A Comparison of Intramuscular Ketorolac with Indomethacin Suppositories in the Treatment of Pain after Oral Surgery

The analgesic effects of 30 mg of intramuscular ketorolac were compared with those of rectal indomethacin in 100 mg and 200 mg doses in 66 patients in a single-blinded trial. Pain scores and the incidence of nausea and vomiting were assessed at 30, 60 and 120 minutes postoperatively, at discharge (4 hours) and on the evening of surgery. Area under the curve of pain scores versus time for pain at 30, 60 and 120 minutes postoperatively was significantly lower in the ketorolac group compared to indomethacin 100 mg and 200 mg groups. There were no significant differences in the pain scores at discharge or at home on the evening of surgery. At 60 minutes post-operatively there was significantly more nausea and vomiting in the indomethacin 200 mg group; at all other time-points there was no significant difference between the groups with regard to nausea and vomiting. The power of the study to determine the significance of side-effects between the groups was low.

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Postoperative Analgesic Effects of Laserpuncture and Meloxicam in Bitches Submitted to Ovariohysterectomy

Veterinary Sciences ◽

10.3390/vetsci7030094 ◽

2020 ◽

Vol 7 (3) ◽

pp. 94

Author(s):

Rubia M. Tomacheuski ◽

Marilda O. Taffarel ◽

Guilherme S. Cardoso ◽

Ana A. P. Derussi ◽

Marcos Ferrante ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Area Under The Curve ◽

Postoperative Pain Management ◽

Pain Scale ◽

Rescue Analgesia ◽

Analgesic Effects ◽

Pain Scores ◽

Chi Squared ◽

Perioperative Pain Management

Background: This prospective, randomised and blind study investigated the efficacy of laserpuncture for postoperative pain management in dogs. Method: Sixteen bitches were sedated with acepromazine and randomly treated before ovariohysterectomy with meloxicam 0.2 mg·kg−1 intramuscular or laserpuncture (wavelength 904 mm, frequency 124 Hz, potency 10 Joules, 100 s in each acupoint). Anaesthesia was performed with propofol, isoflurane/O2, and fentanyl. The Glasgow Composite Measure Pain Scale (GCMPS) and Dynamic Interactive Visual Analog Scale (DIVAS) were used to evaluate postoperative pain before and for 24 h after surgery. Morphine was administrated as rescue analgesia when pain scores were ≥3.33 (GCMPS). Differences between treatments, time points, and amount of rescue analgesia between groups were investigated by the Mann–Whitney test and the area under the curve (AUC) for GCMPS, Friedman, and Chi-squared tests, respectively (p < 0.05). Results: Dogs treated with laserpuncture presented lower GCMPS AUC for 24 h and lower GCMPS scores at 2 and 4 h postoperatively (p = 0.04). Three dogs treated with meloxicam required postoperatively rescue analgesia against none treated with laserpuncture. Conclusions: In this preliminary study, laserpuncture mitigated postoperative pain in dogs following ovariohysterectomy, and the technique is a promising adjunct to perioperative pain management in dogs undergoing soft tissue surgery.

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Comparison of the effects of preoperative melatonin or vitamin C administration on postoperative analgesia

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2019.4379 ◽

2019 ◽

Cited By ~ 3

Author(s):

Demet Laflı Tunay ◽

Murat Türkeün Ilgınel ◽

Hakkı Ünlügenç ◽

Merthan Tunay ◽

Feride Karacaer ◽

...

