Interpleural Morphine vs Bupivacaine for Postthoracotomy Pain Relief

2008 ◽  
Vol 16 (5) ◽  
pp. 370-374 ◽  
Author(s):  
Shideh Dabir ◽  
Tahereh Parsa ◽  
Badiozaman Radpay ◽  
Mojgan Padyab
Keyword(s):  
Side Effects ◽  
Posterolateral Thoracotomy ◽  
Morphine Group ◽  
Double Blind ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Postthoracotomy Pain ◽  
Intravenous Morphine ◽  
American Society ◽  
American Society Of Anesthesiologists

This prospective randomized double-blind trial was designed to compare the analgesic effects of interpleural bupivacaine and interpleural morphine for postthoracotomy pain management. Thirty-six American Society of Anesthesiologists class I and II patients undergoing an elective posterolateral thoracotomy were randomly divided into 2 groups of 18 each. Before chest closure, an interpleural catheter was inserted under direct vision. At the end of the operation and every 4 hours thereafter, they received either 0.25% bupivacaine with epinephrine or 0.2 mg·kg−1 morphine sulfate interpleurally for 24 hours. The chest tubes were clamped during injection and for 15 min afterwards. Supplementary doses of intravenous morphine were given on request. The pain severity was evaluated at rest and on coughing before and 30 min after each interpleural injection, using an 11-point visual analog scale. Supplemental analgesic consumption and side effects were recorded. Both interpleural morphine and bupivacaine significantly reduced pain scores 30 min after each injection. However, pain scores and supplementary analgesic requirements were significantly lower in the interpleural morphine group. No serious side effects were detected in either group. Interpleural morphine provides better pain control than interpleural bupivacaine after a posterolateral thoracotomy.

Preemptive Intravenous Morphine-6-glucuronide Is Ineffective for Postoperative Pain Relief

2000 ◽  
Vol 92 (2) ◽  
pp. 355-355 ◽  
Author(s):  
Cyrus Motamed ◽  
Xavier Mazoit ◽  
Khaldoun Ghanouchi ◽  
Frédéric Guirimand ◽  
Kou Abhay ◽  
...  
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Patient Characteristics ◽  
Skin Closure ◽  
Acute Postoperative Pain ◽  
Morphine Group ◽  
Intravenous Morphine ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Morphine-6-glucuronide (M-6-G), a major metabolite of morphine, is reported to be more potent than morphine when administered intrathecally; however, its efficiency remains under debate when administered intravenously. This study was designed to assess the analgesic efficiency of intravenous M-6-G for the treatment of acute postoperative pain. Methods After informed consent was obtained, 37 adults (American Society of Anesthesiologists physical status I-II) who were scheduled for elective open knee surgery were enrolled in the study. General anesthesia was induced with thiopental, alfentanil, and vecuronium and was maintained with a mixture of nitrous oxide/isoflurane and bolus doses of alfentanil. At skin closure, patients were randomized into three groups: (1) morphine group (n = 13), which received morphine 0.15 mg/kg; (2) M-6-G group (n = 12), which received M-6-G 0.1 mg/kg; and (3) placebo group (n = 12), which received saline. At the time of extubation, plasma concentration of morphine and M-6-G was measured. Postoperative analgesic efficiency was assessed by the cumulative dose of morphine delivered by patient-controlled analgesia. Opioid-related side effects were also evaluated. Results No difference was noted in patient characteristics and opioid-related side effects. Morphine requirements (mean +/- SD) during the first 24 h in the M-6-G group (41+/-9 mg) and the placebo group (49+/-8 mg) were significantly greater (P<0.05) compared with the morphine group (29+/-8 mg). Conclusion A single intravenous bolus dose of M-6-G was found to be ineffective in the treatment of acute postoperative pain. This might be related to the low permeability of the blood-brain barrier for M-6-G.

