The effects of oral pregabalin on post-Lichtenstein herniorrhaphic pain: a
                  randomized clinical trial

Abstract Background Pregabalin is a gamma-aminobutyric acid analog which seems to be effective in different neuropathic pains, as well as in incisional and inflammatory injuries. This study evaluated the effectiveness and safety of pregabalin on pain relief post herniorrhaphy. Methods In this randomized clinical trial, 60 men were chosen for unilateral inguinal herniorrhaphy under spinal anesthesia. The participants were randomly divided into two groups. The investigation (pregabalin) group received 300 mg of oral pregabalin 2 h before and 150 mg of pregabalin 12 and 24 h after surgery in addition to routine postoperative medication and 1 mg/kg of pethidine as needed. The control (placebo) group received placebo capsules similar to the investigation group, as well as routine medication and 1 mg/kg of pethidine as needed. All surgeries were done with the same technique. Post-surgery pain was evaluated in the walking and lying positions with a visual analog scale at 12 and 24 h and at 3 and 7 days after the surgery. Pethidine consumption and adverse effects of pregabalin were also assessed. Results The investigation group had less pain and lower visual analog scale scores at 12 and 24 h and also at 3 days after surgery and consumed less pethidine compared to the control group (p<0.05). Conclusions Pregabalin reduces pain and opioid consumption in the first 3 days after surgery. The adverse effects of pregabalin are limited to the first 12 h after surgery. Pregabalin can be suggested for pain relief, but it should be used with caution in the elderly.

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Transdermal Nitroglycerine Enhances Spinal Neostigmine Postoperative Analgesia following Gynecological Surgery

Anesthesiology ◽

10.1097/00000542-200010000-00011 ◽

2000 ◽

Vol 93 (4) ◽

pp. 943-946 ◽

Cited By ~ 26

Author(s):

Gabriela R. Lauretti ◽

Ana-Paula M. Oliveira ◽

Maria-do-Carmo C. Julião ◽

Marlene P. Reis ◽

Newton L. Pereira

Keyword(s):

Adverse Effects ◽

Visual Analog Scale ◽

Postoperative Analgesia ◽

Visual Analog Scale Score ◽

Spinal Pain ◽

Gynecologic Surgery ◽

Control Group ◽

Sensory Level ◽

Analog Scale ◽

American Society

Background Intrathecal neostigmine causes analgesia by inhibiting the breakdown of acetylcholine. Experimental data suggest that the production of endogenous nitric oxide is necessary for tonic cholinergic inhibition of spinal pain transmission. The purpose of this study was to determine whether association of transdermal nitroglycerine would enhance analgesia from a low dose of intrathecal neostigmine in patients undergoing gynecologic surgery during spinal anesthesia. Methods Forty-eight patients were randomized to one of four groups. Patients were premedicated with use of 0.05-0.1 mg/kg intravenous midazolam and received 15 mg bupivacaine plus 1 ml test drug intrathecally (saline or neostigmine, 5 microgram). Twenty to 30 min after the spinal puncture, a transdermal patch of either 5 mg nitroglycerin or placebo was applied. The control (Con) group received spinal saline and transdermal placebo. The neostigmine group received spinal neostigmine and transdermal placebo. The nitroglycerin group received spinal saline and a transdermal nitroglycerine patch. Finally, the neostigmine-nitroglycerin group received spinal neostigmine and transdermal nitroglycerine. Pain and adverse effects were evaluated using a 10-cm visual analog scale. Results Patients in the groups were similar regarding age, weight, height, and American Society of Anesthesiologists status. Sensory level to pin prick at 10 min, surgical duration, anesthetic duration, and visual analog scale score for pain at the time of administration of first rescue medication were statistically the same for all groups. The time to administration of first rescue analgesic (min) was longer in the neostigmine-nitroglycerin group (550 min; range, 458-1,440 min; median, 25-75th percentile) compared with the other groups (P < 0.001). The neostigmine-nitroglycerin group required fewer rescue analgesics in 24 h than did the control group (P < 0.0005), whereas the neostigmine group required less analgesics compared with the control group (P < 0.02). The incidence of perioperative adverse effects (nausea, vomiting, headache, back pain) was similar among groups (P > 0.05). Conclusion Although neither intrathecal 5 microgram neostigmine alone nor transdermal nitroglycerine alone (5 mg/day) delayed the time to administration of first rescue analgesics, the combination of both provided an average of 14 h of effective postoperative analgesia after vaginoplasty, suggesting that transdermal nitroglycerin and the central cholinergic agent neostigmine may enhance each other's antinociceptive effects at the dose studied.

