The Combination of Ketorolac with Local Anesthesia for Pain Control in Day Care Retinal Detachment Surgery: A Randomized Controlled Trial

This study aims to evaluate the efficacy of ketorolac with local anesthesia compared to local anesthesia alone for perioperative pain control in day care retinal detachment surgery. The randomized controlled trial included 59 eyes of 59 participants for retinal detachment surgery who were randomly assigned (1 : 1) into the ketorolac (K) group and control (C) group. All participants underwent conventional local anesthesia while patients in the K group received an extra administration of preoperative ketorolac. Participants in the K group had a statistically significantly lower intraoperative NRS score (median 1.0 versus 3.0, P=0.003), lower postoperative NRS score (median 0 versus 1.0, P=0.035), fewer proportion of rescue analgesic requirement (10% versus 34.5%, P=0.023), and lower incidence of postoperative nausea and vomiting (13.3% versus 41.4%, P=0.015) compared to the C group. Intraocular pressure (IOP) changes (△IOP) were significantly reduced in the K group (median 1.9 versus 3.0, P=0.038) compared to the C group 24 hours postoperatively. In conclusion, the combination of local anesthesia with ketorolac provides better pain control in retinal detachment surgery compared to local anesthesia alone. The beneficial effect of ketorolac with local anesthesia may contribute to a wider-spread adoption of day care retinal detachment surgery. This trial is registered with ClinicalTrials.gov NCT02729285.

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Reduction of Postoperative Hip Arthroscopy Pain With an Ultrasound-Guided Fascia Iliaca Block: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546519898205 ◽

2020 ◽

Vol 48 (3) ◽

pp. 682-688 ◽

Cited By ~ 1

Author(s):

John L. Glomset ◽

Eugene Kim ◽

John M. Tokish ◽

Suzanne D. Renfro ◽

Tyler B. Seckel ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hip Arthroscopy ◽

Pain Control ◽

Recovery Time ◽

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

Ultrasound Guided ◽

Readmission Rates ◽

Randomized Controlled ◽

Fascia Iliaca Block

Background: Ultrasound-guided fascia iliaca blocks have been used for pain control after hip arthroscopy. There is little evidence regarding their effectiveness in comparison with other pain control modalities in patients who have undergone hip arthroscopy. Purpose: To compare the efficacy of ultrasound-guided fascia iliac block with intra-articular ropivacaine in controlling pain after hip arthroscopy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Between 2015 and 2017, patients (N = 95) undergoing hip arthroscopy were randomly assigned to 2 groups. The first group received an ultrasound-guided fascia iliaca block with 50 to 60 mL of 0.35% ropivacaine. The second group received an intra-articular injection of 20 mL of 0.5% ropivacaine at the completion of the surgical case. Primary outcomes were postoperative pain scores in the recovery room; at postanesthesia care unit (PACU) discharge; and at 2 weeks, 6 weeks, and 3 months. Secondary outcomes included intraoperative and PACU narcotic usage (converted to morphine equivalent use) as well as readmission rates, PACU recovery time, and postoperative nausea and vomiting. Results: Postoperative pain across all points did not significantly differ between the groups. Intraoperative and PACU narcotics did not differ significantly between the groups. Readmission rates, PACU recovery time, and postoperative nausea and vomiting did not significantly differ between the groups. There were no associated complications in either group. Conclusion: Ultrasound-guided fascia iliaca block for hip arthroscopy had no clinical advantage when compared with onetime intra-articular ropivacaine injection. Registration: NCT02365961 (ClinicalTrials.gov identifier).

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Effect on post Tonsillectomy pain control with IV and infiltrated dexamethasone and infiltrated bupivacaine: A Randomized Controlled Trial.

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i2.420 ◽

2021 ◽

Vol 17 (2) ◽

pp. 114-119

Author(s):

Amjad Nadeem ◽

Mirza Nasheed Baig ◽

Nayyer Ayub ◽

Farhan Ahmed

Keyword(s):

Randomized Controlled Trial ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Pain Control ◽

Controlled Trial ◽

Postoperative Nausea And Vomiting ◽

P Value ◽

Randomized Controlled ◽

Dexamethasone Group ◽

Duration Of Surgery

Objectives: To evaluate the effect on post tonsillectomy pain control with IV and infiltrated dexamethasone and infiltrated bupivacaine. Methodology: This randomized controlled trial study was conducted in the department of ENT and neck surgery of Holy Family hospital, Rawalpindi, over a period of one year from May 2019 to May 2020. A total of 140 pediatric patients were selected and were divided into four equal groups randomly by lottery method. Patients in all four groups had endotracheal intubation with general anesthesia. As premedication, all the patients received intravenous midazolam (1mg). Intravenous fentanyl (1.5mg/kg) and propofol (2.5 mg/kg) followed by endotracheal intubation facilitated with atracurium (0.5 mg/kg) were used as general anesthesia in all patients. Results: There was no significant (p-value >0.05) difference in gender, age of children, postoperative heart rate, postoperative SPO2, and fentanyl consumption. The duration of surgery was significantly (p-value < 0.05) different in all four groups. According to the results, no significant (p-value >0.05) difference was found based on postoperative nausea and vomiting and the requirement of antiemetics. The requirement of analgesics was significantly (p-value <0.05) different among four groups. Minimum number (22.86%) of patients who required the analgesic were in IV dexamethasone group and highest requirement rate (60%) was found in local dexamethasone group followed by bupivacaine (48.57%) group. Conclusion: Intravenous dexamethasone was found to be more effective for early postoperative pain control and reduction in requirement of analgesics. The use of dexamethasone can be a preferred choice in patients undergoing tonsillectomy.