Keyword(s):

Vitamin C ◽

Postoperative Analgesia ◽

Nausea And Vomiting ◽

Morphine Consumption ◽

Patient Controlled Analgesia ◽

Analgesic Requirement ◽

Analgesic Effects ◽

Placebo Tablet ◽

Pain Scores ◽

The Mean

The analgesic benefit of melatonin and vitamin C as primary or adjuvant agents has been reported in various studies; however, their analgesic effects in the treatment of postoperative pain remain unclear. Thus, we aimed to evaluate the effect of single preoperative dose of oral melatonin or vitamin C administration on postoperative analgesia. In this study, we recruited 165 adult patients undergoing elective major abdominal surgery under general anesthesia. Patients were randomly divided into three equal (n = 55) groups. One hour before surgery, patients received orally melatonin (6 mg) in group M, vitamin C (2 g) in group C, or a placebo tablet in group P. Pain, sedation, patient satisfaction, total morphine consumption from a patient-controlled analgesia device, supplemental analgesic requirement, and the incidence of nausea and vomiting were recorded throughout 24 h after surgery. The mean pain score and total morphine consumption were found significantly lower in both M and C groups compared with group P (p < 0.001). There were no significant differences between group M and C with respect to pain scores (p = 0.117) and total morphine consumption (p = 0.090). Patients requested less supplemental analgesic and experienced less nausea and vomiting in groups M and C compared with group P. In conclusion, preoperative oral administration of 6 mg melatonin or 2 g vitamin C led to a reduction in pain scores, total morphine consumption, supplemental analgesic requirement, and the incidence of nausea and vomiting compared with placebo.

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Intravenous Acetaminophen Does Not Provide Adequate Postoperative Analgesia in Dogs Following Ovariohysterectomy

Animals ◽

10.3390/ani11123609 ◽

2021 ◽

Vol 11 (12) ◽

pp. 3609

Author(s):

Jessica Leung ◽

Thierry Beths ◽

Jennifer E. Carter ◽

Richard Munn ◽

Ted Whittem ◽

...

Keyword(s):

Plasma Concentration ◽

Short Form ◽

Pain Scale ◽

Rescue Analgesia ◽

Analgesic Effects ◽

Pain Scores ◽

Significant Difference ◽

Intravenous Acetaminophen ◽

Group 3 ◽

Score Evaluation

(1) Objective: To investigate the analgesic effects of intravenous acetaminophen after intravenous administration in dogs presenting for ovariohysterectomy. (2) Methods: 14 ASA I client-owned female entire dogs. In this randomized, blinded, clinical study, dogs were given meperidine and acepromazine intramuscularly before induction of anesthesia with intravenous propofol. Anesthesia was maintained with isoflurane in oxygen. Intravenous acetaminophen 20 mg/kg or 0.9% NaCl was administered postoperatively. Pain assessments were conducted using the Glasgow Pain Scale short form before premedication and at 10, 20, 60, 120, and 180 min post-extubation or until rescue analgesia was given. The pain scores, times, and incidences of rescue analgesia between the groups was compared. Blood was collected before and 2, 5, 10, 20, 40, and 80 min after acetaminophen administration. Acetaminophen plasma concentration was quantified by liquid chromatography-mass spectrometry. The acetaminophen plasma concentration at the time of each pain score evaluation was subsequently calculated. (3) Results: There was no significant difference in pain scores at 10 min, highest pain scores, or time of rescue analgesia between groups. In each group, 3 dogs (43%) received rescue analgesia within 20 min. (4) Conclusions: Following ovariohysterectomy in dogs, there was no detectable analgesic effect of a 20 mg/kg dosage of intravenous acetaminophen administered at the end of surgery.

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Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia

Macedonian Medical Review ◽

10.1515/mmr-2017-0017 ◽

2017 ◽

Vol 71 (2) ◽

pp. 99-104

Author(s):

Dafina Karadjova ◽

Mirjana Shosholcheva ◽

Atanas Sivevski ◽

Emilija Ivanov ◽

Ivo Kjaev ◽

...

Keyword(s):

Patient Satisfaction ◽

Epidural Analgesia ◽

Labor Analgesia ◽

Nausea And Vomiting ◽

Pain Patient ◽

Patient Controlled Analgesia ◽

Pain Scores ◽

Significant Difference ◽

Patient Pain ◽

Remifentanil Group

Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.

