Using intravenous acetaminophen in the reduction of opioids in spinal cord surgeries by patient-controlled analgesia

Background: Proper management of postoperative pain results in improved quality of patient's' life, early postoperative recovery, reduced hospitalization period and decreased treatment costs. Regarding significant efficacy and higher pain relief functions, opioids are amongst the best pain relief drugs. However, use of theses narcotics as pain killers is somehow controversial. Current study investigated the effects of IV acetaminophen in reduced use of opioids in surgeries of spinal cord by PCA method.Methods: Current double blinded clinical trial study performed upon 86 patients of 20-70 years of age who candidate for spinal CD implant with ASA class I or II. Patients randomly divided into two groups of IV Acetaminophen therapy (N=43) and placebo group (N=43) and each group were put equally under general anesthesia in which both received pain pump containing Fentanyl during recovery. Patients were examined regarding pain score, amount of opioid use and request for extra narcotics and the related complications including nausea, vomiting, dizziness, allergy, gastrointestinal bleeding and Ileus every 6 hours for 24 hours and the obtained results were recorded.Results: Regarding VAS, pain was significantly lower during 24 hours of study in IV Acetaminophen group (p<0.05). Mean use of opioid via pain pump was significantly lower in IV Acetaminophen group compared with placebo group (p=0.00). Request for extra doses of narcotics was higher in placebo group while regarding demand for extra pain relief, there was no significant difference between both groups. Regarding other results, no significant difference observed between both study groups.Conclusions: Results of the study indicated that use of a combination of IV acetaminophen along with opioids would be much more effective than use of narcotics alone in postoperative pain control of CD implant surgery of spinal cord and that leads to lower pain score and decreased use of opioids and its related complications.

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Long-term efficacy of 1–1.2 kHz subthreshold spinal cord stimulation following failed traditional spinal cord stimulation: a retrospective case series

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000003 ◽

2019 ◽

Vol 44 (1) ◽

pp. 107-110 ◽

Cited By ~ 7

Author(s):

Leonardo Kapural ◽

Shervin Harandi

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Spinal Cord Stimulation ◽

Case Series ◽

Low Frequency ◽

Opioid Use ◽

Retrospective Case ◽

Pain Scores ◽

Significant Difference

Background and objectiveWe investigated whether an effective long-term pain relief could be achieved using subthreshold 1–1.2 kHz spinal cord stimulation (SCS) among patients who were initially implanted with traditional paresthesia-based SCS but who failed to maintain an adequate pain relief.MethodsRetrospective chart review was conducted of patients’ electronic records who underwent a trial of subthreshold 1–1.2 kHz SCS. One hundred and nine patients implanted and programmed at traditional paresthesia-based frequencies 40–90 Hz (low-frequency SCS) with unsatisfactory pain relief or unpleasant paresthesias were identified. Patients’ settings were switched to 1–1.2 kHz and 60–210 µs, and variable amplitude adjusted to subthreshold. Pain scores and medication usage were collected. Complete data are presented on 95 patients.ResultsData were collected from 36 men and 59 women who were converted from above-threshold 40–90 Hz SCS to 1–1.2 kHz SCS, with a minimum follow-up of 12 months. Nearly a third (63/95 or 66.3%) of the subjects deemed 1–1.2 kHz SCS ineffective and returned to low-frequency SCS within 1 week after switch, and one-sixth (16/95 or 16.8%) of the subjects returned to low-frequency SCS within 1 month. Only 13 (13.7%) subjects continued using 1–1.2 kHz subthreshold SCS for 3 months or longer and 2.1% (2/95) of subjects continued using it at 12 months. A comparison of their pain scores and opioid use before and during the time we used 1–1.2 kHz SCS revealed no significant difference.ConclusionThe results from our single center failed to show additional long-term clinical benefit of 1–1.2 kHz subthreshold SCS in patients with chronic pain failing traditional low-frequency SCS.

