 60 years) patients undergoing elective lower abdominal and lower limb surgeries were randomized into 3 groups to receive intrathecal 0.5% bupivacaine 3 mL with 2.5 µg (group BD2.5), 5µg (group BD5), or 10 µg (group BD10) dexmedetomidine in 0.5 mL normal saline. The 2 segment sensory regression times (TSSRT), duration of motor blockade analgesia, DA, and perioperative adverse effects were assessed. The primary outcome was duration of analgesia and DA. Statistics: ANOVA, Kruskal Wallis test, Chi-square (χ2), and Fisher’s exact test, significance: P < 0.05. Results: The onset of sensory block was significantly earlier in group BD10 compared with group BD5 (P = 0.035) and BD2.5 (P = 0.010) while the onset of motor block was significantly earlier in group BD10 compared with BD2.5 (P = 0.020). There was a significant and dose-dependent prolongation of the duration of sensory block (127.50, 149.17, and 187.50 minutes; P < 0.001), motor block (258.50, 331, and 365 minutes; P < 0.001), analgesia (306.17, 396.50, and 512 minutes; P < 0.001), and DA (47.67, 65.50, and147 minutes; P < 0.001) with escalating doses of ITD, respectively. Group BD10 required significantly fewer rescue analgesics compared with other 2 groups (P = 0.001). Except for mild sedation which was significantly higher in group BD10; all the groups were comparable with respect to hemodynamic and other adverse effects. Limitations: Lack of placebo group, exclusion of higher doses (15µg) of ITD, and short duration of postoperative follow-up. Conclusions: The addition of 10 µg compared with 2.5 µg or 5µg ITD to 0.5% hyperbaric bupivacaine is associated with significantly earlier onset of sensory and motor block as well as prolonged duration of sensory block, motor block, analgesia, and DA with a comparable adverse effect profile. Key words: Analgesia, bupivacaine, dexmedetomidine, differential analgesia, intrathecal, pain, spinal anaesthesia

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Ilioinguinal/Iliohypogastric versus quadratus lumborum nerve blockade for elective open inguinal herniorrhaphy: a prospective, randomized, double-blinded, equivalency trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101571 ◽

2020 ◽

Vol 45 (12) ◽

pp. 970-974

Author(s):

Christopher J Edwards ◽

Robert S Weller ◽

James D Turner ◽

Sean W Dobson ◽

J Douglas Jaffe ◽

...

Keyword(s):

Postoperative Analgesia ◽

Surgical Procedure ◽

Rating Scale ◽

Opioid Analgesic ◽

The Body ◽

Regional Analgesia ◽

Inguinal Herniorrhaphy ◽

Pain Scores ◽

Quadratus Lumborum ◽

Open Inguinal Herniorrhaphy

BackgroundOpen inguinal herniorrhaphy (OIH) is a commonly performed surgical procedure with expected postoperative pain. Historically, an option for regional analgesia has been an ilioinguinal and iliohypogastric nerve block (IINB). More recently, the transmuscular quadratus lumborum block (QLB) has been used as an analgesic technique for a variety of abdominal and truncal surgical procedures. Given our own institutional experiences with the performance of QLB combined with the body of literature supporting the proximal blockade of the ilioinguinal and iliohypogastric nerves via this approach, we compared the analgesia provided by an IINB to a QLB. We hypothesized that the two blocks would provide equivalent analgesia, as defined by a difference of less than±2 points on the pain scale (0–10 numeric rating scale (NRS)), for patients undergoing OIH.MethodsSixty patients scheduled for elective outpatient OIH under general anesthesia were randomized to preoperatively receive either an IINB or a transmuscular QLB with 0.25% bupivacaine/epinephrine/clonidine for postoperative analgesia. The primary endpoint was movement NRS pain scores at 8 hours. Secondary outcomes included resting NRS pain scores at 8 and 24 hours, movement NRS pain scores at 24 hours, incidence of opioid related side effects (nausea, vomiting, pruritus), time-to-first oral opioid analgesic, and total opioid consumption at 24 hours.ResultsFifty-nine patients were analyzed per an intention-to-treat approach (one patient was excluded because the surgical procedure was canceled). Movement pain scores at 8 hours were equivalent (IINB 5.10±3.02 vs QLB 5.03±3.01 (mean NRS±SD); two one-sided test mean difference (90% CI), 0.07 (−1.24 to 1.38), p ≤0.01). There were no differences between groups for any of the secondary endpoints.ConclusionAn IINB and a transmuscular QLB are equivalent with regards to their ability to provide postoperative analgesia after OIH.

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The Efficacy of Programmed Intermittent Epidural Bolus for Postoperative Analgesia after Open Gynecological Surgery: A Randomized Double-Blinded Study

BioMed Research International ◽

10.1155/2018/6297247 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Shiho Satomi ◽

Nami Kakuta ◽

Chiaki Murakami ◽

Yoko Sakai ◽

Katsuya Tanaka ◽

...

Keyword(s):

Epidural Anesthesia ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Analgesic Efficacy ◽

Gynecological Surgery ◽

Double Blind ◽

Continuous Epidural Infusion ◽

Scale Scores ◽

Numerical Rating

Background. It is well known that the programmed intermittent epidural bolus (PIEB) technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI) in patients undergoing gynecological surgery under combined general-epidural anesthesia. Methods. Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4 mL ropivacaine 0.2% plus fentanyl 2 μg/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4 mL/h. In both groups, additional 4 mL boluses of ropivacaine 0.2% plus fentanyl 2 μg/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale) 3, 24, and 48 hours after surgery. Results. In total, 57 patients were randomized (n=28 and 29 in the PIEB and CEI groups, resp.). The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation): 155.38 (4.55) versus 159.73 (7.87) mL, P=0.016). Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower–upper quartiles]: 0 [0–0.5] versus 3 [0–5.5], P=0.002), 24 hours (1 [0–2] versus 3 [1–4], P=0.003), and 48 hours (1 [0–2] versus 2 [2–3.5], P=0.002) after surgery. Conclusion. PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.