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The Effect of Olive Oil and Honey Combination on Episiotomy Wound Healing and Pain Relief: A Randomized Clinical Trial

Current Women s Health Reviews ◽

10.2174/1573404816666200123111718 ◽

2020 ◽

Vol 16 (2) ◽

pp. 145-151

Author(s):

Arezoo Shayan ◽

Hadis Sourinezhad ◽

Fariba Barzegar ◽

Hassan Ahmadinia ◽

Zahra Masoumi ◽

...

Keyword(s):

Clinical Trial ◽

Wound Healing ◽

Pain Relief ◽

Pain Intensity ◽

Olive Oil ◽

Randomized Clinical Trial ◽

Intervention Group ◽

Perineal Pain ◽

Control Group ◽

Primiparous Women

Background: Episiotomy is one of the most common surgical procedures in the world that is associated with perineal pain and can be exposed to infection, or might be healed with delay. Objective: The aim of this study was to investigate the effects of honey-olive oil combination on episiotomy wound healing and pain relief in primiparous women. Methods: This single-blind, parallel randomized clinical trial (IRCT20120215009014N208) was conducted on 80 primiparous women. They were allocated randomly to each of the groups through random allocation rule: 40 in honey-olive oil group and 40 in the control group. Every 12 hours and for 14 days, the treatment group used about 1 inch of the cream on the wound area. Pain intensity and wound healing were measured by REEDA Scale and Visual Analogue Scale on days 7, 10, and 14 in both groups. The statistical analyst was not informed about the allocation of the groups. A significant level of 0.05 was considered. Results: There was a significant difference between healing score and pain intensity between the two groups on 7th, 10th and 14th postpartum days (p <0.05). Wound healing occurred much faster (Scores on days 7,10, and 14 were 11.25±2.13, 7.47±1.96 and 4.95±1.53 in the control group and 4.45±1.25, 2.32±.69 and 10±.30 in the intervention group, p <0.05). Moreover, pain intensity was significantly relieved in those who used Honey and olive oil cream (the scores were 5.6750±1.43, 3.3500±1.52, 2.2250±1.34 in the control group and 1.9750±1.52, .2250±.57, .0250±.15 in the intervention group, p<0.05). Conclusion: Using honey and olive oil combination improves episiotomy wound healing and also relieves its’ associated pain.

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EFFICACY AND SAFETY OF CURCUMA LONGA EXTRACT IN THE TREATMENT OF OSTEOARTHRITIS: A SYSTEMATIC REVIEW

International Journal of Applied Pharmaceutics ◽

10.22159/ijap.2019.v11s6.33578 ◽

2019 ◽

pp. 140-145

Author(s):

ALESSA FAHIRA ◽

ALLYSA SORAYA ◽

ARMAND ACHMADSYAH ◽

RANI WARDANI HAKIM

Keyword(s):

Adverse Effects ◽

Randomized Controlled Trials ◽

Visual Analog Scale ◽

Curcuma Longa ◽

Control Group ◽

Controlled Trials ◽

Analog Scale ◽

Randomized Controlled ◽

Natural Remedies

Objective: Osteoarthritis (OA) is a chronic disease caused by inflammation of the tissue and bony structure of the joint, which affects more than 235 million people worldwide. Due to the adverse effects caused by the long-term use of standard treatment of OA, the attempt to find natural remedies to treat chronic diseases continues to rise. Curcuma longa is known to have anti-inflammatory effects, which may impact the pathophysiology of OA. While many randomized controlled trials show the efficacy of Curcuma longa extract in the treatment of OA, there has been no comprehensive review of this evidence. Methods: We systematically searched PubMed, Cochrane, Scopus, ProQuest, EBSCOhost, and ScienceDirect for randomized controlled trials that evaluated Curcuma longa extract (CE extract) vs. control (placebo or other therapy). Three trials were identified. Data were then extracted from the studies and summarized descriptively. Results: Across all trials, Curcuma longa therapy was proven to reduce Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores significantly compared to the control group. Adverse effects were less likely to appear in patients treated with Curcuma longa extract compared to other groups. Conclusion: CL extract is beneficial as an alternative medication for OA treatment, shown by the reduced scores of the Visual Analog Scale (VAS) and WOMAC in all studies we reviewed.

