scholarly journals Potorakotominis intratekalinis skausmo malšinimas morfinu

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Povilas Miliauskas ◽  
Renatas Tikuišis ◽  
Saulius Cicėnas ◽  
Aleksas Žurauskas ◽  
Narimantas Evaldas Samalavičius
Keyword(s):  
Pain Relief ◽  
Analgesic Effect ◽  
Pain Control ◽  
Intrathecal Morphine ◽  
Group Iv ◽  
Analog Scale ◽  
Post Operative Pain ◽  
Intravenous Morphine ◽  
Intravenous Analgesia ◽  
Intrathecal Analgesia

Povilas Miliauskas, Renatas Tikuišis, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilniaus universiteto Onkologijos institutas,Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Šoninė torakotomija yra viena iš skausmingiausių operacijų. Šiame darbe nagrinėti ligonių, kuriems atliekamos plaučių operacijos, pooperacinio nuskausminimo aspektai. Buvo siekta palyginti intratekaliniu būdu ir į veną švirkščiamo morfino skausmo malšinamąjį efektyvumą po plaučių operacijos atliekant šoninę torakotomiją. Metodai Ligoniai, kuriems buvo atliekamos plaučių operacijos, atsitiktiniu būdu buvo suskirstyti į dvi grupes: IT – kuriems prieš operaciją intratekaliniu būdu sušvirkšta 0,5 mg morfino dozė (n = 40), ir IV – kuriems pooperaciniu laikotarpiu į veną buvo švirkščiama morfino 3 mg/val. (n = 40). Abiejų grupių ligoniai statistiškai nesiskyrė pagal lytį, amžių, svorį, fizinę būklę pagal ASA ir atliktas chirurgines operacijas. Pirmos paros pooperacinio nuskausminimo efektyvumas buvo vertinamas vizualinės analoginės skalės (VAS) skausmo balais ramybėje ir kosint. Papildomai ketorolako buvo švirkščiama ligoniui, jaučiančiam stiprius skausmus. Rezultatai VAS balai ramybėje ir kosint buvo daug mažesni IT grupės (ramybėje p < 0,05; kosint p < 0,05). Vidutinės papildomos ketorolako dozės vienam ligoniui buvo mažesnės IT grupėje (p < 0,05). Pooperacinis pykinimas, vėmimas ir kvėpavimo slopinimas buvo silpnesnis IT grupės pacientų. Išvados Skausmo malšinimas morfinu į intratekalinį tarpą yra pranašesnis už intraveninį nuskausminimą morfinu pirmą parą po šoninės torakotomijos. Pagrindiniai žodžiai: potorakotominis skausmas, intratekalinis skausmo malšinimas, intraveninis skausmo malšinimas Intrathecal morphine for post-thoracotomy pain relief Povilas Miliauskas, Renatas Tikuišis, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilnius University, Institute of Oncology,Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background / objective Post-thoracotomy pain is one of the most severe types of post-operative pain. Intrathecal morphine has been shown to provide superior pain control within the first postoperative day compared with intravenous morphine after thoracotomy. Methods In this study, we compared the analgesic effect of lumbar intrathecal 0.5 mg morphine (IT group, n = 40) given before general anaesthesia and analgesia with intravenous morphine 3 mg/h (group IV, n = 40). Additionally, ketorolac was injected on request. The intensity of pain was assessed 2, 4, 8, 16 and 24 hours after extubation by visual analog scale (VAS = 1–10) at rest and on coughing. Results Analgesia at rest and while coughing was significantly better in the IT group on the first postoperative day. Ketorolac consumption was lower in the IT group. Nausea, vomiting and respiratory depression were more frequent in the IV group. Conclusions These results show that intrathecal analgesia compared with IV morphine improved pain control after thoracotomy on the first postoperative day. Keywords: post-thoracotomy pain, intrathecal analgesia, intravenous analgesia

scholarly journals Tarpšonkaulinių nervų blokada atliekant torakotomiją

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Povilas Miliauskas ◽  
Renatas Tikuišis ◽  
Saulius Cicėnas ◽  
Aleksas Žurauskas ◽  
Narimantas Evaldas Samalavičius
Keyword(s):  
Body Weight ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Pain Control ◽  
Intercostal Nerve ◽  
Analog Scale ◽  
Intercostal Nerve Block ◽  
Nerve Blockade ◽  
Post Operative Pain

