scholarly journals Can Combination of Peripheral Nerve Block and Non-opioidal Patient Controlled Analgesia Be an Effective Postoperative Pain Control Method?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Chan Kang ◽  
Gi Soo Lee ◽  
Dong Yeol Kim ◽  
Jeong-kil Lee ◽  
Ki Jun Ahn ◽  
...  

Category: Ankle, Pain medicine Introduction/Purpose: Even though bone surgery is very painful after operation, there is no established method to control postoperative pain due to efficacy and side effects. Ultrasound-guided peripheral nerve block (PNB) and nonsteroidal anti- inflammatory drugs (NSAIDs) patient controlled analgesia (PCA) can effectively control pain and reduce side effects. Methods: We conducted a prospective study of 150 patients over 18 years of age who underwent bone surgery from June 2018 to December 2018. All operations were performed under anesthetic ultrasound-guided PNB and additional PNB was performed to control postoperative pain. Among the 120 patients who participated in the final study, NSAIDs PCA was used in group A (65 patients) and NSAIDs PCA was not used in group B (55 patients) for pain control. Postoperative management except PCA was same in both groups. Pain scores are measured at 6, 12, 18, 24, 36, 48, and 72 hours after the operation and they were compared using visual analogue scale (VAS) pain scores. Survey was done on satisfaction of patients, and their willingness to reconsider same method of pain control when they undergo same surgery next time. Also, we evaluated possible side effects that might happen during process of controlling pain. Results: VAS pain score were significantly different only at 24 h postoperatively (p=0.004). In Group A, three patients were prescribed 3 amples of pethidine intramuscular injection as rescue analgesic. In group B, 35 patients were prescribed 50 amples of pethidine and 12 patients of them were received additional 18 amples of ketorolac intramuscular injection as rescue analgesic(p=0.000). In group A, all patients were satisfied with the pain control method, but 5 of the group B patients were dissatisfied (p=0.001). 3 patients responded to severe pain after operation and 2 of them due to postoperative nausea and vomiting (PONV). In group A, there were no patients complaining of PONV, but in group B, 5 patients complained of symptoms (p=0.018), and 3 of them were prescribed additional antiemetics (p=0.093). Conclusion: Combined use of ultrasound-guided PNB and NSAIDs PCA seems to be an effective postoperative pain control method in foot and ankle surgery. Because, pain can be effectively controlled and PONV can be reduced.

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Gi-Soo Lee ◽  
Chan Kang ◽  
Yoo Jung Park ◽  
June Bum Jun ◽  
Byung Hak Oh ◽  
...  

Category: Ankle, Pain Introduction/Purpose: We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery of the foot and ankle. Methods: Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound- guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25 mg) was applied in group A (30 patients), diluted anesthetic (0.2% ropivacaine, 30 ml) was injected into the sciatic nerve once, about 12 hours after the pre-operative nerve block in group B (27 patients), and periodic analgesic intramuscular injection (ketorolac (Tarasyn? R), 30 mg) was performed in group C (27 patients). Visual analog scale (VAS) pain scores at 6, 12, 18, 24, and 48 hours after surgery were checked, and complications of all methods were surveyed. Results: The mean VAS pain score was lower in group B, with a statistically significantly difference (p < .05) between groups A, B, and C at 12 and 18 hours after surgery. Four patients in group A suffered from nausea and vomiting, whereas no other patients complained of any complications or side effects. Conclusion: The ultrasound-guided injection of diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase following foot and ankle bone surgery. By injecting the diluted anesthetic once on the evening of the day of surgery, patients suffered less postoperative pain.


2011 ◽  
Vol 18 (01) ◽  
pp. 106-111
Author(s):  
ARSALAN SIRAJ ◽  
ATHAR ABBAS SHAH GILANI ◽  
MUHAMMAD FAROOQ DAR ◽  
Sohail Raziq

