scholarly journals Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Irén Sellbrant ◽  
Jon Karlsson ◽  
Jan G. Jakobsson ◽  
Bengt Nellgård
Keyword(s):  
Postoperative Pain ◽  
Local Anaesthetic ◽  
Rating Scale ◽  
Anaesthetic Agent ◽  
Study Groups ◽  
Distal Radial Fractures ◽  
Randomised Study ◽  
Post Surgery ◽  
Long Acting ◽  
Supraclavicular Block

Abstract Background Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. Methods Patients (n = 90) with ASA physical status 1–3 were prospectively randomised to receive; SCB with mepivacine 1%, 25–30 ml (n = 30), SCB with ropivacaine 0.5%, 25–30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. Results The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3–3.3) and 2.7 (IQR 1.3–4.2) (p = 0.017) and OEC 30 mg (IQR 10–80) and 85 mg (IQR 45–125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). Conclusions The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution. Trial registration NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).

scholarly journals Brace versus cast following surgical treatment of distal radial fracture: a prospective randomised study comparing quality of recovery

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 336
Author(s):  
Irén Sellbrant ◽  
Johanna Blomstrand ◽  
Jon Karlsson ◽  
Bengt Nellgård ◽  
Jan Jakobsson
Keyword(s):  
Surgical Treatment ◽  
Recovery Of Function ◽  
Day Surgery ◽  
Distal Radial Fracture ◽  
Distal Radial Fractures ◽  
Randomised Study ◽  
Quality Of Recovery ◽  
Post Surgery ◽  
Supraclavicular Block

Background: Immobilisation following surgical treatment of distal radial fractures (DRF) is traditionally performed with a dorsal cast splint. There is an interest in changing the rigid cast to a removable brace. This can reduce the risk for cast-corrections, complications and improve recovery of function. The aim of the study was to compare quality of recovery (QoR) between brace and traditional cast for immobilisation during the first postoperative week. Methods: 60 patients with American Society of Anesthesiologists (ASA) physical status 1–3, scheduled for surgical treatment of DRF under a supraclavicular block (SCB) in a day-surgery setting were randomised into two groups of immobilisation post-surgery; brace (n=30) versus traditional cast (n=30). Study objectives were: differences in self-assessed QoR using the QoR-15 questionnaire, postoperative oral oxycodone consumption, perioperative time events and unplanned healthcare contacts one week postoperatively. Results: 54 patients, 46 females/eight males were included in the analysis; 27 with brace and 27 with traditional cast. QoR-15 sum median scores improved significantly from baseline/preoperative to day 7 (brace p=0.001, cast p=0.001) with no differences between the two groups. The only difference found was that patients in the brace group had significantly worse pain score 24-hours post-surgery (p=0.022). No significant differences were seen in sum median oxycodone consumption the first three postoperative days. No differences were found in perioperative events or unplanned healthcare contacts. Conclusions: Brace appears to be a feasible option to traditional cast for immobilisation following surgical treatment of DRF. The early QoR was similar in both groups apart from more pain in the brace group the first 24 postoperative hours.

scholarly journals Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): results from a randomised controlled feasibility trial

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029233 ◽  
Author(s):  
David Bosanquet ◽  
Graeme Ambler ◽  
Cherry-Ann Waldron ◽  
Emma Thomas-Jones ◽  
Lucy Brookes-Howell ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Rating Scale ◽  
Lower Limb Amputation ◽  
Feasibility Trial ◽  
Limb Amputation ◽  
Effectiveness Trial ◽  
Randomised Controlled

ObjectivesTo determine the feasibility of undertaking a randomised controlled effectiveness trial evaluating the use of a perineural catheter (PNC) after major lower limb amputation with postoperative pain as the primary outcome.DesignRandomised controlled feasibility trial.SettingTwo vascular Centres in South Wales, UK.Participants50 patients scheduled for major lower limb amputation (below or above knee) for complications of peripheral vascular disease.InterventionsThe treatment arm received a PNC placed adjacent to the sciatic or tibial nerve at the time of surgery, with continuous infusion of levobupivacaine hydrochloride 0.125% for up to 5 days. The control arm received neither local anaesthetic nor PNC. Both arms received usual perioperative anaesthesia and postoperative analgesia.Primary and secondary outcome measuresThe primary outcomes were the proportion of eligible patients who were randomised and the proportion of recruited patients who provided primary effectiveness outcome data. Secondary outcomes were: the proportion of recruited patients reaching 2 and 6 month follow-up and supplying pain data; identification of key cost drivers; development of an economic analysis framework for a future effectiveness trial; identification of barriers to recruitment and site set-up; and identification of the best way to measure postoperative pain.ResultsSeventy-six of 103 screened patients were deemed eligible over a 10 month period. Fifty (64.5%) of these patients were randomised, with one excluded in the perioperative period. Forty-five (91.3%) of 49 recruited patients provided enough pain scores on a 4-point verbal rating scale to allow primary effectiveness outcome evaluation. Attrition rates were high; 18 patients supplied data at 6 month follow-up. Costs were dominated by length of hospital stay. Patients and healthcare professionals reported that trial processes were acceptable.ConclusionsRecruitment of patients into a trial comparing PNC use to usual care after major lower limb amputation with postoperative pain measured on a 4-point verbal rating scale is feasible. Evaluation of longer-term symptoms is difficult.Trial registration numberISRCTN: 85 710 690. EudraCT: 2016-003544-37.

