scholarly journals Efficacy of Mesoglycan in Pain Control after Excisional Hemorrhoidectomy: A Pilot Comparative Prospective Multicenter Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Gaetano Gallo ◽  
Massimiliano Mistrangelo ◽  
Roberto Passera ◽  
Valentina Testa ◽  
Mauro Pozzo ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Multicenter Study ◽  
Management Strategies ◽  
Postoperative Bleeding ◽  
Treated Group ◽  
Control Group ◽  
Oral Tablet ◽  
Postoperative Thrombosis ◽  
Pain Symptoms ◽  
To Receive

Introduction. Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint. Objective. To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms. Patients and Methods. For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4–6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG). Results. Postoperative thrombosis (SG 1/48 versus CG 5/45) (p<0.001) and pain after rectal examination (p<0.001) were significantly reduced at 7–10 days after surgery in the mesoglycan-treated group, permitting a faster return to work (p<0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug’s antithrombotic properties. Conclusions. The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7–10 days after surgery, permitting a faster return to normal activities.

scholarly journals Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

2017 ◽  
Vol 127 (4) ◽  
pp. 633-644 ◽  
Author(s):  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Delirium ◽  
Intervention Group ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Treated Group ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

scholarly journals Aspirin-Persantin Prophylaxis in Elective total hip Replacement

1977 ◽  
Author(s):  
A.J. Silvergleid ◽  
R. Bernstein ◽  
D.S. Burton ◽  
J.B. Tanner ◽  
J.F. Silverman ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Treated Group ◽  
Control Group ◽  
Double Blind ◽  
Total Hip ◽  
Blind Area ◽  
Effective Prophylaxis ◽  
Clinically Significant ◽  
To Receive

A prospective, double-blind clinical study was performed to evaluate the combination of dipyridamole(Persantin)225 mg/day and acetyl salicyclic acid (ASA) 1 g/day prophylaxis of post-operative venous thromboembolism in elective total hip replacement. Patients were stratified according to age, and randomly assigned to receive drug or placebo. All patients were followed with 125I-labelledfibrinogen scanning for one week post-operatively, or until fully mobile. Venography was performed in 67/129 patients; in 27 patients the venogram was obtained to confirm a positive fibrinogen scan, in 40 patients an elective venogram was obtained on the 7th post-operative day to evaluate the operated thigh (a blind area for scanning). Thrombosis (by scan or venogram) was found in 16/66(24%) in the control group, and in 21/63(33%) in the treated group. Overall incidence was 37/129 (29%). Correlation of scan with venography was 90%. There were no clinically significant pulmonary emboli in either group. We conclude that the combination of ASA and dipridamole as given in this study is not effective prophylaxis in elective total hip replacement.

scholarly journals Evaluation of Oral Robenacoxib for the Treatment of Postoperative Pain and Inflammation in Cats: Results of a Randomized Clinical Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Stephen King ◽  
Elizabeth S. Roberts ◽  
Linda M. Roycroft ◽  
Jonathan N. King
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Rescue Therapy ◽  
Clinical Signs ◽  
Weight Changes ◽  
Body Weight Changes ◽  
Nerve Blocks ◽  
Oral Tablet ◽  
Parallel Group ◽  
To Receive

The efficacy and safety of robenacoxib were assessed for the control of postoperative pain and inflammation in cats. The study was a multicenter, prospective, randomized, blinded, and parallel group clinical trial. A total of 249 client-owned cats scheduled for forelimb onychectomy plus either ovariohysterectomy or castration surgeries were included. All cats received butorphanol prior to anesthesia and forelimb four-point regional nerve blocks with bupivacaine after induction of general anesthesia. Cats were randomized to receive daily oral tablet robenacoxib, at a mean (range) dosage of 1.84 (1.03–2.40) mg/kg , or placebo , once prior to surgery and for two days postoperatively. Significantly fewer robenacoxib cats received additional analgesia rescue therapy (16.5%) than placebo cats (46.3%). Pain elicited on palpation of the soft tissue incision site, behavior following social interaction, and posture assessed during the first 8 hours after extubation were significantly improved in cats receiving robenacoxib. Frequency of reported adverse clinical signs, hematology, serum chemistry and urinalysis variables, and body weight changes weresimilar between groups. In conclusion, robenacoxib was effective and well tolerated in the control of postoperative pain and inflammation in cats undergoing onychectomy with ovariohysterectomy or castration.

