scholarly journals Ketamine for pain

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1711 ◽  
Author(s):  
Kelly Jonkman ◽  
Albert Dahan ◽  
Tine van de Donk ◽  
Leon Aarts ◽  
Marieke Niesters ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Side Effects ◽  
Postoperative Pain ◽  
Cancer Pain ◽  
Literature Search ◽  
Analgesic Agent ◽  
Aspartate Receptor ◽  
Persistent Postoperative Pain ◽  
Meta Analyses

The efficacy of theN-methyl-D-aspartate receptor antagonist ketamine as an analgesic agent is still under debate, especially for indications such as chronic pain. To understand the efficacy of ketamine for relief of pain, we performed a literature search for relevant narrative and systematic reviews and meta-analyses. We retrieved 189 unique articles, of which 29 were deemed appropriate for use in this review. Ketamine treatment is most effective for relief of postoperative pain, causing reduced opioid consumption. In contrast, for most other indications (that is, acute pain in the emergency department, prevention of persistent postoperative pain, cancer pain, and chronic non-cancer pain), the efficacy of ketamine is limited. Ketamine’s lack of analgesic effect was associated with an increase in side effects, including schizotypical effects.

scholarly journals Comparison of intravenous Acetaminophen and Morphine Sulfate for abdominal pain management in patients with acute abdomen

2019 ◽  
Vol 6 (5) ◽  
pp. 1626
Author(s):  
Mirsalim Seyedsadeghi ◽  
Jafar Ghobadi Samiyan ◽  
Keyvan Amini ◽  
Amir Ahmad Arabzadeh ◽  
Seyyed Mohammad Mosannen Tabatabaie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Acute Abdomen ◽  
Morphine Group ◽  
Rebound Tenderness ◽  
Intravenous Acetaminophen ◽  
Intravenous Morphine ◽  
The Mean

Background: Pain management is a crucial component in the postoperative care of patient. Opioids, which have been the mainstay of postoperative pain control for some time, are being used less because of significant adverse effects. Recently Intravenous acetaminophen that is an analgesic and antipyretic drug is used for reducing postoperative pain. Our Objective in this study was to use intravenous acetaminophen as an analgesic and antipyretic drug with the least complications and more safe than intravenous opioids for comparison with the effects of intravenous morphine sulfate in patients with acute abdominal surgery referred to emergency department of Fatemi Hospital.Methods: 120 patients with acute abdomen will be assigned into the study by randomized allocation. Demographic data, pain severity in admission to the emergency department and 30 minutes after injection, vital signs in admission, side effects, and clinical findings will record questionnaires. The pain level, tenderness and the rebound tenderness of the patients will determine by the Visual Analog scale. The subjects will be divided into two groups A and B randomly. The intravenous acetaminophen (15 mg/kg/100cc normal saline in the form of intravenous infusion for 30 minutes) will be administered for group (A) and intravenous morphine sulphate (0.1 mg/kg Slow-acting intravenous injection for 1.5 to 2 minutes) will be administered for group (B). After 30, 60 and 90 minutes, the patient's pain is re-examined. Changes in the patient's pain, tenderness, rebound tenderness and side effects will documented in two groups and they will be compared. Finally, the collected data will be analyzed.Results: The mean age of patients in acetaminophen group was 58.24±8.06 years with a mean age of 27-26 years and in morphine group was 56.7±7.63 years with age range of 34-69 years. There was no significant relationship between age and effect of intravenous acetaminophen and venous morphine sulphate (p=0.16). The mean of pain before injection of intravenous acetaminophen group was 8.92±1.25 and the mean pain before injection of morphine group was 8.80±1.35. There was no significant difference between the mean pain before injection of patients in the intravenous staphylococci group and the morphine group (p=0.049). The mean pain after injection of intravenous acetaminophen group was 4.46±1.25 and the mean pain after injection of the morphine group was 2.56±1.71. The mean pain after injection was significantly higher in patients with intravenous acetaminophen than in the morphine group (p<0.001).Conclusion: Due to the effectiveness of morphine in relieving the pain of patients, it is recommended that doctors and associates use this painkiller to relieve pain in patients.

