scholarly journals Comparision of Caudal Ropivacaine, Ropivacaine Plus Ketamine and Ropivacaine Plus Fentanyl Administration for Postoperative Analgesia in Children

2013 ◽  
Vol 32 (3) ◽  
pp. 210-215 ◽  
Author(s):  
Jeevan Singh ◽  
Dikshya Hamal ◽  
Avish Karmacharya
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Saline Group ◽  
Normal Saline Group ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Caudal Analgesia ◽  
Lower Pain ◽  
The Mean ◽  
Fentanyl Administration

Introduction: The purpose of the study was to compare the analgesic quality and duration of Ropivacaine 0.2% with the addition of Fentanyl (1 mcg/kg) with that of Ropivacaine 0.2% and the addition of Ketamine (0.5 mg/kg) and also compare the post complications. Materials and Methods: Ninety children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of three groups: caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine in normal saline (Group R) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Ketamine 0.5 mg/kg (Group RK) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Fentanyl 1 mcg/kg (Group RF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results: The mean duration of analgesia was significantly longer in Group RK (629.06 ± 286.32 min) than other two groups P < 0.05. The pain score assessed using FLACC scale was compared between the three groups, and children in Group RK had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group RK. Ketamine in a dose of 0.5 mg/kg added to 0.2% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of Ropivacaine, without any side effects in compare to Ropivacaine alone or Fentanyl. Conclusion: We conclude that Ketamine in a dose of 0.5 mg/kg, added to 0.2% Ropivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia without any side effects. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6956 J. Nepal Paediatr. SocVol.32(3) 2012 210-215

scholarly journals Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

2013 ◽  
Vol 10 (3) ◽  
pp. 25-29
Author(s):  
Jeevan Singh ◽  
RS Shah ◽  
N Vaidya ◽  
PK Mahato ◽  
S Shrestha ◽  
...  
Keyword(s):  
Side Effects ◽  
Normal Saline ◽  
Saline Group ◽  
Single Shot ◽  
Normal Saline Group ◽  
Post Operative Pain ◽  
Caudal Anaesthesia ◽  
Caudal Analgesia ◽  
Lower Pain ◽  
Group B

Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. Kathmandu University Medical Journal | VOL.10 | NO. 3 | ISSUE 39 | JUL- SEP 2012 | Page 25-29 DOI: http://dx.doi.org/10.3126/kumj.v10i3.8013

scholarly journals The Influence of Adrenaline on Postoperative Analgesia after Subarachnoid Morphine

1993 ◽  
Vol 21 (1) ◽  
pp. 79-84 ◽  
Author(s):  
M. J. Paech
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Saline Group ◽  
Control Group ◽  
Double Blind Study ◽  
Gynaecological Surgery ◽  
Normal Saline Group ◽  
Double Blind ◽  
Significant Difference ◽  
To Receive

A randomised, double-blind study was conducted to investigate the postoperative effects of subarachnoid morphine, with or without adrenaline, after major gynaecological surgery. Seventy-five women having spinal anaesthesia combined with either sedation or general anaesthesia were randomised to receive subarachnoid morphine 0.25 mg with (group MA) or without (group M) adrenaline 200 ūg; or normal saline (group C). Groups M (n=22) and MA (n=25) differed significantly from control (n=23) with respect to the quality and duration of postoperative analgesia (P<0.0002) and to a higher incidence of pruritus (P<0.02). Groups were similar with respect to the incidence of other postoperative side-effects and respiratory data, although the latter showed a trend to less hypoxaemia in the control group. There was no significant difference in any outcome between groups MA and M. It was concluded that, under the study conditions in a post-gynaecological surgery population, the addition of adrenaline to subarachnoid morphine was of no benefit.