Single Dose of Magnesium Sulfate as an Adjuvant to General Anesthesia Improves Pain Control, Discomfort and Quality of Sleep Postoperatively

2016 ◽  
Vol 70 (3) ◽  
pp. 145-147
Author(s):  
Biljana Kuzmanovska ◽  
Marija Donevska Tolevska ◽  
Andrijan Kartalov ◽  
Marija Jovanovski Srceva ◽  
Mirjana Shosholcheva ◽  
...  
Keyword(s):  
Single Dose ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Magnesium Sulfate ◽  
Treated Group ◽  
Control Group ◽  
Quality Of Sleep ◽  
Analgesic Consumption ◽  
Pain At Rest

Abstract Introduction. As a N-methyl-D-aspartate receptors antagonist, magnesium may play a role in prevention of pain. The aim of this study was to assess the effects of single dose magnesium sulfate preoperatively on postoperative pain scores, discomfort and quality of sleep. Methods. Forty patients scheduled for elective laparoscopic cholecystectomy were randomized in two groups. Group A received 20 mg/kg magnesium sulfate after the anesthesia induction, prior to surgical incision, and Group B was the control group. Assessment was made for pain at rest in both groups according to VAS (0-10), analgesic consumption, discomfort and quality of sleep during first 48 hours postoperatively. Resultѕ. Compared to control group, magnesium-treated patients had lower postoperative pain at rest according to VAS score (p< 0.05) and consumed less analgesic drugs during the first 48 hours (p<0.05). The magnesium-treated group experienced less discomfort during the first and the second postoperative day. The magnesium-treated group reported no changes in sleeping pattern compared to preoperative sleeping pattern, while the control group showed an increase in insomnia during the first and the second postoperative night, compared to that preoperatively. Conclusion. Perioperative use of magnesium sulfate as an adjuvant to general anesthesia is associated with lower postoperative pain, less analgesic consumption, less discomfort and better sleep in the postoperative period.

Ursodeoxycholic acid for the prevention of hepatic complications in allogeneic stem cell transplantation

Blood ◽  
2002 ◽  
Vol 100 (6) ◽  
pp. 1977-1983 ◽  
Author(s):  
Tapani Ruutu ◽  
Britta Eriksson ◽  
Kari Remes ◽  
Eeva Juvonen ◽  
Liisa Volin ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Ursodeoxycholic Acid ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Treated Group ◽  
Control Group ◽  
To Receive

Abstract The role of ursodeoxycholic acid (UDCA) in the prevention of hepatic complications after allogeneic stem cell transplantation was studied in a prospective randomized open-label multicenter trial. A total of 242 patients were allocated to receive (n = 123) or not to receive (n = 119) UDCA in the dose of 12 mg/kg/d orally from the day preceding the conditioning until day 90 after transplantation. In the UDCA-treated group a significantly smaller proportion of patients developed a serum bilirubin level exceeding 50 μM (18 of 123 versus 31 of 119, P = .04), and similarly a smaller proportion of patients exceeded the alanine aminotransferase level of 100 U/L. There was no difference in the incidence of veno-occlusive disease of the liver. Compared to the control group, in the UDCA-treated group there was a nonsignificant trend toward a lower overall incidence of acute graft-versus-host disease (GVHD) and a significantly lower incidence of grade III to IV acute GVHD (5 of 123 versus 17 of 119,P = .01), stage II to IV liver and intestinal GVHD, and stage III to IV skin GVHD. There was no difference in the incidence of chronic GVHD or in the relapse rate. Among the patients given UDCA, the survival at 1 year was significantly better, 71% versus 55% (P = .02), and the nonrelapse mortality rate was lower, 19% versus 34% (P = .01), than in the control group. There were significantly more deaths in GVHD in the control group. In conclusion, UDCA administration reduced hepatic problems and severe acute GVHD and improved survival. These results suggest a role for UDCA in the prevention of transplant-related complications in allogeneic transplantation.

Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis

2010 ◽  
Vol 112 (2) ◽  
pp. 268-272 ◽  
Author(s):  
Scott Y. Rahimi ◽  
Cargill H. Alleyne ◽  
Eric Vernier ◽  
Mark R. Witcher ◽  
John R. Vender
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Management Strategies ◽  
Length Of Hospital Stay ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Pain Scores ◽  
Pain Medications ◽  
Hospitalization Costs ◽  
Hospital Stays

Object Patients undergoing craniotomies have traditionally received opiates with acetaminophen for the management of their postoperative pain. The use of narcotic pain medications can be costly, decrease rates of early postoperative ambulation, lengthen hospital stays, and alter a patient's neurological examination. The use of alternative pain medications such as tramadol may benefit patients by resolving many of these issues. Methods The authors conducted a randomized, blinded prospective study to evaluate the efficacy of alternative pain management strategies for patients following craniotomies. Fifty patients were randomly assigned either to a control group who received narcotics and acetaminophen alone or an experimental group who received tramadol in addition to narcotic pain medications (25 patients assigned to each group). Results The control group was noted to have statistically significant higher visual analog scale pain scores, an increased length of hospital stay, and increased narcotic use compared with the tramadol group. The narcotics and acetaminophen group also had increased hospitalization costs when compared with the tramadol group. Conclusions The use of scheduled atypical analgesics such as tramadol in addition to narcotics with acetaminophen for the management of postoperative pain after craniotomy may provide better pain control, decrease the side effects associated with narcotic pain medications, encourage earlier postoperative ambulation, and reduce total hospitalization costs.

scholarly journals Using random assignment to measure court accessibility for low-income divorce seekers

2021 ◽  
Vol 118 (14) ◽  
pp. e2009086118
Author(s):  
D. James Greiner ◽  
Ellen Lee Degnan ◽  
Thomas Ferriss ◽  
Roseanna Sommers
Keyword(s):  
Low Income ◽  
Treated Group ◽  
Control Group ◽  
Random Assignment ◽  
Legal Process ◽  
Court Records ◽  
The Us ◽  
Pro Bono ◽  
Us Constitution ◽  
To Receive

We conducted a field experiment in which 311 low-income individuals seeking a divorce were randomly assigned to receive access to a pro bono lawyer (versus minimal help) to assist with filing for divorce. Examining court records, we found that assignment to an attorney made a large difference in whether participants filed for and obtained a divorce. Three years after randomization, 46% of the treated group had terminated their marriages in the proper legal venue, compared to 9% of the control group. Among “compliers”—participants who obtained representation only if assigned to receive it—those with lawyers were far more likely to file for and obtain a divorce than those not assigned lawyers. Because divorce implicates fundamental constitutional interests and can be effectuated only by resort to the courts, the US Constitution requires that dissolution of marriage be made achievable regardless of ability to pay. Yet, we observed few low-income individuals who were able to initiate divorce suits on their own. Through interviews and archival research, we identified barriers that low-income litigants faced in navigating the divorce system, including mandatory wait times, limited hours at important facilities, and burdensome paperwork sometimes requiring access to photocopiers and typewriters. This study therefore documents a salient instance in which a civil legal process was inaccessible to those without lawyers, even though their legal issues were straightforward, involving few if any matters for courts to adjudicate.

