scholarly journals Intravenous Diclofenac vs. Tramadol infusion for Post-operative Pain Management: A Randomized Trial

2018 ◽  
Vol 2 (1) ◽  
pp. 38-42
Author(s):  
Thakur Binay ◽  
Devkota Mukti ◽  
Khanal Krishna ◽  
Sapkota Bishal
Keyword(s):  
Adverse Effect ◽  
Clinical Trial ◽  
Pain Management ◽  
Cancer Patients ◽  
Intravenous Infusion ◽  
Average Cost ◽  
Rating Scale ◽  
Major Surgery ◽  
Post Operative Pain ◽  
The Mean

Purpose: The study was conducted to compare the analgesic and adverse effect profiles of intravenous infusion of Tramadol and Diclofenac in post-operative pain management. Method: Cancer patients undergoing major surgery were prospectively randomized into two groups of 35 and was entered into single blinded clinical trial. Patients in each arm received either Tramadol (Gr A) or Diclofenac Infusion (Voveran®) (Gr B) for first 48 hours after surgery. Pain intensity was measured based on a 10 point Verbal Rating Scale (VRS). VRS was obtained at 6, 12, 18, 24, 30, 36, 42 and 48 hrs post-operatively. Result: The mean age was 56.3 and 49.5 years in Gr A and B, respectively (p=.056). Mean length of incision was 16.46 cm and 18.23 cm in Gr A and B, respectively (p=.1). On 0 post-operative day, 14 patients in Gr A and 6 patients in Gr B required accessory analgesics (p=.18). On 1st post-operative day, 2 patients in Gr A and 1 patient in Gr B required accessory analgesics (p=.6). One patient on Tramadol group had nausea post-operatively. Average cost was 471.73 and 227.80 Nepali rupees in Gr A and Gr B, respectively (p=.032). Conclusion: Intravenous infusion of Diclofenac should be considered as a safe and cheaper alternative to Tramadol infusion for pain management after major surgical oncological procedures.

scholarly journals The Opioid Analgesic Reduction Study (OARS): A Comparison of Opioid vs. Non-Opioid Combination Analgesics for Management of Post-Surgical Pain Study Protocol for a Double-Blind Randomized Multi-Center Clinical Trial

2021 ◽  
Author(s):  
Cecile A. Feldman ◽  
Janine Fredericks-Younger ◽  
Shou-En Lu ◽  
Paul J. Desjardins ◽  
Hans Malmstrom ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Pain Management ◽  
Opioid Analgesic ◽  
Third Molar ◽  
The United States ◽  
Double Blind ◽  
Post Operative Pain ◽  
Decision Making Tool ◽  
Molar Extraction

Abstract Background: Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription a patient’s risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the United States, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient’s risk for addiction.Methods: A double blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision making tool, pain management, extraction difficulty and number of tablets taken is being collected enabling an experimental decision making tool to be developed. Discussion: The proposed methods address the short comings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 hours. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, either related to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management.Trial registration: ClinicalTrials.gov NCT04452344. Registered on June 20, 2020

Pancreatic cancer survivorship: Intrathecal drug delivery system for pain management

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14100-14100
Author(s):  
L. J. Stearns ◽  
W. H. Poling ◽  
J. Kiser ◽  
J. Nasternak ◽  
E. Berryman
Keyword(s):  
Drug Delivery ◽  
Pancreatic Cancer ◽  
Pain Management ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Treatment Center ◽  
Celiac Plexus Block ◽  
Maricopa County ◽  
Intrathecal Drug Delivery ◽  
The Mean

14100 Background: Pancreatic cancer is predominantly unresectable at diagnosis and is most frequently fatal. Nationally the average survivorship is 10 months. Among pancreatic cancer patients, pain is associated with decreased survival rates. Quality of life and survivorship are the principal outcome measures for these patients. Successful pain management may be a significant predictor of prolonged survivorship. No study has demonstrated an impact on survivorship secondary to the treatment of pancreatic cancer pain and the use of Intrathecal Drug Delivery Systems (IDDS). Methods: A retrospective chart review identified all pancreatic cancer patients treated at a cancer pain treatment center between January 2002 and June 2005. 43 patients had known dates of diagnosis and known dates of death. The Arizona Department of Health Services Cancer Registry provided similar information for pancreatic cancer patients residing in Maricopa County for that time period. 713 Maricopa county residents had known dates of diagnosis and known dates of death. Results: Among the Maricopa County pancreatic cancer patients, the mean survivorship was 5 months. Among the treatement center patients who did not receive the IDDS for pain, 10 (23.3%), the mean survivorship was 10.8 months. Among the pancreatic cancer patients receiving IDDS for pain management, 33 (76.7%), the mean survivorship was 14.2 months. Mean survivorship among the treatment center patients receiving IDDS for pain management is nearly 3 times greater than the general survivorship of pancreatic cancer patients in Maricopa County. Among the treatement center patients the mean survivorship is nearly 50% greater for patients receiving IDDS versus those that did not. Conclusions: The implantable IDDS for pain management among pancreatic cancer patients may be a significant predictor of increased survivorship. A larger sample size may be needed to detect significant differences in survivorship. Controlled studies examining survivorship as the primary outcome for patients with unresectable pancreatic cancer by evaluating the implantable IDDS as compared to usual care modalities such as comprehensive medical management (CMM) or neurolytic celiac plexus block (NCPB) for pain management are warranted. No significant financial relationships to disclose.