scholarly journals Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study

2018 ◽  
Vol 5 (12) ◽  
pp. 2898-2903 ◽  
Author(s):  
Masoum Khoshfetrat ◽  
Ali Rosom Jalali ◽  
Gholamreza Komeili ◽  
Aliakbar Keykha
Keyword(s):  
Normal Saline ◽  
Pearson Correlation ◽  
Saline Group ◽  
Normal Saline Group ◽  
Chi Square ◽  
Double Blind ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Mean ◽  
One Way Anova

Background: Shivering is an undesirable complication following general anesthesia and spinal anesthesia, whose early control can reduce postoperative metabolic and respiratory complications. Therefore, this study aims to compare the effects of prophylactic injection of ketamine and pethidine on postoperative shivering. Methods: This double-blind clinical trial was performed on 105 patients with short-term orthopedic and ENT surgery. The patients were randomly divided into three groups; 20 minutes before the end of the surgery, 0.4 mg/kg of pethidine was injected to the first group, 0.5 mg/kg of ketamine was injected to the second group, and normal saline was injected to the third group. After the surgery, the tympanic membrane temperature was measured at 0, 10, 20, and 30 minutes. The shivering was also measured by a four-point grading from zero (no shivering) to four (severe shivering). Data were analyzed by one-way ANOVA, Kruskal Wallis, Chi-square and Pearson correlation. Results: The mean age of patients was 35.8+/-11.45 years in the ketamine group, 34.8+/-11.64 years in the normal saline group, and 33.11+/-10.5 years in the pethidine group. The one-way ANOVA showed no significant difference in the mean age between the three groups (P=0.645). The incidence and intensity of shivering were significantly higher in the normal saline group than in the ketamine and pethidine groups (p=0.001). However, there was no significant difference in the incidence and the intensity of shivering between the ketamine and the pethidine groups (p=0.936). Conclusion: The results showed that the 0.5 mg/kg of ketamine could control the post-anesthetic shivering.  

scholarly journals Effect of Dexamethasone as an Adjuncton Efficacy of Ropivacaine in Caudal Block forPostoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

2021 ◽  
Author(s):  
Veena Patodi ◽  
Kavita Jain ◽  
Mukesh Choudhary ◽  
Surendra Kumar Sethi ◽  
Neena Jain ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Controlled Study ◽  
P Value ◽  
Single Shot ◽  
Caudal Block ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Paediatric Patients ◽  
Haemodynamic Changes

Introduction: Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries. Various adjuvants have been used along with local anaesthetics like ropivacaine in single-shot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries. Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients. Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019. These total subjects were randomly allocated into two groups. GroupR (n=40) administered 0.2% ropivacaine (1 mL/kg) while GroupRD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block. The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and side-effects were noted. The rescue analgesic (paracetamol 15 mg/kg oral) was given whenever FLACC ≥4. Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained. Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to GroupR (440.38±76.44 min); (p-value <0.001). The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05). The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value <0.05). No significant haemodynamic changes or side-effects were observed in both groups; (p-value >0.05). Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R. None complications were observed in the patients of RD group. Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.

scholarly journals The Effect of Systemic and Regional Use of Magnesium Sulfate on Postoperative Tramadol Consumption in Lumbar Disc Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Melek Demiroglu ◽  
Canan Ün ◽  
Dilsen Hatice Ornek ◽  
Oya Kıcı ◽  
Ali Erdem Yıldırım ◽  
...  
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Lumbar Disc ◽  
Demographic Data ◽  
The Other ◽  
Lumbar Disc Surgery ◽  
Paraspinal Muscles ◽  
Pain Scores ◽  
Disc Surgery ◽  
C 30