11 FERTILITY RESPONSE IN SUCKLED BEEF COWS SUPPLEMENTED WITH LONG-ACTING PROGESTERONE AFTER TIMED ARTIFICIAL INSEMINATION

2015 ◽  
Vol 27 (1) ◽  
pp. 98 ◽  
Author(s):  
G. Pugliesi ◽  
F. B. Santos ◽  
E. Lopes ◽  
É. Nogueira ◽  
J. R. G. Maio ◽  
...  
Keyword(s):  
Prostaglandin F2α ◽  
Beef Cows ◽  
Treated Group ◽  
Control Group ◽  
Placebo Control ◽  
Negative Effects ◽  
Group V ◽  
Buserelin Acetate ◽  
Long Acting ◽  
To Receive

Corpus luteum (CL) and progesterone (P4) secretion are affected by preovulatory follicle (POF) size. Increased circulating P4 during early diestrus has a positive effect on embryo development in beef cattle. However, the combined effects of the POF size and P4 supplementation during early diestrus on fertility of beef cows are not known. The objective was to evaluate the effects of POF size and supplementation of long-acting P4 after timed-AI on pregnancy rates (P/AI). Suckled Nelore cows (n = 596) were evaluated twice by transrectal Doppler ultrasonography (US) 10 days apart to detect the cyclic status. In Study 1, anestrous cows (absence of CL on both exams) received an intravaginal P4 device and an oestradiol benzoate (EB) injection on Day –10 (day of the second US). Devices were removed and sodium cloprostenol [prostaglandin F2α (PGF2α)], oestradiol cypionate, and eCG were given on Day –2. Cows were timed-AI on Day 0 and assigned to receive placebo (control group, n = 187) or 150 mg of long-acting P4 on Day 4 (P4 group, n = 189). In Study 2, cyclic cows (presence of CL) received a PGF2α injection on Day –20 (first US). Cows with a new CL on Day –10 received an intravaginal P4 device and an injection of EB and were split to receive an injection of PGF2α [large follicle (LF); n = 109] or not [small follicle (SF); n = 111]. Devices were removed and PGF2α was injected on Day –2. Ovulation was induced with buserelin acetate, and cows were timed-AI on Day 0 and split to receive placebo (LF/control group, n = 55, and SF/control group, n = 55) or 150 mg of long-acting P4 on Day 4 (LF/P4 group, n = 56, and SF/P4 group, n = 54). Ultrasonographic scanning was done on Days 0, 4, and between 35 and 40 to detect the POF and CL sizes and P/AI, respectively. Data were analysed using PROC GLIMMIX (SAS Institute Inc., Cary, NC). In anestrous cows, P/AI was reduced in POF with <11 mm. The P/AI was greater in the P4-treated group than in the control group for all cows (55.6% v. 46.0%; P = 0.05) and for ovulated cows (59%, 105/178 v. 49%, 86/173; P = 0.08). For cyclic cows, POF size (mm) on Day 0 (13.5 ± 0.3 v. 11.2 ± 0.2), ovulation rate (90% v. 77%), and CL area (cm2) on Day 4 (1.46 ± 0.05 v. 1.25 ± 0.05) were greater (P < 0.007) in the LF group than in the SF group. There was a main effect of follicle group on P/AI (54%, LF group v. 38%, SF group; P < 0.01). Moreover, P/AI were greater (P < 0.05) in the LF/control (56%) and LF/P4 (52%) groups than in the SF/control group (31%), whereas no difference was detected between the SF/P4 group (45%) and the other groups. Among cows that ovulated, P/AI was lower (P = 0.05) in the SF/control group (41%, 17/41) compared with the LF/control group (62%, 31/50) and were similar for the SF/P4 group (56%, 25/45) and LF/P4 group (57%, 28/49) compared with others. We suggest that P4-stimulated embryotrophic effects improved fertility in anestrous beef cows supplemented with long-acting P4 on Day 4 after timed-AI. Also, the presence of a functional CL during follicle growth results in smaller POF and CL and reduces the ovulatory and P/AI rates in cyclic cows. Post-AI P4 supplementation may attenuate the negative effects of small POF/CL. Research was supported by CNPq, FAPESP, Ouro Fino Agronegócio, and Innovare.

scholarly journals Long-term Effect of Sciatic Nerve Block with Slow-release Lidocaine in a Rat Model of Postoperative Pain