Objectives: To compare the diathermy incision with scalpel incision in patients undergoing midline elective laparotomy. Design of Study: A prospective, experimental comparative study. Place and Duration: Department of surgery, PNS Shifa Karachi, from March 2007 to June 2008. Patients and Methods: A total of 100 patients were included in the study, and equally divided into 2 groups. Group A received scalpel incision while in group B diathermy was employed to incise all layers. Peroperative parameters including, incision time and blood loss were calculated. Postoperatively, pain was assessed by visual analogue score and wound infection documented. Results: Both groups included fifty patients each out of the total 44 females and 56 were males, with similar gender preposition in both the groups. Mean age of patients in scalpel group was 48.78 (±14.47) while it was 44.92 (±15.87) in diathermy group. The mean incision related blood loss in Scalpel group was 1.53 (±0.20) ml/cm2 and in Diathermy group was 1.43 (±0.20) ml/cm2, showing significantly less bleeding in diathermy group (p-value= 0.014). Diathermy group, with incision related time of 6.20 sec/cm2 (±0.97 sec/cm2), was significantly quicker (p-value= 0.003) than scalpel incision, with incision time of 6.76 sec/cm2 (±0.84 sec/cm2). Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups. Conclusions: Diathermy, employed for midline laparotomy, is quicker and hemostatic, compared to the scalpel. The two are, however, similar in terms of wound infection and postoperative pain.


2021 ◽  
Vol 9 (1) ◽  
pp. 74-78
Author(s):  
Neena Jain ◽  
Rahul Bankapur ◽  
Preeti Lamba ◽  
saurav Singh

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.


2014 ◽  
Vol 10 (1) ◽  
pp. 39 ◽  
Author(s):  
Clyde T. Matava, MBCHB ◽  
Mark W. Crawford, MBBS ◽  
Carolyne Pehora, RN ◽  
Basem Naser, MD ◽  
Conor McDonnell, MBCHB

Background: The identification of patients at risk for developing severe postoperative pain and/or opioid-related side effects is difficult due to a lack of sensitive indicators. The patient-controlled analgesia (PCA) ratio of demands to deliveries is a potential tool for early identification of patients who experience severe postoperative pain. The authors hypothesized that the PCA ratio is able to predict morphine requirement in the first 24 hours after scoliosis surgery.Methods: The authors performed a retrospective study of adolescents who had surgery for idiopathic scoliosis. They collected data describing PCA demands and deliveries, morphine consumption, numerical rating scale (NRS) pain scores, opioidrelated side effects, and duration of hospital stay. Spearman rank analysis assessed association among 4-hour PCA ratios, NRS pain score, and 24-hour morphine consumption. Patients were divided into groups on the basis of PCA ratios <1.5 and ≥1.5. Univariate analysis and multiple regression were used to identify independent factors predictive for increased 24-hour morphine. Mann-Whitney rank-sum and Fisher exact tests were used to compare data. p < 0.05 was considered statistically significant.Results: One hundred forty-seven patients were included in the analysis, mean (SD) age and weight were 15 (1.8) years and 55 (27) kg, respectively. There was a significant positive correlation between the 4-hour PCA ratio and initial 24-hour cumulative morphine consumption (r = 0.33, p = 0.0002). Patients with a 4-hour PCA ratio ≥1.5 demonstrated a significantly greater initial 24-hour morphine consumption (p = 0.0002), greater pain scores at 24 hours after surgery (p = 0.02), a greater incidence of at least one opioid-related side effect within the initial 24 hours after surgery, and a longer duration of hospital stay (p = 0.04) compared with those patients with a 4-hour PCA ratio <1.5. PCA ratio ≥1.5, age, and patient sex were predictive for 24-hour morphine consumption.Conclusions: The authors have demonstrated that a PCA ratio of demands/deliveries ≥1.5 is predictive of increased opioid requirements and is associated with greater pain scores in the initial 24 hours after surgery, an increased incidence of opioid-related side effects, and duration of hospital stay.