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Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04354-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Aaron Gazendam ◽

◽

Seper Ekhtiari ◽

Nolan S. Horner ◽

Nicole Simunovic ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Pain Control ◽

Shoulder Arthroscopy ◽

Controlled Trial ◽

Arthroscopic Surgery ◽

Standard Of Care ◽

Opioid Prescription ◽

Randomized Controlled ◽

Secondary Outcomes ◽

Arthroscopic Knee

Abstract Background Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy. Methods This is a multi-centre, RCT with a target sample size of 200 patients. Adult (18+ years of age) patients undergoing outpatient knee and shoulder arthroscopy will be randomized to a non-opioid postoperative protocol (intervention) or the current standard of care (control). The intervention will consist of a standardized non-opioid analgesic prescription, a limited rescue opioid prescription, and a patient education infographic. The control is defined as the treating surgeons’ pre-trial postoperative analgesic regimen. Exclusion criteria include chronic opioid use, concomitant open surgery, contraindications to the prescribed analgesics or ongoing workers compensation/litigation. The primary outcome is OMEs consumed at 6 weeks postoperatively. Secondary outcomes will include patient-reported pain and satisfaction, quantity of OMEs prescribed, number of opioid refills, and any adverse events up to 6 weeks postoperatively. Utilizing the intention to treat principle for all analyses, independent samples t-test and presented with a p-value as well as a mean difference (MD) with 95% confidence intervals (CIs) will be performed for primary and secondary outcomes. Discussion The ongoing opioid epidemic and overprescribing of opioids in orthopaedics serve as the rationale for this trial. There is a lack of evidence upon which to develop post-operative pain management guidelines for patients undergoing arthroscopic surgery. A prospective evaluation of this relatively inexpensive intervention will demonstrate whether an explicit effort to reduce the number of opioids prescribed results in a reduction in the amount of opioids consumed and help to inform future studies and guidelines. Trial registration The NO PAin trial has been prospectively registered with clinicaltrials.gov (NCT04566250).

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Correction to: Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04474-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

◽

Aaron Gazendam ◽

Seper Ekhtiari ◽

Nolan S. Horner ◽

Nicole Simunovic ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Pain Control ◽

Controlled Trial ◽

Standard Of Care ◽

Shoulder Surgery ◽

Opioid Prescription ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Arthroscopic Knee

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Efficacy and safety of duloxetine for postoperative pain after total knee arthroplasty in centrally sensitized patients: study protocol for a randomized controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04168-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shicheng Wang ◽

Wensheng Wang ◽

Long Shao ◽

Jing Ling

Keyword(s):

Clinical Trial ◽

Total Knee Arthroplasty ◽

Randomized Controlled Trial ◽

Pain Control ◽

Controlled Trial ◽

Control Group ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Total Knee ◽

Postoperative Residual

Abstract Background Postoperative residual knee pain after total knee arthroplasty (TKA) is a significant factor that contributes to patient dissatisfaction. Patients with preoperative central sensitization (CS) may be more susceptible to unexplained chronic pain after TKA, and duloxetine has been reported to be effective in post-TKA pain control in patients with CS. However, there remains limited evidence to support this off-label use in routine clinical practice. Hence, we designed this randomized, placebo-controlled, triple-blind clinical trial to evaluate the effects of preoperative screening and targeted duloxetine treatment of CS on postoperative residual pain compared with the care-as-usual control group. Methods This randomized controlled trial includes patients with knee osteoarthritis on a waiting list for primary unilateral TKA. Patients with preoperative CS will be randomly allocated to the perioperative duloxetine treatment group (duloxetine group) or the care-as-usual control group (placebo group). Patients in the duloxetine group will receive a half-dose of preemptive duloxetine (30 mg/day) for a week before surgery and a full-dose of duloxetine (60 mg/day) for six weeks after surgery. The primary outcome is the intensity of residual pain at six months after TKA, including the visual analogue scale, 11-point numeric rating scale, the sensory dimension of the brief pain inventory, and the pain subscale of the Knee injury and Osteoarthritis Outcome Score. The secondary outcome measures will include the pain and function related outcomes. All of the patients will be followed up at one, three, and six months after surgery. All adverse events will be recorded and immediately reported to the primary investigator and ethics committee to decide if the patient needs to drop out from the trial. Discussion This clinical trial will convey the latest evidence of the efficacy and safety of the application of duloxetine in postoperative pain control in CS patients who are scheduled for TKA. The study results will be disseminated at national and international conferences and published in peer-reviewed journals. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) registration number: ChiCTR2000031674. Registered 07 April 2020.

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