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Intramuscular Pethidine for Pain Relief in the First Stage of Labor

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v7i1-2.53965 ◽

2019 ◽

Vol 7 (1-2) ◽

pp. 99-106

Author(s):

Saria Sharmin ◽

Shafeya Khanam ◽

Samar Chandra Saha ◽

Fatema Kamrun Naher ◽

Mafruha Jahan ◽

...

Keyword(s):

Placebo Group ◽

Pain Relief ◽

Pregnant Women ◽

Pain Score ◽

Apgar Score ◽

Cervical Dilatation ◽

Normal Delivery ◽

Significant Difference ◽

Experimental Group ◽

First Stage Of Labor

Objective: The objective of this study was to see the efficacy of intramuscular pethidine for pain relief in the 1st stage of labor. Methods: This prospective study was carried out in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka from April 2005 to December 2005. Age and parity matched 80 pregnant women were recruited in the study and were divided equally in experimental and palcebo groups (40 in each group). The Experimental group received intramuscular Inj. Pethidine HCI 1.5 mg/kg body weight in 2 ml with Inj. metoclopramide 12.5 mg and the Placebo group received 2 ml intramuscular normal saline. The intervention was started at active first stage of labor with cervical dilatation of 3-4 cm and when patients requested for analgesia. Pain was assessed at the highest point of pain at 15- and 30-minute intervals using 100 mm visual analogue scale (VAS) and patients were asked to give a verbal categorical rating of their pain as "a lot better", "a little better", "much the same", "a little worse", or "much worse". Level of sedation was also assessed at the same intervals. Details of labor, including cervical dilatation before and after analgesia, mode of delivery, duration of injection to delivery time and assessment of neonates by APGAR score at one and five minutes were recorded. Result: All the baseline characteristics like maternal age, body surface area (BSA), parity, gestational age of the subjects between the Experimental and Placebo groups were almost identical. All the intrapartum variables like baseline cervical dilatation, VAS pain score, VAS sedation score and injection to delivery interval were also found to be fairly comparable between groups. At 15 minutes interval more than one-quarter (27.5%) of the Experimental group got mildly drowsy, while none of the Placebo group changed from their baseline status. At 30 minutes interval 27.5% were mildly drowsy, 22.5% were moderately drowsy and 1 (2.5%) was asleep in the Experimental group, while all of the Placebo group subjects were alert as before. The groups were quite different in respect to level of sedation following intervention (p < 0.001). Nearly three quarters (72.5%) of the Experimental group had VAS pain score at 30 minutes interval at or below median level, whereas only 25% of the Placebo group had the same level at same interval (p < 0.001). The Experimental group had a significantly lower demand for further analgesia (50%) compared to the Placebo group (80%) (p=0.005). However, 15 (37.5%) subjects of the Experimental group experienced nausea and or vomiting, whereas none of the Placebo group had such experience (p<0.001). Majority (82.5%) of the Experimental group and 75% of the Placebo group had normal delivery. The comparison of foetal outcome in terms of APGAR score at 1 and 5 minutes, oxygen needed and NICU admission required for resuscitation revealed no significant difference between the groups with respect to any of these variables (p<0.05). Conclusion: The intramuscular Pethidine is significantly effective at providing analgesia in pregnant women in 1st stage of labor. The findings support the continued use of pethidine as a simple and cheap therapeutic option in the management of labor pain. Ibrahim Card Med J 2017; 7 (1&2): 99-106

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Evaluation of Postoperative Pain after Sinonasal Surgery

American Journal of Rhinology ◽

10.1177/194589240501900509 ◽

2005 ◽

Vol 19 (5) ◽

pp. 471-477 ◽

Cited By ~ 25

Author(s):

