scholarly journals Dezocine Prevents Postoperative Hyperalgesia in Patients Undergoing Open Abdominal Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fang Yu ◽  
Jie Zhou ◽  
Suyun Xia ◽  
Huan Xu ◽  
Xiangrui Wang
Keyword(s):  
Treatment Group ◽  
Abdominal Surgery ◽  
Pain Threshold ◽  
Controlled Trial ◽  
Thermal Hyperalgesia ◽  
Postoperative Nausea And Vomiting ◽  
Open Gastrectomy ◽  
Sham Treatment ◽  
Pain Scores ◽  
Open Abdominal Surgery

Objective. Postoperative hyperalgesia is very frequent and hard to treat. Dezocine is widely used and has a modulatory effect for thermal hyperalgesia in animal models. So, this study was designed to investigate the potential role of dezocine in decreasing postoperative hyperalgesia for patients undergoing open abdominal surgery.Methods. This is a randomized, double-blinded, and placebo-controlled trial. 50 patients for elective open gastrectomy were randomly allocated to either a true treatment group (0.15 mg/kg intravenous dezocine at the end of surgery) or a sham treatment group (equivalent volume of saline) in a 1 : 1 ratio. Patients were followed up for 48 hours postoperatively and pain threshold to Von Frey filaments, pain scores, PCIA consumption, rescue analgesics use, sedation score, and occurrence of postoperative nausea and vomiting were recorded.Results. Patients in the true treatment group experienced statistically significantly higher pain threshold on forearm and smaller extent of peri-incisional hyperalgesia than the sham treatment group. Rescue analgesic use, cumulative PCIA consumption, and pain scores were statistically significantly decreased in the true treatment group compared to the sham treatment group.Conclusions. Dezocine offers a significant antihyperalgesic and analgesic effect in patients undergoing elective open gastrectomy for up to 48 hours postoperatively.

Circular pOlyethylene drape in preVEntion of suRgical site infection (COVER Trial): Study protocol of a randomized controlled trial

2018 ◽  
Author(s):  
Ri Na Yoo ◽  
Hyung Jin Kim ◽  
Jae Im Lee ◽  
Won-Kyung Kang ◽  
Bong-Hyeon Kye ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Controlled Trial ◽  
Dropout Rate ◽  
Site Infection ◽  
Gi Tract ◽  
Randomized Controlled ◽  
Wound Protector ◽  
Open Abdominal Surgery

Abstract Background: Surgical site infection (SSI) after abdominal surgery is still a significant morbidity associated with an increased socioeconomic burden and poor quality of life. SSI prevalence rates as high as 40% in cases of fecal contamination have been reported; however, current methods to reduce SSI are limited to elective abdominal surgery. Further evaluation of preventive measures for reducing SSI is necessary. Methods/design: The COVER trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing open abdominal surgery related to the gastrointestinal (GI) tract, regardless of the type of wound classified by the Center for Disease Control (CDC). The COVER trial is a multicenter, randomized controlled clinical trial with two parallel arms – one using a wound protector and the other using conventional surgical dressing gauze. The primary outcome will measure the rate of SSI in two groups. Statistical analysis of the primary end point will be based on the intention-to-treat population. The sample size is determined to achieve a study power of 80% at 95% 2-sided confidence limits. Considering a dropout rate of up to 5%, a total of 458 patients, 229 patients in each group, will be enrolled in this study. Discussion: The COVER trial will provide high-quality evidence for using a circular polyethylene drape in open abdominal surgery for the GI tract in all types of wound. The design of the trial will deliver high external validity and clinical significance. Trial registration: The trial protocol was registered at ClinicalTrials.gov (NCT 03170843) on May 31, 2017. https://clinicaltrials.gov/ct2/show/NCT03170843?term=NCT+03170843&rank=1 Keywords: Circular polyethylene drape, Abdominal surgery, Gastrointestinal tract, Surgical site infection, Randomized controlled trial

scholarly journals Prospective Audit Comparing Intrathecal Analgesia (Incorporating Midazolam) with Epidural and Intravenous Analgesia after Major Open Abdominal Surgery

2007 ◽  
Vol 35 (4) ◽  
pp. 558-562 ◽  
Author(s):  
M. A. Duncan ◽  
J. Savage ◽  
A. P. Tucker
Keyword(s):  
Abdominal Surgery ◽  
Intrathecal Morphine ◽  
Median Number ◽  
Prospective Audit ◽  
Suitable Alternative ◽  
Usual Practice ◽  
Pain Scores ◽  
Analgesic Regimen ◽  
Open Abdominal Surgery ◽  
Service Intervention

Potentiation of opioid analgesia can be achieved by the addition of midazolam intrathecally. At our institution, analgesia following open abdominal surgery is provided by continuous infusion of analgesic solutions either intravenously, intrathecally (incorporating midazolam) or epidurally. We report the results of a study comparing outcomes with these three analgesic regimens following major open abdominal surgery. This was an unblinded prospective audit of pain service intervention rates, pain scores and other outcomes after intravenous, intrathecal and epidural analgesia after open abdominal surgery in patients over 60 years of age. Both elective and emergency cases were included over a nine-month period. Patients ventilated for 24 hours or more were excluded. The analgesic regimens were as follows: 1. Intravenous: patient controlled analgesia with morphine + ketamine infusion 0.1 to 0.2 mg/kg/h. 2. Intrathecal: (morphine 10 μg/ml+midazolam 100 μg/ml + bupivacaine 0.05%) commenced at 2 ml/h. 3. Epidural: bupivacaine 0.125% + fentanyl 2 μg/ml at 6 to 14 ml/h. Co-analgesic administration was as per our usual practice but was not standardised. The median number of calls per patient to the pain service differed between the intravenous (1), intrathecal (1) and epidural (3) groups. The number of unintentional analgesic regimen terminations differed between the intravenous (1), intrathecal (1) and epidural (5) groups. Pain scores differed significantly between groups and were lowest in the intrathecal group at all time points. The findings indicate that the intrathecal group had both a low requirement for postoperative interventions/ resources and excellent analgesia. It appears to be a suitable alternative to the other techniques.

scholarly journals Dexmedetomidine as an Opioid-Sparing Agent in Pediatric Craniofacial Surgery

Children ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. 68
Author(s):  
Srijaya Reddy ◽  
Jacob Jones ◽  
Heather Gordish-Dressman ◽  
Sophie Pestieau
Keyword(s):  
Side Effects ◽  
Reconstructive Surgery ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Pain Modulation ◽  
Craniofacial Surgery ◽  
Nausea And Vomiting ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Pain Scores

Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings.

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