Comparing Intradermal Sterile Water with Intravenous Morphine in Reducing Pain in Patients with Renal Colic: A Double-Blind Randomized Clinical Trial

2020 ◽  
Vol 15 (1) ◽  
pp. 76-82
Author(s):  
Javad Mozafari ◽  
Mohammadreza Maleki Verki ◽  
Fatemeh Tirandaz ◽  
Reza Mahjouri
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Renal Colic ◽  
Therapeutic Effects ◽  
Sterile Water ◽  
Morphine Group ◽  
Double Blind ◽  
Water Group ◽  
Intravenous Morphine ◽  
Painful Area

Objective: The present study was conducted to investigate the effect of intradermal administration of sterile water compared to intravenous morphine on patients with renal colic. Methods: This double-blind, randomized clinical trial study was conducted in 2017 to compare the therapeutic effects of intradermal sterile water with those of intravenous morphine on patients with renal colic presenting to the emergency departments (ED) of Imam Khomeini and Golestan Hospitals in Ahvaz, Iran. The first group received 0.5 ml of intradermal sterile water, and the second group 0.1mg/kg of intravenous morphine plus 0.5 ml of intradermal sterile water in the most painful area or the center of the painful area in the flank. The pain severity was measured using a visual analogue scale (VAS), and the medication side-effects were recorded at the beginning of the study and minutes 15, 30,45 and 60. Result: A total of 94 patients were studied in two groups. The mean severity of pain was 2.97 ± 1.51 in the sterile water group and 2.34 ± 1.89 in the morphine group at minute 30 (P=0.042), 2.58 ± 1.43 in the sterile water group and 1 ± 1.23 in the morphine group at minute 45 (p<0.001), and 1.89 ± 1.7 in the sterile water group and 0.52 ± 0.79 in the morphine group at minute 60 (p<0.001). Conclusion: Morphine reduces pain faster and more effectively than intradermal sterile water; nevertheless, treatment with intradermal sterile water can be used as an appropriate surrogate or adjunct therapy for pain control, particularly in special patients or in case of medication scarcity.

scholarly journals Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

2020 ◽  
Author(s):  
Atef Mohamed Sayed Mahmoud ◽  
Joseph Makram Botros ◽  
Safaa Gaber Ragab
Keyword(s):  
General Anesthesia ◽  
Polycystic Ovary ◽  
Controlled Trial ◽  
Controlled Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
Airway Response ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Better Than

Abstract Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

scholarly journals Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Scalp Block and Scalp Infiltration to Control Postcraniotomy Pain: A Double-Blind Randomized Trial

2018 ◽  
Vol 09 (01) ◽  
pp. 073-079 ◽  
Author(s):  
Shankar Vallapu ◽  
Nidhi Bidyut Panda ◽  
Navneh Samagh ◽  
Neerja Bharti
Keyword(s):  
Nerve Block ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Objective ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Respiratory Parameters ◽  
Scalp Block ◽  
American Society ◽  
American Society Of Anesthesiologists

ABSTRACT Context: Scalp infiltration and scalp block are being used to manage postcraniotomy pain. Dexmedetomidine has been successfully used as an adjuvant in regional anesthesia. The study was intended to compare whether addition of dexmedetomidine prolonged the duration of analgesia as well as to compare the two techniques. Aims: The primary objective was to assess whether addition of dexmedetomidine to bupivacaine prolonged the duration of analgesia. The secondary objective was to compare between scalp nerve block and scalp infiltration as techniques for pain relief. Settings and Design: The randomized control study was conducted in a tertiary care center from November 2013 to October 2014. Materials and Methods: A total of 150 American Society of Anesthesiologists Physical Status I–II patients, aged 18–70 years undergoing elective craniotomy were included. Patients were randomized into three groups of 50 patients, i.e., Group BI (bupivacaine infiltration), Group BDI (bupivacaine and dexmedetomidine infiltration), and Group BDNB (bupivacaine and dexmedetomidine scalp nerve block). Patient's pain score, pain-free interval, rescue analgesic requirement, and hemodynamic and respiratory parameters were noted for 48 h. Patients were followed up at 1 and 3 months to assess postcraniotomy pain. Results: Pain-free period was significantly longer in Group BDNB than Groups BDI and BI (P < 0.0001) and pain control was better in dexmedetomidine containing groups than in bupivacaine group (BI) (P < 0.0001). The rescue analgesic requirement was significantly lower in Group BDNB and Group BDI compared to Group BI. Conclusion: The addition of dexmedetomidine (1 µg/kg) to bupivacaine prolonged the pain-free period. Scalp nerve block is a superior technique than scalp infiltration.

