The effect of PECS-1 block on postoperative pain in total implantable venous access port catheter (TIVAP) insertion

2021 ◽  
pp. 112972982110346
Author(s):  
Özcan Pişkin ◽  
Bülent Altınsoy ◽  
Çağdaş Baytar ◽  
Bengü Gülhan Aydın ◽  
Dilek Okyay ◽  
...  
Keyword(s):  
Venous Access ◽  
Multimodal Analgesia ◽  
Anterior Chest Wall ◽  
Controlled Study ◽  
Rescue Analgesia ◽  
Access Port ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores ◽  
Infiltration Anesthesia

Background: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of US-guided Pectoral (PECS) I blocks on postoperative analgesia after TIVAP insertion. Methods: A hundred-twenty patients were included in this study. The patients were divided into two groups: Group PECS and Group INF (infiltration). A total 0.4 mL kg−1 0.25% bupivacaine was injected to below the middle of the clavicle in the interfascial space between the pectoralis major and minor muscles for PECS-1. The skin and deep tissue infiltration of the anterior chest wall was performed with 0.4 mL kg−1 0.25% bupivacaine for INF group. Tramadol and paracetamol consumption, visual analog scale pain scores were recorded at 0, 1, 4, 12, and 24 h postoperatively. Results: The use of the PECS in TIVAP significantly decreased the amount of paracetamol used in the first 24 h postoperatively ( p < 0.001). There was a statistically significant difference in the number of tramadol rescue analgesia administered between the groups ( p < 0.001) There was no significant difference between the groups in terms of the VAS scores at 0 and 24 h. However, VAS scores at 1, 4, and 12 h were found to be significantly lower in patients who underwent PECS than in those who received infiltration anesthesia ( p < 0.001). Conclusions: This study shows that US-guided PECS-1 provides adequate analgesia following TIVAP insertion as part of multimodal analgesia. The PECS-1 significantly reduced opioid consumption.

scholarly journals The Effect of Ultrasound Guided Superficial Cervical Plexus Block on Postoperative Opioid Consumption in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery: A Prospective, Randomized Controlled Study

2021 ◽  
Author(s):  
İrem Ateş ◽  
Erkan Cem Çelik ◽  
Ufuk DEmir ◽  
Muhammed Enes Aydın ◽  
Ali Ahiskalıoğlu
Keyword(s):  
Opioid Consumption ◽  
Anterior Cervical Discectomy ◽  
Controlled Study ◽  
Control Group ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Cervical Discectomy ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) surgery is a procedure that can cause moderate pain in the postoperative period. Superficial cervical block (SCB) is a regional anesthesia technique that can provide analgesia during and after surgery. The aim of this study is to investigate the effect of ultrasound-guided SCB block on pain scores and postoperative opioid consumption in patients undergoing ACDF surgery. METHODS: 48 patients planned to undergo single or two levels of ACDF surgery were randomly divided into two groups, SCB and Control (C). Ultrasonography (USG) guided SCB was performed in the SCB group (n=24) with 10 mL of 0.25% bupivacaine. No attempt was made to the control group (n=24) before the operation. Intravenous 50 mg dexketoprofen was administered to both groups half an hour before the end of the operation and at the 12th hour postoperatively. Patient controlled analgesia (PCA) device containing fentanyl was initiated. Postoperative visual analog scale (VAS) scores, opioid consumption, need for rescue analgesia and side effects were recorded. RESULTS: There was no statistically significant difference between the groups in terms of demographic data, anesthesia and surgery times. Compared to the control group, VAS scores were statistically low at all measurement times in the SCB group (p <0.05). The 24-hour total opioid consumption was statistically significantly higher in the control group than in the SCB group (375.83±235.96 µg vs. 112.50±102.41 µg, respectively p<0.001). The need of rescue analgesia was statistically higher in the control group than the SCB group (12/24 vs. 0/24, respectively, p <0.001). DISCUSSION AND CONCLUSION: We believe that USG-guided SCB can be an effective component of the multimodal analgesia protocol by reducing opioid consumption and pain scores in patients undergoing ACDF surgery.