Sarah K. Wise ◽

Justin C. Wise ◽

John M. DelGaudio

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Postoperative Period ◽

Repeated Measures ◽

Medication Use ◽

Pain Rating ◽

Pain Location ◽

Significant Difference ◽

Chi Square Analysis ◽

Analgesic Use

Background Pain after sinonasal surgery concerns both patients and surgeons. Factors affecting sinonasal postoperative pain have not been examined extensively. Methods Using a prospective survey design, sinonasal surgery patients evaluated postoperative pain (on a scale of 0–10), pain location, and medication use. Results One hundred twenty-seven patients consented to participate. One hundred fifteen patients returned surveys, with 100 patients appropriate for analysis over the 6-day postoperative period. Pain score and medication use were evaluated with respect to sex, primary/revision case, nasal packing, and other factors. Repeated measures analysis of variance and chi-square analysis were conducted (p < 0.05). Pain ratings and analgesic use declined significantly over the postoperative period (p < 0.05). Mean pain score on postoperative day (POD) 1 was 3.61 and on POD 6 was 1.72. Mean medication use was 1.37 tablets on POD 1 and 0.55 tablets on POD 6. Additionally, a significant interaction existed, such that narcotic medication use declined from 1.91 tablets on POD 1 to 0.52 tablets on POD 6, whereas nonnarcotic medication use remained steady (p < 0.05). Periorbital pain was most frequent (46.3%), with unilateral facial pain reported least (4.1%). A significant difference existed for distribution of pain location (p < 0.05). Finally, the difference in pain rating between primary and revision procedure for women (0.65) was less than for men (1.12); this interaction was significant (p < 0.05). Conclusion Multiple patient and operative factors affect pain rating and medication use after sinonasal surgery. Generally, pain level should be low with little analgesic use postoperatively.

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Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1189 ◽

2016 ◽

Vol 8 (3) ◽

pp. 189-192

Author(s):

Reyaz M Singaporewalla ◽

Anil D Rao ◽

Arunesh Majumder

Keyword(s):

Postoperative Pain ◽

Minimally Invasive ◽

Pain Score ◽

Open Surgery ◽

Operating Time ◽

Incision Length ◽

Video Assisted ◽

Asian Patients ◽

Significant Difference ◽

Conventional Open Surgery

ABSTRACT Introduction Although the technique of minimally invasive video assisted thyroidectomy (MIVAT) is well established in continental Europe, data on it's role in Asian patients is limited. We compared the results of MIVAT with conventional open hemithyroidectomy in Asian patients. Materials and methods Over a 1-year period, patients undergoing hemithyroidectomy for benign symptomatic goiters were selected. Inclusion criteria for MIVAT were benign colloid goiters, recurrent cysts or follicular lesions and neoplasms with lobe volume of less than 40 cc or nodule diameter less than 35 mm. Larger goiters underwent conventional open surgery. Patients with previous neck surgery and proven malignancy were excluded. Operative time, complications, postoperative pain score, incision length and cosmetic satisfaction at 6 months were recorded. Results Thirty-six patients (MIVAT-21, Conventional-15) were included. Both groups were comparable in terms of demographic profile and co-morbidities. The mean operating time for both groups showed no significant difference (MIVAT = 111.67 ± 19.4 min, Conventional = 112.40 ± 25.06 min; p = 0.925). Minimally invasive video assisted thyroidectomy patients had significantly less pain in the immediate postoperative period (mean pain score 2.38 vs 4.8, p < 0.001). Mean incision length at end of surgery was significantly smaller in the MIVAT group (2.58 vs 6.3 cm; p < 0.001). Neck scar satisfaction at 6 months was excellent in 71.4% of MIVAT cases vs 26.6% of conventional hemithyroidectomy cases. There were no complications in any of the treatment groups. Conclusion In selected cases, MIVAT is as safe as conventional open surgery with distinct advantages of better postoperative pain control and cosmesis. How to cite this article Rao AD, Singaporewalla RM, Majumder A. Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients. World J Endoc Surg 2016;8(3):189-192.

