scholarly journals Analgesic Effects of Pre-induction Low-dose Ketamine on Post-tonsillectomy Patients

2018 ◽  
Vol 8 (2) ◽  
pp. 74-79
Author(s):  
Muhammad Delwar Hussain ◽  
Md Torab Mallick ◽  
Mohammad Kamal Hossain
Keyword(s):  
Pain Intensity ◽  
General Anaesthesia ◽  
Analgesic Effect ◽  
Low Dose ◽  
Demographic Data ◽  
Operation Time ◽  
Patient Comfort ◽  
Military Hospital ◽  
Control Group ◽  
Post Operative Pain

Background: Post-operative pain management aims to decrease pain intensity with patient comfort and to improve post-operative outcome. Multimodal analgesia is currently recommended for effective post-operative pain control with lower total doses of analgesics and fewer side effects.Objective: To compare the analgesic effect of pre-induction low-dose ketamine against conventional general anaesthesia.Materials and Methods: This prospective comparative study was conducted over a period of 12 months at Combined Military Hospital, Dhaka. Two hundred and forty patients of either sex requiring tonsillectomy were divided into two groups: conventional general anaesthesia (control group) and general anaesthesia with low-dose ketamine (ketamine group). Non-invasive blood pressure, heart rate and SpO2 were recorded at regular intervals throughout the anaesthetic period. Post-operative analgesia was provided for both the groups using pethidine intramuscularly. Time to complete operation, pain intensity, time to request for first analgesia were noted and total opioid consumption and complications, if any occurred in 24 hours post-operatively, were also recorded and addressed accordingly.Results: The demographic data and mean operation time were similar in both the groups (p>0.05).Time to request for first analgesia was longer in lowdose ketamine group (mean ± SD 5.36±3.21 hours) than in control group (mean ± SD 2.49±1.53 hours) (p<0.05). Total dosage of pethidine consumption over 24 hours period was less in ketamine group with satisfactory pain relief (mean ± SD 98.73±2.60 mg) than in control group (mean ± SD 142.52±3.48 mg) (p<0.05). Post-operative complications were also less in ketamine group than control group (p<0.05).Conclusion: The result of this study suggests that pre-induction low-dose ketamine has pre-emptive analgesic effect and reduces overall post-operative opioid requirements.J Enam Med Col 2018; 8(2): 74-79

scholarly journals Effect of acupuncture TENS versus conventional TENS on post cesarean section incision pain

2018 ◽  
Vol 7 (9) ◽  
pp. 3738
Author(s):  
Priti A. Mehendale ◽  
Mayur T. Revadkar
Keyword(s):  
Pain Intensity ◽  
Rating Scale ◽  
Control Group ◽  
P Value ◽  
Random Allocation ◽  
Lower Segment Caesarean Section ◽  
Post Operative Pain ◽  
Group A ◽  
Group B ◽  
Pain Rating Scale

Background: There is evidence regarding beneficial use of Transcutaneous Electrical Nerve Stimulation (TENS) on post Lower Segment Caesarean Section (LSCS) incision pain. However, efficacy of different types of TENS following C section pain has not yet been explored adequately.Methods: 96 women who had recently undergone LSCS were included for the study. The subjects were in the age group of 20 to 40 years (25.84±3.96); having pain intensity 4 or more on Numerical Pain Rating Scale (NPRS). They were divided into three groups by random allocation method; namely Group A: Acupuncture (Low/Motor) TENS, Group B: Conventional (High/Sensory) TENS and Group C: Control group. Group A and B received specific type of TENS twice a day for 15 minutes. Control group C did not receive any TENS intervention. All subjects received standard post-operative medications and physiotherapy. Pain intensity was recorded on NPRS pre and post intervention.Results: Both Acupuncture TENS and Conventional TENS significantly decreased post-operative pain intensity as compared to control group (p value <0.0001).Conclusions: Both, acupuncture and conventional TENS are equally effective in reducing post LSCS incision pain at a strong and non-painful intensity.

scholarly journals Prospective study on standard and totally tubeless percutaneous nephrolithotomy

2019 ◽  
Vol 6 (11) ◽  
pp. 3972
Author(s):  
V. Vishnu Vardhana Reddy ◽  
Amar Kumar Repaka
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Elective Surgery ◽  
Demographic Data ◽  
Operation Time ◽  
Patient Comfort ◽  
Standard Group ◽  
Early Return ◽  
Significant Difference ◽  
Analgesia Requirement ◽  
Tubeless Percutaneous Nephrolithotomy

