scholarly journals Entonox® versus Pethidine in Labor Pain Relief: A Randomized Controlled Trial

2021 ◽  
Vol 18 (23) ◽  
pp. 12571
Author(s):  
Rasrawee Chantrasiri ◽  
Chanane Wanapirak ◽  
Theera Tongsong
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Rating Scale ◽  
Controlled Trial ◽  
Satisfaction Score ◽  
Labor Pain ◽  
P Value ◽  
Group 4 ◽  
Pain Scores ◽  
Secondary Outcomes

Background: Pain relief during labor is a part of standard care in modern obstetrics. Several modalities used for pain relief have their own disadvantages and benefits in terms of side effects, effectiveness, availability, and satisfaction. The objectives of this study are primarily to compare the effectiveness and patients’ satisfaction for pain relief during labor between pethidine and inhaled 50% nitrous oxide (Entonox®). Methods: Laboring women at 37–41 + 6 weeks of gestation were randomly allocated to receive pethidine (50 mg intravenously) or Entonox® for reducing labor pain. Pain scores were evaluated at 0, (baseline), 30, 60, 90, and 120 min after initiation, using the visual analog scale (VAS) and also satisfaction score after delivery using the verbal rating scale (VRS). The secondary outcomes were also assessed, including APGAR scores, labor course, side effects, and cesarean section rate. Results: A total of 136 laboring women underwent randomization into two groups, but only 58 and 65 in the pethidine group and the Entonox® group were available for analysis. The median pain scores at baseline, 30, 60, and 90 min were comparable between both groups (p-value > 0.05); however, pain score at 120 min in the pethidine group was significantly higher (p-value: 0.038). The median of satisfaction score was significantly higher in the Entonox® group (4 vs. 3; p-value 0.043). All of the secondary outcomes were comparable between the two groups. Conclusions: Both have comparable effectiveness, but Entonox® has a higher satisfaction score. Entonox® could be an alternative to pethidine for reducing labor pain, because of its efficacy, ease for self-adjustment for satisfaction, and no serious effects on the labor course and newborns.

scholarly journals Effectiveness of tramadol compared to pentazocine in pain management during labour

2021 ◽  
Vol 8 (9) ◽  
pp. 4216
Author(s):  
Bushra Bano ◽  
Kalavanti Bai ◽  
Shaista Jumani ◽  
Noreen Bashir ◽  
Humaira Mohsin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Rating Scale ◽  
Medical Center ◽  
Controlled Trial ◽  
Labour Pain ◽  
Labor Pain ◽  
Tramadol Hydrochloride ◽  
Visual Rating ◽  
Background Pain ◽  
Trial Drug

Background: Pain and agony during childbirth is quite often unbearable and at times beyond description. Pain relief can help in removing curb due to pain. To determine the efficacy of intramuscular tramadol hydrochloride as an analgesic during labor compared to those of pentazocine.Methods: This randomized controlled trial conducted at Jinnah post graduate medical center, ward 8 (Gynaecology and obstetrics) between 2nd December 2013 to 1st June 2014 after approval from the ethical committee of the hospital. Pregnant women aged 15 to 45 years, parity ≥1 with Gestational age between 37 to 42 weeks with a single fetus were included in this study. The subjects fulfilling inclusion criteria were enrolled after informed consent. Women were allocated randomly to pentazocine or tramadol. Labour pain was assessed immediately by 4-point visual rating scale before, at 30, and 60 minutes after injection of the trial drug and mean score was calculated. The data was analysed using SPSS version 20.Results: A total of 128 patients were randomized to ether tramadol or pentazocine. The mean age of enrolled participants is 30±7.01 years and 53.1% participants were below 30 years of age. Of 64 patients who received tramadol, 53 (82.8%) had pain relief compared to 39 (60.9%) in patient who received pentazocine (p=0.005).Conclusions: It is concluded from this study that tramadol is more effective in reducing labor pain

scholarly journals Communicating personalised statin therapy-effects as 10-year CVD-risk or CVD-free life-expectancy: does it improve decisional conflict? Three-armed, blinded, randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e041673
Author(s):  
Nicole E M Jaspers ◽  
Frank L J Visseren ◽  
Yolanda van der Graaf ◽  
Yvo M Smulders ◽  
Olga C Damman ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomised Controlled Trial ◽  
Life Expectancy ◽  
Statin Therapy ◽  
Controlled Trial ◽  
Decisional Conflict ◽  
P Value ◽  
Cvd Risk ◽  
Secondary Outcomes ◽  
Randomised Controlled