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

2019 ◽  
Vol 27 (2) ◽  
pp. 150-159
Author(s):  
Francesco Mongelli ◽  
Davide La Regina ◽  
Irin Zschokke ◽  
Marcello Ceppi ◽  
Antonjacopo Ferrario di Tor Vajana ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Literature Search ◽  
Operative Time ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trocar Site ◽  
First Choice ◽  
Significant Difference ◽  
Meta Analyses ◽  
Adequate Data

Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.

scholarly journals Quadratus Lumborum and Transversus Abdominis Plane Blocks and Their Impact on Acute and Chronic Pain in Patients after Cesarean Section: A Randomized Controlled Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3500
Author(s):  
Michał Borys ◽  
Aleksandra Zamaro ◽  
Beata Horeczy ◽  
Ewa Gęszka ◽  
Marek Janiak ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Pain Intensity ◽  
Hospital Discharge ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Randomized Controlled ◽  
Quadratus Lumborum ◽  
Persistent Postoperative Pain

Background: Severe postoperative pain is a significant problem after cesarean sections. Methods: This study was a randomized, controlled trial of 105 patients conducted in two hospitals. All patients were anesthetized spinally for elective cesarean section. Each participant was randomly allocated to one of three study groups: the quadratus lumborum block (QLB) group, the transversus abdominis plane block (TAPB) group, or the control (CON) group. The primary outcome of this study determined acute pain intensity on the visual analog scale (VAS). The secondary outcomes determined morphine consumption and chronic pain evaluation according to the Neuropathic Pain Symptom Inventory (NPSI) after hospital discharge. Results: At rest, the pain intensity was significantly higher in the CON group than in the QLB and TAPB groups at hours two and eight. Upon activity, the pain in the control subjects was more severe than in the QLB and TAPB groups in three and two of five measurements, respectively. Moreover, morphine consumption was significantly lower in the QLB (9 (5–10)) and TAPB (10 (6–14)) groups than in the CON (16 (11–19)) group. Persistent postoperative pain was significantly lower in the QLB group than in the CON group at months one and six following hospital discharge. Conclusions: Both the QLB and TAPB can improve pain management after cesarean delivery. Moreover, the QLB might reduce the severity of persistent postoperative pain months after cesarean section.

SNP in TNFα T308G is predictive for persistent postoperative pain following inguinal hernia surgery

2012 ◽  
Vol 3 (3) ◽  
pp. 188-188
Author(s):  
Maija Kalliomäki ◽  
Anne-Li Lind ◽  
Alfhild Grönbladh ◽  
Ulf Gunnarsson ◽  
Gabriel Sandblom ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Postoperative Pain ◽  
Significant Risk ◽  
Taqman Assay ◽  
Control Group ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery ◽  
Increased Risk ◽  
Persistent Postoperative Pain

Abstract Aim of investigation Persistent postoperative pain of some extent is seen in about 20% of patients after surgical operations, while 80% heal without chronic pain. The type of chronic pain that arises is mainly neuropathic, and is suggested to be in part regulated by genetic factors. In order to study the possible involvement of some candidate genes suggested to be involved in the processing of pain (BDNF, CACNA2D2, ORPM1, GRIK 3, GCH1 and TNF-α ), we performed a genetic association study in a well characterized clinical material of patients that had undergone surgery for inguinal hernia (n = 189). Of those 94 had developed a persistent postoperative pain state when investigated 2–3 years following the operation. The control group (n = 95) had undergone the same surgical procedure, and were pain free at follow up. Methods Genomic DNA was extracted from blood samples and genotyped by the Handy Bio-strand method and the TaqMan assay. Results The patients with persistent postoperative pain that had homozygous SNP in the TNF-α gene displayed increased risk of persistent postoperative pain with an odds risk of 2.42, compared the pain free controls. None of the other of the investigated genes were associated with significant risk of development of chronic pain following surgery. Conclusion The expression of TNF-α shows a significant impact on the risk of developing chronic pain after surgery. Further experimental and clinical studies are needed in order to fine map the TNF-α effect and to address underlying mechanisms.

scholarly journals Nonselective and NR2B-selective N -methyl-d-aspartic Acid Receptor Antagonists Produce Antinociception and Long-term Relief of Allodynia in Acute and Neuropathic Pain

2011 ◽  
Vol 115 (1) ◽  
pp. 165-174 ◽  
Author(s):  
Maarten Swartjes ◽  
Aurora Morariu ◽  
Marieke Niesters ◽  
Leon Aarts ◽  
Albert Dahan
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Side Effects ◽  
Receptor Antagonist ◽  
Nerve Injury ◽  
Side Effect ◽  
Receptor Antagonists ◽  
Chronic Neuropathic Pain ◽  
Pain Model ◽  
Aspartate Receptor

