scholarly journals Analgesic Effect of Nalbuphine When Added to Intravenous Regional Anesthesia: A Randomized Control Trial

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. 575-581
Author(s):  
Sayed Kaoud Abd-Elshafy
Keyword(s):  
Postoperative Pain ◽  
Adverse Events ◽  
Regional Anesthesia ◽  
Recovery Time ◽  
Onset Time ◽  
Controlled Clinical Trial ◽  
University Hospitals ◽  
Double Blind ◽  
Intravenous Regional Anesthesia ◽  
Cortisol Levels

Background: Different adjuvant drugs are currently added to lidocaine for intravenous regional anesthesia (IVRA) to decrease tourniquet and postoperative pain. Objective: The aim of the study was to examine the effect of nalbuphine when added to IVRA. Study Design: Prospective, randomized, double-blind, controlled clinical trial. Setting: Assiut University Hospitals. Methods: One hundred-six adult patients scheduled for unilateral hand surgery under IVRA were randomized into 2 equal groups. The lidocaine-nalbuphine (LN) group received nalbuphine plus lidocaine and the lidocaine (L) group received lidocaine. A tourniquet and postoperative pain were assessed using a visual analogue scale (VAS). The following parameters were measured: onset and recovery time for both sensory and motor blocks, intra- and postoperative analgesic consumption, time to first analgesic request, postoperative nausea and/or vomiting (PONV), hemodynamics, and cortisol levels. Results: Early tourniquet and postoperative pain were significantly lower in the LN group. The onset time for both sensory and motor blocks was significantly shorter in the LN group. In addition, the recovery time for both sensory and motor blocks was longer in the LN group. Intra- and postoperative fentanyl consumption was significantly lower in the LN group with no significance in postoperative diclofenac consumption. The patient first analgesic request was significantly delayed in the LN group (P < 0.0001). There were no significant differences between the 2 groups in PONV, hemodynamic parameters abnormalities, medications adverse events or cortisol levels. Limitations: The inclusion of a study group in which the nalbuphine administered systemically could determine whether its beneficial effects were due to its local or systemic action. Conclusions: Nalbuphine decreases early tourniquet and postoperative pain after IVRA and delays the need for analgesic rescue. In addition, nalbuphine accelerates the onset and prolongs the recovery time for both sensory and motor blocks with no significant adverse events. However, it has no effect on postoperative cortisol levels. Key words: Intravenous, regional anesthesia, lidocaine, nalbuphine, pain, postoperative

scholarly journals Effects of Addition of Systemic Tramadol or Adjunct Tramadol to Lidocaine Used for Intravenous Regional Anesthesia in Patients Undergoing Hand Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Abdulkadir Yektaş ◽  
Funda Gümüş ◽  
Abdulhalim Karayel ◽  
Ayşin Alagöl
Keyword(s):  
Regional Anesthesia ◽  
Recovery Time ◽  
Motor Block ◽  
Onset Time ◽  
Hand Surgery ◽  
Cost Effective ◽  
Analgesic Requirement ◽  
Intravenous Regional Anesthesia ◽  
Clinical Benefits ◽  
American Society

Intravenous regional anesthesia (IVRA) is used in outpatient hand surgery as an easily applicable and cost-effective technique with clinical advantages. The present study aimed to investigate the effects of addition of systemic tramadol or adjunct tramadol to lidocaine for IVRA in patients undergoing hand surgery. American Society of Anesthesiologists (ASA) I-II patients (n=60) who underwent hand surgery were included. For this purpose, only lidocaine (LDC), lidocaine+adjunct tramadol (LDC+TRA group), or lidocaine+systemic tramadol (LDC+SysTRA group) was administered to the patients for IVRA and the groups were compared in terms of onset and recovery time of sensory and motor blocks, quality of anesthesia, and the degree of intraoperative and postoperative pain. The onset time of sensorial block was significantly shorter in the LDC+TRA group than that in the LDC+SysTRA group. The motor block recovery time was significantly shorter in the LDC+SysTRA group than that in the LDC+TRA and LDC groups. Administration of tramadol as an adjunct showed some clinical benefits by providing a shorter onset time of sensory and motor block, decreasing pain and analgesic requirement, and improving intraoperative conditions during IVRA. It was determined that systemic tramadol administration had no superiority.

