scholarly journals Dexmedetomidine as an Opioid-Sparing Agent in Pediatric Craniofacial Surgery

Children ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. 68
Author(s):  
Srijaya Reddy ◽  
Jacob Jones ◽  
Heather Gordish-Dressman ◽  
Sophie Pestieau
Keyword(s):  
Side Effects ◽  
Reconstructive Surgery ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Pain Modulation ◽  
Craniofacial Surgery ◽  
Nausea And Vomiting ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Pain Scores

Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings.

scholarly journals Effects of auriculotherapy for postoperative nausea and vomiting: A systematic review protocol

2021 ◽  
Author(s):  
Isabella Boechat Faria Santos ◽  
Amanda Suzane Alves da Silva ◽  
Giovana Salomão Melo ◽  
Cleuma Oliveira Soares ◽  
Edila Monteiro de Andrade ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Conclusive Evidence ◽  
Nausea And Vomiting ◽  
Electrolyte Imbalance ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Auricular Acupuncture

Abstract Background Postoperative nausea and vomiting (PONV) is a distressing complication of anesthesia and can lead to aspiration, dehydration, and electrolyte imbalance. Antiemetic agents are conventionally prescribed to manage PONV; however, they have associated side effects. Therefore, unconventional methods, such as auricular acupuncture (AA), are also utilized to prevent and control emesis after surgery. AA originated in traditional Chinese medicine and is based on a diagnostic and treatment system that aims to normalize dysfunction through stimulation of reflex points on the ear. The aim of this study is to evaluate the effects of AA in controlling PONV. Methods We will perform a systematic review according to the Cochrane methodology. An overall search strategy will be developed and adapted for PubMed, PEDro, the Virtual Health Library, SciELO, EMBASE, the Web of Science, SciVerse Scopus, and the Cochrane Library to search for the following descriptors: “Acupressure”; “Antiemetics”; “Postoperative nausea and vomiting”; “Surgery”; “Auriculotherapy”; “Nausea”; “Vomiting”; and “Postoperative period.” Articles with a mean score of 6 ± 1.5 on the PEDro scale will be evaluated. The size of the intervention effect (Z) will be calculated for each outcome included in this review. The primary outcome will be the incidence of PONV. The secondary outcome will be the severity of PONV. Quality assessment will be performed with the Cochrane instrument. If possible, a meta-analysis will be performed using Review Manager 5.3 software. Discussion Several studies have reported positive outcomes of AA for patients with PONV. This study could provide robust and conclusive evidence of the usefulness of AA as an effective treatment alternative for emesis without the side effects of conventional medication. Trial registration Systematic review registration number: CRD42020149772 (S1 File)

scholarly journals Dezocine Prevents Postoperative Hyperalgesia in Patients Undergoing Open Abdominal Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fang Yu ◽  
Jie Zhou ◽  
Suyun Xia ◽  
Huan Xu ◽  
Xiangrui Wang
Keyword(s):  
Treatment Group ◽  
Abdominal Surgery ◽  
Pain Threshold ◽  
Controlled Trial ◽  
Thermal Hyperalgesia ◽  
Postoperative Nausea And Vomiting ◽  
Open Gastrectomy ◽  
Sham Treatment ◽  
Pain Scores ◽  
Open Abdominal Surgery

Objective. Postoperative hyperalgesia is very frequent and hard to treat. Dezocine is widely used and has a modulatory effect for thermal hyperalgesia in animal models. So, this study was designed to investigate the potential role of dezocine in decreasing postoperative hyperalgesia for patients undergoing open abdominal surgery.Methods. This is a randomized, double-blinded, and placebo-controlled trial. 50 patients for elective open gastrectomy were randomly allocated to either a true treatment group (0.15 mg/kg intravenous dezocine at the end of surgery) or a sham treatment group (equivalent volume of saline) in a 1 : 1 ratio. Patients were followed up for 48 hours postoperatively and pain threshold to Von Frey filaments, pain scores, PCIA consumption, rescue analgesics use, sedation score, and occurrence of postoperative nausea and vomiting were recorded.Results. Patients in the true treatment group experienced statistically significantly higher pain threshold on forearm and smaller extent of peri-incisional hyperalgesia than the sham treatment group. Rescue analgesic use, cumulative PCIA consumption, and pain scores were statistically significantly decreased in the true treatment group compared to the sham treatment group.Conclusions. Dezocine offers a significant antihyperalgesic and analgesic effect in patients undergoing elective open gastrectomy for up to 48 hours postoperatively.

scholarly journals Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting

2016 ◽  
Vol 10 (1) ◽  
pp. 505-511 ◽  
Author(s):  
Ran Schwarzkopf ◽  
Nimrod Snir ◽  
Zachary T. Sharfman ◽  
Joseph B. Rinehart ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Patient Care ◽  
Postoperative Nausea ◽  
Total Joint Replacement ◽  
Postoperative Nausea And Vomiting ◽  
Improve Patient Care ◽  
Immediate Release ◽  
Nausea And Vomiting ◽  
Pain Scores ◽  
Management Protocol ◽  
Post Operative Nausea

Background: A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol. Methods: All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs. GA) on these outcomes. The groups were compared using chi-square tests of proportions. Results: The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs. 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols. Conclusion: Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.

The Efficacy of Hypertonic Saline Nasal Irrigation for Chronic Sinonasal Symptoms

2005 ◽  
Vol 133 (1) ◽  
pp. 3-8 ◽  
Author(s):  
David Rabago ◽  
Thomas Pasic ◽  
Aleksandra Zgierska ◽  
Marlon Mundt ◽  
Bruce Barrett ◽  
...  
Keyword(s):  
Side Effects ◽  
Hypertonic Saline ◽  
Outcome Measures ◽  
Controlled Trial ◽  
Intervention Group ◽  
Community Setting ◽  
Adjunctive Treatment ◽  
Secondary Outcome ◽  
Nasal Irrigation ◽  
Sinonasal Symptoms

OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. STUDY DESIGN AND SETTING: The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinonasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 ± 2.6 points to 80.6 ± 2.4 points ( P < 0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 ± 3.9 points to 79.7 ± 3.7 points ( P < 0.05), SNOT-20 scores improved from 43.5 ± 5.7 points to 28.4 ± 4.8 points, and SIA scores improved from 4.2 ± 0.3 points to 2.6 ± 0.3 points ( P < 0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms.

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