Morphine versus Nalbuphine for Open Gynaecological Surgery: A Randomized Controlled Double Blinded Trial

Introduction. Pain is the commonest morbidity after open surgical procedures. The most effective treatment of postoperative pain is opioid therapy. Morphine, the commonly used opioid, is associated with many side effects including respiratory depression, sedation, postoperative nausea vomiting, and pruritus. Nalbuphine, on the other hand, is known to cause less respiratory depression. Thus this study was undertaken to compare the intraoperative and postoperative analgesic efficacy and side effect profile of the two drugs. Methodology. 60 patients undergoing open gynaecological surgery were randomized to receive either morphine (Group M) or nalbuphine (Group N) in the intraoperative and postoperative period. Intraoperative analgesic efficacy (measured by need for rescue analgesics), postoperative pain by visual analogue scale, and side effects like postoperative nausea, vomiting, sedation, respiratory depression, and pruritus were compared in both groups. Intraoperative and postoperative heart rate and blood pressure were also compared between the groups. Results. Need for intraoperative analgesia was significantly more in Group N (P=0.023). Postoperative VAS scores were significantly different between the groups at various time points; however, none of the patients required any rescue analgesia. The incidence of various side effects was not significantly different between the groups. The haemodynamic profile of patients was comparable between the groups in both intraoperative and postoperative period. Conclusion. Nalbuphine provides less effective intraoperative analgesia than morphine in patients undergoing open gynaecological surgery under general anaesthesia. Both drugs, however, provided similar postoperative analgesia and had similar haemodynamic and side effect profile.

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The Use of Intrathecal Morphine for Acute Postoparative Pain in Lower Limb Arthroplasty Surgery: A Survey of Practice at an Academic Hospital.

10.21203/rs.3.rs-902587/v1 ◽

2021 ◽

Author(s):

Mpumelelo Sibanyoni ◽

Ntombiyethu Biyase ◽

Palesa Motshabi Chakane

Keyword(s):

Side Effects ◽

Respiratory Depression ◽

Spinal Anaesthesia ◽

Side Effect ◽

Intrathecal Morphine ◽

Side Effect Profile ◽

Academic Hospital ◽

Rescue Analgesia ◽

Vas Score ◽

Total Knee

Abstract Background and purpose of the study: Intrathecal morphine (ITM) provides optimal postoperative analgesia in patients who are scheduled for total knee and hip operation with spinal anaesthesia. However, the ideal dose at which maximal analgesic effect occurs with minimal side effects is not known. This study aimed to describe the use of two doses of ITM, and side effect profile in patients undergoing elective hip and knee arthroplasty.Methods: This was a prospective, descriptive, and contextual study conducted on patients who had total hip and knee replacement at Chris Hani Baragwanath Academic Hospital from 1 September to 30 November 2020. The sample size consisted of 66 patients who were 18 years and older, American Society of Anaesthesiology (ASA) classification 1-3, patients who had received either 100 mcg or 150 mcg ITM dose under spinal anaesthesia and sent to the ward postoperatively. Visual Analogue Scale (VAS) score was used to assess pain in the first 24 hours, consumption of rescue analgesia and reported side effects were documented.Results: There was no relationship between age, weight, ASA classification or type of surgery and VAS score classification groups. Patients who received 100 mcg ITM had a higher median VAS pain score 2 (1-5) compared to those who received 150 mcg ITM 1 (0-2), p = 0.01. The need for rescue analgesia between the two groups was marginally less in the 150mcg ITM group (p =0.098). There was no difference in the rate of side effects between the 100 mcg ITM group [12 (41%)] and the 150 mcg ITM group [17 (59%)], p = 0.92. Rescue analgesia was marginally different between groups, p = 0.09. There were no real differences in the VAS pain scores between the total knee and total hip surgeries. None of the patients experienced clinically significant respiratory depression. Conclusion: The 150mcg ITM dose provided good analgesic effects with longer duration of action and comparable side effect profile to the 100mcg ITM dose. This dose was not associated with development of respiratory depression can therefore be administered safely to patients who are discharged to the ward postoperatively in a resource constraint environment.