scholarly journals The Effect of Dexmedetomidine in Combination with Bupivacaine on Sensory and Motor Block Time and Pain Score in Supraclavicular Block

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Shahryar Sane ◽  
Shahram Shokouhi ◽  
Parang Golabi ◽  
Mona Rezaeian ◽  
Behzad Kazemi Haki
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Upper Extremity ◽  
Motor Block ◽  
Intervention Group ◽  
Onset Time ◽  
Double Blind ◽  
Old Patients ◽  
Arterial Blood ◽  
Supraclavicular Block

Background. Brachial plexus block is frequently recommended for upper limb surgeries. Many drugs have been used as adjuvants to prolong the duration of the block. This study aimed to assess the effect of dexmedetomidine with bupivacaine combination and only bupivacaine on sensory and motor block duration time, pain score, and hemodynamic variations in the supraclavicular block in upper extremity orthopedic surgery. Methods. This prospective, double-blind clinical trial study was conducted on 60 patients, 20 to 60 years old. Patients were candidates for upper extremity orthopedic surgeries. The sensory and motor block were evaluated by using the pinprick method and the modified Bromage scale. The postoperative pain was assessed by utilizing a visual analog scale. Results. The mean onset time of sensory and motor block in patients receiving only bupivacaine was, respectively, 31.03 ± 9.65 min and 24.66 ± 9.2 min, and in the dexmedetomidine receiving group, it was about 21.36 ± 8.34 min and 15.93 ± 6.36 minutes. The changes in heart rate and mean arterial blood pressure were similar in both groups. The duration of sensory and motor block and the time of the first analgesia request in the intervention group were longer. Postoperative pain was lower in the intervention group for 24 hours ( P  = 0.001). Conclusion. Dexmedetomidine plus bupivacaine reduced the onset time of sense and motor blocks and increased numbness and immobility duration. Also, dexmedetomidine reduced postoperative pain significantly with the use of bupivacaine for supraclavicular blocks. Trial Registration. IRCT, IRCT20160430027677N15. Registered 05/28/2019, https://www.irct.ir/trial/39463.

A comparison of intranasal dexmeditomidine versus intranasal midazolam as a pre anesthetic medication in children undergoing adenotonsillectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nourhan M El Zoghby ◽  
Ahmed S Mohammed ◽  
Ahmed M El Hennawy ◽  
Ramy M Wahba
Keyword(s):  
Pediatric Patients ◽  
Controlled Clinical Trial ◽  
Physical Status ◽  
University Hospitals ◽  
Double Blind ◽  
Institutional Ethics ◽  
Pediatric Anesthesiologist ◽  
Important Concern ◽  
Anxiety Levels ◽  
Intranasal Midazolam

Abstract Background Adenotonsillectomy is one of the most common surgical procedures performed on pediatric patients. Relieving pre- and post-operative anxiety is an important concern for the pediatric anesthesiologist. Aim of the Work: to compare dexmedetomidine with midazolam effect on preoperative sedation, the ease of children parent separation, the mask tolerance, intraoperative hemodynamics stability, emergence of anesthesia and postoperative analgesia. Patients and Methods A Prospective, randomized and double blind controlled clinical trial was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include fifty pediatric patients, aged 5 to 10 years old of both genders, with physical status ASA Ι. Results statistically significant increase mean of Dexmedetomidine compared to midazolam according to sedation score after 15min. to after 45min. Conclusion Premedication with intranasal dexmedetomidine 1 μg/kg attained significant and satisfactory sedation with better parent separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam 0.2 mg/kg in children undergoing adenotonsillectomy.

Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial

2013 ◽  
Vol 127 (4) ◽  
pp. 383-391 ◽  
Author(s):  
A M A El-Fattah ◽  
E Ramzy
Keyword(s):  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Post Surgery ◽  
Scale Scores ◽  
Randomised Controlled ◽  
At Home

AbstractIntroduction:This double-blind, controlled, parallel-group study was designed to determine the efficacy of pre-emptive triple analgesia for paediatric post-tonsillectomy pain management.Materials and methods:One hundred and thirty-five children were randomised into two groups: pre-emptive triple analgesia (n = 55) and control (n = 80). Pain was assessed using a visual analogue scale (in hospital) and the Parent's Postoperative Pain Measure (at home), and scores recorded.Results:Visual analogue scale scores on awakening and for 6 hours post-surgery were significantly better in the study group than the control group (p < 0.05). The Parent's Postoperative Pain Measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia.Conclusion:The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.