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Effects of aquatic physiotherapy versus conventional physical therapy on the risk of fall in the elderly: a randomized clinical trial

Fisioterapia Brasil ◽

10.33233/fb.v21i3.3459 ◽

2020 ◽

Vol 21 (3) ◽

pp. 253

Author(s):

Christye Ramos Da Silva ◽

Leonardo Farias Rodrigues Magalhães ◽

Fernanda Manaia Gonçalves Chaves ◽

Erica Cardaretti do Nascimento Vieira ◽

Ana Paula Radies Adames ◽

...

Keyword(s):

Clinical Trial ◽

Physical Therapy ◽

Randomized Clinical Trial ◽

Gait Speed ◽

The Elderly ◽

Individual Treatment ◽

Control Group ◽

Timed Up And Go ◽

Motor Abilities ◽

Risk Of Fall

Objective: To identify whether physiotherapy treatment in water is more effective than the treatment in land environment, aiming at improving the process of physical limitation or functional inability (gait speed, balance, motor abilities) caused by lack of balance in elderly with risk of fall. Methods: Randomized clinical trial, experimental study. The sample was composed of 35 senior individuals of both sexes, with average age of 65. Nineteen people composed the control Group /Conventional Physiotherapy, while the rest composed the experimental Group/Aquatic Physical therapy. Both groups were submitted to twenty sessions of physical therapy, twice a week, for 50 minutes in individual treatment. Aerobic activities were conducted for both groups separately. Exercises using water specific therapy, such as Halliwick rotation control and Bad Ragaz ring method, were used in the aquatic group and in the conventional group, physiotherapeutic techniques were applied, approaching the concepts of proprioceptive neuromuscular facilitation (PNF) and decubitus change training. The following tests were used to measure the risk of fall/balance: Timed Up and Go Test, Sit-to-Stand in 30 seconds and Functional Reach. Results: Both physiotherapeutic interventions, aquatic and conventional, showed to be greatly efficient however aquatic physiotherapy showed certain advantages compared to conventional physical therapy, promoting more beneficial effects in the gait speed, balance, motor abilities and, mainly, in the reduction of the risk of fall.Keywords: elderly, Halliwick, Bad Ragaz, Physical therapy, aquatic, risk of fall.

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Study of Three Different Doses of Epidural Neostigmine Coadministered with Lidocaine for Postoperative Analgesia

Anesthesiology ◽

10.1097/00000542-199906000-00006 ◽

1999 ◽

Vol 90 (6) ◽

pp. 1534-1538. ◽

Cited By ~ 67

Author(s):

Gabriela R. Lauretti ◽

Raquel de Oliveira ◽

Marlene P. Reis ◽

Maria-do-Carmo C. Juliao ◽

Newton L. Pereira

Keyword(s):