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Analgesic Efficacy of Paracetamol/Codeine and Paracetamol/Dextropropoxyphene in Pain after Episiotomy and Ruptures in Connection with Childbirth

Journal of International Medical Research ◽

10.1177/030006058701500205 ◽

1987 ◽

Vol 15 (2) ◽

pp. 89-95 ◽

Cited By ~ 17

Author(s):

J. Jacobson ◽

S. O. Bertilson

Keyword(s):

Side Effects ◽

Pain Relief ◽

Side Effect ◽

Post Partum ◽

Analgesic Efficacy ◽

Side Effect Profile ◽

Combination Analgesics

Pain after episiotomy and/or perineal/vaginal rupture in childbirth is severe in many patients and in most cases it can be treated with oral analgesics. In this trial the efficacy and side-effect profile of two combination analgesics, paracetamol/codeine and paracetamol/dextropropoxyphene hydrochloride, were compared in post-partum pain after episiotomy and/or rupture of the perineum. Eighty-five patients were analysed for efficacy and 96 were included in an analysis of side-effects. Paracetamol/codeine was shown to give faster and more efficient pain relief while not causing constipation or other troublesome side-effects.

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Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2007.06.013 ◽

2007 ◽

Vol 19 (8) ◽

pp. 576-582 ◽

Cited By ~ 29

Author(s):

Maria E. Gómez-Vázquez ◽

Eduardo Hernández-Salazar ◽

Abel Hernández-Jiménez ◽

Arturo Pérez-Sánchez ◽

Vilma A. Zepeda-López ◽

...

Keyword(s):

Side Effects ◽

Postoperative Period ◽

Analgesic Efficacy ◽

Early Postoperative Period ◽

Knee Surgery ◽

Arthroscopic Knee Surgery ◽

Arthroscopic Knee

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Suvorexant: A boon for Sleepless Nights

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v14i1.14842 ◽

2016 ◽

Vol 14 (1) ◽

pp. 43-45

Author(s):

Anjan Khadka ◽

Dick Brashier ◽

Amol Vijay Khanpure ◽

Pem Chuki

Keyword(s):

General Practice ◽

Side Effects ◽

Side Effect ◽

Sleep Onset ◽

Side Effect Profile ◽

New Class ◽

Sleep Maintenance ◽

Nonrestorative Sleep ◽

Arousal System ◽

Falling Asleep

Insomnia is characterized by difficulty in falling asleep, difficulty maintaining sleep, or experiencing nonrestorative sleep. Insomnia is the most common medical complaint in general practice. Low efficacy and various side effects limit the use of existing treatment option. Suvorexant is an orexin receptor antagonist (ORA), first in a new class of drugs in development for the treatment of insomnia. It inhibits the wakefulness-promoting orexin neurons of the arousal system thereby promoting the natural transition from wakefulness. It also improves sleep onset and sleep maintenance and has a favorable tolerability and limited side-effect profile.

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A Comparison of Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia for Orthopedic Surgery Under Spinal Anaesthesia

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0901.15 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74-78

Author(s):

Neena Jain ◽

Rahul Bankapur ◽

Preeti Lamba ◽

saurav Singh

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Orthopedic Surgery ◽

Lower Limb ◽

Analgesic Efficacy ◽

Double Blind Study ◽

Group A ◽

Group B

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.

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Comparison of post-operative analgesic effect between Pregabalin and Gabapentin given as premedication drugs for patients undergoing laproscopic cholecystectomy

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.037 ◽

2021 ◽

Vol 8 (2) ◽

pp. 179-184

Author(s):

Arun Kumar Balasubramanian ◽

Rasikapriya Madhanagopal ◽

Priyanka S Gowda ◽

Brindha Rathnasabapathy ◽

R Shankar

Keyword(s):

