A comparison of bupivacaine lavage and diclofenac suppository effects on post-operative pain of laparascopic transabdominal pre-peritoneal herniorrhaphy: a randomized clinical trial study

Abstract Objectives Injection of a topical anaesthetic has been proved to be helpful with reducing pain after laparoscopic herniorrhaphy. We aimed to assess the effect of bupivacaine lavage on postoperative pain and compare it with diclofenac suppository. In this randomized clinical trial, 60 patients—scheduled for laparoscopic herniorrhaphy—were enrolled and randomized into three groups of 20 each, including diclofenac suppository, bupivacaine lavage, and normal saline as a placebo.The patients were investigated for postoperative pain scores, vomiting, nausea, morphine request, and duration of hospitalization. Results In the bupivacaine group, pain levels in recovery room, 4, 8 and 12 h after surgery, were significantly lower than diclofenac group; at time points of 16, 20 and 24 h after surgery, difference between two groups was not significant. Regarding vomiting and nausea, at time points of 1 and 3 h after surgery, results show no significant difference between the groups. Incident of infection, 1 h and 1 week after the surgery, was not significantly different among the groups. Duration of hospitalization in the bupivacaine group was much lower than the diclofenac group. Based on our results, use of the bupivacaine lavage can reduce postoperative pain in patients undergoing laparoscopic herniorrhaphy. Trial Registration Randomized clinical trial IRCT20180522039782N2; date of registration:14/10/2018

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Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/05166 ◽

2021 ◽

Vol 23 (05) ◽

pp. 421-432

Author(s):

Dr. Mohammad Kheiri Mahmod ◽

◽

Dr. Bashar Naser Hussein ◽

Dr. Ammar Hamid Hanoosh ◽

◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Analgesic Effect ◽

Analgesic Requirement ◽

Pain Scores ◽

Post Operative Pain ◽

Significant Difference ◽

Group A ◽

Group B

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.

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

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211040406 ◽

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.

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Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

Pain Medicine ◽

10.1093/pm/pnaa240 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3437-3442

Author(s):

Hamed Basir Ghafouri ◽

Niloofar Abazarian ◽

Mohammadreza Yasinzadeh ◽

Ehsan Modirian

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Pain Score ◽

Randomized Clinical Trial ◽

Renal Colic ◽

Rating Scale ◽

Pain Scores ◽

Intravenous Paracetamol ◽

Significant Difference ◽

Intranasal Desmopressin

Abstract Objective To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. Design Randomized clinical trial. Setting This study was conducted in the emergency unit of a university hospital. Subjects Patients referred to the emergency room with renal colic. Primary Outcome Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. Methods In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15 mg/kg) and intranasal desmopressin spray (40 μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60 minutes. Adverse effects and need for rescue analgesic (0.05 mg/kg max 3 mg morphine sulphate) were also recorded at the end of the study. Results Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15 minutes was more reduced and was clinically significant (>3) in the desmopressin group (P < 0.0001). There was no significant difference between mean pain scores in the two groups after 30 minutes (P = 0.350) or 60 minutes (P = 0.269), but the efficacy of the two drugs was significant in terms of pain reduction (>6). Conclusions Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin.

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Six-month Follow-up of the Effect of Nonvital Bleaching on IL-1β and RANK-L: A Randomized Clinical Trial

Operative Dentistry ◽

10.2341/18-023-c ◽

2019 ◽

Vol 44 (6) ◽

pp. 581-588 ◽

Cited By ~ 1

Author(s):

C Bersezio ◽

J Estay ◽

M Sáez ◽

F Sánchez ◽

R Vernal ◽

...

Keyword(s):

Clinical Trial ◽

Hydrogen Peroxide ◽

Randomized Clinical Trial ◽

Gingival Crevicular Fluid ◽

Color Change ◽

Double Blind ◽

Time Points ◽

Periodontal Tissues ◽

Significant Difference ◽

Spearman Test

SUMMARY Objectives: It has been reported that bleaching generates an increase in the activity of osteoclasts in vitro. We quantified the RANK-L and IL-1β biomarkers in a double-blind, randomized clinical trial evaluating the in vivo effect of hydrogen peroxide (35%) and peroxide carbamide (37%) six months after whitening. Methods and Materials: Fifty volunteers participated, each with color change in a nonvital tooth. Fifty teeth were randomly divided into two groups (n=25), and the teeth were bleached using either 35% hydrogen peroxide (G1) or 37% carbamide peroxide (G2). Intracoronal bleaching was carried out by a technical “walking bleach” over four sessions. Gingival crevicular fluid samples were collected and used to quantify the IL-1β and RANK-L secreted levels. Samples of six periodontal sites (three vestibular and three palatal) were collected for up to six months (at the beginning of the study [baseline] and at one week, one month, and six months posttreatment). The color change was visually monitored using the Vita Bleached Guide (ΔSGU). Results: Comparing each time to baseline assessment, a significant increase in the levels of IL-1β and RANK-L across time points was detected (p<0.05). The color change was 4 in G1 and G2, and a statistically significant difference (p<0.05) was found at the month time point between the groups. Using the Spearman test, a strong correlation (>0.8) between the IL-1β and RANK-L levels in both groups at all time points was detected. Conclusions: Nonvital bleaching using a technical walking bleach induces an increase in the IL-1β and RANKL production in periodontal tissues, which persists for six months after treatment. Both biomarkers were highly correlated in both groups and at all time points.