Oral paracetamol versus zolmitriptan to treat acute migraine attack in the emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Tertiary Care ◽  
Numeric Rating Scale ◽  
Controlled Study ◽  
Care Hospital ◽  
Acute Migraine ◽  
Pain Scores ◽  
Significant Difference

Background: Treatment provided in an emergency department is aimed at alleviating pain immediately with minimized adverse effects as well as warding off further migraine attacks. The primary aim of this article is to compare the effectiveness of oral paracetamol versus zolmitriptan in treating acute migraine attacks. Methods: This prospective, randomized, and controlled study was carried out at a tertiary care hospital visited by 95,000 patients annually. The study recruited 200 participants who were randomized into two groups. One group received 1000 mg paracetamol while the other group received 2.5 mg zolmitriptan orally. Baseline pain scores were recorded using the Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 15, 30 and at 60 min following administration of the study drugs. Patients requiring further treatment were provided fentanyl at a dosage of 1 µg/kg as a rescue therapy. Results: A significant decrease was evident in VAS and NRS scores following the administration of the study drugs in both groups (P < 0.001). The change in VAS pain scores after 15, 30 and 60 min was calculated as 17.0 ± 13.9, 41.2 ± 16.3 and 61.2 ± 17.5 mm, respectively, in the paracetamol group and 14.2 ± 11.7, 39.2 ± 17.9 and 59.2± 19.3 mm, respectively, in the zolmitriptan group, which did not indicate significant differences (P = 0.103, P = 0.425, P = 0.483, respectively). Likewise, NRS pain scores showed a downward trend in line with VAS pain scores and did not yield a significant difference (P = 0.422). No significant difference concerning rescue therapy was noted between the two groups (P = 0.596). Conclusion: Oral paracetamol and zolmitriptan prove to be similarly effective and have low incidence of acute side effects in treating acute migraine cases without aura.

Randomised clinical trial comparing the perioperative analgesic efficacy of oral tramadol and intramuscular tramadol in cats

2021 ◽  
pp. 1098612X2110404
Author(s):  
Sébastien H Bauquier
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Analgesic Efficacy ◽  
Randomised Clinical Trial ◽  
Rescue Analgesia ◽  
Exact Test ◽  
Pain Scores ◽  
Significant Difference ◽  
American Society ◽  
Induction Of Anaesthesia

Objectives The aim of this study was to evaluate the analgesic efficacy of oral tramadol in cats undergoing ovariohysterectomy. Methods Twenty-four female domestic cats, American Society of Anesthesiologists class I, aged 4–24 months, were included in this positive controlled, randomised, blinded clinical trial. Cats admitted for ovariohysterectomy were allocated to group oral tramadol (GOT, n = 12) or group intramuscular tramadol (GIMT, n = 12). In GOT, tramadol (6 mg/kg) was given orally 60 mins, and saline was given intramuscularly 30 mins, before induction of anaesthesia. In GIMT, granulated sugar in capsules was given orally 60 mins and tramadol (4 mg/kg) intramuscularly 30 mins before induction of anaesthesia. In both groups, dexmedetomidine (0.007 mg/kg) was given intramuscularly 30 mins before induction of anaesthesia with intravenous propofol. Anaesthesia was maintained with isoflurane in oxygen, and atipamezole (0.037 mg/kg) was given intramuscularly 10 mins after extubation. The UNESP-Botucatu multidimensional composite scale was used to conduct pain assessments before premedication and at 20, 60, 120, 240 and 360 mins post-extubation or until rescue analgesia was given. To compare groups, the 60 min postoperative pain scores and the highest postoperative pain scores were analysed via a two-tailed Mann–Whitney test, and the incidences of rescue analgesia were analysed via a Fisher’s exact test; P <0.05. Results There was no significant difference between groups for the 60 min ( P = 0.68) pain scores. The highest postoperative pain score was higher for GIMT compared with GOT ( P = 0.04). Only two cats required rescue analgesia, both from GIMT. The incidence of rescue analgesia was not significantly different between groups ( P = 0.46). Conclusions and relevance In the present study, preoperative administration of oral tramadol at 6 mg/kg to cats provided adequate analgesia for 6 h following ovariohysterectomy surgery.

scholarly journals The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshan Lal Bajracharya ◽  
Asish Subedi ◽  
Krishna Pokharel ◽  
Balkrishna Bhattarai
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Analgesia ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Double Blind ◽  
Lidocaine Group ◽  
Pain Scores ◽  
Sedation Scores ◽  
Vas Scores

Abstract Background As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. Methods In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively. Results Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later. Conclusion Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol. Trial registration ClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.

scholarly journals Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

2021 ◽  
pp. 1
Keyword(s):  
Postoperative Pain ◽  
Observational Study ◽  
Postoperative Analgesia ◽  
Prospective Observational Study ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Caudal Epidural

Background and objective: Circumcision is one of the most common operations and can cause postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty boys aged 1 to 14 years who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in mean age and Aldrete scores (p > 0.05). Body mass index (BMI) of the caudal block group was statistically lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in 30th-minute VAS values (p > 0.05), the CE block group's 1st, 2nd, 4th, 8th, 12th, 18th, and 24th hour VAS values were statistically lower than the TAP block group's (p < 0.05). Conclusion: USG-guided TAB block under general anesthesia was not associated with lower postoperative pain scores and delayed rescue analgesia need compared with CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after elective circumcision surgery in this study.