Placebo Group ◽

Side Effects ◽

Postoperative Pain ◽

Adverse Events ◽

Multimodal Analgesia ◽

Dose Requirement ◽

College Hospital ◽

Rescue Analgesia ◽

Entire Study ◽

The Difference

Currently most of the anesthetist prefer the usage of multimodal analgesia technique to improve the degree of pain relief without inducing any side effects. Pregabalin and gabapentin when given in higher doses reduces the preoperative anxiety and induce sedation without causing undesirable side effects.To compare and evaluate the effects of premedication drugs Pregabalin or Gabapentin versus placebo for attenuation of postoperative pain among patients undergoing laparoscopic cholecystectomy under general anaesthesia.A prospective comparative study was conducted for a period of 6 months in the department of anesthesiology of our medical college hospital. A total of 90 patients posted for elective laproscopic cholecystectomy in the age group between 20 and 60 years were taken as our study subjects. The entire study subjects were randomized into three groups of 30 each. Group B subjects received 3 tablets of Beplex forte (as placebo), Group G subjects received 3 tablets of Gabapentin 300mg (total 900mg) and Group P subjects received 3 tablets of Pregabalin 50mg (total 150mg). Post-operatively degree of pain, requirement for rescue analgesia, sedation score and adverse events occurred was monitored and analysed between the three groups. Pain score was less in the pregabalin group at all intervals compared to gabapentin and placebo group and the difference was found to be statistically significant. Maximum amount of tramadol requirement as a part of rescue analgesia was seen in the placebo group followed by gabapentin group and minimal dose requirement was needed for pregabalin group and the difference was found to be statistically significant. The occurrence of adverse events such as somnolence and dizziness was almost similar in all the three groups whereas the incidence of nausea and vomiting was less in pregabalin group compared to gabapentin and placebo group. Pregabalin can be effectively used as a part of the multimodal analgesic to prevent acute postoperative pain among patients undergoing elective laproscopic cholecystectomy.

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Randomised clinical trial comparing the perioperative analgesic efficacy of oral tramadol and intramuscular tramadol in cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211040406 ◽

2021 ◽

pp. 1098612X2110404

Author(s):

Sébastien H Bauquier

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Analgesic Efficacy ◽

Randomised Clinical Trial ◽

Rescue Analgesia ◽

Exact Test ◽

Pain Scores ◽

Significant Difference ◽

American Society ◽

Induction Of Anaesthesia

Objectives The aim of this study was to evaluate the analgesic efficacy of oral tramadol in cats undergoing ovariohysterectomy. Methods Twenty-four female domestic cats, American Society of Anesthesiologists class I, aged 4–24 months, were included in this positive controlled, randomised, blinded clinical trial. Cats admitted for ovariohysterectomy were allocated to group oral tramadol (GOT, n = 12) or group intramuscular tramadol (GIMT, n = 12). In GOT, tramadol (6 mg/kg) was given orally 60 mins, and saline was given intramuscularly 30 mins, before induction of anaesthesia. In GIMT, granulated sugar in capsules was given orally 60 mins and tramadol (4 mg/kg) intramuscularly 30 mins before induction of anaesthesia. In both groups, dexmedetomidine (0.007 mg/kg) was given intramuscularly 30 mins before induction of anaesthesia with intravenous propofol. Anaesthesia was maintained with isoflurane in oxygen, and atipamezole (0.037 mg/kg) was given intramuscularly 10 mins after extubation. The UNESP-Botucatu multidimensional composite scale was used to conduct pain assessments before premedication and at 20, 60, 120, 240 and 360 mins post-extubation or until rescue analgesia was given. To compare groups, the 60 min postoperative pain scores and the highest postoperative pain scores were analysed via a two-tailed Mann–Whitney test, and the incidences of rescue analgesia were analysed via a Fisher’s exact test; P <0.05. Results There was no significant difference between groups for the 60 min ( P = 0.68) pain scores. The highest postoperative pain score was higher for GIMT compared with GOT ( P = 0.04). Only two cats required rescue analgesia, both from GIMT. The incidence of rescue analgesia was not significantly different between groups ( P = 0.46). Conclusions and relevance In the present study, preoperative administration of oral tramadol at 6 mg/kg to cats provided adequate analgesia for 6 h following ovariohysterectomy surgery.