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Postoperative pain of patients with necrotic teeth with apical periodontitis following single visit endodontic treatment versus multiple visit endodontic treatment using triple antibiotic paste: a randomized clinical trial

F1000Research ◽

10.12688/f1000research.19936.1 ◽

2019 ◽

Vol 8 ◽

pp. 1203

Author(s):

Safeya AbdurRahman ◽

Saied M. Abdel Aziz ◽

Shaimaa I. Gawdat ◽

Ahmed M. AbdalSamad

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Rating Scale ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Single Visit ◽

Triple Antibiotic Paste ◽

Multiple Visit ◽

Significant Difference

Background: A randomized clinical trial was conducted to compare the postoperative pain following endodontic treatment of necrotic teeth with apical periodontitis. Treatments were performed in multiple visits with application of triple antibiotic paste interappointment dressing or single visit without interappointment dressing. Methods: In total 44 participants were assigned randomly into two groups. Group A: multiple visit endodontic treatment with triple antibiotic paste interappointment dressing; group B: single visit endodontic treatment without interappointment dressing. Postoperative pain of participants was assessed after 24, 48, 72 hours and one week using numerical rating scale. Results: No statistically significant difference was found in postoperative pain after 24, 48, 72 hours and one week between the two groups. Conclusion: Triple antibiotic paste as an interappointment dressing in multiple visits endodontic treatment was not proved to reduce the postoperative pain compared to a single visit in patients with necrotic teeth with apical periodontitis who did not have an interappointment dressing. Trial registration: clinicaltrials.gov, NCT02947763. Date: 28th October 2016.

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Comparison of Intraoperative Infusion of Remifentanil versus Fentanyl on Pain Management in Patients Undergoing Spine Surgery: A Double Blinded Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.115576 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Reza Shariat Moharari ◽

Shervin Shahinpour ◽

Negin Saeedi ◽

Elaheh Sahraei ◽

Atabak Najafi ◽

...

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Spine Surgery ◽

Intervention Group ◽

Morphine Consumption ◽

Control Group ◽

Scoliosis Surgery ◽

Canal Stenosis ◽

Significant Difference

Background: Remifentanil is an ultra-short-acting opioid which facilitates hemodynamic management. However, there are concerns about postoperative Remifentanil hyperalgesia because of its potent fast onset and offset. Objectives: The aim of this study was to determine visual analog scale (VAS), postoperative pain, and morphine used in two groups after spine surgery. Methods: In this randomized clinical trial study, 60 patients aged 18 - 60 years old, according to the American Society of Anesthesiology (ASA) I - II, who underwent spinal canal stenosis or scoliosis surgery, were divided into two groups. In the control group, patients received 0.07 - 0.1 µg/kg/h intraoperative Fentanyl infusion, and in the intervention group 0.1 - 0.2 µg/kg/min remifentanil was infused during the surgery. Both groups received 15 mg/kg intravenous Acetaminophen 20 minutes before the end of the surgery. Postoperative pain score and morphine consumption were measured 6, 12, 24, and 48 hours after discharge from the post-anesthesia care unit (PACU). Results: During the first 12 hours, VAS and morphine consumption were significantly higher in remifentanil group (P < 0.001). However, no significant difference was found between the two groups in morphine consumption 12 - 48 hours after surgery. Conclusions: These findings suggest that Remifentanil infusion during surgery may increase postoperative pain. Also, VAS and morphine consumption were higher during the first 12 hours.

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Comparison of the effect on postoperative pain between instrumentation with and without connected electronic apex locator: a randomized clinical trial

F1000Research ◽

10.12688/f1000research.70645.1 ◽

2021 ◽

Vol 10 ◽

pp. 868

Author(s):

Khoa Van Pham ◽

Cuong Hoang

Keyword(s):

Clinical Trial ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Root Canal ◽

Single Visit ◽

Significant Difference ◽

Group 2 ◽

Root Canal Instrumentation ◽

Electronic Apex Locator ◽

Group 1

Background: The aim of the present study was to evaluate the postoperative pain between root canal instrumentation with unconnected electronic apex locator and instrumentation with connected electronic apex locator. Methods: Forty-two patients were randomly divided into two groups (n=21). Group 1 was treated using the traditional endodontic motor with unconnected electronic apex locator (EAL) and group 2 was treated using the endodontic motor with connected EAL. All teeth were treated in single-visit endodontic therapy. Postoperative pain levels at 6, 24, 48, 72 h and 1 week were recorded by patients. The data were collected and analyzed using the χ2, and Mann-Whitney U tests with significance at 0.05. Results: Postoperative pain levels were significantly reduced by half at 6 hours in both experimental groups; however, no significant differences were found in postoperative pain levels between the two groups at all considered times. The postoperative pain levels using a percussion test were reduced on day 7 in both groups, and there was no significant difference in this variable between two groups. Conclusions: Both groups have a similar effect on reduction of the postoperative pain for endodontic patients undergoing root canal.

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Influence of maintaining apical patency in post-endodontic pain

BMC Oral Health ◽

10.1186/s12903-021-01632-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Snigdha Shubham ◽

Manisha Nepal ◽

Ravish Mishra ◽

Kishor Dutta

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Linear Regression Analysis ◽

Secondary Outcome ◽

Preoperative Pain ◽

Pain Scores ◽

Post Operative Pain ◽

Significant Difference ◽

Number Of Visits

Abstract Background The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann–Whitney U test, Spearman correlation and Multiple linear regression analysis. Results The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

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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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