Povilas Miliauskas, Renatas Tikuišis, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas: Potorakotominis skausmas susijęs su tarpšonkaulinių nervų trauma. Šoninė torakotomija yra viena iš skausmingiausių operacijų. Šiame darbe nagrinėti pacientų, kuriems buvo atliktos torakotomijos, pooperacinio skausmo malšinimo aspektai. Tyrimo tikslas – įvertinti epidurinio skausmo malšinimo efektyvumą papildomai taikant tarpšonkaulinių nervų blokadą. Ligoniai ir metodai: 2008–2009 m. VUOI ištyrėme 45 pacientus, kuriems atliktos torakotomijos dėl plaučių vėžio. Atsitiktinės imties būdu pacientai buvo suskirstyti į dvi grupes. Vieną grupę (TNB, n=23) sudarė pacientai, kuriems operacijos metu atlikta tarpšonkaulinių nervų blokada (TNB) 0,5 % bupivakaino tirpalu, švirkščiant po 1,0 ml į tris tarpšokaulinius tarpus, kartu taikant epidurinį skausmo malšinimą morfinu (ESMM) pooperaciniu laikotarpiu. Kontrolinės grupės pacientams (ESMM, n=22) po operacijos taikytas vien ENM. Skausmas buvo vertinamas subjektyviai pagal vizualiąją skausmo vertinimo skalę (VAS), kur skausmo intensyvumo balai nuo 0, kai pacientas skausmo nejaučia, iki 10, kai skausmas labai stiprus. Tyrimas buvo atliekamas operacijos dieną ir 1–5 dieną po operacijos pacientui esant ramybės būsenos ir kosint. Rezultatai: VAS balai pacientui esant ramybės būsenos pirmąsias penkias dienas buvo mažesni TNB pacientų grupėje, palyginti su ESMM tiriamųjų grupe. Skausmas balais pagal VAS pacientui kosint buvo mažesnis TNB pacientų grupėje. Statistiškai reikšmingas skirtumas buvo pirmąsias tris paras (0,05). Išvada: Epidurinis skausmo malšinimas kartu taikant tarpšonkaulinių nervų blokadą yra daug efektyvesnis už vien epidurinį skausmo malšinimą pirmąsias tris paras po torakotomijos. Reikšminiai žodžiai: potorakotominis skausmas, tarpšonkaulinių nervų blokada, epidurinis skausmo malšinimas. Intercostal nerve blockade during thoracotomy Povilas Miliauskas, Renatas Tikuišis, Saulius Cicėnas, Aleksas Žurauskas, Narimantas Evaldas SamalavičiusVilnius University, Institute of Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background / objective: Post-thoracotomy pain is one of the most severe types of post-operative pain. Intraoperative intercostal nerve block in combination with epidural analgesia has been shown to provide superior pain control within the five postoperative days, compared with epidural analgesia alone. Patients and methods: In this study, we compared the effect of epidural analgesia with or without intercostal nerve blockade, performed during operation, on postoperative pain relief in patients undergoing thoracotomy. 45 patients were included in this study. We used epidural analgesia with additional intercostal nerve blockade for the TNB group (n = 23) and epidural analgesia for the ENM group (n = 22). The two groups were comparable for age, sex, body weight and the type of sugery. The intensity of pain was assessed in the first five days after operation on the visual analog scale (VAS = 0–10) at rest and on coughi Results: Analgesia at rest was better in the TNB group during the first five postoperative days and while coughing was significantly better during three postoperative days (0.05). Conclusion: These results show that additional intercostal nerve blockade with epidural analgesia, compared with epidural analgesia alone, offered an improved pain control during the first three days after thoracotomy. Key words: post-thoracotomy pain, intercostal nerve blockade, epidural analgesia.