scholarly journals Comparison in Sedative Effects between Dexmedetomidine and Midazolam in Dental Implantation: A Randomized Clinical Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Li Wang ◽  
Yi Zhou ◽  
Tiejun Zhang ◽  
Lili Huang ◽  
Wei Peng
Keyword(s):  
Vital Signs ◽  
Pain Scores ◽  
Dental Implantation ◽  
Group I ◽  
Random Manner ◽  
The Difference ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Adrenergic Receptor Agonist ◽  
Alternative Drugs

Dexmedetomidine refers to an α2-adrenergic receptor agonist causing potent sedative, analgesic, and minimal respiratory depression compared with alternative drugs. The present study was aimed at comparing the efficaciousness and safety of midazolam and dexmedetomidine as sedatives for dental implantation. We recruited 60 patients belonging to group I or II of the American Society of Anesthesiologists (ASA) and treated them with either midazolam or dexmedetomidine in a random manner. Patients’ duration of analgesia after surgery, surgeon and patient degrees of satisfaction, Observer’s Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, visual analogue scale (VAS) pain scores, and vital signs were recorded variables. Patients administered dexmedetomidine had significantly lower OAAS scores than those administered midazolam (p<0.05). Patients administrated dexmedetomidine had a significantly longer analgesia duration after the surgical procedure than those administered midazolam, and the difference was statistically significant (p<0.05). Dexmedetomidine had a significantly larger number of surgeons satisfied with the level of sedation/analgesia than midazolam (p<0.05). Accordingly, it is considered that dexmedetomidine can achieve better postoperative analgesia, surgeon satisfaction, and sedation than midazolam.

Effect of Patient-controlled Perineural Analgesia on Rehabilitation and Pain after Ambulatory Orthopedic Surgery

2006 ◽  
Vol 105 (3) ◽  
pp. 566-573 ◽  
Author(s):  
Xavier Capdevila ◽  
Christophe Dadure ◽  
Sophie Bringuier ◽  
Nathalie Bernard ◽  
Philippe Biboulet ◽  
...  
Keyword(s):  
Adverse Events ◽  
Functional Recovery ◽  
Orthopedic Surgery ◽  
Infusion Pump ◽  
Daily Activities ◽  
Morphine Group ◽  
Patient Satisfaction Score ◽  
Pain Scores ◽  
Intravenous Morphine ◽  
Basal Bolus

Background Efficacy of continuous perineural and patient-controlled ropivacaine infusion at home after orthopedic surgery was compared with patient-controlled intravenous morphine for functional recovery and postoperative analgesia in a multicenter randomized trial. Methods Eighty-three patients scheduled to undergo acromioplasty or hallux valgus surgery received an interscalene (n = 40) or popliteal (n = 43) peripheral nerve block with 30 ml ropivacaine, 0.5%. After randomization, patients were discharged home 24 h after surgery with a disposable infusion pump delivering either patient-controlled intravenous morphine (n = 23) or perineural 0.2% ropivacaine infusion, either continuous infusion without bolus (n = 30) or basal infusion plus bolus (n = 30). The patients recorded pain scores on movement and/or walking and were directed to take paracetamol and rescue analgesics if necessary. The time necessary to be able to walk for 10 min; daily activities on days 1, 2, and 3; adverse events; and overall satisfaction scores were noted and graded by the patient. Results Basal-bolus ropivacaine decreased the time to 10 minutes' walk, optimized daily activities (P &lt; 0.01), and decreased the amount of ropivacaine used. The morphine group had greater pain scores and consumption of morphine and ketoprofen compared with both ropivacaine groups (P &lt; 0.05). The incidence of nausea/vomiting, sleep disturbance, and dizziness increased, and the patient satisfaction score decreased in the morphine group (P &lt; 0.05). Conclusions After ambulatory orthopedic surgery, 0.2% ropivacaine delivered as a perineural infusion using a disposable elastomeric pump with patient-controlled anesthesia bolus doses optimizes functional recovery and pain relief while decreasing the consumption of rescue analgesics and ropivacaine, and the number of adverse events.

scholarly journals Oxycodone for prevention of etomidate-induced myoclonus: a randomized double-blind controlled trial

