scholarly journals Comparative study between the effect of dexmedetomidine and lidocaine infusion in lumbar fixation on hemodynamics, fentanyl requirements, and postoperative analgesia

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Nayera S. Mohammed ◽  
Mariam K. Habib ◽  
Essam A. Abbas ◽  
Sahar M. Mahmoud ◽  
Ibraheem A. Ramadan
Keyword(s):  
Postoperative Pain ◽  
Comparative Study ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Hospital Costs ◽  
Treatment Modalities ◽  
Double Blind ◽  
Alternative Mode ◽  
Arterial Blood ◽  
Group D

Abstract Background Spinal surgery is associated with high incidence of severe postoperative pain difficult to easy control. Appropriate treatment modalities decreased the postoperative morbidity, increased patient satisfaction, allowed early mobility, and decreased hospital costs. Lidocaine was used as intravenous additives to control intraoperative pain and decrease postoperative pain. As lidocaine, dexmedetomidine infusion associated with lower postoperative pain scores decreased the opioid consumption and its related adverse events. The aim of this double blind randomized prospective comparative study was to compare the efficacy of intraoperative dexmedetomidine versus lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among 66 patients subjected to lumbar fixation surgery and randomized into group D which received dexmedetomidine 1 μg/kg infusion over 10 min as a loading dose then 0.3–0.5 μg/kg/h after induction of anesthesia as maintenance dose and group X which received lidocaine 0.3–0.5 mg/kg/h after induction of anesthesia. Results At 10, 15, 30, and 60 min, the mean arterial blood pressure and heart rate significantly decreased in group D compared to group X, and there was significantly higher total dose of intraoperative analgesic for fentanyl in group X than group D. There was significantly higher numeric rating scale in group X compared to group D at 2, 4, 6, 9, 12, 18, and 24 h postoperative with significant early request of the first analgesia, higher incidence of analgesic needs, and higher dose of postoperative analgesia paracetamol, voltaren, or pethidine in group X compared to group D. Conclusions The intraoperative use of dexmedetomidine IV infusion was an alternative mode to decrease the demands of analgesia following spine surgery.

scholarly journals Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study

2016 ◽  
Vol 125 (6) ◽  
pp. 1513-1522 ◽  
Author(s):  
Nir Shimony ◽  
Uri Amit ◽  
Bella Minz ◽  
Rachel Grossman ◽  
Marc A. Dany ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Sleep Quality ◽  
Rating Scale ◽  
Preoperative Anxiety ◽  
Controlled Study ◽  
Double Blind ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Neurosurgical Patients ◽  
Duration Of Surgery

OBJECTIVE The aim of this study was to assess in-hospital (immediate) postoperative pain scores and analgesic consumption (primary goals) and preoperative anxiety and sleep quality (secondary goals) in patients who underwent craniotomy and were treated with pregabalin (PGL). Whenever possible, out-of-hospital pain scores and analgesics usage data were obtained as well. METHODS This prospective, randomized, double-blind and controlled study was conducted in consenting patients who underwent elective craniotomy for brain tumor resection at Tel Aviv Medical Center between 2012 and 2014. Patients received either 150 mg PGL (n = 50) or 500 mg starch (placebo; n = 50) on the evening before surgery, 1.5 hours before surgery, and twice daily for 72 hours following surgery. All patients spent the night before surgery in the hospital, and no other premedication was administered. Opioids and nonsteroidal antiinflammatory drugs were used for pain, which was self-rated by means of a numerical rating scale (score range 0–10). RESULTS Eighty-eight patients completed the study. Data on the American Society of Anesthesiologists class, age, body weight, duration of surgery, and intraoperative drugs were similar for both groups. The pain scores during postoperative Days 0 to 2 were significantly lower in the PGL group than in the placebo group (p < 0.01). Analgesic consumption was also lower in the PGL group, both immediately and 1 month after surgery. There were fewer requests for antiemetics in the PGL group, and the rate of postoperative nausea and vomiting was lower. The preoperative anxiety level and the quality of sleep were significantly better in the PGL group (p < 0.01). There were no PGL-associated major adverse events. CONCLUSIONS Perioperative use of twice-daily 150 mg pregabalin attenuates preoperative anxiety, improves sleep quality, and reduces postoperative pain scores and analgesic usage without increasing the rate of adverse effects. Clinical trial registration no.: NCT01612832 (clinicaltrials.gov)

scholarly journals The Effect of Dexmedetomidine in Combination with Bupivacaine on Sensory and Motor Block Time and Pain Score in Supraclavicular Block