ObjectiveTo determine whether communicating personalised statin therapy-effects obtained by prognostic algorithm leads to lower decisional conflict associated with statin use in patients with stable cardiovascular disease (CVD) compared with standard (non-personalised) therapy-effects.DesignHypothesis-blinded, three-armed randomised controlled trialSetting and participants303 statin users with stable CVD enrolled in a cohortInterventionParticipants were randomised in a 1:1:1 ratio to standard practice (control-group) or one of two intervention arms. Intervention arms received standard practice plus (1) a personalised health profile, (2) educational videos and (3) a structured telephone consultation. Intervention arms received personalised estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (ie, atorvastatin 80 mg). Intervention arms differed in how these changes were expressed: either change in individual 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group) calculated with the SMART-REACH model (http://U-Prevent.com).OutcomePrimary outcome was patient decisional conflict score (DCS) after 1 month. The score varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at 1 or 6 months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomisation low-density lipoprotein cholesterol level and physician opinion of the intervention. Outcomes are reported as median (25th– 75th percentile).ResultsDecisional conflict differed between the intervention arms: median control 27 (20–43), iAR-group 22 (11–30; p-value vs control 0.001) and iLE-group 25 (10–31; p-value vs control 0.021). No differences in secondary outcomes were observed.ConclusionIn patients with clinically manifest CVD, providing personalised estimations of treatment-effects resulted in a small but significant decrease in decisional conflict after 1 month. The results support the use of personalised predictions for supporting decision-making.Trial registrationNTR6227/NL6080.

scholarly journals THE EFFECT OF ACUPRESSURE AND EFFLEURAGE ON PAIN RELIEF IN THE ACTIVE PHASE OF THE FIRST STAGE OF LABOR IN THE COMMUNITY HEALTH CENTER OF KAWUNGANTEN, CILACAP, INDONESIA

2017 ◽  
Vol 3 (5) ◽  
pp. 508-514
Author(s):  
Yuli Sya’baniah Khomsah ◽  
Agus Suwandono ◽  
Ida Ariyanti
Keyword(s):  
Community Health ◽  
Health Center ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Community Health Center ◽  
Active Phase ◽  
Labor Pain ◽  
Control Group ◽  
P Value ◽  
First Stage Of Labor

Background: Pain during pregnancy and childbirth is a physiological process, but it leads to discomfort without pain management. Acupressure and effleurage are considered to be effective in reducing labor pain.Objective: To examine the effect of acupressure and effleurage in reducing pain during in the active phase of the first stage of labor in the community health center of Kawunganten, Cilacap regency.Methods: This was a quasi-experimental study with pretest-posttest control group design. There were 33 respondents recruited using simple random sampling. Numerical rating scale was used to measure labor pain. Data were analyzed using one way anova, Post hoc anova and repeated anova for normal data distribution. Kruskal Wallis was also used for non-normal data distribution.Results: There was a statistically significant mean difference of pain scale before and after given acupressure and effleurage (p-value <0.05). However, acupressure treatment had a greater effect  in reducing pain compared with effleurage.Conclusion: Acupressure and efflurage had a significant effect in reducing pain in mothers in the active phase of the first stage of labor. The results of this study are expected to enrich and contribute to the development of science in the field of health promotion, and  serve as an additional input for midwives in order to carry out the care of mother during labor.

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 Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability

2017 ◽  
Vol 103 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Jeremy R Parr ◽  
Emma Todhunter ◽  
Lindsay Pennington ◽  
Deborah Stocken ◽  
Jill Cadwgan ◽  
...  
Keyword(s):  
Side Effects ◽  
Controlled Trial ◽  
Symptom Control ◽  
Randomised Trial ◽  
Frequency Scale ◽  
Skin Patch ◽  
Impact Scale ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Randomised Controlled

ObjectiveInvestigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability.DesignMulticentre, single-blind, randomised controlled trial.SettingRecruitment through neurodisability teams; treatment by parents.ParticipantsNinety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management.InterventionChildren were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks.Primary and secondary outcomesPrimary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment.ResultsBoth medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95).ConclusionsHyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation.Trial registration numbersISRCTN75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003