Ropivacaine 0.2% and Lidocaine 0.5% for Intravenous Regional Anesthesia in Outpatient Surgery

2001 ◽  
Vol 95 (3) ◽  
pp. 627-631 ◽  
Author(s):  
Peter G. Atanassoff ◽  
Carlos A. Ocampo ◽  
Marcos Castro Bande ◽  
Maximilian W. B. Hartmannsgruber ◽  
Thomas M. Halaszynski
Keyword(s):  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Outpatient Surgery ◽  
Postanesthesia Care Unit ◽  
Double Blind Study ◽  
Double Blind ◽  
Lidocaine Group ◽  
Binding Effect ◽  
Pain Scores ◽  
Intravenous Regional Anesthesia

Background A longer-acting local anesthetic agent, such as ropivacaine, may offer advantages over lidocaine for intravenous regional anesthesia. The objectives of this study were to evaluate whether the findings of volunteer investigations with intravenous regional anesthesia with ropivacaine (which have shown prolonged analgesia after release of the tourniquet) translates into improved pain control after surgery. Methods With Human Investigation Committee approval and a double-blind study design, 20 healthy patients with American Society of Anesthesiologists physical status I or II classification who were scheduled to undergo forearm and hand surgery were randomly assigned to administration of 40 ml of either 0.2% ropivacaine or 0.5% lidocaine for intravenous regional anesthesia. Evidence of central nervous system side effects, such as lightheadedness, tinnitus, and metallic taste, as well as cardiac arrhythmias, were evaluated and treated (if necessary) after local anesthetic administration, before and during surgery, and after release of the tourniquet until discharge from the postanesthesia care unit. Regression of sensory anesthesia in the nerve distributions of the forearm and hand was recorded. Verbal numerical pain scores were monitored and quantified until the patients were discharged to home from the postanesthesia care unit. Patient pain scores, side effect profiles, time to first oral intake, and total amount of oral analgesics were recorded 24 h postoperatively. Results Intravenous regional anesthesia with 0.2% ropivacaine and 0.5% lidocaine provided equivalent levels of surgical anesthesia. After release of the tourniquet, the first evidence for return of sensation in the distribution of the five peripheral nerves occurred later in the ropivacaine group (median, 20 min; range, 15-40 min) than in the lidocaine group (median, 1 min; range, 1-25 min). Verbal numerical pain scores were significantly lower at the time of admission, whereas during the remainder of the postanesthesia care unit stay and later at home, the difference in verbal numerical pain scores between the two groups was no longer statistically significant. Conclusions Ropivacaine 0.2% may be an alternative to 0.5% lidocaine for intravenous regional anesthesia in the outpatient surgical setting. Longer-lasting analgesia in the immediate postoperative period may be due to a more profound and prolonged tissue binding effect of ropivacaine.

scholarly journals Study design of a randomised, placebo-controlled trial of nintedanib in children and adolescents with fibrosing interstitial lung disease

2021 ◽  
pp. 00805-2020
Author(s):  
Robin Deterding ◽  
Matthias Griese ◽  
Gail Deutsch ◽  
David Warburton ◽  
Emily M. DeBoer ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Adverse Events ◽  
Lung Disease ◽  
Children And Adolescents ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Life Questionnaire ◽  
Long Term Effects ◽  
Double Blind ◽  
Clinically Significant