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Shahryar Sane ◽  
Shahram Shokouhi ◽  
Parang Golabi ◽  
Mona Rezaeian ◽  
Behzad Kazemi Haki
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Upper Extremity ◽  
Motor Block ◽  
Intervention Group ◽  
Onset Time ◽  
Double Blind ◽  
Old Patients ◽  
Arterial Blood ◽  
Supraclavicular Block

Background. Brachial plexus block is frequently recommended for upper limb surgeries. Many drugs have been used as adjuvants to prolong the duration of the block. This study aimed to assess the effect of dexmedetomidine with bupivacaine combination and only bupivacaine on sensory and motor block duration time, pain score, and hemodynamic variations in the supraclavicular block in upper extremity orthopedic surgery. Methods. This prospective, double-blind clinical trial study was conducted on 60 patients, 20 to 60 years old. Patients were candidates for upper extremity orthopedic surgeries. The sensory and motor block were evaluated by using the pinprick method and the modified Bromage scale. The postoperative pain was assessed by utilizing a visual analog scale. Results. The mean onset time of sensory and motor block in patients receiving only bupivacaine was, respectively, 31.03 ± 9.65 min and 24.66 ± 9.2 min, and in the dexmedetomidine receiving group, it was about 21.36 ± 8.34 min and 15.93 ± 6.36 minutes. The changes in heart rate and mean arterial blood pressure were similar in both groups. The duration of sensory and motor block and the time of the first analgesia request in the intervention group were longer. Postoperative pain was lower in the intervention group for 24 hours ( P  = 0.001). Conclusion. Dexmedetomidine plus bupivacaine reduced the onset time of sense and motor blocks and increased numbness and immobility duration. Also, dexmedetomidine reduced postoperative pain significantly with the use of bupivacaine for supraclavicular blocks. Trial Registration. IRCT, IRCT20160430027677N15. Registered 05/28/2019, https://www.irct.ir/trial/39463.

scholarly journals Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

2016 ◽  
Vol 134 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Eduardo Jun Sadatsune ◽  
Plínio da Cunha Leal ◽  
Rachel Jorge Dino Cossetti ◽  
Rioko Kimiko Sakata
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Postoperative Analgesia ◽  
Pain Syndrome ◽  
Double Blind ◽  
Tunnel Syndrome

ABSTRACT CONTEXT AND OBJECTIVES: Effective postoperative analgesia is important for reducing the incidence of chronic pain. This study evaluated the effect of preoperative gabapentin on postoperative analgesia and the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgical treatment. DESIGN AND SETTINGS: Randomized, double-blind controlled trial, Federal University of São Paulo Pain Clinic. METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a six-month period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery.

Local Infiltrative Anesthetic Effect of Tramadol Compared to Lidocaine for Excision of Cutaneous Lesions: Pilot Randomized, Double-Blind Clinical Study

2012 ◽  
Vol 16 (2) ◽  
pp. 101-106 ◽  
Author(s):  
Despoina Kakagia ◽  
Theodosia Vogiatzaki ◽  
Savvas Eleftheriadis ◽  
Gregory Trypsiannis ◽  
Christos Iatrou
Keyword(s):  
Injection Site ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Demographic Data ◽  
Randomized Study ◽  
Cutaneous Lesions ◽  
Double Blind ◽  
Lidocaine Group ◽  
Pain Scores

Background: In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face. Methods: Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n = 46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n = 42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded. Results: There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p = .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p = .741 and p = .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p = .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours. Conclusion: Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

scholarly journals Intraoperative and Postoperative Analgesia Using Intravenous Opioid, Clonidine and Lignocaine