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A comparative study of bilateral ilioinguinal and iliohypogastric nerve block for postoperative analgesia in lower segment cesarean section

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v4i2.21208 ◽

2018 ◽

Vol 4 (2) ◽

pp. 81-86

Author(s):

Anjali Poudel ◽

Prashant Kumar Dutta

Keyword(s):

Comparative Study ◽

Nerve Block ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

College Teaching ◽

Lower Segment ◽

Lower Segment Cesarean Section ◽

Numerical Rating ◽

Group B

Background: Modern techniques incorporate regional anesthesia in pain management and it is the best and safest technique. It avoids the side effects that remain with the traditional use of opioids. Ilioinguinal and iliohypogastric nerve block can provide a satisfactory postoperative analgesia in parturients with pfannenstiel incision thereby reducing postoperative opioid consumption.Objective: To compare opioid consumption and pain relief postoperatively with ilioinguinal and iliohypogastric nerve block in patients undergoing lower segment cesarean section.Methods: It is a hospital based comparative study done in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke in a period of one year. Total of sixty patients, thirty in each were randomly allocated into the two groups. Group B received bilateral ilioinguinal and iliohypogastric nerve block by landmark technique with 20ml of 0.5% bupivacaine; 10ml in each side. Group NS received ilioinguinal and iliohypogastric nerve block with 20ml of 0.9% normal saline. In postoperative period blood pressure, pulse, oxygen saturation, numerical rating scale score at different allocated duration, total dose of tramadol consumption and time to first dose of tramadol were recorded.Results: The total postoperative tramadol consumption in the first 24hr postoperatively was significantly less in group B (125 ± 34.11mg) than in group NS (205 ±37.93mg). The mean effective duration of analgesia measured from the time of onset of spinal blockade to the time of request for tramadol was 264 ±78.27 minutes in group B and 178.17±30.61minutes in group NS, which was statistically significant and also numerical rating scale scores were low at all points postoperatively in group B.Conclusion: Bilateral ilioinguinal and iliohypogastric nerve block significantly lowers the consumption of tramadol and also provides adequate postoperative pain relief.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 81-86

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Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered IV morphine in a pragmatic study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.01.003 ◽

2015 ◽

Vol 7 (1) ◽

pp. 17-24 ◽

Cited By ~ 10

Author(s):

Boel Niklasson ◽

Catarina Arnelo ◽

Susanne Georgsson Öhman ◽

Märta Segerdahl ◽

Agneta Blanck

Keyword(s):

Caesarean Section ◽

Pain Intensity ◽

Postoperative Analgesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Oral Treatment ◽

Standard Of Care ◽

Adverse Outcomes ◽

Open Label ◽

Serious Adverse Events

AbstractBackground and aims The present randomized open label parallel group study was conducted to evaluate if an oral oxycodone (OXY) regimen can be at least equally effective and as safe for postoperative analgesia after caesarean section (CS) as a standard of care program using nurse-administered intravenous morphine (IVM), followed by oral codeine.MethodsEighty women (40 + 40) were scheduled for elective CS under spinal anaesthesia. All patients received postoperative multimodal analgesic therapy, including ibuprofen and paracetamol. The OXY group got standardized extended release and short acting oral treatment (and in a few cases intravenous OXY) as needed and the other group received current standard of care, IVM as needed for 24 h, followed by codeine. Opioid treatment lasted maximum five days. Outcome measures were pain intensity (numerical rating scale, NRS), opioid requirements, duration of administering opioids and safety for mother and newborn. All opioids in the study were expressed in OXY equivalents, using a conversion table. As the bioavailability of each opioid has a certain extent of interindividual bioavailability this conversion represents an approximation. The possible influence of opioids on the newborns was evaluated by the Neurological Adaptive Capacity Score at birth and at 24 and 48 h.Results During the first 24 h, there were no differences between treatments in opioid requirements or mean pain intensity at rest but pain intensity when asking for rescue medication was lower in the OXY than in the IVM group (mean ± SD; 5.41 ± 6.42 vs. 6.42 ± 1.61; p = 0.027). Provoked pain (uterus palpation) during the first 6h was also less in the OXY group (3.26 ± 2.13 vs. 4.60 ± 2.10; p = 0.007). During the 25–48 h period postoperatively, patients on OXY reported significantly lower pain intensity at rest (2.9 ± 1.9 vs. 3.8 ± 1.8; p = 0.039) and consumed less opioids (OXY equivalents; mg) (31.5 ± 9.6 vs. 38.2 ± 38.2; p = 0.001) than those on IVM/codeine. The total amount of opioids 0–5 days postoperatively was significantly lower in the OXY than in the IVM/codeine group (108.7 ± 37.6 vs. 138.2 ± 45.1; p = 0.002). Duration of administering opioids was significantly shorter in the OXY group. Time to first spontaneous bowel movement was shorter in the OXY group compared with the IVM/codeine group. No serious adverse events were recorded in the mothers but the total number of common opioid adverse effects was higher among women on IVM/codeine than among those receiving OXY (15 vs. 3; p = 0.007). No adverse outcomes in the newborns related to treatment were observed in either group.Conclusions In a multimodal protocol for postoperative analgesia after CS better pain control and lower opioid intake was observed in patients receiving oral OXY as compared to those on IVM/codeine. No safety risks for mother and child were identified with either protocol.ImplicationsOur findings support the view that use of oral OXY is a simple, effective and time saving treatment for postoperative pain after CS.

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