Adverse Effects ◽

Scale Score ◽

Visual Analog Scale ◽

Visual Analog Scale Score ◽

Orthopedic Procedures ◽

Control Group ◽

Analog Scale ◽

Analgesic Consumption ◽

Group 2 ◽

Group 1

Background Intrathecal neostigmine produces analgesia in volunteers and patients. However, the use of epidural neostigmine has not been investigated. The purpose of the current study was to define the analgesic effectiveness of epidural neostigmine coadministered with lidocaine and side effects in patients after minor orthopedic procedures. Methods After Institutional Review Board approval and informed consent, 48 patients (n = 12) undergoing knee surgery were randomly allocated to one of four groups and studied in a prospective way. After 0.05-0.1 mg/kg intravenous midazolam premedication, patients were randomized to receive 20 mg intrathecal bupivacaine plus epidural lidocaine (85 mg) with saline (control group); 1 microg/kg epidural neostigmine (1 microg group); 2 microg/kg epidural neostigmine (2 microg group); or 4 microg/kg epidural neostigmine (4 microg group). The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Postoperatively, pain was assessed using the visual analog scale, and intramuscular 75 mg diclofenac was available at patient request. Results Groups were demographically the same and did not differ in intraoperative characteristics (blood pressure, heart rate, ephedrine consumption, oxyhemoglobin saturation, sensory loss before start of surgery, or duration of sensory motor block). The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among groups (P > 0.05). The time (min +/- SD) to first rescue analgesic was as follows: control group: 205+/-48; 1-microg group: 529+/-314; 2-microg group: 504+/-284; 4-microg group: 547+/-263 (P < 0.05). The analgesic consumption (number of intramuscular diclofenac injections [mean, 25th-75th percentile]) in 24 h was as follows: control group: 3 [3 or 4]; 1-microg group: 1 [1 or 2]; 2-microg group: 2 [1 or 2]; 4-microg group: 2 [1-3] (P < 0.05). The 24-h-pain visual analog scale score (cm +/- SD) that represents the overall impression for the last 24 h was as follows: control group: 5+/-1.6; 1-microg group: 1.6+/-1.8; 2-microg group: 1.4+/-1.6; 4-microg group: 2.2+/-1.9 (P < 0.005). The incidence of adverse effects was similar among groups (P > 0.05). Conclusion Epidural neostigmine (1, 2, or 4 microg/kg) in lidocaine produced a dose-independent analgesic effect (approximately 8 h) compared to the control group (approximately 3.5 h), and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.

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Clinical Outcomes and Safety of Passive Leg Raising in Out-of-Hospital Cardiac Arrest. A Randomized Clinical Trial.

10.21203/rs.3.rs-258801/v1 ◽

2021 ◽

Author(s):

Youcef Azeli ◽

Alfredo Bardají ◽

Eneko Barbería ◽

Vanesa Lopez-Madrid ◽

Jordi Bladé-Creixenti ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Arrest ◽

Adverse Effects ◽

Randomized Clinical Trial ◽

Hospital Discharge ◽

Passive Leg Raising ◽

Control Group ◽

Complication Rates ◽

X Rays ◽

Hospital Cardiac Arrest

Abstract Background: There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).Methods: We conducted a randomized clinical trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as Cerebral Performance Category (CPC 1-2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays in survivors and lungs weight from autopsies in non-survivors. Results: In total, 445 randomized CPR attempts were included, 234 were treated with PLR and 211 were controls. Overall, 71.5% were men and the median age was 69 IQR (58-78) years old. At hospital discharge, 4.3% in the PLR group and 4.7% in the control group were alive with CPC 1-2 (OR 0.9; 95% CI 0.4-2.2, p=0.81). A higher survival at hospital admission was found among patients with a shockable rhythm, but there were no significant differences (OR 1.6; 95% CI 0.8-3.4, p=0.18). There were no differences in pulmonary complication rates in chest X-rays (25.9% vs 17.9%, p=0.47) or lung weight 1223 IQR (909.5-1500) mg vs. 1239 IQR (900-1507) mg. Conclusion: In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1-2. No evidence of adverse effects has been found.Clinical Trial Registration: ClinicalTrials.gov: NCT01952197, registration date: Sept 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197.

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A Randomized Clinical Trial of the Effect of Zinc Supplement on Depression and Anxiety in the Elderly

The Open Public Health Journal ◽

10.2174/1874944502114010537 ◽

2021 ◽

Vol 14 (1) ◽

pp. 537-544

Author(s):

Abolfazl Afzali ◽

Zarichehr Vakili ◽

Shahrbanoo Goli ◽

Hossein Bagheri ◽

Seyedmohammad Mirhosseini ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Zinc Supplementation ◽