scholarly journals Intravenous and Oral Paracetamol Have the Same Effect in Reducing Fever in Pediatric Patients

2020 ◽  
Vol 4 (3) ◽  
pp. 140
Author(s):  
Fitri Asymida ◽  
Yazid Dimyati ◽  
Bidasari Lubis ◽  
Aznan Lelo ◽  
Muhammad Ali ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Clinical Trial ◽  
Pediatric Patients ◽  
Intravenous Route ◽  
Open Label ◽  
Axillary Temperature ◽  
Antipyretic Effect ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: The antipyretic effect of intravenous versus oral paracetamol is not well known. This study was aimed to compare the antipyretic effect of intravenous and oral paracetamol therapy to reduce fever.Materials and Methods: This was an open-label randomized clinical trial study. The subjects were children who presented to Pediatric Ward and Emergency of Haji Adam Malik Hospital, aged from 2 months to 18 years old, with axillary temperature ≥38.0ºC. Subjects were divided into two groups, group 1 received 15 mg/kg paracetamol intravenous and group 2 received the same dose of paracetamol but given through intravenous. The temperature reduction was analyzed by ANOVA, and the change in temperature was recorded at 0, 15, 30, 60, 120, and 180 minutes after drug administration.Results: In the first group, the mean temperature was decreased (p<0.001) from 15 to 180 minutes after the administration of paracetamol. Nausea was documented as the adverse effect for both oral and intravenous administration groups.Conclusion: The administration of 15 mg/kg paracetamol, either though intravenous or oral, have similar effect in reducing fever in children. Paracetamol therapy though intravenous route can be given if it cannot be given orally.Keywords: antipyretic, pediatrics, fever, intravenous, oral, paracetamol

A randomized controlled clinical trial comparing different numbers of acupuncture sessions for migraine

2021 ◽  
pp. 096452842110560
Author(s):  
Thanan Supasiri ◽  
Chanchai Jariengprasert ◽  
Mayuri Phithaksilp ◽  
Puritat Sangtongpanichakul ◽  
Suchada Anotayanonth ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Rating Scale ◽  
Acupuncture Group ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Open Label ◽  
Randomized Controlled ◽  
The Mean

Background: Acupuncture has shown benefit in preventing migraine attacks, but there has been no clear recommendation about the number of treatment sessions that should be provided. Objectives: The aim of this study was to examine whether 5 sessions of acupuncture treatment is non-inferior to 10 sessions for migraine. Methods: We performed a multicenter, open-label, randomized, controlled clinical trial across five hospitals in Thailand. Migraine patients were randomly assigned into two groups: treatment with 5 sessions of acupuncture (group A) or 10 sessions of acupuncture (group B). Acupuncture was performed twice a week. We measured the number of migraine days, average pain severity according to a 0–10 numeric pain rating scale (NPRS) and quality of life using the EQ-5D-5L questionnaire, comparing 4 weeks after treatment versus baseline. Results: Of 156 patients, 83 and 73 patients were assigned to groups A and B, respectively. Comparing 4 weeks after treatment with baseline, the mean reduction in the number of headache days in groups A and B was 6.4 (95% confidence interval [CI] 4.8 to 7.9) days and 6.4 (95% CI 4.5 to 8.4) days, respectively (p = 0.97). The mean difference between the reduction in headache days of the two groups was −0.1 (95% CI −2.5 to 2.4) days, which included the pre-specified non-inferiority limit of −1. The mean reduction of NPRS scores in groups A and B was 4.5 (95% CI 3.8 to 5.1) and 3.8 (95% CI 3.1 to 4.5), respectively (p = 0.17). Both groups showed an improvement in quality of life. Conclusion: Both 5 and 10 sessions of acupuncture were associated with apparent benefits in terms of preventing migraine attacks, reducing the severity of the headache and improving quality of life, based on comparisons between baseline and follow-up in both study groups. Although we were unable to demonstrate non-inferiority of 5 sessions versus 10 sessions of acupuncture, the effects in the two groups were not significantly different and the temporal effects appeared to last for at least 1 month. Trial registration number: TCTR20170612002 (Thai Clinical Trials Registry).

