scholarly journals Comparison of efficacy and safety of oxycodone versus fentanyl for intravenous patient-controlled analgesia in postoperative pain management: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Peng Chen ◽  
Fuchao Chen ◽  
Jiexin Lei ◽  
zhou benhong
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Meta Analysis ◽  
Postoperative Pain Relief ◽  
Cochrane Library ◽  
Patient Controlled Analgesia ◽  
Significant Difference

Abstract Backgroud Patient-controlled analgesia(PCA) with intravenous an opioid has been suggested as a effective method of postoperative pain relief. There are several randomized controlled trials (RCTs) of comparison of oxycodone and fentanyl for IV-PCA in surgical patients. The purpose of this study was to performed a meta-analysis to compare the effect of intravenous oxycodone and fentanyl on post-operative pain in sugical patients from collected current data. Methods The RCTs of oxycodone versus fentanyl for IV-PCA were gathered from PubMed, Embase, Cochrane library, CNKI and VIP data. After data extraction and quality assessment of the included RCTs, the RevMan 5.3 software was applied for meta-analysis of numerical rating scale (NRS) scores, accumulated IV-PCA consumption of oxycodone and fentanyl, patient satisfaction, postoperative nausea and vomiting (PONV), and other adverse events (AEs). Results Results reported from eight RCTs involving 600 patients are included in the meta-analysis. The NRS score at rest and upon movement of group oxycodone was significantly lower than that of group fentanyl (WMD= -3.85, 95% CI -4.93~-2.76, P<0.00001; WMD= -4.31, 95% CI -5.79~-2.84, P<0.00001); however, the incidence of PONV and dizziness was significantly higher in group oxycodone than in group fentanyl (OR = 2.41, 95% CI 1.60~3.63, P < 0.0001; OR=3.69, 95% CI 2.17~6.26, P<0.00001). Accumulated IV-PCA consumption in group oxycodone was less than in group fentanyl overall the 48 hours postoperatively (WMD= -12.11, 95% CI -18.42~-5.80, P = 0.0002). There was no significant difference in patient satisfaction between oxycodone and fentanyl (OR=0.73, 95% CI 0.11~5.04, P= 0.75). Conclusion According to the evidence, this meta-analysis suggest that oxycodone IV-PCA is superior to fentanyl in postoperative pain relief, whereas the higher incidence of PONV and dizziness was accompanied with oxycodone. Further large-scale and well-designed studies are needed to summarize and analyse the data to draw a more convincing conclusion.

scholarly journals Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (12) ◽  
pp. 2636
Author(s):  
Ka Wing Ma ◽  
Hoonsub So ◽  
Euisoo Shin ◽  
Janice Hoi Man Mok ◽  
Kim Ho Kam Yuen ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Small Sample ◽  
Cochrane Library ◽  
Endoscopic Drainage ◽  
Complication Rates ◽  
Surgical Drainage ◽  
Endocrine Insufficiency ◽  
Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

scholarly journals Postoperative Pain Relief after Major Pancreatic Resection: Systematic Review and Meta-analysis of Analgesic Modalities

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S893
Author(s):  
N. Akter ◽  
B. Ratnayake ◽  
D.B. Joh ◽  
S.-J. Chan ◽  
E. Bonner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Pancreatic Resection ◽  
Meta Analysis ◽  
Postoperative Pain Relief

Comparison of Butorphanol with Morphine in Intravenous Patient Controlled Analgesia (PCA) for Postoperative Pain Relief

1997 ◽  
Vol 33 (3) ◽  
pp. 502 ◽  
Author(s):  
Jun Ku Hwang ◽  
Seung Joon Lee ◽  
Ho Yeong Kil ◽  
Sung Woo Lee ◽  
Young Joon Yoon ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Pain Relief ◽  
Patient Controlled Analgesia

scholarly journals Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Mohammad Jafar Eghbal ◽  
Ali Haeri ◽  
Arash Shahravan ◽  
Ali Kazemi ◽  
Fariborz Moazami ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Root Canal ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Mineral Trioxide Aggregate ◽  
Preoperative Pain ◽  
Multicenter Randomized Controlled Trial ◽  
The Mean

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients’ demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P<0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

scholarly journals Perioperative Gabapentin in Pediatric Thoracic Surgery Patients—Randomized, Placebo-Controlled, Phase 4 Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1562-1571 ◽  
Author(s):  
Lucyna Tomaszek ◽  
Dariusz Fenikowski ◽  
Piotr Maciejewski ◽  
Halina Komotajtys ◽  
Danuta Gawron
Keyword(s):  
Patient Satisfaction ◽  
Placebo Group ◽  
Side Effects ◽  
Thoracic Surgery ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Care Providers ◽  
Significant Difference ◽  
Group 6 ◽  
Ravitch Procedure