INTRATHECAL MORPHINE FOR POST-OPERATIVE PAIN RELIEF

1980 ◽  
Vol 53 (3 Suppl) ◽  
pp. S218-S218 ◽  
Author(s):  
W. Nelson ◽  
J. Katz
Keyword(s):  
Pain Relief ◽  
Intrathecal Morphine ◽  
Post Operative Pain

Analgesic Effect of Low-dose Intrathecal Morphine after Spinal Fusion in Children

2001 ◽  
Vol 94 (3) ◽  
pp. 447-452 ◽  
Author(s):  
Olivier Gall ◽  
Jean-Vincent Aubineau ◽  
Josée Bernière ◽  
Luc Desjeux ◽  
Isabelle Murat
Keyword(s):  
Spinal Fusion ◽  
Analgesic Effect ◽  
Low Dose ◽  
Intrathecal Morphine ◽  
Postanesthesia Care Unit ◽  
Free Access ◽  
Scoliosis Surgery ◽  
Pain Scores ◽  
Duration Of Surgery ◽  
Intravenous Morphine

Background This study was designed to assess the postoperative analgesic effect of low-dose intrathecal morphine after scoliosis surgery in children. Methods Thirty children, 9-19 yr of age, scheduled for spinal fusion, were randomly allocated into three groups to receive a single dose of 0 (saline injection), 2, or 5 microg/kg intrathecal morphine. After surgery, a patient-controlled analgesia device (PCA) provided free access to additional intravenous morphine. Children were monitored for 24 h in the postanesthesia care unit. Results The three groups were similar for age, weight, duration of surgery, and time to extubation. The time to first PCA demand was dose-dependently delayed by intrathecal morphine. The first 24 h of PCA morphine consumption was 49 +/- 17, 19 +/- 10, and 12 +/- 12 mg (mean +/- SD) in the saline, 2 microg/kg morphine, and 5 microg/kg morphine groups, respectively. Pain scores at rest were significantly lower over the whole study period after 2 and 5 microg/kg intrathecal morphine than after saline, but there was no difference between intrathecal doses. Pain scores while coughing and the incidence of side effects were similar in the three groups. Conclusions These data demonstrate that low-dose intrathecal morphine supplemented by PCA morphine provides better analgesia than PCA morphine alone after spinal fusion in children. The doses of 2 and 5 microg/kg seem to have similar effectiveness and side-effect profiles, whereas a reduction of intraoperative bleeding was observed in patients who received 5 microg/kg but not 2 microg/kg intrathecal morphine.

scholarly journals Post – operative analgesia in patients under thoracotomy

2019 ◽  
Vol 2 (1) ◽  
pp. 7
Author(s):  
Evangelos Giavasopoulos
Keyword(s):  
Chronic Pain ◽  
Pain Relief ◽  
Pain Control ◽  
Postoperative Morbidity ◽  
Significant Risk ◽  
Pain Syndrome ◽  
Multimodal Approach ◽  
Postoperative Pain Control ◽  
Post Operative Pain ◽  
Respiratory Physiotherapy

The thoracotomy is one of the most painful surgery operations, and the final outcome is directly associated with the postoperative pain control, because it allows quick mobilization, intense respiratory physiotherapy and reduces postoperative morbidity. Unfortunately, patients under thoracotomy, incur a significant risk of chronic pain. Although there are guidelines for the management of post-operative pain relief in these patients, however there is no widespread surgical or anesthetic "gold standard."  In the present article it has been investigated the current literature related to the proposed therapies and other interventions that were recommended for  post-operative pain relief  after thoracotomy. The treatment of chronic pain after thoracotomy is difficult and includes physical rehabilitation techniques and multimodal approach. More and more researchers support that minimization of acute post-operative pain is the best method so as to avoid, prevent or reduce post- thoracotomy pain syndrome.