2018 ◽  
Vol 46 (5) ◽  
pp. 1839-1845
Author(s):  
Wei Wang ◽  
Jie Lv ◽  
Qi Wang ◽  
Lei Yang ◽  
Wanyou Yu
Keyword(s):  
General Anesthesia ◽  
Intravenous Injection ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Vital Signs ◽  
Physical Status ◽  
Double Blind ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective This study was performed compare the effectiveness of oxycodone and fentanyl in reducing the incidence and severity of etomidate-induced myoclonus. Methods In total, 162 patients with an American Society of Anesthesiologists physical status of I or II were assigned at random to three groups. Patients assigned to Group O received 0.1 mg/kg of oxycodone (n = 54), those assigned to Group F were given 1 µg/kg of fentanyl (n = 54), and those assigned to Group S were given an equal volume of saline intravenously 2 minutes prior to administration of 0.3 mg/kg of etomidate (n = 54). The incidence and severity of myoclonus was evaluated 2 minutes after etomidate administration. The patients’ vital signs, coughing, nausea, dizziness, and other related adverse reactions were also recorded. Results The incidence of myoclonus was significantly lower in Group O (0.0%) than in Group F (31.5%) and Group S (72.2%); the intensity was also lowest in Group O. All patients in each group had stable cardiovascular profiles. Conclusions Intravenous injection of 0.1 mg/kg of oxycodone 2 minutes prior to etomidate is more effective in preventing etomidate-induced myoclonus during general anesthesia than is 1 µg/kg of fentanyl.

scholarly journals Comparison of intravenous Acetaminophen and Morphine Sulfate for abdominal pain management in patients with acute abdomen

2019 ◽  
Vol 6 (5) ◽  
pp. 1626
Author(s):  
Mirsalim Seyedsadeghi ◽  
Jafar Ghobadi Samiyan ◽  
Keyvan Amini ◽  
Amir Ahmad Arabzadeh ◽  
Seyyed Mohammad Mosannen Tabatabaie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Acute Abdomen ◽  
Morphine Group ◽  
Rebound Tenderness ◽  
Intravenous Acetaminophen ◽  
Intravenous Morphine ◽  
The Mean

Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients.

scholarly journals Does Gabapentin Relieve Acute Preoperative Anxiety?

2014 ◽  
Vol 2 (3) ◽  
pp. 9-14
Author(s):  
L Pathak
Keyword(s):  
Side Effects ◽  
Open Cholecystectomy ◽  
Preoperative Anxiety ◽  
Controlled Study ◽  
Anesthetic Technique ◽  
Medical Sciences ◽  
Double Blind ◽  
Group 2 ◽  
American Society ◽  
Chronic Anxiety

INTRODUCTION: The role of Gabapentin in relieving chronic pain, chronic anxiety disorders and acute postoperative pain is well known by now. Trials done with the administration of Gabapentin to treat preoperative anxiety showed mixed results. So, this study was conducted to test the hypothesis that premedication with Gabapentin 1200 mg versus placebo would reduce preoperative anxiety in patients undergoing open cholecystectomy under general anesthesia. MATERIAL AND METHODS: A prospective, randomized, double blind and placebo controlled study was carried out at Universal College of Medical Sciences & Teaching Hospital (UCMSTH) from August 2012 to Januray 2014. Total 160 adult patients of American Society of Anaesthesiologist (ASA) I and II were divided into 2 groups of 80 each. Patients in group 1 and group 2 received capsules Gabapentin (1200mg) or identical placebo capsules 2 hours prior to surgery respectively. Preoperative anxiety was assessed for three times using Anxiety Visual Analogue Scale (VAS) score. A uniform anesthetic technique was used in both groups. Parameters including preoperative and postoperative sedation scores and various side effects were also observed.RESULTS: VAS anxiety scores after one hour of drug intake (47.19±17.37 versus 63.13±17.77) and just before induction of anaesthesia (43.81±17.72 versus 81.81±21.57) were significantly lower in Gabapentin group as compared to placebo group. No patient experienced any significant side effects or sedation in either group throughout the study period.CONCLUSIONS: Premedication with 1200 mg Gabapentin in open cholecystectomy patients significantly reduced preoperative anxiety as evident by decrease in anxiety VAS scores without any significant side effects.  DOI: http://dx.doi.org/10.3126/jucms.v2i3.11821 Journal of Universal College of Medical Sciences Vol.2(3) 2014: 9-14

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