1994 ◽  
Vol 22 (1) ◽  
pp. 15-21 ◽  
Author(s):  
M. de Kock ◽  
P. Lavandhomme ◽  
J. L. Scholtes
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Randomised Trial ◽  
Skin Incision ◽  
Time Interval ◽  
Colonic Surgery ◽  
Double Blind ◽  
Group A ◽  
Group B ◽  
Group D

The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentany 15 μg.kg−1 at induction and another 4 μg.kg−1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 μg.kg−1 in 20 min + 2 μg.kg−1.h−1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg−1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 μg.kg−1 were given in response to the painful stimulation of the procedure. Postoperative pain was managed with PCA delivering 2 mg morphine per request in group A, 1.5 mg morphine in group B, 1.5 mg morphine + 15 μg clonidine in group C and 1.2 mg morphine + 15 μg clonidine + 23 mg lignocaine in group D. Postoperative analgesia was assessed by recording the analgesic demands (met and unmet) and the dose of morphine delivered at 6, 12, 18, 24, 36 hours. Side-effects, pain and sedation analogue scores were also recorded. A nalgesic demands and delivered morphine dose were reduced, at any time interval considered, in groups B, C, D, compared with A (P <0.001). No differences were noted between the groups B, C, D. Pain analogue scores were better in groups B, C, D compared with group A (P <0.001). Sedation and side-effects were not increased in groups B, C, D. Intraoperative clonidine was the major determinant of the reduction in analgesic demands and morphine delivered. Lignocaine, at the dose used, failed to afford any additional benefit.

Effectiveness of postoperative pain therapy in children assessed by their parents – is inadequate analgesia potentially dangerous?

Ból ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 17-24
Author(s):  
Michał Zięba ◽  
Artur Baranowski ◽  
Magdalena Mierzewska-Schmidt
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Analgesia ◽  
Sleep Disturbances ◽  
Parental Education ◽  
Pain Therapy ◽  
Rating Scale ◽  
Likert Scale ◽  
Assessment Tools ◽  
University Hospital

Inadequate pain therapy can lead to negative physical and psychological consequences, increase complications and even mortality. We aimed to assess effectiveness of postoperative analgesia in children from their parents’ point of view. We also wanted to evaluate their degree of satisfaction of postoperative analgesia and to identify areas for improvement. Patients’ parents (n = 85) from Paediatric University Hospital in Warsaw, Poland, took part in our survey. They evaluated pain intensity on five-point Likert Scale and on numerical rating scale (NRS). Mean value of pain on NRS was 4.22 (SD±2,53). On Likert scale the majority of parents described pain intensity as moderate. High percentage (38.82%) of children were in pain while their parents took the survey and only 19% of children did not feel pain at all. In 36 children (42.36%) pain caused sleep disturbances. In same cases non-pharmacological methods of analgesia were effective. Due to inadequate pain relief one of the parents arbitrarily administered a formulation containing paracetamol and codeine. The study revealed low efficacy of analgesia among children of surveyed parents. Their level of satisfaction was inadequately high (91% of them were „very satisfied” or “rather satisfied”). The survey confirmed the need for systematic pain assessment tools. Parental education seems necessary to make them aware that postoperative pain can be treated effectively. Administration of drugs without consulting medical staff is dangerous. It may result in the use of contraindicated agents (as in the case described), drug overdose or unexpected interactions.

Preoperative Intradermal Acupuncture Reduces Postoperative Pain, Nausea and Vomiting, Analgesic Requirement, and Sympathoadrenal Responses

2001 ◽  
Vol 95 (2) ◽  
pp. 349-356 ◽  
Author(s):  
Naoki Kotani ◽  
Hiroshi Hashimoto ◽  
Yutaka Sato ◽  
Daniel I. Sessler ◽  
Hideki Yoshioka ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Acupuncture Group ◽  
Double Blind Study ◽  
Analgesic Requirement ◽  
Bladder Meridian ◽  
Intravenous Morphine ◽  
Intradermal Acupuncture