Background: With the improvement of instrumentation and experience of percutaneous nephrolithotomy (PCNL), several modifications to the procedure have taken place in order to reduce the morbidity and early return to normal lifestyle. This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques.Methods: It is a prospective randomized, clinical trial done on 60 patients was patients older than 20 years and younger than 60 years who were chosen for elective surgery of kidney stones via the PCNL technique. Patients were divided into two groups, standard PCNL (with a nephrostomy tube) and totally tubeless PCNL (no ureter stents or ureteric catheters).Results: Demographic data is matched in two groups of patients. The mean operation time was slightly longer in the standard group (108 minutes) than in the totally tubeless group (102 minutes), but there was no statistically significant difference. There was no significant difference between the two groups with regard to serum creatinine change or blood loss. Haemoglobin drop, hospital stay, Pain score and analgesia requirement was significantly less in the totally tubeless group. 4 patients in each group had bleeding postoperatively. Only five patients developed pyrexia in the postoperative period. The differences in the need for blood transfusion and postoperative pyrexia were not found to be statistically significant. 19 in standard group and 2 patients in totally tubeless group developed urine leak, found to be statistically significant.Conclusions: Author can conclude that the tubeless procedure has fewer complications, improved postoperative patient comfort, shorter hospitalization, and a reduced need for analgesics. 

scholarly journals Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost–utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055351
Author(s):  
Ariadna Colomer-Carbonell ◽  
Juan P Sanabria-Mazo ◽  
Halbert Hernández-Negrín ◽  
Xavier Borràs ◽  
Carlos Suso-Ribera ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Low Dose ◽  
Cost Utility ◽  
Phase Iii ◽  
Control Group ◽  
Phase Iii Trial ◽  
Life Years ◽  
Double Blinded ◽  
Ecological Momentary ◽  
Low Dose Naltrexone

IntroductionThere is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost–utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up.Methods and analysisA single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured.Ethics and disseminationThis study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities.Trial registration numberNCT04739995.

scholarly journals A Randomised Controlled Study to Evaluate Efficacy of the Landmark Guided Erector Spinae Plane Block for Postoperative Pain in Percutaneous Nephrolithotomy Surgeries in Kolhapur District in Western Maharashtra

2021 ◽  
Vol 8 (20) ◽  
pp. 1559-1564
Author(s):  
Rashmee Vijay Chavan ◽  
Archita Rajaram Patil ◽  
Anupama Deepak Sahasrabudhe ◽  
Aarati Bhaskar Jadhav ◽  
Prithiv Rishardhan Prabhakaran
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
General Anaesthesia ◽  
Percutaneous Nephrolithotomy ◽  
Erector Spinae ◽  
Control Group ◽  
Study Group ◽  
Vas Score ◽  
Erector Spinae Plane Block ◽  
Post Operative Pain

BACKGROUND Post-operative pain and discomfort is a common side effect of percutaneous nephrolithotomy (PCNL) surgery. The study intended to evaluate the efficacy of landmark guided erector spinae plane block (ESPB) in early post-operative pain relief following (PCNL) surgery. METHODS In this randomised prospective, single blind, interventional study, 70 patients aged 20 - 60 years of ASA grade I and II, scheduled for elective percutaneous nephrolithotomy (PCNL) surgery under general anaesthesia were included. Patients were randomly allotted into two groups of 35 each. Group 1 was the control group and received parenteral analgesia according to institutional protocol for postoperative pain relief. Group 2 was the study group and received landmark guided erector spinae plane block (ESPB) with 20 cc of 0.25 % bupivacaine for postoperative pain relief. Post-operatively patients were monitored for pain and Visual Analogue Scale (VAS) score was noted at 2nd, 4th and 6th hr and was maintained below 4 by providing them with additional analgesics if required. Time and doses of analgesics required were recorded. RESULTS All the statistical analysis was done using R-Studio 1.2.5001 software. MannWhitney-U test was used for quantitative variables of pain score. Proportion test was used for qualitative demographic data and for post-operative analgesics requirement. Both the groups were comparable on demographic variables. The average VAS score at 2nd and 4th hr was significantly lower in the study group than in the control group (P < 0.05). The VAS score at 6th hr was comparable in both the groups. The analgesic requirement was significantly lower in study group as compared to the control group. CONCLUSIONS The landmark guided ESPB is an effective and simple method to alleviate immediate postoperative pain in PCNL surgeries under general anaesthesia. KEYWORDS Erector Spinae Plane Block, Percutaneous Nephrolithotomy Surgery, Postoperative Pain

scholarly journals The Effect of Adding Low-Dose Naloxone to Intrathecal Morphine on Postoperative Pain and Morphine Related Side Effects after Cesarean Section: A Double-Blind, Randomized, Clinical Trial

2019 ◽  
Vol 7 (23) ◽  
pp. 3979-3983 ◽  
Author(s):  
Saloumeh Peivandi ◽  
Mohammad Reza Habibi ◽  
Afshin Gholipour Baradari ◽  
Abdolmajid Gholinataj ◽  
Ali Habibi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Spinal Anaesthesia ◽  
Postoperative Nausea ◽  
Low Dose ◽  
Intrathecal Morphine ◽  
Control Group ◽  
Study Group ◽  
Double Blind

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 μg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

scholarly journals Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 226 ◽  
Author(s):  
Beatriz Nistal-Nuño ◽  
Enrique Freire-Vila ◽  
Francisco Castro-Seoane ◽  
Manuel Camba-Rodriguez
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Low Dose ◽  
Randomized Study ◽  
Colon Surgery ◽  
Morphine Consumption ◽  
Control Group ◽  
Hemodynamic Parameters ◽  
Rescue Analgesia

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery.Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kgˉ¹∙hˉ¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.Results: No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05).Conclusions: Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.

Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial

2020 ◽  
pp. 175045892091263
Author(s):  
Yanipan Chungsamarnyart ◽  
Jiranun Pairart ◽  
Sithapan Munjupong
Keyword(s):  
Clinical Trial ◽  
General Anaesthesia ◽  
Low Dose ◽  
Randomised Clinical Trial ◽  
Control Group ◽  
Significant Difference ◽  
Comparison Groups

Background Coughing and laryngospasm are undesirable consequences occurring when patients awaken from general anaesthesia. The objective of the study aimed to compare the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm. Methods In all, 120 patients scheduled surgery under general anaesthesia were randomly assigned into three groups. Patients in the control group (C-group) obtained intravenous 0.9% NaCl, while patients in the propofol group (P-group) obtained intravenous 0.25mg/kg propofol and patients in the propofol combined with ketamine group (PK-group) obtained intravenous 0.25mg/kg of propofol plus 0.15mg/kg of ketamine. Drugs were administered before extubation. Incidence and severity of coughing and laryngospasm were recorded by a blinded anaesthesiologist. Results Subjects of the PK-group (25%) experienced significantly reduced incidence of postoperative cough than that in the P-group (55%) and C-group (72.5%) (all P < 0.05). The severity of cough in the PK-group was significantly less than that in the P-group and C-group (P = 0.039 and P < 0.001, respectively). No significant difference was found in the incidence and severity of laryngospasm between comparison groups. Conclusion Intravenous combination of propofol and low-dose ketamine significantly reduced the incidence and severity among patients awakening from general anaesthesia.

scholarly journals Pain and Vomiting after Vitreoretinal Surgery: A Potential Role for Local Anaesthesia

1995 ◽  
Vol 23 (4) ◽  
pp. 444-448 ◽  
Author(s):  
N. Williams ◽  
A. Strunin ◽  
W. Heriot
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Potential Role ◽  
Neuromuscular Block ◽  
Operating Time ◽  
Vitreoretinal Surgery ◽  
Patient Comfort ◽  
Anaesthetic Technique ◽  
Control Group ◽  
Postoperative Vomiting

Periconal local anaesthesia with subtenon supplementation was used to provide anaesthesia for 94 patients having vitreoretinal surgery. Of these, 44 patients also received general anaesthesia with neuromuscular block. None of these patients received opioid or antiemetic before or during surgery. In comparison with a retrospective control group, patients who had received local anaesthesia as part of their anaesthetic technique were less likely to be given a parenteral opioid (P< 0.001) or to vomit (P<0.001) within six hours of the completion of surgery. They also experienced significantly fewer bradycardic episodes during surgery (P=0 001). For patients having general anaesthesia, administration of an intraoperative antiemetic reduced the incidence of vomiting within six hours of the completion of surgery (P=0.008). For patients who did not receive local anaesthetic, shorter operating time was a factor associated with both reduced postoperative vomiting (P=0.0015) and administration of parenteral opioid (P=0.0014). It is suggested that the use of local anaesthesia as part of the anaesthetic technique for vitreoretinal surgery is associated with improved patient comfort.

scholarly journals Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

2005 ◽  
Vol 2 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Taras I. Usichenko ◽  
Maria Hermsen ◽  
Torsten Witstruck ◽  
Andre Hofer ◽  
Dragan Pavlovic ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Analogue Scale ◽  
Knee Arthroscopy ◽  
Auricular Acupuncture ◽  
Control Group ◽  
Acupuncture Points ◽  
Analgesic Requirement ◽  
Post Operative Pain ◽  
Analgesic Medication

Auricular acupuncture (AA) is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points) or sham procedure (three non-acupuncture points on the auricular helix) before ambulatory knee arthroscopy. Permanent press AA needles were retainedin situfor one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg,P= 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

scholarly journals 17. Comparison of analgesic effect of infusion of low dose ketamine and dexmedetomidine on post-operative pain in spine surgery

2014 ◽  
Author(s):  
Nidhi Panda ◽  
Neha Garg ◽  
Y. Batra ◽  
Hemant Bhagat ◽  
R. Chabra
Keyword(s):  
Spine Surgery ◽  
Analgesic Effect ◽  
Low Dose ◽  
Post Operative Pain
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