scholarly journals Pain Level of Postoperative Orthopedic Patients at Dr. Soetomo General Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 19
Author(s):  
David Wicaksono ◽  
Lilik Herawati ◽  
Herdy Sulistyono
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Medical Personnel ◽  
Numeric Rating Scale ◽  
Individual Factors ◽  
Pain Level ◽  
Post Surgery ◽  
Significant Difference

Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient’s pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients’ pain level were measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion: The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.

scholarly journals GAMBARAN SKALA NYERI PADA PASIEN PASCABEDAH CAESAR DENGAN PENGGUNAAN OBAT KETAMIN DOSIS RENDAH

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Richi M. Posumah ◽  
Harold F. Tambajong ◽  
Lucky T. Kumaat
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Caesarean Section ◽  
Low Dose ◽  
Rating Scale ◽  
Anaesthetic Agent ◽  
Numerical Rating Scale ◽  
Emotional Experience ◽  
Pain Scale ◽  
Numerical Rating

Abstract : Pain is an uncomfortable sensorical feeling and emotional experience that relate to the destruction of tissue actually or potentially. Pain management is an important thing for the postoperative patients. Postoperative pain causing the change of body hormones that eventually lead to pain, nausea and vomitting. Postoperative pain management is an important aspect and therefore the analgetic drugs will be administered to overcome the pain. Not only function as an anaesthetic agent, low dose ketamine also has an analgetic effect. This study was aimed to determine the pain scale of the caesarean section patients using low – dose ketamine. This is an descriptive prospective study and the samples were the postoperative caesarean section patients from Prof. DR. R.D Kandou Hospital, Bhayangkara Hospital and GMIM Pancaran Kasih Hospital in Manado from December 2015 – January 2016. Patient that has been finished the operation were administered low dose ketamine as bolus 0,1 mg/kg and continuous IV 0,1 mg/kg/hour for 6 hours then the pain were assessed by using the Numerical Rating Scale (NRS) and FACES Pain Scale (FPS) starts from two hours, four hours and six hours after the ketamine was administered. Conclusion : Low dose ketamine was able to lower postoperative pain on caesarean section patients.Keywords : Postoperative Pain, Pain Scale, Caesarean Section, Low – Dose KetamineAbstrak : Nyeri merupakan perasaan sensorik dan pengalaman emosional yang tidak nyaman dan berhubungan dengan kerusakan jaringan secara actual maupun potensial. Manajemen nyeri merupakan hal yang penting dalam penganganan pasien pascabedah. Nyeri yang disebabkan oleh pembedahan terjadi karena perubahan hormon – hormon dalam tubuh dan hasilnya berupa rasa nyeri, mual dan muntah. Manajemen nyeri pascabedah merupakan aspek penting maka diberikan obat analgetik untuk mengatasinya. Selain sebagai obat anestetik, obat ketamin dengan dosis rendah memiliki fungsi analgetik. Tujuan penelitian ini adalah untuk mengetahui gambaran skala nyeri pada pasien pascabedah caesar dengan menggunakan obat ketamin dosis rendah. Penelitian ini bersifat deskriptif prospektif dan sampel merupakan pasien pascabedah caesar diambil di RSUP. Prof. DR. R. D. Kandou Manado, RS Bhayangkara Mando dan RSU GMIM Pancaran Kasih Manado yang dilaksanakan pada bulan Desember 2015 – Januari 2016. Pasien setelah selesai operasi diberikan ketamin dosis rendah dengan dosis bolus 0,1 mg/kg dan infus kontinyu IV 0,1 mg/kg/jam selama 6 jam kemudian penilaian nyeri pasien menggunakan skala nyeri Numerical Rating Scale (NRS) dan FACES Pain Scale (FPS) pada jam II, jam IV dan jam VI setelah pemberian obat ketamin. Simpulan : Ketamin dengan dosis rendah mampu menurunkan nyeri pascabedah pada pasien bedah caesar.Kata Kunci : Nyeri Pascabedah, Skala Nyeri, Bedah Caesar, Ketamin Dosis Rendah

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