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Comparison of Epidural and Systemic Tramadol for Analgesia Following Ovariohysterectomy

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5795 ◽

2012 ◽

Vol 48 (5) ◽

pp. 310-319 ◽

Cited By ~ 16

Author(s):

Sandra Mastrocinque ◽

Tatiana F. Almeida ◽

Angélica C. Tatarunas ◽

Viviani H. Imagawa ◽

Denise A. Otsuki ◽

...

Keyword(s):

Postoperative Analgesia ◽

Blood Gases ◽

Arterial Blood Gases ◽

Anesthetic Induction ◽

Time Points ◽

Analgesic Effects ◽

Pain Scores ◽

Arterial Blood ◽

Baseline Values ◽

End Tidal

The objective of the study was to compare epidural and systemic tramadol for postoperative analgesia in bitches undergoing ovariohysterectomy. Twenty animals, randomly divided into two groups, received either epidural (EPI) or intramuscular (IM) tramadol (2 mg/kg) 30 min before anesthetic induction. Analgesia, sedation, cardiorespiratory parameters, end-tidal isoflurane, blood catecholamines and cortisol, and arterial blood gases were measured at different time points up to 24 hr after agent administration. There were no differences between the two groups regarding cardiorespiratory parameters, end-tidal isoflurane, and pain scores. Two dogs in the IM and one in the EPI group required supplemental analgesia. Cortisol was increased (P<0.05) at 120 min (3.59 μg/dL and 3.27μg/dL in the IM and EPI groups, respectively) and 240 min (2.45 μg/dL and 2.54μg/dL in the IM and EPI groups, respectively) compared to baseline. Norepinephrine was also increased (P<0.05) at 120 min in both groups compared to baseline values. Epinephrine values were higher (P<0.05) in the IM group compared with the EPI group at 50 min, 120 min, and 1,440 min after tramadol administration. Epidural tramadol is a safe analgesic, but does not appear to have improved analgesic effects compared with IM administration.

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Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery

Korean Journal of Anesthesiology ◽

10.4097/kja.20141 ◽

2020 ◽

Vol 73 (5) ◽

pp. 408-416 ◽

Cited By ~ 1

Author(s):

Yean Chin Lim ◽

Zhao Kun Koo ◽

Vivian. W. Ho ◽

See Seong Chang ◽

Shivani Manohara ◽

...

Keyword(s):

Lung Function ◽

Controlled Trial ◽

Suprascapular Nerve ◽

Forced Expiratory Volume ◽

Nerve Blocks ◽

Analgesic Effects ◽

Pain Scores ◽

Significant Difference ◽

Arthroscopic Shoulder Surgery ◽

Plexus Block

BackgroundInterscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis. We aimed to compare the respiratory effects, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) between suprascapular nerve block (SSB) and ISB.MethodsSixty patients were recruited and randomized into ISB, anterior SSB, and posterior SSB groups. FVC, FEV1, and diaphragmatic excursion were evaluated at baseline and 30 minutes after intervention. Blocks were performed under ultrasound guidance with 15 ml of 0.5% ropivacaine. Pain scores were assessed at 6, 12, and 24 hours postoperatively.ResultsThe ISB group showed a reduced FVC of 31.2% ± 17.5% (mean ± SD), while the anterior and posterior SSB groups had less reduction of 3.6% ± 18.6% and 6.8% ± 6.5%, respectively (P < 0.001). The ISB group showed more reduction in diaphragmatic excursion than the anterior and posterior SSB groups (median [IQR]): −85.7% (−95.3% to −63.3%) vs. −1.8% (−13.1% to 2.3%) and −1.2% (−8.8% to 16.8%), respectively (P < 0.001). The median pain scores (IQR) in the ISB and anterior SSB groups were lower than those in the posterior SSB group at 6 hours on movement: 0 (0–2), 1.8 (0–4.5) vs. 5 (2.5–8), respectively (P = 0.002). There was no significant difference in oxycodone consumption postoperatively.ConclusionsAnterior SSB preserves lung function and has a comparable analgesic effect as ISB. Thus, it is recommended for arthroscopic shoulder surgeries, especially in patients who have reduced lung function.