A Controlled Trial of Extended-Release Guanfacine and Psychostimulants on Executive Function and ADHD

2018 ◽  
Vol 24 (2) ◽  
pp. 318-325 ◽  
Author(s):  
Judy P. M. van Stralen
Keyword(s):  
Executive Function ◽  
Adverse Events ◽  
Extended Release ◽  
Rating Scale ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
P Value ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Stimulant Therapy

Objective: To evaluate the effectiveness of guanfacine extended-release (GXR) versus placebo as adjunct therapy to usual care stimulant therapy in improving executive function in children aged 6 to 12 years diagnosed with ADHD. Method: In this single center, double-blind placebo-controlled crossover trial, subjects continued to take their psychostimulant and were randomly assigned at baseline to receive active treatment or placebo first. Efficacy measures included Behavioural Rating Inventory of Executive Function (BRIEF-P), ADHD Rating Scale IV (ADHD-RS IV), and Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) scales. Safety measures included adverse events and vital signs. Results: Significant benefits of GXR plus psychostimulant were observed on BRIEF-P ( p value = .0392), ADHD-RS-IV ( p < .0001), CGI-S ( p = .0007), and CGI-I ( p = .003). There were no serious adverse events and no new safety signals. Conclusion: Use of GXR as adjunctive therapy to stimulant therapy significantly improves executive function in children with ADHD.

The Effectiveness of Lavender (Lavendula Augustfolia) and Neroli (Citrus Aurantium) Aromatherapy Inhalation to Decrease Pain Labor

2020 ◽  
Vol 6 (1) ◽  
pp. 26-31
Author(s):  
Nurul Azizah ◽  
Rafhani Rosyidah ◽  
Hanik Machfudloh
Keyword(s):  
Labor Pain ◽  
P Value ◽  
Citrus Aurantium ◽  
Uterine Contractions ◽  
Pain Scores ◽  
Quasi Experimental ◽  
The Mean ◽  
Group 2 ◽  
Almost All ◽  
Postpartum Pain

Maternal labor will experience almost all body pain, such as painful ribs, stitches, abdominal pain due to uterine contractions, and discomfort in the back due to epidural needles, and this discomfort will last several days and can be overcome by prescription for painkillers. In this study aimed at carrying out non-famacological pain relief therapy, namely by using aromatherapy which is believed to reduce pain, this study tried to compare the effectiveness of lavender and neroli aromatherapy inhalation to decrease post-labor pain. The research method used quasi-experimental that is given aromatherapy lavender (Lavendula Augustfolia) and neroli (Citrus Aurantium) inhalation treatments. The number of respondents was 60 with 1-2 days of normal and postpartum criteria, each group consisted of 30 respondents. Group 1 was held at the Pearl Delta Clinic RB and group 2 in the Karunia RB Clinic. Data were analyzed by univariable by using mean and standard deviation, bivariable with statistical test independent sample T test. The results of this study showed a mean reduction in pain scores on lavender aromatherapy inhalation of 2.36 ± 0.15, whereas in the aromatherapy neroli inhalation group the mean reduction in pain score was 3.03 ± 0.067 with a P value <0.002 indicating a significant relationship. The conclusion of this study is the inhalation of lavender aromatherapy (LavendulaAugustfolia) and neroli (Citrus Aurantium) can reduce the intensity of postpartum pain, but in the aromatherapy neroli inhalation group has a greater pain reduction score than the lavender group. 

Magnesium Sulphate for Seizure Prophylaxis in Women With Preeclampsia

2021 ◽  
pp. 1-6
Author(s):  
Peter Lindner ◽  
Shad Deering
Keyword(s):  
Side Effects ◽  
High Risk ◽  
Randomized Trial ◽  
Magnesium Sulphate ◽  
Neonatal Death ◽  
Maternal Morbidity ◽  
Controlled Trial ◽  
Before And After ◽  
Secondary Outcomes ◽  
High Risk Cohort

The article “Do Women With Pre-Eclampsia, and Their Babies, Benefit From Magnesium Sulphate? The Magpie Trial: A Randomized Placebo-Controlled Trial” is the first randomized trial that objectively evaluates the utility of magnesium sulphate therapy as prophylaxis against progression to eclamptic convulsions in a high-risk cohort of women. It specifically evaluates the effect of magnesium sulphate given before and after delivery on maternal progression to eclampsia and fetal/neonatal death. It also evaluates secondary outcomes such as maternal morbidity; magnesium toxicity; side effects of magnesium sulphate; and, for those who received magnesium sulphate prior to delivery, it evaluated complications of the labor process.