Background At low dose, the nonselective N-methyl-D-aspartate receptor antagonist ketamine produces potent analgesia. In humans, psychedelic side effects limit its use. To assess whether other N-methyl-D-aspartate receptor antagonist have an improved therapeutic utility index, we compared antinociceptive, side effect, and locomotor activity of three N-methyl-D-aspartate receptor antagonists. Methods Ketamine, its active metabolite norketamine, and the NR2B-selective antagonist traxoprodil (CP-101,606) were tested in rat models of acute antinociception (paw-withdrawal response to heat) and chronic neuropathic pain (spared nerve injury). Side effects (stereotypical behavior, activity level) were scored and locomotor function of the nerve-injured paw was assessed using computerized gait analysis. In the chronic pain model, treatment was given 7 days after surgery, for 3 h on 5 consecutive days. Results All three N-methyl-D-aspartate receptor antagonists caused dose-dependent antinociception in the acute pain model and relief of mechanical and cold allodynia for 3-6 weeks after treatment in the chronic pain model (P &lt; 0.05 vs. saline). In both tests, ketamine was most potent. Norketamine was as much as two times less potent and traxoprodil was up to 8 times less potent than ketamine (based on area under the curve measures). Nerve injury caused an inability to use the affected paw that either did not improve after treatment (ketamine, traxoprodil) or showed only a limited effect (norketamine). Traxoprodil, but not ketamine or norketamine, showed clear separation between effect and side effect. Conclusions The observation that traxoprodil causes relief of chronic pain outlasting the treatment period with no side effects makes it an attractive alternative to ketamine in the treatment of chronic neuropathic pain.

scholarly journals To what extent are we confident that tapentadol induces less constipation and other side effects than the other opioids in chronic pain patients? a confidence evaluation in network meta-analysis

2020 ◽  
pp. 204946372094528
Author(s):  
Patrice Forget ◽  
Mathieu Vermeersch
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Meta Analysis ◽  
Random Effect ◽  
Chronic Pain Patients ◽  
High Level ◽  
Meta Analyses ◽  
Pain Patients ◽  
Random Effect Models ◽  
Indirect Comparisons

Background: A confidence evaluation helps to make informed decisions about the results of meta-analyses. The goal of this work is to perform a confidence evaluation of results of a network meta-analysis (NMA) on the digestive side effects of tapentadol in patients with chronic pain. Methods: An updated search in PubMed/Medline and Web of Science search until March 2020 was done to perform pairwise meta-analyses with NMA using random-effect models and confidence in network meta-analysis (CiNeMA) for the confidence analysis. Results: Twenty-five studies were included in the final analyses. Pairwise and indirect comparisons showed a reduced risk of constipation with tapentadol compared to oxycodone. The confidence evaluation did not raise any concerns in terms of confidence for the oxycodone versus tapentadol comparisons. The oxycodone-naloxone versus tapentadol comparisons showed some concerns, particularly in terms of imprecision and incoherence. Regarding the overall risk of any side effects, the confidence evaluation showed a major concern regarding imprecision, but not for the comparison between tapentadol and oxycodone. However, this comparison showed a major heterogeneity. Discussion and conclusions: A confidence evaluation in meta-analysis on the effect of tapentadol compared to other opioids in chronic pain showed possible imprecision, heterogeneity and/or incoherence. However, with a high level of confidence, tapentadol was associated with a lower incidence of constipation than oxycodone. Confidence analyses can help to get more information from meta-analyses.

scholarly journals THE ROLE OF KETAMINE IN THE TREATMENT OF CHRONIC CANCER PAIN

2015 ◽  
Vol 88 (4) ◽  
pp. 457-461 ◽  
Author(s):  
Armeana Olimpia Zgaia ◽  
Alexandru Irimie ◽  
Dorel Sandesc ◽  
Catalin Vlad ◽  
Cosmin Lisencu ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Neuropathic Pain ◽  
Side Effects ◽  
Cancer Pain ◽  
Nmda Receptors ◽  
Evidence Based ◽  
Chronic Cancer Pain ◽  
Clinical Benefits

         Background and aim. Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain.The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain.Method. We reviewed the literature from the electronic databases of MEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998-2014), as well as chapters of specialized books (palliative care, pain management, anesthesia).Results. A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive.Conclusions. Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored.

Persistent Postsurgical Pain

2018 ◽  
Vol 129 (3) ◽  
pp. 590-607 ◽  
Author(s):  
Philippe Richebé ◽  
Xavier Capdevila ◽  
Cyril Rivat
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Critical Factor ◽  
Major Complication ◽  
Science Research ◽  
Clinical Practices ◽  
Postsurgical Pain ◽  
Pain Sensitization ◽  
Central Nervous Systems ◽  
Persistent Postoperative Pain