IntroductionChildhood interstitial lung disease (chILD) comprises >200 rare respiratory disorders, with no currently approved therapies and variable prognosis. Nintedanib reduces the rate of forced vital capacity (FVC) decline in adults with progressive fibrosing ILDs. We present the design of a multicentre, prospective, double-blind, randomised, placebo-controlled clinical trial of nintedanib in patients with fibrosing chILD (1199-0337 or InPedILD™; ClinicalTrials.gov: NCT04093024).Methods and analysisMale or female children and adolescents aged 6–17 years (≥30; including ≥20 adolescents aged 12–17 years) with clinically significant fibrosing ILD will be randomised 2:1 to receive oral nintedanib or placebo on top of standard of care for 24 weeks (double-blind), followed by variable duration nintedanib (open-label). Nintedanib dosing will be based on body weight-dependent allometric scaling, with single-step dose reductions permitted to manage adverse events. Eligible patients will have evidence of fibrosis on high-resolution computed tomography (within 12 months of their first screening visit), FVC ≥25% predicted, and clinically significant disease (Fan score of ≥3 or evidence of clinical progression over time). Patients with underlying chronic liver disease, significant pulmonary arterial hypertension, cardiovascular disease, or increased bleeding risk are ineligible. The primary endpoints are pharmacokinetics and the proportion of patients with treatment-emergent adverse events at Week 24. Secondary endpoints include change in FVC% predicted from baseline, Pediatric Quality of Life Questionnaire™, oxygen saturation, and 6-minute walk distance at Weeks 24 and 52. Additional efficacy and safety endpoints will be collected to explore long-term effects. #PedILD. #InPedILD.

scholarly journals Efficacy And Safety Of 5% Lidocaine Patches For Postoperative Pain Management In Patients Undergoing Unilateral Inguinal Hernia Repair: Study Protocol For A Prospective, Double-Blind, Randomized, Controlled Clinical Trial

2021 ◽  
Author(s):  
Hong-min Ahn ◽  
Heung-Kwon Oh ◽  
Duck-Woo Kim ◽  
Sung-Bum Kang ◽  
Bon-Wook Koo ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Postoperative Pain Management ◽  
Day Surgery ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Unilateral Inguinal Hernia

Abstract Background: Acute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units.Methods/design: This is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow-up at our outpatient clinic on the first postoperative day and at one week after surgery. The primary outcome is pain intensity, which will be measured using the Visual Analogue Scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 hours and one week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height).Discussion: This trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management.Trial registration: ClinicalTrials.gov: NCT04754451 (registered on February 10, 2021). https://clinicaltrials.gov/ct2/show/NCT04754451

A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA

2021 ◽  
Vol 74 (9) ◽  
pp. 2259-2264
Author(s):  
Diana Salam Sami ◽  
Ali Hadi Muslih
Keyword(s):  
Regional Anesthesia ◽  
Motor Block ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Intravenous Regional Anesthesia ◽  
Group 3 ◽  
Group 2 ◽  
Different Doses ◽  
Group 1

The aim: To compare the different doses of dexmedetomidine as adjuvant to lidocaine in intravenous regional anesthesia. Materials and methods: Ninety patients participated in this study in Al-Yarmook teaching hospital in period between January 1st 2016 – July 1st 2016, divided randomly in to 3 groups. Group 1: received lidocaine diluted with normal saline; Group 2 – lidocaine with dexmedetomidine 0.5 μg/kg; Group3 -lidocaine with dexmedetomidine 1 μg/kg. Statistical analysis was done by IBM SPSS program version 20 and Microsoft excel version 2010 , the means were compared by ANOVA methods and Dunnett t3, significancebetween groups were recorded if p value less than 0.05. Results: Dexmedetomidine was effective in decreasing the sensory block onset time and motor block onset time and prolongation of the motor and sensory recovery with no significant hemodynamic changes than is often shown by the lidocaine alone, it also prolongs the time interval for analgesic requirement after the operation. For the group 3 it was faster than in group 2 and faster than in group 1 significantly (p value < 0.001) to form a sensory block onset and motor block onset; and it took significantly more time to recover the sensation than in group 1 (p value <0.001) and 2 (p value <0.002) , and more time for motor recovery than in group 1 (p value < 0.001). Group 3 had the longest time to call for the analgesia after operation than group 2 and 3 (p value < 0.001); and group 2 also had longer time for the same process than group 1 (p value < 0.001). Conclusions: A variety of adjuvants have been used in IVRA to decrease tourniquet pain, improve block quality, and prolong analgesia after cuff deflation. Opioids are relatively ineffective and cause nausea, vomiting, and dizziness after tourniquet deflation, but several NSAIDs have been shown to be beneficial, dexmedetomidine improves block quality and postoperative analgesia.

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