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Comparison of morphine and carprofen administered alone or in combination for analgesia in dogs undergoing ovariohysterectomy

Journal of the South African Veterinary Association ◽

10.4102/jsava.v77i3.358 ◽

2006 ◽

Vol 77 (3) ◽

Cited By ~ 16

Author(s):

T.B. Dzikiti ◽

K.E. Joubert ◽

L.J. Venter ◽

L.N. Dzikiti

Keyword(s):

Analgesic Efficacy ◽

Pain Scale ◽

Morphine Group ◽

Time Points ◽

Pain Scores ◽

Time Period ◽

Total Pain ◽

Significant Difference ◽

The University

In this study the analgesic efficacy of the pure agonistic opioid morphine and the cyclo-oxygenase type-2-selective carprofen were compared since there is no previous specific comparative study for these two common analgesics. Forty-five bitches undergoing elective ovariohysterectomy were randomly assigned to one of three groups; receiving morphine 0.4 mg/kg bodyweight pre-operatively and 0.2 mg/kg every 4-6 hours thereafter (Morphine group), receiving a once-off carprofen 4 mg/kg injection (Carprofen group) or receiving both morphine and carprofen (MorphCarp group). The dogs were premedicated with acepromazine 0.01 mg/kg and induced with either thiopentone 5-10 mg/kg or propofol 4-6 mg/kg. General anaesthesia was maintained with halothane in oxygen. The degree of pain was assessed over a 24-hour period under blinded conditions using a pain scale modified from the University of Melbourne pain scale and the Glasgow composite pain tool. Physiological parameters such as respiratory rate, pulse rate and body temperature were also assessed over the same time period. There was no significant difference in pain-scores and thus analgesia offered by the three analgesia protocols at any assessment point across the three groups, but there were differences within groups across time points. Baseline total pain-scores were lower than scores at all post-operative points within all three groups. Both morphine and carprofen provided good analgesia without any obvious adverse effects. This study indicates that at the dosages indicated above, carprofen administered on its own produces analgesia equal to that produced by morphine and that the two drugs administered together do not produce better analgesia than either drug administered on its own.

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Intraureteral lidocaine for ureteral stent symptoms post-ureteroscopy: A randomized, phase 2, placebo-controlled trial

Canadian Urological Association Journal ◽

10.5489/cuaj.4408 ◽

2017 ◽

Vol 11 (10) ◽

pp. 326-30 ◽

Cited By ~ 3

Author(s):

Gregory Roberts ◽

Robert Leslie ◽

Syliva Robb ◽

D. Robert Siemens ◽

Darren Beiko

Keyword(s):

Postoperative Pain ◽

Ureteral Stent ◽

Complication Rates ◽

Phase 2 ◽

Lidocaine Group ◽

Time Points ◽

Pain Scores ◽

Significant Difference ◽

Patient Reported ◽

Randomized Phase 2

Introduction: Ureteral stent and ureteral manipulation-related pain is a significant complication for patients undergoing ureteroscopy. Herein, we report a phase 2, randomized trial to assess efficacy of direct instillation of intraureteral lidocaine in reducing postoperative pain and ureteral stent symptoms.Methods: We performed a randomized, double-blinded trial of patients undergoing elective ureteroscopy for ureteral calculi. Patients were randomized to direct instillation of 2% lidocaine plus bicarbonate, or to normal saline as control. The primary outcome of interest was early postoperative pain scores. Patients completed10-point visual analog pain scale at one-hour, two-hour, four-hour, 24-hours, four- and seven-day time points. Other outcome measurements collected included a medication diary and voiding questionnaire.Results: A total of 41 patients were randomized in the study. Mean flank pain scores at one hour were 2.2 (±2.9) vs.1.9 (±2.4) in the intervention and placebo group, respectively (p=0.84). There was no significant difference at any time point between the intervention and placebo groups in patient-reported pain scores. Patients reported lower dysuria scores at all time points in the lidocaine group, however, none reached statistical significance. There was no difference in complication rates or adverse effects between groups.Conclusions: In this randomized, phase 2 study, direct instillation of lidocaine into the ureter did not appear to significantly improve pain or voiding symptoms following stented ureteroscopy.