Aim.To investigate the effect of magnesium administered to the operative region muscle and administered systemically on postoperative analgesia consumption after lumbar disc surgery.Material and Method.The study included a total of 75 ASA I-II patients aged 18–65 years. The patients were randomly allocated into 1 of 3 groups of 25: the Intravenous (IV) Group, the Intramuscular (IM) Group, and the Control (C) Group. At the stage of suturing the surgical incision site, the IV Group received 50 mg/kg MgSO4intravenously in 150 mL saline within 30 mins. In the IM Group, 50 mg/kg MgSO4in 30 mL saline was injected intramuscularly into the paraspinal muscles. In Group C, 30 mL saline was injected intramuscularly into the paraspinal muscles. After operation patients in all 3 groups were given 100 mg tramadol and 10 mg metoclopramide and tramadol solution was started intravenously through a patient-controlled analgesia device. Hemodynamic changes, demographic data, duration of anesthesia and surgery, pain scores (NRS), the Ramsay sedation score (RSS), the amount of analgesia consumed, nausea- vomiting, and potential side effects were recorded.Results.No difference was observed between the groups. Nausea and vomiting side effects occurred at a rate of 36% in Group C, which was a significantly higher rate compared to the other groups (p<0.05). Tramadol consumption in the IM Group was found to be significantly lower than in the other groups (p<0.05).Conclusion.Magnesium applied to the operative region was found to be more effective on postoperative analgesia than systemically administered magnesium.

scholarly journals Is Intra-Articular Magnesium Effective for Postoperative Analgesia in Arthroscopic Shoulder Surgery?

2015 ◽  
Vol 20 (1) ◽  
pp. 35-38 ◽  
Author(s):  
Tuba Berra Saritas ◽  
Hale Borazan ◽  
Selmin Okesli ◽  
Mustafa Yel ◽  
Seref Otelcioglu
Keyword(s):  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Postoperative Analgesia ◽  
Analogue Scale ◽  
Serum Magnesium ◽  
Diclofenac Sodium ◽  
Saline Group ◽  
Shoulder Surgery ◽  
Pain Scores ◽  
Arthroscopic Shoulder Surgery

BACKGROUND: Various medications are used intra-articularly for postoperative pain reduction after arthroscopic shoulder surgery. Magnesium, aN-methyl-D-aspartate receptor antagonist, may be effective for reduction of both postoperative pain scores and analgesic requirements.METHODS: A total of 67 patients undergoing arthroscopic shoulder surgery were divided randomly into two groups to receive intra-articular injections of either 10 mL magnesium sulphate (100 mg/mL; group M, n=34) or 10 mL of normal saline (group C, n=33). The analgesic effect was estimated using a visual analogue scale 1 h, 2 h, 6 h, 8 h, 12 h, 18 h and 24 h after operation. Postoperative analgesia was maintained by intra-articular morphine (0.01%, 10 mg) + bupivacaine (0.5%, 100 mL) patient-controlled analgesia device as a 1 mL infusion with a 1 mL bolus dose and 15 min lock-out time; for visual analogue scale scores >5, intramuscular diclofenac sodium 75 mg was administered as needed during the study period (maximum two times).RESULTS: Intra-articular magnesium resulted in a significant reduction in pain scores in group M compared with group C 1 h, 2 h, 6 h, 8 h and 12 h after the end of surgery, respectively, at rest and with passive motion. Total diclofenac consumption and intra-articular morphine + bupivacaine consumption were significantly lower in group M. Postoperative serum magnesium levels were significantly higher in group M, but were within the normal range.CONCLUSIONS: Magnesium causes a reduction in postoperative pain in comparison to saline when administered intra-articularly after arthroscopic shoulder surgery, and has no serious side effects.

scholarly journals Postoperative Analgesia for Haemorrhoid Surgery

1983 ◽  
Vol 11 (1) ◽  
pp. 27-30 ◽  
Author(s):  
D. A. Pybus ◽  
B. E. D'Bras ◽  
G. Goulding ◽  
H. Liberman ◽  
T. A. Torda
Keyword(s):  
Postoperative Pain ◽  
General Anaesthesia ◽  
Postoperative Analgesia ◽  
Normal Saline ◽  
Morphine Sulphate ◽  
Control Group ◽  
Treatment Groups ◽  
Number Of Patients ◽  
Caudal Analgesia ◽  
The Mean