2014 ◽  
Vol 23 (2) ◽  
pp. 56-61
Author(s):  
Md Mustafa Kamal ◽  
Abdullah Al Maruf ◽  
Sabina Yeasmeen ◽  
Abdul Hye

Background Most spinal surgery is painful and good postoperative analgesia is important. Opioids are the traditional first-line treatment. Ketorolac has been used for postoperative pain relief. However, there is no data available about controlling postoperative pain with ketorolac after open lumbar discectomy or laminectomy in Bangladesah. Objective To compare the efficacy of a Parentral ketorolac with conventional opioid for management of postoperative pain after lumbar disectomy or laminectomy. Methods Sixty patients who underwent lumbar disectomy or laminectomy were randomly allocated into two groups. Group A (n = 30) patients received 30 mg intramuscular ketorolac upon surgical closure and every 6 hours for 24 hours and intramuscular pethidine 1.5 mg/kg/b.w. as needed (PRN). Group B (n = 30) patients received only intramuscular pethidine 1.5 mgkg-1/b.w. every 6 hours for 24 hours and as needed (PRN). Postoperative analgesia was assessed in both groups by Visual Analogue Scale at arrival in postoperative ward and at 6, 12 and 24 hours for 24 hours. Total postoperative narcotic consumption and side effects like post operative nausea and vomiting (PONV), dizziness, urinary retention and pruritus were also recorded. Results Baseline data were comparable between the two groups. The mean VAS almost similar and less than 3 at different reading in both groups which indicate adequate postoperative analgesia and the differences were statistically not significant. The mean total cumulative amount of pethidine administered over 24 hrs period was less in group A it was 64.31+19.13 mg where as in group B was 161.23+21.25 mg. and the difference was statistically significant (p<0.01). Incidences of side effects like PONV, urinary retention and pruritus were more in group B than group A and differences were statistically significant (p<0.01). Conclusion For postoperative pain management after lumbar spine surgery both ketorolac and traditional parental opioid found effective. Total opioid consumption is significantly less with ketorolac and side effects like PONV, dizziness, urinary retention and pruritus were more with opioid alone. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18175 Journal of BSA, 2009; 23(2): 56-61


Author(s):  
Prashant Sachan ◽  
Prem Raj Singh ◽  
Sateesh Verma ◽  
Brij Bihari Kushwaha

Introduction: Pain control is an important factor for postoperative recovery. Many drugs have been studied for effectiveness of postoperative analgesia. Fentanyl is a conventional drug and dexmedetomidine is one of the emerging drugs used for analgesia and postoperative pain control. Aim: To compare the effect of fentanyl and dexmedetomidine on pain control and haemodynamic stability. Materials and Methods: A randomised controlled trial was conducted on 60 patients (30 each group) undergoing for abdominal surgery, between January 2019 to January 2020. Group A received fentanyl loading dose 2 μg/kg I.V. followed by 0.5 μg/kg/hr infusion and group B received dexmedetomidine loading 1 μg/kg over 10 minutes followed by maintenance 0.5 μg/kg/hr infusion. Infusion was continued up to four hours during surgery and till eight hours of postoperative in both groups. Haemodynamic parameters {Heart Rate (HR), Mean Arterial Pressure (MAP)} were recorded after start of study drug infusion, after intubation, then every 15 minutes till 1 hour, then every 30 minutes till end of surgery and after extubation. In postoperative period, HR and MAP were recorded at interval of one hour till eight hours after extubation and postoperative analgesia was assessed by Visual Analogue Scale (VAS) at interval of one hour till eight hours. Present study used descriptive statistical analysis for data analysis. Analysis of variance (ANOVA) was used to compare data between two groups. Chi-square test was used to find the significance of difference on categorical scale between two groups. Results: This study showed that group-B had significantly less VAS score most of time in recovery period as compared to group-A (1.97±0.18 vs 2.10±0.31 at eight hours postoperative). HR, MAP was found significantly less all the time during surgery and most of the time postoperatively in group-B (p-value <0.05). Conclusion: Intravenous infusion of dexmedetomidine can be better for controlling postoperative pain and perioperative haemodynamic stability as compared to infusion of fentanyl in patients undergoing abdominal surgeries.