Background In a controlled and double-blind study, the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm from the spinal vertebrae (bladder meridian) provide satisfactory postoperative analgesia. Methods The authors enrolled patients scheduled for elective upper and lower abdominal surgery. Before anesthesia, patients undergoing each type of surgery were randomly assigned to one of two groups: acupuncture (n = 50 and n = 39 for upper and lower abdominal surgery, respectively) or control (n = 48 and n = 38 for upper and lower abdominal surgery, respectively). In the acupuncture group, intradermal needles were inserted to the left and right of bladder meridian 18-24 and 20-26 in upper and lower abdominal surgery before induction of anesthesia, respectively. Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine. Consumption of intravenous morphine was recorded. Incisional pain at rest and during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale. We also evaluated time-dependent changes in plasma concentrations of cortisol and catecholamines. Results Starting from the recovery room, intradermal acupuncture increased the fraction of patients with good pain relief as compared with the control (P &lt; 0.05). Consumption of supplemental intravenous morphine was reduced 50%, and the incidence of postoperative nausea was reduced 20-30% in the acupuncture patients who had undergone either upper or lower abdominal surgery (P &lt; 0.01). Plasma cortisol and epinephrine concentrations were reduced 30-50% in the acupuncture group during recovery and on the first postoperative day (P &lt; 0.01). Conclusion Preoperative insertion of intradermal needles reduces postoperative pain, the analgesic requirement, and opioid-related side effects after both upper and lower abdominal surgery. Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery.

Amisulpride versus fluoxetine in dysthymia: preliminary results of a double-blind comparative study

1996 ◽  
Vol 11 (S3) ◽  
pp. 141s-143s ◽  
Author(s):  
E Smeraldi ◽  
E Haefele ◽  
G Crespi ◽  
GL Casadei ◽  
F Biondi ◽  
...  
Keyword(s):  
Comparative Study ◽  
Rating Scale ◽  
Low Doses ◽  
Double Blind Trial ◽  
Efficacy And Safety ◽  
Main Criterion ◽  
Double Blind ◽  
Blind Trial ◽  
Preliminary Results ◽  
Significant Difference

SummaryThe efficacy and safety of low doses of amisulpride (50 mg/day) and of fluoxetine (20 mg/day) were compared respectively in 139 and 129 outpatients with dysthymia during three months in a multi-centre double-blind trial. No statistically significant difference between the two groups was found in the number of responders at study-end with the Montgomery and Asberg Depressive Rating Scale, which was the main criterion for efficacy. In addition, amisulpride was well tolerated. These preliminary results suggest that low doses of amisulpride may be effective in the treatment of dysthymic patients.

scholarly journals Efficiency and safety of intrathecal morphine for analgesia after hysterectomy

2020 ◽  
Vol 148 (5-6) ◽  
pp. 322-327
Author(s):  
Milanka Tatic ◽  
Dragan Ladjinovic ◽  
Sanja Skeledzija-Miskovic ◽  
Ranko Zdravkovic ◽  
Dragana Radovanovic ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Intrathecal Morphine ◽  
Randomized Study ◽  
Numeric Rating Scale ◽  
Time Interval ◽  
Subjective Feeling ◽  
Group A

Introduction/Objective. This prospective, randomized study was done to determine the efficiency and safety of the administration of intrathecal morphine chloride combined with the local anesthetic levobupivacaine given to female patients subjected to hysterectomy to ensure postoperative analgesia. Methods. The study sample consisted of 50 patients who were to undergo hysterectomy with adnexectomy and they were divided into two groups of 25 each. The patients in group A were given the combination of 0.3 mg of morphine chloride with 1.7 ml of 0.5% levobupivacaine immediately before the surgery, whereas the patients in group B were intravenously administered 5 mg of morphine chloride before the end of surgery, and after the surgery at certain time intervals. The postoperative pain was assessed at the first, sixth, 12th, and 24th hour by Numeric Rating Scale (NRS). Side effects, such as nausea, vomiting, itching and respiratory depressions were followed as well. Results. The postoperative pain was less expressed at any time interval both at rest and on exertion in group A (p < 0.001) and therefore the need for additional analgesia was less in group A (p < 0.001). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in group A (p < 0.001). Conclusion. Intrathecal administration of morphine chloride combined with levobupivacaine ensures better postoperative analgesia after hysterectomy than intravenous morphine chloride, their side effects being equally frequent..

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