A 6-months, randomised, placebo-controlled evaluation of efficacy and tolerability of a low-dose 7-day buprenorphine transdermal patch in osteoarthritis patients naïve to potent opioids

2010 ◽  
Vol 1 (3) ◽  
pp. 122-141 ◽  
Author(s):  
Harald Breivik ◽  
Tone Marte Ljosaa ◽  
Kristian Stengaard-Pedersen ◽  
Jan Persson ◽  
Hannu Aro ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Low Dose ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Double Blind Study ◽  
Double Blind ◽  
Skin Reactions ◽  
Local Skin

AbstractObjectivePatients with osteoarthritis (OA) pain often have insufficient pain relief from non-opioid analgesics. The aim of this trial was to study efficacy and tolerability of a low dose 7-day buprenorphine transdermal delivery system, added to a NSAID or coxib regimen, in opioid-naïve patients with moderate to severe OA pain.MethodsA 6 months randomised, double-blind, parallel-group study at 19 centres in Denmark, Finland, Norway, and Sweden, in which OA patients (>40 years) with at least moderate radiographic OA changes and at least moderate pain in a hip and/or knee while on a NSAID or a coxib were randomised to a 7-day buprenorphine patch (n = 100) or an identical placebo patch (n = 99). The initial patch delivered buprenorphine 5 μg/h. This was titrated to 10 or 20 μg/h, as needed. Rescue analgesic was paracetamol 0.5–4 g daily. Statistical analysis of outcome data was mainly with a general linear model, with treatment as factor, the primary joint of osteoarthritis, baseline scores, and season as covariates.ResultsMost patients had OA-radiographic grade II (moderate) or grade III (severe), only 8 in each group had very severe OA (grade IV). The median buprenorphine dose was 10 μg/h. 31 buprenorphine-treated patients and 2 placebo-treated patients withdrew because of side effects. Lack of effect caused 12 placebo-treated and 7 buprenorphine-treated patients to withdraw. The differences in effects between treatments: Daytime pain on movement, recorded every evening on a 0–10 numeric rating scale decreased significantly more (P = 0.029) in the buprenorphine group. Patients’ Global Impression of Change at the end of the double blind period was significantly improved in the buprenorphine group (P = 0.017). The chosen primary effect outcome measure, the Western Ontario and McMaster Universities (WOMAC) OA Index for Pain (P = 0.061), and secondary outcome measures, the WOMAC OA score for functional abilities (P = 0.055), and the WOMAC total score (P = 0.059) indicated more effects from buprenorphine than placebo, but these differences were not statistically significant. In a post-hoc, subgroup analysis with the 16 patients with radiographic grad IV (very severe) excluded, WOMAC OA Index for Pain was significantly (P = 0.039) reduced by buprenorphine, compared with placebo. WOMAC OA score for stiffness and the amount of rescue medication taken did not differ. Sleep disturbance, quality of sleep, and quality of life improved in both groups. Side effects: Typical opioid side effects caused withdrawal at a median of 11 days before completing the 168 days double blind trial in 1/3 of the buprenorphine group. Mostly mild local skin reactions occurred equally often (1/3) in both groups.ConclusionsAlthough the 24 hours WOMAC OsteoArthritis Index of pain was not statistically significantly superior to placebo, day-time movement-related pain and patients’ global impression of improvement at the end of the 6-months double blind treatment period were significantly better in patients treated with buprenorphine compared with placebo. Opioid side effects caused 1/3 of the buprenorphine-patients to withdraw before the end of the 6-months double blind study period.ImplicationsA low dose 7-days buprenorphine patch at 5–20 μg/h is a possible means of pain relief in about 2/3 of elderly osteoarthritis patients, in whom pain is opioid-sensitive, surgery is not possible, NSAIDs and coxibs are not recommended, and paracetamol in tolerable doses is not effective enough. Vigilant focus on and management of opioid side effects are essential.

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.

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