2020 ◽  
Vol 17 (2) ◽  
Author(s):  
Farah Syaza Rahman ◽  
Nurlia Yahya ◽  
Nor Mohammad Md Din ◽  
Azarinah Izaham ◽  
Wan Rahiza Wan Mat

Introduction: Non-pharmacological interventions are considered as successful adjuncts to manage pain. We are studying the comparative effects of listening to prayer recitation and music therapy intraoperatively as non-pharmacological interventions on postoperative pain and intraoperative haemodynamics. Materials and Methods: Seventy two muslim patients with acute appendicitis requiring open, emergency appendicectomies under general anaesthesia were recruited and randomised into three groups: Group A: patients who listened to prayer recitation, Group B: patients who listened to music, Group C: control group - patients who did not listen to any prayer or music. Intraoperative blood pressure, heart rate and postoperative pain scores were monitored. Results: The demographic data, pre- and post-headphones application haemodynamics were compared. There were significantly lower heart rates at 10, 20, 30, 40, 50, 60 minutes for Group A and at 50 and 60 minutes for Group B patients when compared to Group C. Significant reduction in postoperative pain scores were seen in Group A patients at 30 minutes and 8 hours as compared to Group C patients. No significant differences in pain scores were seen between Group B and C patients. No significant differences in additional analgesic requirements postoperatively were seen in all three groups. Conclusion: Listening to prayer recitation or music intraoperatively significantly lowered intraoperative heart rates, however only prayer recitation significantly reduced postoperative pain scores as compared to the control group.


2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.


1991 ◽  
Vol 19 (4) ◽  
pp. 539-545 ◽  
Author(s):  
H. Kastrissios ◽  
G. A. G. Mogg ◽  
E. J. Triggs ◽  
J. W. Higbie

Twenty-six cholecystectomy patients received either an interpleural infusion of bupivacaine (Group B, n = 12) or an intravenous infusion of pethidine (Group P, n = 14) for management of postoperative pain over a three-day period. Patients in Group P experienced a significantly (P < 0.05) greater incidence of total side-effects (146) than patients in Group B (66). Pain scores (VAS) and responses to a pain questionnaire were similar for both groups; however, within Group B improvement in mean VAS scores at rest with time were more sustained. Similar reductions in FEV, and FVC from preoperative values occurred for both groups, while for Group P there were significant (P < 0.05) changes in arterial blood gases (increase in Pco2, decrease in Po2) over two days postoperatively. Patients in Group P recorded longer times to passing flatus and unaided mobilisation (P < 0.05), and required a significantly greater number of additional medications (anti-emetics and analgesics) over the postoperative period (41 vs 29, P < 0.05).


2019 ◽  
Vol 8 (1) ◽  
pp. 29-33
Author(s):  
Tabish Hussain ◽  
Asifa Anwar Mir ◽  
Jawad Zahir ◽  
Pervaiz Minhas

Background: Postoperative pain creates complications by increasing circulating level of catecholamines and systemic vascular resistance, thus putting the patients on increased risks of having stroke and myocardial infarction. In addition, it increases hospital stay, causing burden over economic as well as healthcare infrastructure. The aim of this study was to determine the frequency of pain in the postoperative period while using Pregabalin as pre-medication among patients undergoing laparoscopic cholecystectomy.Material and Methods: The randomized control trail was conducted at Department of Anesthesiology, Holy Family hospital, Rawalpindi from 1st Sept 2015 to 28th Feb 2016 over a period of 6 months. A total of 200 patients undergoing laparoscopic cholecystectomy were randomly divided in group A and B by consecutive non-probability lottery method. Group A received 100 mg oral Pregabalin 1 hour before surgery and Group B were not given Pregabalin and were taken as controls. Post-operative pain was measured by visual analog scale (VAS) in terms of pain scores at 4 hours postoperatively after the arrival of patient in the post-anesthesia care unit (PACU). SPSS version 17.0 was used to analyze the data.Results: A total of 200 patients were included in the study. There were 100 patients in each group. Based on the visual analog pain scores, 9 patients were pain free in group A compared with none in group B. Similarly, there were 55 patients in group A, who reported a pain score of 1 whereas no patient in group B had a VAS score of 1. There were 29 patients in group A and only 3 patients in group B with VAS score of 2 (90.6% vs. 9.4%). For VAS score of 3, there were 6 patients in group A and 34 patients from group B (15% vs. 85%). For a VAS score of 4, there were 1 patient in group A and 61 patients in group B (1.6% vs. 98.4%). Two patients in group B experienced a VAS score of 5. All this data was significant with chi square p value of 0.0001.Conclusion: Oral Pregabalin administered prior to laparoscopic cholecystectomy was effective in reducing postoperative pain in the patients. Further studies are needed for post-operative evaluation of side effects, different dosing schedules at different time intervals for both rest and dynamic pain.


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