Abstract Objective To determine whether the use of perioperative gabapentin reduces postoperative pain and anxiety, decreases ropivacaine consumption and side effects, and improves patient satisfaction. Design Randomized, placebo-controlled, phase 4 trial. Blinding Participants, care providers, investigators, data analysts. Setting Department of Thoracic Surgery of the Institute of Tuberculosis and Lung Disease, Rabka Zdrój Branch, Poland. Subjects Forty patients undergoing the Ravitch procedure. Methods Patients aged nine to 17 years were randomized into a gabapentin (preoperative 15 mg/kg, treatment) or placebo group. Postoperative analgesia included gabapentin (7.5 mg/kg) or placebo two times per day for three days, epidural ropivacaine + fentanyl, paracetamol, nonsteroidal anti-inflammatory drugs, and metamizol as a “rescue drug.” Pain, anxiety, analgesic consumption, side effects, and patient satisfaction were recorded. Results There was no statistically significant difference in median pain scores (numerical rating scale &lt; 1/10) or incidence of adverse side effects between the gabapentin group (N = 20) and the placebo group (N = 20). Postoperative anxiety scores were significantly lower than before surgery in the gabapentin group (6 [4–8] vs 7 [6–8.5], P &lt; 0.01) and remained unchanged in the placebo group (6 [5–6.5] vs 6 [5–7], P = 0.07). Gabapentin-treated patients received a lower number of doses of ondansetron when compared with the placebo group (6 [5–6] vs 7 [6–9], P = 0.02). A significant negative association was found between patient satisfaction and postoperative state anxiety in the gabapentin group (R = –0.51, P = 0.02). Conclusions Perioperative administration of gabapentin resulted in a decrease of postoperative anxiety in pediatric patients undergoing the Ravitch procedure.

The advent of patient-controlled analgesia for post-operative analgesia

2018 ◽  
Author(s):  
Suzanne Chapman
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Postoperative Pain Relief ◽  
Patient Controlled Analgesia ◽  
Administration Methods

The landmark paper discussed in this chapter is ‘Patient-controlled analgesia: A new concept of postoperative pain relief’, published by Bennett et al. in 1982. This paper presents data from two investigations in which patient-controlled analgesia using morphine was evaluated in patients who had undergone elective gastric bypass surgery for the management of morbid obesity. The paper shows that patient-controlled analgesia achieved adequate analgesia more often than conventional intermittent analgesia did when both administration methods were compared, but with less sedation. In addition, patients who had experienced both methods of analgesia felt that patient-controlled analgesia was superior. The paper also demonstrates that individuals can vary in their analgesic requirements.

Nebulized morphine for analgesia in an emergency setting

2018 ◽  
Vol 5 (1) ◽  
pp. 23 ◽  
Author(s):  
Vincent Bounes, MD ◽  
Jean Louis Ducassé, MD ◽  
Annie Momo Bona, MD ◽  
Florent Battefort, MD ◽  
Charles-Henri Houze-Cerfon, MD ◽  
...  
Keyword(s):  
Pain Relief ◽  
Acute Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Statistical Significance ◽  
A Priori ◽  
Primary Outcome Measure ◽  
Point Estimate ◽  
Emergency Setting ◽  
Significant Difference

Objective: To evaluate the efficacy and safety of inhaled morphine delivered in patients experiencing severe acute pain in an emergency setting.Patients and Methods: Patients were eligible for inclusion if they were aged 18 years or older, with a severe acute pain defined by a numerical rating scale (NRS) score of 60/100 or higher. The intervention involved administering a single dose of 0.2 mg/kg morphine nebulized using a Misty-Neb nebulizer system. NRSs were recorded and were repeated at 1, 3, 5, and 10 minute after the end of inhalation (T10). The protocol-defined primary outcome measure was pain relief (defined by an NRS score of 30/100 or lower) at T10. Secondary outcomes included differences between pain scores at baseline and at T10 and incidence of adverse events.Results: A total of 28 patients were included in this study. No patient experienced pain relief 10 minutes after the end of inhalation, and no adverse effects were recorded. Respective initial and final median NRS scores were 80 (70-90) and 70 (60-80), p < 0.0001. Despite achieving statistical significance, the value of this point estimate is less than the 14 NRS difference that was defined a priori as representing a minimum clinically significant difference in pain severity.Conclusion: 0.2 mg/kg nebulized morphine is not effective in managing acute pain in an emergency setting. In spite of the potential advantages of the pulmonary route of administration, opioids should be intravenous prescribed at short fixed intervals to control severe acute pain in an emergency setting.

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