Statistical Tests ◽

Intervention Group ◽

Depression Scale ◽

The Elderly ◽

Control Group ◽

Depression And Anxiety ◽

Zinc Supplements

Background: Anxiety and depression in the elderly are considered important mental disorders. Objective: This study was designed to determine the effect of zinc Supplementation on depression and anxiety in the elderly. Methods: This study was a parallel randomized clinical trial. A total of 150 elderly aged 60 years and older were allocated into intervention and control groups by using the quadruple blocking method. The elderly in the intervention group received a daily dose of 30 mg zinc supplementation pill for 70 days and the elderly in the control group did not receive this supplement. Depression and anxiety in the elderly were measured using the Geriatric Depression Scale and the Beck Anxiety Inventory, respectively. A significance level of 0.05 was considered for all statistical tests. Results: After the intervention, the mean scores of depression and anxiety in the elderly were significantly decreased in the intervention group, as compared with the control group. Moreover, after the intervention, the serum zinc level in the elderly was significantly increased in the intervention group, as compared with the control group (P<0.05). Conclusion: The use of zinc supplements improved depression and anxiety in the elderly. Therefore, it is recommended to use zinc supplements as a new therapeutic strategy for the prevention and treatment of depression and anxiety in the elderly. Registration No: This research was registered in the Iranian clinical trial system with code IRCT2017071635110N1.

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Effects of Osteopathic T9–T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial

Healthcare ◽

10.3390/healthcare9040394 ◽

2021 ◽

Vol 9 (4) ◽

pp. 394

Author(s):

Agustín Luceño-Mardones ◽

Irene Luceño-Rodríguez ◽

Elena Sonsoles Rodríguez-López ◽

Jesús Oliva-Pascual-Vaca ◽

Ignacio Rosety ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Effects ◽

Randomized Clinical Trial ◽

High Speed ◽

Control Group ◽

Controlled Clinical Trial ◽

Osteopathic Manipulation ◽

Data Analyst ◽

Low Amplitude

This study aimed to determine whether osteopathic manipulation of the T9–T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a “sham” manipulation. A high-speed, low-amplitude technique was applied to the T9–T10 vertebrae in the osteopathic manipulative group (OMG) patients. The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). Additionally, the number of episodes of tonsillitis after the treatment decreased significantly more in the OMG (0.8 ± 1.88 episodes/year in total) than the CG (2 ± 2.12) (p = 0.005). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year (χ2 (1) = 15.57, p < 0.001). No patients reported adverse effects. It has been concluded that during an episode of tonsillitis, the number of days to resolution was significantly lower after the application of an osteopathic manipulation of the T9–T10 vertebrae, compared to a sham manipulation. The number of subsequent year tonsillitis episodes was greatly reduced in both groups, significantly more in the OMG than in the CG patients.

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Postoperative Titration of Intravenous Morphine in the Elderly Patient

Anesthesiology ◽

10.1097/00000542-200201000-00009 ◽

2002 ◽

Vol 96 (1) ◽

pp. 17-23 ◽

Cited By ~ 115

Author(s):

Frédéric Aubrun ◽

Stéphanie Monsel ◽

Olivier Langeron ◽

Pierre Coriat ◽

Bruno Riou

Keyword(s):

Body Weight ◽

Pain Relief ◽

Elderly Patients ◽

Scale Score ◽

Visual Analog Scale ◽

Visual Analog Scale Score ◽

The Elderly ◽

Analog Scale ◽

Number Of Patients ◽

Intravenous Morphine

Background Intravenous morphine titration is used to obtain rapid and complete postoperative pain relief. Whether this titration can be safely administered in the elderly patients remains a matter for debate. Methods Intravenous morphine titration was administered as a bolus of 2 (body weight < or = 60 kg) or 3 (body weight > 60 kg) mg. The interval between each bolus was 5 min. There was no limitation in the number of boluses given until pain relief or severe adverse effect occurred. The visual analog scale threshold required to administer morphine was 30 mm, and pain relief was defined as a visual analog scale score of 30 mm or less. Patients were divided into two groups: young and elderly (age > or = 70 yr) patients. Data were expressed as mean +/- SD. Results Eight hundred seventy-five patients (83%) were young and 175 patients (17%) were elderly. At the end of morphine titration, the visual analog scale score and the number of patients with pain relief were not significantly different between groups. The total dose of morphine per kilograms of body weight administered was not significantly different between groups (0.15 +/- 0.10 vs. 0.14 +/- 0.09 mg/kg, not significant). No significant differences were observed in the incidence of morphine-related adverse effects (13 vs. 14%, not significant), the number of sedated patients (60 vs. 60%, not significant), and the number of patients whose titration had to be stopped (2 vs. 2%, not significant). Conclusion Intravenous morphine titration can be safely administered to elderly patients. Because titration is adapted to individual pain, the same protocol can be applied to young and elderly patients.

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