Seventy patients undergoing haemorrhoidectomy under general anaesthesia were randomly allocated to one of five treatment groups in order to compare the effectiveness of various caudal agents in the control of postoperative pain. Four groups were given a caudal injection of either 2% lignocaine, 0.5% bupivacaine, 2% lignocaine + morphine sulphate 4 mg or normal saline + morphine sulphate 4 mg, while the fifth (control) group did not receive an injection. The number of patients requiring postoperative opiates was significantly higher in the lignocaine group than in the morphine (p <0.05) and morphine-lignocaine (p <0.05) groups. No agent significantly reduced the number requiring opiates. In those who received opiates, the mean analgesic period was 228 minutes in the control group, and was significantly longer following bupivacaine (577 min, p <0.01), morphine-lignocaine (637 min, p <0.05) and morphine (665 min, p <0.01). The mean analgesic period following lignocaine (349 min) was not significantly different from control. The incidence of catheterisation was lowest in those patients who did not receive caudal analgesia.

A Comparison of Naproxen, Indomethacin and Acetylsalicylic Acid in Pain after Varicose Vein Surgery

1978 ◽  
Vol 6 (2) ◽  
pp. 152-156 ◽  
Author(s):  
Ulla Aromaa ◽  
Kari Asp
Keyword(s):  
Side Effects ◽  
Acetylsalicylic Acid ◽  
Postoperative Analgesia ◽  
Varicose Vein ◽  
Randomized Study ◽  
Analgesic Efficacy ◽  
Varicose Vein Surgery ◽  
Double Blind ◽  
Post Operative Pain ◽  
Minor Surgery

Oral naproxen in doses of 500 mg and 750 mg daily was compared with oral indomethacin, 75 mg daily, in a double-blind, completely randomized study of patients with post-operative pain after out-patient varicose vein surgery. Altogether, 120 patients were studied. In the study 750 mg naproxen proved to be equal in respect of analgesic efficacy to 75 mg indomethacin, and it was clearly superior to 1500 mg acetylsalicylic acid. Naproxen, 500 to 750 mg daily, afforded adequate postoperative analgesia in 98% of patients. The side-effects were mild. On the basis of the study, naproxen can be recommended as a pain-relieving drug after minor surgery, particularly when an antiphlogistic effect is also desirable.

Postoperative analgesia after radical prostatectomy with high-dose intrathecal morphine and intravenous naloxone: A retrospective review

2018 ◽  
Vol 5 (6) ◽  
pp. 331-339 ◽  
Author(s):  
Annette Rebel, MD ◽  
Paul Sloan, MD ◽  
Michael Andrykowski, PhD
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Radical Prostatectomy ◽  
Respiratory Depression ◽  
Postoperative Analgesia ◽  
Intrathecal Morphine ◽  
Major Surgery ◽  
High Dose ◽  
The Mean