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Analgesic Effect of Dexamethasone after Arthroscopic Knee Surgery: A Randomized Controlled Trial

Pain Research and Management ◽

10.1155/2016/4216469 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Jairo Moyano ◽

Maria García ◽

Maria Caicedo

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Knee Surgery ◽

Controlled Study ◽

Opioid Use ◽

Arthroscopic Knee Surgery ◽

Randomized Controlled ◽

Significant Difference ◽

Intraoperative Period ◽

Arthroscopic Knee

Background.Dexamethasone is sometimes used as a coanalgesic because of its anti-inflammatory properties.Objective. To evaluate opioid use, postoperative pain intensity, and side effects after a single dose of dexamethasone in patients undergoing arthroscopic knee surgery.Methods. In this randomized controlled study patients were randomized to receive either 10 mg of intravenous dexamethasone (DM group) or 0.9% normal saline (NS group) during the intraoperative period. Primary outcomes were pain intensity and total morphine and codeine use after surgery.Results. Seventy-eight patients were included in the study. The DM group showed statistically significant higher pain intensity at the fourth postoperative hour (DM: 3.96/10, standard deviation [SD] 0.54; NS: 2.46/10, SD 0.45;p=0.036). No statistically significant difference in total opioid use (morphine plus codeine) was identified with 15.9 (SD 1.97) codeine tablets used in DM group and 20 (SD 2.14) in NS group (p=0.25).Discussion. Pain intensity tended to decrease in both groups suggesting morphine as the main source of analgesia.Conclusions. Intravenous dexamethasone during the intraoperative period has no clinical impact on postoperative pain intensity during the first 48 h after arthroscopic knee surgery. This trial is registered withR000020892.

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Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

10.53350/pjmhs2115102622 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2622-2624

Author(s):

Haq dad Durrani ◽

Rafia Kousar ◽

Ejaz Iqbal ◽

Muhammad Abdul Aziz ◽

Syed Aushtar Abbas Naqvi ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Subcutaneous Tissue ◽

Difficult Problem ◽

P Value ◽

Trial Methodology ◽

Analgesic Requirement ◽

Rescue Analgesia ◽

Post Operative Pain ◽

Significant Difference

Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

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Epidural Morphine by the Thoracic or Lumbar Routes in Cholecystectomy. Effect on Postoperative Pain and Respiratory Variables

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700207 ◽

1989 ◽

Vol 17 (2) ◽

pp. 166-169 ◽

Cited By ~ 15

Author(s):

E. Hakanson ◽

M. Bengtsson ◽

H. Rutberg ◽

A. M. Ulrick

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Analogue Scale ◽

Epidural Morphine ◽

Morphine Group ◽

Thoracic Epidural ◽

Respiratory Parameters ◽

Significant Difference ◽

Elective Cholecystectomy ◽

Respiratory Variables

Thirty-seven women undergoing elective cholecystectomy were randomised into two groups, receiving either lumbar epidural morphine (group L) or epidural morphine via the thoracic route (group T). The effect on pain relief was assessed by a visual analogue scale and included both resting pain and ‘provoked’ pain. Respiratory parameters (PEF, FEVI and FVC) were also studied. The patients were investigated preoperatively, and 4, 6, 12 and 24 hours after the start of surgery. No significant difference was observed between the groups concerning pain relief or respiratory performance. We conclude that after cholecystectomy lumbar epidural morphine is as effective as thoracic epidural morphine in relieving postoperative pain.

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Pain relief and opioid usage in upper limb and neck pain patients after 10-kHz spinal cord stimulation treatment: subanalysis of USA studies

Pain Management ◽

10.2217/pmt-2020-0074 ◽

2020 ◽

Author(s):

Kasra Amirdelfan ◽

Ricardo Vallejo ◽

Ramsin Benyamin ◽

Steven Rosen ◽

Peter Kosek ◽

...

