scholarly journals Remifentanil versus combined spinal-epidural technique for labour analgesia in multiparous women: a prospective non-randomized trial

2020 ◽  
Author(s):  
Tatjana Stopar Pintaric ◽  
Tea Zagar ◽  
Neli Semrl ◽  
Nejc Umek ◽  
Miha Lucovnik ◽  
...  
Keyword(s):  
Pain Relief ◽  
Randomized Trial ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Personal Control ◽  
Labour Analgesia ◽  
High Rate ◽  
Combined Spinal Epidural ◽  
Multiparous Women ◽  
Spinal Epidural

Abstract Background : Remifentanil has a suitable pharmacological profile for labour analgesia. Fast set up, onset, and limited time efficacy may render it useful in multiparas with a faster labour progression. The objective of this prospective, non-randomized trial was to compare the pain relief for vaginal delivery between remifentanil patient-controlled analgesia (RPCA) with that of combined spinal-epidural analgesia (CSEA) in multiparas. Methods : After making an informed choice of either RPCA or CSEA, 162 multiparous women in the active phase of first-stage labour were enrolled in this study. The primary outcome was pain intensity measured during the whole period of labour using an 11-point numerical rating scale. The secondary outcomes were satisfaction with pain-relief, adverse effects, labour progress and outcomes. Results : CSEA provided lower pain scores and a higher satisfaction rate than RPCA [3.9 (0.36) vs 2.6 (1.1), P <0.001]. Also, more patients opted for the CSEA for their next labour [CSEA; 77 (95%) vs. RPCA; 65 (81%), P =0.003]. However, more than 80% of women in the RPCA group graded their satisfaction as good and very good with a high rate of recommendation and no crossovers observed. Remifentanil was associated with desaturation, bradypnea and apnoea in 27 (34%), 17 (21%) and 20 (25%) respective cases. All recovered spontaneously upon verbal or tactile stimulation. No clinically important differences were noted in sedation level, labour progress and outcomes. Conclusions : CSEA provided superior pain relief compared to RPCA in multiparas. Despite that, remifentanil was highly rated, with a high rate of recommendation and no crossovers to CSEA. That can be attributed to the fact that women with previewed shorter labour were more likely to choose a less invasive analgesic option which provided an element of personal control. Thus, given no difference in labour outcomes, remifentanil could be offered as a routine analgesic option provided rigorous adherence to the necessary protocols are ensured. The presence of a midwife is essential for timely management of respiratory depression or other severe outcomes.

scholarly journals A comparison of intravenous remifentanil patient-controlled analgesia with combined spinal-epidural analgesia in multiparous women: a prospective observational study

2020 ◽  
Author(s):  
Tatjana Stopar Pintaric ◽  
Tea Zagar ◽  
Neli Semrl ◽  
Nejc Umek ◽  
Miha Lucovnik ◽  
...  
Keyword(s):  
Pain Relief ◽  
Observational Study ◽  
Epidural Analgesia ◽  
Prospective Observational Study ◽  
Opioid Analgesic ◽  
Personal Control ◽  
Satisfaction Rate ◽  
Combined Spinal Epidural ◽  
Multiparous Women ◽  
Spinal Epidural

Abstract Background The combined spinal-epidural analgesia (CSEA) proved useful in multiparous women on account of faster onset and better analgesia in the first 30 minutes compared to standard epidural analgesia. Remifentanil has a suitable pharmacological profile for labour analgesia. Fast set up, onset, and limited time efficacy may render it useful in multiparous women with a faster labour progression.Methods The prospective observational study was performed in multiparous women in their active phase of the first stage labour after their informed choice of either RPCA (n=80) or CSEA (n=82). The primary outcome was pain-relief assessed on a 11-point numerical rating scale. The secondary outcomes were with pain-relief satisfaction, adverse effects, labour progress and labour outcomes.Results CSEA provided significantly lower pain scores and a higher satisfaction rate compared to RPCA [3.9 (0.36) vs 2.6 (1.1), P<0.001]. Likewise, more patients from the CSEA group would choose the same technique for the next labour CSEA; 77 (95%) vs. RPCA; 65 (81%), P=0.003. No difference between the groups was observed in recommending the respective technique to others CSEA; 77 (95%) vs. RPCA; 72 (90%), P=0.118. No crossovers were observed in either group. RPCA was associated with desaturation, bradypnea and apnoea in 27 (34%), 17 (21%) and 20 (25%) respective cases. All recovered spontaneously upon verbal or tactile stimulation. No clinically important differences were noted in sedation level, labour progress and labour outcomes between the groups.Conclusions This prospective observational study has shown that despite inferior pain relief and satisfaction, the remifentanil acceptance in multiparous women was still high as the vast majority of them graded their satisfaction rate as high/very high. That can be attributed to the facts that women with previewed shorter labour were more likely to choose a less invasive opioid analgesic option which provides an element of personal control. Thus, given no difference in labour outcomes, remifentanil could be routinely offered to parous women as a labour analgesic option, provided rigorous adherence to the protocols and continuous supervision by midwifes are ensured. Trial registration The trial was registered at ClinicalTrials.gov on November 15, 2016 (ID NCT02963337)

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

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.

Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain

2020 ◽  
Vol 45 (9) ◽  
pp. 696-701
Author(s):  
Uri Hochberg ◽  
Asaf Berger ◽  
Miri Atias ◽  
Rotem Tellem ◽  
Ido Strauss
Keyword(s):  
Pain Relief ◽  
Cancer Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Treatment Plan ◽  
Metastatic Cancer ◽  
Spinothalamic Tract ◽  
Pain Syndromes ◽  
Intractable Cancer Pain ◽  
Ablative Procedures

IntroductionNeurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon.MethodsA retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients’ specific pain syndromes.ResultsA total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits.ConclusionsAn interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain.Trial registration numberIR0354-17.

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