Background and methods: Intrathecal opioids (ITOs) have been used for decades to control postoperative pain. Intrathecal opioid dosing is limited, however, by opioid-related side effects, most importantly respiratory depression. To overcome these limitations, we combined intrathecal morphine with a continuous intravenous (IV) postoperative naloxone infusion to control opioid-related side effects. The purpose of this study is to document the efficacy and safety of high-dose intrathecal morphine combined with postoperative naloxone infusion to provide postoperative analgesia after major surgery. After IRB approval, a retrospective chart analysis was performed on 35 patients who had a radical prostatectomy from 2004 to 2006. All patients received a single injection of ITOs before anesthesia, a typical general anesthestic, followed by naloxone infusion at 5 μg/kg/h started 1 hour post-ITOs and continued for 22 hours postoperatively. The following information was collected: patient age, height, weight, anesthesia technique/time, and dose of ITOs given. Postoperative pain relief was assessed for 48 hours using the Visual Analog Score (VAS) for pain (0, no pain; 10, worst pain), perioperative opioid use, NSAID consumption, and ability of patient to ambulate. The safety of this novel treatment was assessed with opioid-related side effects and vital signs. All data are reported as mean (SD).Results: Mean ITOs given were morphine 1.3 (0.3) mg combined with fentanyl 56 (9) μg. The intrathecal morphine dose ranged from 0.8 to 1.7 mg. The mean worst pain VAS in the first 12 hours postoperatively was only 1.0 (1.7). The first NSAID dose was given 6.6 (3.1) hours post-ITOs. The first opioid on the floor was given an average of 22.6 (14.5) hours post-ITOs. A mean of only 5.7 (12.3) morphine equivalents were required on postoperative day 1 (POD 1). On POD 2, the mean worst pain VAS was only 2.6 (2.2) with only 5.7 (6.2) morphine equivalents needed to provide pain relief. On POD 1, 25 patients required no additional opioids for their entire hospital stay. Overall, 11 of 35 patients did not require any additional postoperative opioids. Thirtyfour patients (97 percent) were able to ambulate in the first 12 hours postoperatively. No opioid-induced respiratory depression was observed. Opioid-related side effects (pruritus, nausea) were infrequent and minor.Conclusions: High-dose ITOs combined with postoperative IV naloxone infusion provided excellent analgesia for radical prostate surgery. IV naloxone infusion appeared to control opioid side effects without diminishing the analgesia. No serious adverse effects were noted.

scholarly journals Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid

2014 ◽  
Vol 23 (2) ◽  
pp. 56-61
Author(s):  
Md Mustafa Kamal ◽  
Abdullah Al Maruf ◽  
Sabina Yeasmeen ◽  
Abdul Hye
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Urinary Retention ◽  
Postoperative Analgesia ◽  
Lumbar Spine Surgery ◽  
Surgical Closure ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Post Operative Nausea

Background Most spinal surgery is painful and good postoperative analgesia is important. Opioids are the traditional first-line treatment. Ketorolac has been used for postoperative pain relief. However, there is no data available about controlling postoperative pain with ketorolac after open lumbar discectomy or laminectomy in Bangladesah. Objective To compare the efficacy of a Parentral ketorolac with conventional opioid for management of postoperative pain after lumbar disectomy or laminectomy. Methods Sixty patients who underwent lumbar disectomy or laminectomy were randomly allocated into two groups. Group A (n = 30) patients received 30 mg intramuscular ketorolac upon surgical closure and every 6 hours for 24 hours and intramuscular pethidine 1.5 mg/kg/b.w. as needed (PRN). Group B (n = 30) patients received only intramuscular pethidine 1.5 mgkg-1/b.w. every 6 hours for 24 hours and as needed (PRN). Postoperative analgesia was assessed in both groups by Visual Analogue Scale at arrival in postoperative ward and at 6, 12 and 24 hours for 24 hours. Total postoperative narcotic consumption and side effects like post operative nausea and vomiting (PONV), dizziness, urinary retention and pruritus were also recorded. Results Baseline data were comparable between the two groups. The mean VAS almost similar and less than 3 at different reading in both groups which indicate adequate postoperative analgesia and the differences were statistically not significant. The mean total cumulative amount of pethidine administered over 24 hrs period was less in group A it was 64.31+19.13 mg where as in group B was 161.23+21.25 mg. and the difference was statistically significant (p<0.01). Incidences of side effects like PONV, urinary retention and pruritus were more in group B than group A and differences were statistically significant (p<0.01). Conclusion For postoperative pain management after lumbar spine surgery both ketorolac and traditional parental opioid found effective. Total opioid consumption is significantly less with ketorolac and side effects like PONV, dizziness, urinary retention and pruritus were more with opioid alone. DOI: http://dx.doi.org/10.3329/jbsa.v23i2.18175 Journal of BSA, 2009; 23(2): 56-61

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