scholarly journals The Effect of Pain Training Before Thoracotomy Operation on Postoperative Pain Levels

2020 ◽  
Author(s):  
Emel Gündüz ◽  
Hakan Keskin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Pain Scale ◽  
Pain Scores ◽  
Extubation Time ◽  
Significant Difference ◽  
The World ◽  
The Hours ◽  
Vas Scores

INTRODUCTION: Postoperative pain is a condition that patients frequently complain about all over the world. The aim of this study was to investigate the effect of pain training before elective thoracotomy on postoperative pain levels in patients. METHODS: 100 patients who underwent thoracotomy for any reason were included in the study. Patients were given a 20-30-minute training on postoperative pain and how the pain is controlled, and what the patient can do to minimize the pain 24-48 hours before thoracotomy. The patients were divided into two groups; those that were trained and those that were not trained. Extubation time was accepted as baseline (0 hour). At the hours of 4, 8, 12, 16, 20 and 24, patients were asked about their pain on the visual pain scale (VAS). Respiratory rate, blood pressure, heart rate, and oxygen saturation levels were recorded at the hours. RESULTS: When VAS scores were compared between the two groups, no significant difference was found in the values measured at the 4th hour whereas there was a significant difference between the subsequent values. DISCUSSION AND CONCLUSION: The results of this study showed that pain training before thoracotomy operation gradually decreased postoperative VAS pain scores in patients.

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

Animals ◽  
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.

Effects of perioperative S (+) ketamine infusion added to multimodal analgesia in patients undergoing ambulatory haemorrhoidectomy

2010 ◽  
Vol 1 (2) ◽  
pp. 100-105 ◽  
Author(s):  
Ulrich J. Spreng ◽  
Vegard Dahl ◽  
Johan Ræder
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Analgesic Effect ◽  
Low Dose ◽  
Isotonic Saline ◽  
Multimodal Analgesia ◽  
Controlled Study ◽  
Double Blind ◽  
Pain Scores ◽  
Pacu Stay

AbstractBackground and objectivePerioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis.MethodsSeventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1–2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine. Patients randomized to S (+) ketamine received an intravenous bolus dose of 0.35 mg kg−1 S (+) ketamine before start of surgery followed by continuous infusion of 5 μg kg−1 min−1 until 2 min after end of surgery. Patients in the placebo group got isotonic saline (bolus and infusion). BISTM monitoring was used. Pain intensity and side-effects were assessed by blinded nursing staff during PACU stay and by phone 1, 7 and 90 days after surgery.ResultsIn patients randomized to S (+) ketamine emergence from anaesthesia was significantly longer (13.1 min vs. 9.3 min; p < 0.001). BIS values were significantly higher during anaesthesia (maximal value during surgery: 62 vs. 57; p = 0.01) and when opening eyes (81 vs. 70, p < 0.001). Pain scores (NRS and VAS) did not differ significantly between groups.ConclusionsThe addition of perioperative S (+) ketamine for postoperative analgesia after haemorrhoidectomy on top of multimodal non-opioid pain prophylaxis does not seem to be warranted, due to delayed emergence and recovery, more side-effects, altered BIS readings and absence of additive analgesic effect.

scholarly journals Intrauterine levobupivacaine for pain control during intrauterine device insertion

2017 ◽  
Vol 6 (3) ◽  
pp. 1117
Author(s):  
Nilufer Akgun ◽  
Esra Keskin ◽  
Muberra Namlı Kalem ◽  
Batuhan Bakirarar
Keyword(s):  
Pain Control ◽  
Controlled Trial ◽  
Intrauterine Device ◽  
Saline Control ◽  
Control Group ◽  
Double Blind ◽  
Pain Scores ◽  
Significant Difference ◽  
Vas Scores

Background: Safe, effective, long term and a reversible contraception method is offered by intrauterine devices (IUDs).  The objective was to determine the potency of intrauterine administration of 5 cc levobupivacain for pain relief with IUD insertion, when compared with saline placebo.Methods: This was a prospective randomized, double blind placebo-controlled trial undergoing İUD insertion. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine. Our primary outcome was self-reported pain scores on a 10 cm visual analogue scale (VAS) immediately following IUD insertion.Results: 95 women were enrolled, and data for 88 women were analyzed. In IUD insertion procedure, no difference was observed between groups during teneculum placement and solution administration, in the course of VAS scores (p=0.349, p=0.396). There was a significant difference in the VAS scores measuring pain suffering during and after IUD procedure (p=0.001).Conclusions: Intrauterine instillation of 5 cc of levobupivacaine along with saline solution reduces pain with IUD insertion when compared to intrauterine saline placebo. Broad deviation in pain scores and persistent pain after IUD insertion recommends that patient would benefit from more functioning method of pain control than before at IUD insertion and during the post interval.

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