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Syndrome of Inappropriate Antidiuretic Hormone Associated with Escitalopram Therapy

CNS Spectrums ◽

10.1017/s1092852900014620 ◽

2006 ◽

Vol 11 (6) ◽

pp. 429-432 ◽

Cited By ~ 15

Author(s):

Anjali Nirmalani ◽

Saundra L. Stock ◽

Glenn Catalano

Keyword(s):

United States ◽

Side Effects ◽

High Risk ◽

Antidiuretic Hormone ◽

Side Effect ◽

Parent Compound ◽

The United States ◽

Side Effect Profile ◽

Significant Side Effect ◽

Risk Patients

ABSTRACTEscitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patient's hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.

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The Science of Antipsychotics: Mechanistic Insight

CNS Spectrums ◽

10.1017/s1092852900008129 ◽

2003 ◽

Vol 8 (S2) ◽

pp. 5-9 ◽

Cited By ~ 9

Author(s):

Carol A. Tamminga

Keyword(s):

Side Effects ◽

Tardive Dyskinesia ◽

Side Effect ◽

Negative Symptoms ◽

New Drugs ◽

Receptor Subtypes ◽

Side Effect Profile ◽

Cognitive Symptoms ◽

Conventional Antipsychotics ◽

New Antipsychotics

ABSTRACTWith the introduction of conventional antipsychotics in the 1950s, clinicians began to expect effective treatment of positive symptoms of schizophrenia. However, these drugs do not resolve negative and cognitive symptoms of schizophrenia and are also associated with serious side effects, including extrapyramidal side effects (EPS) and tardive dyskinesia. In 1989, clozapine was introduced and labeled the first new antipsychotic owing to its improved efficacy and side-effect profile. Clozapine proved effective in alleviating many of the positive, negative, and cognitive symptoms of schizophrenia, without causing inevitable EPS or tardive dyskinesia. Over the past decade, a number of different new antipsychotics have been developed. These drugs have an affinity for multiple dopamine-receptor subtypes as well as serotonin, norepinephrine, and glutamate receptors, allowing for better treatment outcomes. The antagonism of the 5-HT2A receptor may be responsible for improvement in negative symptoms and decrease in EPS. In addition to providing enhanced efficacy, the affinity of the new drugs for multiple receptors introduces new side effects not seen with the conventional agents, including weight gain. Each new antipsychotic has a unique receptor-binding profile that corresponds to its pharmacologic and side-effect profile. Understanding the differences in mechanisms of action of new antipsychotics will allow physicians to better choose treatment that meets the needs of each individual patient.

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Adenosine Receptor Antagonists Do Not Disrupt Rodent Prepulse Inhibition: An Improved Side Effect Profile in the Treatment of Parkinson's Disease

Parkinson s Disease ◽

10.1155/2012/591094 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Carina J. Bleickardt ◽

Abigail L. LaShomb ◽

Carrie E. Merkel ◽

Robert A. Hodgson

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Side Effects ◽

Dopamine Receptor ◽

Prepulse Inhibition ◽

Adenosine Receptor ◽

Side Effect ◽

Side Effect Profile ◽

Dopamine Receptor Agonists ◽

Receptor Agonists

Parkinson's disease (PD) is characterized by loss of dopaminergic neurons in the substantia nigra. Current treatments for PD focus on dopaminergic therapies, including L-dopa and dopamine receptor agonists. However, these treatments induce neuropsychiatric side effects. Psychosis, characterized by delusions and hallucinations, is one of the most serious such side effects. Adenosine receptor antagonism is a nondopaminergic treatment for PD with clinical and preclinical efficacy. The present studies assessed antagonists SCH 412348 and istradefylline in rodent prepulse inhibition (PPI), a model of psychosis. Dopamine receptor agonists pramipexole (0.3–3 mg/kg), pergolide (0.3–3 mg/kg), and apomorphine (0.3–3 mg/kg) significantly disrupted PPI; ropinirole (1–30 mg/kg) had no effect; L-dopa (100–300 mg/kg) disrupted rat but not mouse PPI. SCH 412348 (0.3–3 mg/kg) did not disrupt rodent PPI; istradefylline (0.1–1 mg/kg) marginally disrupted mouse but not rat PPI. These results suggest that antagonists, unlike dopamine agonists, have an improved neuropsychiatric side effect profile.

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