Post-operative pain

2018 ◽  
Author(s):  
Jane Quinlan
Keyword(s):  
Epidural Analgesia ◽  
Pain Control ◽  
Severe Pain ◽  
Major Surgery ◽  
Patient Controlled Analgesia ◽  
New Techniques ◽  
Main Form ◽  
Post Operative Pain ◽  
The Mean

The landmark paper discussed in this chapter, published in 2002 by Dolin et al., examines the incidence of moderate-to-severe pain and severe pain after major surgery with three analgesic techniques: intramuscular analgesia, patient-controlled analgesia, and epidural analgesia. Up until 1990, intramuscular morphine was the main form of post-operative pain control, with patient-controlled analgesia and epidural analgesia as relatively new techniques. The authors found that the mean incidence of moderate-to-severe pain was more common with intramuscular analgesia (67%) than with patient-controlled analgesia (36%) or epidural analgesia (21%), while the incidence of severe pain was similar, with the incidence of pain with intramuscular analgesia being highest (29%), followed by that associated with patient-controlled analgesia (10%) and epidural (8%). Of note, only patient-controlled analgesia and epidural achieved the Audit Commission’s 1997 standard of no more than 20% of patients experiencing severe pain, while no technique reached their 2002 standard of less than 5%.

Ginger for chemotherapy-related nausea in cancer patients: A URCC CCOP randomized, double-blind, placebo-controlled clinical trial of 644 cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9511-9511 ◽  
Author(s):  
J. L. Ryan ◽  
C. Heckler ◽  
S. R. Dakhil ◽  
J. Kirshner ◽  
P. J. Flynn ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Receptor Antagonist ◽  
Cancer Patients ◽  
Rating Scale ◽  
Zingiber Officinale ◽  
Time Of Day ◽  
Nausea And Vomiting ◽  
Analysis Of Covariance ◽  
Controlled Clinical Trial ◽  
Double Blind

9511 Background: Despite the widespread use of antiemetics, post-chemotherapy nausea and vomiting continue to be reported by up to 70% of patients receiving chemotherapy. Ginger (Zingiber Officinale), an ancient spice, is used by practitioners worldwide to treat nausea and vomiting. We conducted a multi-site, phase II/III randomized, placebo-controlled, double-blind clinical trial to assess the efficacy of ginger for chemotherapy-related nausea in cancer patients at the University of Rochester-affiliated Community Clinical Oncology Program (CCOP) member sites. Methods: Cancer patients who experienced nausea following any chemotherapy cycle and were scheduled to receive at least three additional cycles were eligible. Patients were randomized into four arms: 1) placebo, 2) 0.5g ginger, 3) 1.0g ginger, or 4) 1.5g ginger. All patients received 5-HT3 receptor antagonist antiemetics on Day 1 of all cycles and took three 250mg capsules of ginger or placebo twice daily for six days starting three days before the first day of the next two cycles. Patients reported the severity of nausea during the morning, afternoon, evening, and night on a 7-point semantic rating scale (‘1' = ‘Not at all Nauseated' and ‘7' = “Extremely Nauseated”) for Days 1–4 of each cycle. The goal was to determine if ginger was more effective than placebo in controlling chemotherapy-related nausea in participants given a 5-HT3 receptor antagonist antiemetic. Results: A total of 644 patients were accrued (90% female, mean age = 53). Breast (66%), alimentary (6.5%), and lung (6.1%) cancers were the most common cancer types. Analysis of covariance (ANCOVA) examined change in nausea in the four study arms on Day 1 of cycles 2 and 3. All doses of ginger significantly reduced nausea (p=0.003). The largest reduction in nausea occurred with 0.5g and 1.0g of ginger. Also, time of day had a significant effect on nausea (p<0.001) with a linear decrease over 24 hours for patients using ginger. Conclusions: Ginger supplementation at daily dose of 0.5g-1.0g significantly aids in reduction of nausea during the first day of chemotherapy. Supported by NCI PHS grants 1R25CA10618 and U10CA37420. No significant financial relationships to disclose.

scholarly journals CONCEPT OF POST OPERATIVE PAIN AND ITS MANAGEMENT IN AYURVEDA: A LITERATURE REVIEW

2021 ◽  
pp. 81-89
Author(s):  
Dhanokar C.A ◽  
Badwe Y.R
Keyword(s):  
Adverse Effect ◽  
Pain Management ◽  
Postoperative Pain ◽  
Literature Review ◽  
Intestinal Obstruction ◽  
Postoperative Pain Management ◽  
Management Measures ◽  
Post Operative Pain ◽  
The World ◽  
Made In

Adequate analgesia in postoperative period is an essential and humanitarian factor for faster recovery. Currently used analgesics are opioids and NSAIDs which have certain adverse effect. So there is need to search pain management measures from alternative science to minimise use of opioids and NSAIDs. Sushruta samhita (Sushruta’s compendium) is the oldest reference for surgery in the world. He did various surgeries including laprotomy for intestinal obstruction, perforation, rhinoplasty, cataract and so many minor surgeries like cyst, lipoma etc removal thousand years back. Certainly he managed postoperative pain also. An effort is made in this article to explore Sushruta concept of postoperative pain and its management. Also currently available online articles regarding postoperative pain management in Ayurveda are searched. By using Ayurvedic protocols, polyherbal formulations effective pain management is possible and use of NSAIDs and opioids can be minimised.

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