Keyword(s):

Spinal Cord ◽

Pain Relief ◽

Neck Pain ◽

Spinal Cord Stimulation ◽

Opioid Consumption ◽

Upper Limbs ◽

Opioid Use ◽

Scale Scores ◽

Post Hoc ◽

Pain Patients

Aim: It is argued that chronic pain patients who reduce/eliminate their opioids may have compromised pain relief. This study therefore aimed to analyze if reduced opioid consumption associated with 10-kHz spinal cord stimulation adversely affected pain relief. Methods: Post hoc analysis was performed on data from two prospective studies in subjects with upper limbs and neck pain conducted in USA. Results & conclusion: A 10-kHz spinal cord stimulation treatment was associated with reduction in mean visual analog scale scores for upper limbs and neck pain and mean daily opioid consumption. Pain scores decreased in subjects who decreased opioid use and in those who maintained/increased use. Opioid reduction and pain relief was also achieved in subjects taking >90 mg morphine equivalents of opioids at baseline.

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Effect of preoperative information about pain on postoperative pain experience and patient satisfaction following orthopaedic surgery: A randomised controlled trial.

10.21203/rs.3.rs-130942/v1 ◽

2020 ◽

Author(s):

Moses Othin ◽

Cornelius Sendagire ◽

John Mukisa ◽

Clare Lubulwa ◽

Phillip Mulepo ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Postoperative Pain ◽

Pain Score ◽

Orthopaedic Surgery ◽

Controlled Trial ◽

P Value ◽

Pain Experience ◽

Significant Difference ◽

Preoperative Information

Abstract Background: Preoperative information about pain has been shown to improve postoperative pain perception and reduce postoperative analgesia requirements. However, there is limited data regarding the effect of preoperative counselling in low resource settings. This study aimed at assessing the effect of preoperative information about pain on postoperative pain experience measured as postoperative pain using a verbal numerical rating scale (VNRS) and patient satisfaction with pain management. Methods: A randomised, double blind, controlled trial was done in Mulago National Referral Hospital (MNRH), Kampala. We prospectively enrolled 400 participants aged 18years and above scheduled for elective orthopaedic surgery. The consented patients were randomised to either receive the specific preoperative information about pain or not. The primary end points were postoperative pain score and patient satisfaction. A total of 340 were analysed with 170 in either arm. Secondary analyses where done to determine the factors that were associated with postoperative pain and patient satisfaction.Results: In both arms, the lowest pain score was 0/10 at 0 hours and the highest was 7/10 at 12 hours. A statistically significant difference between the intervention and control arms for the median pain score at 48hours (4/10 vs. 5/10) P-value= 0.029 was seen but none at 0, 12, 24hours. There was no difference in satisfaction with pain management (P value=0.059). Conclusion: Preoperative information about pain improves postoperative pain experience and may negatively impact patients’ satisfaction with pain management due to unmet expectations.Trial registration: Clinicaltrials.gov, NCT03056521. Registered 17 February 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03056521

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Analgesic efficacy and associated plasma concentration of tramadol and O-desmethyltramadol following oral administration post ovariohysterectomy in dogs

10.7287/peerj.preprints.1510v1 ◽

2015 ◽

Author(s):

Elizabeth M Goudie-DeAngelis ◽

Kerry J Woodhouse

Keyword(s):

Plasma Concentration ◽

Postoperative Pain ◽

Pain Score ◽

Short Form ◽

Plasma Concentrations ◽

Analgesic Efficacy ◽

Pain Scale ◽

Clinical Pain ◽

Drug Plasma ◽

Significant Difference

Tramadol is used in both human and veterinary medicine to treat postoperative pain. The purpose of this study was to evaluate tramadol as a sole postoperative analgesic and to compare drug plasma concentration to clinical pain score. A high or low dose of tramadol was randomly assigned and administered to 14 mixed breed female dogs after ovariohysterectomy. The Short-Form of the Glasgow Composite Measure Pain Scale was used for pain evaluation post-operatively. Plasma was collected for evaluation of tramadol and O-desmethyltramadol concentrations. The effect of weight and dose on pain scores as well as how pain score correlated with plasma concentration of tramadol and O-desmethyltramadol was evaluated. A significant difference in pain score was noted between doses when weight classes were pooled. The plasma concentrations did not correlate with pain score. Based on our results, the use of tramadol as a sole analgesic agent provides inadequate postoperative pain control.

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