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Intramuscular Ketorolac for Postoperative Analgesia following Laparoscopic Sterilisation

Anaesthesia and Intensive Care ◽

10.1177/0310057x9402200104 ◽

1994 ◽

Vol 22 (1) ◽

pp. 22-24 ◽

Cited By ~ 13

Author(s):

M. H. Shapiro ◽

B. L. Duffy

Keyword(s):

Side Effects ◽

Intramuscular Injection ◽

Double Blind Study ◽

Day Case ◽

Double Blind ◽

Apparent Lack ◽

Pain Scores ◽

Significant Difference ◽

To Receive ◽

Intramuscular Ketorolac

The analgesic effect of intramuscular ketorolac was assessed by double blind study in forty women presenting for day-case laparoscopic sterilisation. The patients were randomly allocated to receive either ketorolac 30 mg or saline by intramuscular injection immediately following induction of general anaesthesia. There was no statistically significant difference between the groups in pain scores, opioid requirements or incidence of nausea and vomiting in the postoperative period. In view of the potential side-effects of ketorolac, and the apparent lack of efficacy when used prophylactically, the routine use of the drug in this group of patients cannot be recommended.

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Effects of Dexmedetomidine on Postoperative Nausea and Vomiting in Adult Patients Undergoing Ambulatory Thyroidectomy: A Randomized Clinical Trial

Frontiers in Medicine ◽

10.3389/fmed.2021.781689 ◽

2021 ◽

Vol 8 ◽

Author(s):

Cuiyu Xie ◽

Caihui Zhang ◽

Hao Sun ◽

Yao Lu

Keyword(s):

Relative Risk ◽

Postoperative Nausea ◽

Prospective Trial ◽

Postoperative Nausea And Vomiting ◽

Adult Patients ◽

Nausea And Vomiting ◽

Severe Nausea ◽

Double Blind ◽

Pain Scores ◽

Significant Difference

Background: Postoperative nausea and vomiting (PONV) is a common and disturbing problem in patients undergoing ambulatory thyroidectomy. This prospective trial aimed to explore whether dexmedetomidine (DEX) combined with azasetron (AZA) can further drop the incidence of PONV in patients undergoing ambulatory thyroidectomy compared with AZA.Methods: This single-center, randomized, double-blind trial involved 172 adult patients undergoing ambulatory thyroidectomy. The individuals were randomized to DEX + AZA group and AZA group. In the DEX + AZA group, patients received dexmedetomidine 0.5 μg kg−1 for 10 min and then the infusion rate was held at 0.1 μg kg−1 h−1 until the completion of the operation, while the same amount of 0.9% saline in the AZA group. At the completion of the surgery, 10 mg azasetron was administered to every patient in both groups. The primary outcome was the incidence of 24 h PONV after ambulatory thyroidectomy. The secondary outcomes included residence time in recovery room, pain scores, severity of nausea, and adverse events.Results: No significant difference was found in the incidence of 24-h PONV between the DEX + AZA group and the AZA group [36% (30 of 84) vs. 38% (32 of 84); relative risk, 0.94; 95% confidence interval (CI), 0.63–1.40; P = 0.749]. The incidence of severe nausea was similar between the DEX + AZA group and the AZA group [57% (12 of 21) vs. 43% (9 of 21); relative risk, 1.33; 95% CI, 0.72–2.50; P = 0.355].Conclusions: Intraoperative dexmedetomidine combined with azasetron failed to drop the incidence of 24-h PONV compared with azasetron alone in patients undergoing ambulatory thyroidectomy.

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