2010 ◽  
Vol 112 (6) ◽  
pp. 1473-1481 ◽  
Author(s):  
Masaru Tobe ◽  
Hideaki Obata ◽  
Takashi Suto ◽  
Hideaki Yokoo ◽  
Yoichi Nakazato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Postoperative Pain ◽  
Sciatic Nerve ◽  
Slow Release ◽  
Treated Group ◽  
Spinal Cord Dorsal Horn ◽  
Control Group ◽  
Withdrawal Threshold ◽  
Spinal Cord Dorsal ◽  
Fos Expression

Background Postoperative pain management is important for preventing perioperative complications. The authors examined the effectiveness of controlled-release lidocaine for sciatic nerve block in a rat model of postoperative pain. Methods The authors created a novel slow-release lidocaine sheet (SRLS) with polylactic-coglycolic acid. In male Sprague-Dawley rats (postoperative pain model), the authors applied the SRLS, lidocaine alone, or polylactic-coglycolic acid (control) near the ipsilateral sciatic nerve just before making the paw incision. Mechanical hypersensitivity was assessed using von Frey filaments, and c-fos expression was examined in the spinal cord dorsal horn at segments L4-L5. Neurotoxicity and muscle toxicity were also evaluated via histopathology. Results The SRLS (30%, w/w) continuously released lidocaine for 1 week in vitro. The withdrawal threshold in the SRLS-treated group was higher than that in the control group at all time points measured (2 h to 7 days). The withdrawal threshold in the lidocaine-treated group was higher than that in the control group only at 2 h after paw incision. The mean number of c-fos immunoreactive neurons in the SRLS-treated group was lower than in the control group at 2, 5, and 48 h after paw incision and lower than in the lidocaine-treated group at 5 and 48 h after paw incision. On histopathology, signs of inflammation were only slightly present in the muscle and nerve tissues of the SRLS-treated group. Conclusions Single treatment with the SRLS inhibited hyperalgesia and c-fos expression in the spinal cord dorsal horn for 1 week. Slow-release local anesthetics are promising for the management of postoperative pain.

scholarly journals The Effect of Intraoperative Diphenhydramine/Morphine on Acute Pain and Opioid Consumption after Spine Surgery

2022 ◽  
Author(s):  
Ahmad Pour-Rashidi ◽  
Maryam Mardani ◽  
Farhad Etezadi ◽  
Reza Shariat Moharari ◽  
Mohammad Reza Khajavi
Keyword(s):  
Postoperative Pain ◽  
Spine Surgery ◽  
Acute Pain ◽  
Multimodal Analgesia ◽  
Early Postoperative Period ◽  
Control Group ◽  
Double Blind ◽  
The Mean ◽  
Common Problems ◽  
To Receive

Background: One of the most common problems after spine surgery is very severe pain that usually affects outcome of patients after surgery and duration of hospital stay. Acute postoperative pain has several mechanisms, and multimodal analgesia by different mechanism of action will help control to it. In this study, we intended to investigate the effect of intravenous diphenhydramine injection during induction of anesthesia and morphine before incision on the control of acute pain in postoperative laminectomy. Methods: 130 patients scheduled for spine surgeries were assigned to receive a single pre induction dose of diphenhydramine 0.4mg/kg IV (D group) and morphine 0.15mg/kg before incision in addition acetaminophen 1gr IV at the end of surgery and just morphine 0.15mg/kg and acetaminophen 1gr IV (C group) in a randomized, double-blind trial. Postoperative pain, analgesic requirements in recovery and 24 hr after surgery were assessed. Results: The mean pain intensity in recovery was lower in the diphenhydramine group than in the control group (MD, 2.13; 95% confidence interval (CI), 1.72–2.53; P < .0001) and the need for analgesia was much lower in the diphenhydramine group than in the control group. P < 0.001. The severity of pain and the need for analgesics in the diphenhydramine group had a significant decrease in the ward compared to the control group. Conclusion: Prophylactic diphenhydramine 0.4 mg/kg at induction of general anesthesia in combination with morphine 0.15mg/kg before incision and acetaminophen 1gr at the end of surgery reduced the postoperative severity of acute pain and opioids requirement in the early postoperative period after spine surgeries.

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