Relationships between Measurement of Pain Using Visual Analog Score and Morphine Requirements during Postoperative Intravenous Morphine Titration

2003 ◽  
Vol 98 (6) ◽  
pp. 1415-1421 ◽  
Author(s):  
Frédéric Aubrun ◽  
Olivier Langeron ◽  
Christophe Quesnel ◽  
Pierre Coriat ◽  
Bruno Riou
Keyword(s):  
Body Weight ◽  
Pain Relief ◽  
Analog Scale ◽  
Morphine Dose ◽  
Vas Score ◽  
Score Threshold ◽  
Intravenous Morphine ◽  
Sigmoid Curve ◽  
The Mean ◽  
The Relationship

Background Although intravenous morphine titration is widely used to obtain rapid and complete postoperative pain relief, the relationship between measurement of pain and morphine requirements varies, and the evolution of pain during titration is poorly understood. Methods Intravenous morphine titration was administered as a bolus of 2 (body weight &lt; or = 60 kg) or 3 mg (body weight &gt; 60 kg) during the immediate postoperative period in the PACU. The interval between each bolus was 5 min. The visual analog scale (VAS) score threshold required to administer morphine was 30, and pain relief was defined as a VAS score of 30 or less. Results Data from 3,045 patients were analyzed. The mean initial VAS score was 73 +/- 19 (mean +/- SD), and the mean morphine dose required to obtain pain relief was 0.17 +/- 0.10 mg/kg, i.e., a median of four boluses (range, 1-20). When patients were grouped according to several classes of initial VAS score (31-39, 40-49, 50-59, 60-69, 70-79, 80-89, 90-100), it seemed that the relationship between VAS score and morphine requirements was a sigmoid curve. A VAS score of 70 or greater predicted the need for a high (&gt;0.15 mg/kg) morphine dose (sensitivity, 0.77; specificity, 0.54). During the pain relief process, the relationship between VAS score and time was depicted by a sigmoid curve. Conclusion A VAS score of 70 or greater should be considered indicative of severe pain. The relationship between the initial VAS score and morphine requirements is not linear, and the evolution of the VAS score during the pain relief process is described by a sigmoid curve.

Postoperative Titration of Intravenous Morphine in the Elderly Patient

2002 ◽  
Vol 96 (1) ◽  
pp. 17-23 ◽  
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 &lt; or = 60 kg) or 3 (body weight &gt; 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 &gt; 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.

scholarly journals Achieving Pain Control in Rheumatoid Arthritis with Baricitinib or Adalimumab Plus Methotrexate: Results from the RA-BEAM Trial

2019 ◽  
Vol 8 (6) ◽  
pp. 831 ◽  
Author(s):  
Peter C. Taylor ◽  
Yvonne C. Lee ◽  
Roy Fleischmann ◽  
Tsutomu Takeuchi ◽  
Elizabeth L. Perkins ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Pain Control ◽  
Inadequate Response ◽  
Double Blind Trial ◽  
Inflammation Markers ◽  
Analog Scale ◽  
Double Blind ◽  
The Relationship

The purpose of the study was to assess the proportion of patients who achieve pain relief thresholds, the time needed to reach the thresholds, and the relationship between pain and inflammation among patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate in RA-BEAM (NCT0170358). A randomized, double-blind trial was conducted, comparing baricitinib (N = 487), adalimumab (N = 330), and placebo (N = 488) plus methotrexate. Pain was evaluated by patient’s assessment on a 0–100 mm visual analog scale (VAS). The following were assessed through a 24-week placebo-controlled period: the proportion of patients who achieved ≥30%, ≥50%, and ≥70% pain relief, the time to achieve these pain relief thresholds, remaining pain (VAS ≤ 10 mm, ≤20 mm, or ≤40 mm), and the relationship between inflammation markers and pain relief. Baricitinib-treated patients were more likely (p < 0.05) to achieve ≥30%, ≥50%, and ≥70% pain relief than placebo- and adalimumab-treated patients, as early as Week 1 vs. placebo and at Week 4 vs. adalimumab. A greater proportion of baricitinib-treated patients achieved ≤20 mm or ≤40 mm remaining pain vs. placebo- and adalimumab-treated patients. Baricitinib-treated patients tended to demonstrate consistent pain relief independent of levels of inflammation control. In RA patients with an inadequate response to methotrexate, baricitinib provided greater and more rapid pain relief than adalimumab and placebo. Analyses suggest the relationship between inflammation and pain may be different for baricitinib and adalimumab treatments.

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