Abstract The development of chronic pain is considered a major complication after surgery. Basic science research in animal models helps us understand the transition from acute to chronic pain by identifying the numerous molecular and cellular changes that occur in the peripheral and central nervous systems. It is now well recognized that inflammation and nerve injury lead to long-term synaptic plasticity that amplifies and also maintains pain signaling, a phenomenon referred to as pain sensitization. In the context of surgery in humans, pain sensitization is both responsible for an increase in postoperative pain via the expression of wound hyperalgesia and considered a critical factor for the development of persistent postsurgical pain. Using specific drugs that block the processes of pain sensitization reduces postoperative pain and prevents the development of persistent postoperative pain. This narrative review of the literature describes clinical investigations evaluating different preventative pharmacologic strategies that are routinely used by anesthesiologists in their daily clinical practices for preventing persistent postoperative pain. Nevertheless, further efforts are needed in both basic and clinical science research to identify preclinical models and novel therapeutics targets. There remains a need for more patient numbers in clinical research, for more reliable data, and for the development of the safest and the most effective strategies to limit the incidence of persistent postoperative pain.

Nonsteroidal Anti-Inflammatory Drugs, Alone or Combined With Opioids, for Cancer Pain

2004 ◽  
Vol 22 (10) ◽  
pp. 1975-1992 ◽  
Author(s):  
Ewan McNicol ◽  
Scott Strassels ◽  
Leonidas Goudas ◽  
Joseph Lau ◽  
Daniel Carr
Keyword(s):  
Side Effects ◽  
Cancer Pain ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Clinical Difference ◽  
Significant Difference ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Meta Analyses ◽  
Dose Dependent

Purpose To assess the safety and efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), alone or combined with opioids, for the treatment of cancer pain. Patients and Methods Forty-two trials involving 3,084 patients met inclusion criteria: eight compared NSAID with placebo; 13 compared one NSAID with another; 23 compared NSAID with opioid, NSAID or opioid versus NSAID plus opioid combinations, or NSAID plus opioid combinations versus NSAID plus opioid combinations; and nine studies assessed the effect of increasing NSAID dose. Results Sixteen studies lasted 1 week or longer and 11 evaluated a single dose. Seven of eight trials demonstrated superior efficacy of single doses of NSAID compared with placebo. Only four of 13 studies reported increased efficacy of one NSAID compared with another; four other studies found that one NSAID had fewer side effects than one or more others. Thirteen of 14 studies found no difference, or minimal clinical difference, when comparing an NSAID plus opioid combination versus either drug alone. Comparisons between various NSAID plus opioid combinations were inconclusive. Four studies demonstrated increased efficacy with increased NSAID dose, without dose-dependent increases in side effects. Conclusion Heterogeneity of study methods and outcomes precluded meta-analyses. Short duration of studies undermines generalization of findings on efficacy and safety. On the basis of limited data, NSAIDs appear to be more effective than placebo for cancer pain; clear evidence to support superior safety or efficacy of one NSAID compared with another is lacking; and trials of combinations of an NSAID with an opioid have disclosed either no significant difference, or at most a slight but statistically significant advantage, compared with either single entity.

Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

2021 ◽  
pp. 1-18
Author(s):  
Alexey A. Murashko ◽  
Konstantin A. Pavlov ◽  
Olga V. Pavlova ◽  
Olga I. Gurina ◽  
Alexander Shmukler
Keyword(s):  
Systematic Review ◽  
Clinical Relevance ◽  
Literature Search ◽  
Psychotic Disorders ◽  
Evidence Synthesis ◽  
Detection Methods ◽  
Aspartate Receptor ◽  
Detection Assay ◽  
Sample Characteristics ◽  
Meta Analyses

<b><i>Objective:</i></b> The objective of this study was to provide comprehensive evidence synthesis including all available up-to-date data about the prevalence of N-methyl D-aspartate receptor (NMDAR) antibodies (ABs) in psychotic patients in order to evaluate the clinical relevance of ABs as well as to specify potential explanations of the heterogeneity of the findings and determine areas for further research. <b><i>Methods:</i></b> A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases. <b><i>Results:</i></b> Forty-seven studies and 4 systematic reviews (including 2 meta-analyses) were included in the present review. Studies that used cell-based assays (CBAs) provided heterogeneous results on AB prevalence, obviously depending on the type of detection assay and sample characteristics. Improvement of AB detection methods is necessary to determine the real prevalence of ABs across different groups of patients and healthy people. Live CBAs seem to have better sensitivity but probably poorer specificity than fixed CBAs. Moreover, some links between AB-positive status and acute symptoms are possible. A small amount of data on immunotherapy in AB-positive patients raises the possibility of its effectiveness but obviously require further research. <b><i>Conclusions:</i></b> NMDAR ABs are definitely present in a subset of psychotic patients. NMDAR ABs might shape psychosis and underlie some symptoms, and immunotherapy might be regarded as a treatment option for patients failing to respond to other therapies.

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