scholarly journals Use of Intraoperative Analgesic and Anesthetic Substances by Intramuscular Infiltrations during Hip Surgery for Postoperative Pain Monitoring

2019 ◽  
Vol 69 (12) ◽  
pp. 3530-3532
Author(s):  
Bogdan Hogea ◽  
Bogdan Corneliu Andor ◽  
Alina Totorean ◽  
Lavinia Maria Hogea ◽  
Laura Alexandra Nussbaum ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Hip Surgery ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Pain Scores ◽  
Important Benefit ◽  
Active Mobilization ◽  
Management Techniques ◽  
Arthroplasty Surgery

The authors present their intraoperative and postoperative experience in using intramuscular infiltrations with analgesic and anesthetic substances as pain control methods in patients that undergo hip surgery: arthroplasty or hemiarthroplasty. A total of 30 patients that have undergone either an elective total hip arthroplasty surgery or hemiarthroplasty of the hip following a hip fracture, since May 2018 until August 2018. The patients were divided in two equal groups, one group that followed through the protocol and one control group. The intramuscular infiltrations were administered intraoperatively at the timeline of the muscle suture and contained: Bupivacaine 10 mL + Morphine 1 mL + Methylprednisolone 40mg. Postoperative protocol used the visual analogue scale (VAS) pain scores on days 1, 2, 3, 4, 5, 6 and 7 for measuring the postoperative pain control. Intraoperative intramuscular infiltrations, with an analgesic and anesthetic cocktail consisting of Bupivacaine, Morphine and Methylprednisolone, for patients that are going through hip surgery are safe to use with very good results in terms of postoperative pain control. We reduced the consumption of opioids and analgesic drugs, which indirectly leads to decreased direct cost per patient. Another important benefit was an early active mobilization of the patient, with shorter hospitalization time. All things considered, using regional anesthesia and multimodal pain management techniques may lead to a nearly painless hip surgery.

scholarly journals Electroacupuncture to alleviate postoperative pain after a laparoscopic appendectomy: study protocol for a three-arm, randomised, controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015286 ◽  
Author(s):  
Seunghoon Lee ◽  
Dongwoo Nam ◽  
Minsoo Kwon ◽  
Won Seo Park ◽  
Sun Jin Park
Keyword(s):  
Postoperative Pain ◽  
Laparoscopic Appendectomy ◽  
Pain Control ◽  
Rating Scale ◽  
Acupuncture Treatment ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Control Group ◽  
Acupuncture Points ◽  
Postoperative Pain Control

BackgroundThe purpose of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for postoperative pain after laparoscopic appendectomy compared with sham electroacupuncture (SEA) and no acupuncture treatment.Methods and analysisThis study is a protocol for a three-arm, randomised, patient-assessor-blinded (to the type of acupuncture treatment), controlled, parallel trial. 138 participants diagnosed with appendicitis and scheduled for laparoscopic appendectomy will be randomly assigned to the EA group (n=46), SEA group (n=46) or control group (n=46). The EA group will receive acupuncture treatment at both regional and distal acupuncture points with electrostimulation. The SEA group will receive sham acupuncture treatment with mock electrostimulation. Both EA and SEA groups will receive a total of four treatments 1 hour preoperative, 1 hour postoperative and during the morning and afternoon the day after surgery with the same routine postoperative pain control. The control group will receive only routine postoperative pain control. The primary outcome is the 11-point Pain Intensity Numerical Rating Scale (PI-NRS) at 24 hours after surgery. The secondary outcomes are the PI-NRS, analgesic consumption, opioid-related side effects, time to first passing flatus, quality of life and adverse events evaluated 6, 12, 24 and 36 hours and 7 days after surgery.Ethics and disseminationThe study was planned in accordance with the Helsinki Declaration and the Korean Good Clinical Practice Guidelines to protect the participants and was approved by the institutional review board (IRB) of Kyung Hee University Medical Center (KMC IRB-1427–02). The results will be disseminated in peer-reviewed journals and presented at international conferences.Trial registration numberClinical Research Information Service (KCT0001328).

scholarly journals Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Luiz Eduardo de Paula Gomes Miziara ◽  
Ricardo Francisco Simoni ◽  
Luís Otávio Esteves ◽  
Luis Henrique Cangiani ◽  
Gil Fernando Ribeiro Grillo-Filho ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Pain Control ◽  
Controlled Trial ◽  
Intervention Group ◽  
Morphine Consumption ◽  
Postoperative Pain Control ◽  
Intravenous Anesthesia ◽  
Ketamine Infusion ◽  
Pain Scores

Aim.A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control.Methods.Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg−1·h−1(n=24, intervention group) or an equivalent volume of saline at the same rate (n=24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery.Results.Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P=0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200±2.707) than in the placebo group (7.525±1.872).Conclusions.Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement.Trial Registration. This trial is registered with ClinicalTrials.govNCT02421913.

Efficacy of the Morphine-Adcon-L Compound in the Management of Postoperative Pain after Lumbar Microdiscectomy

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 518-525 ◽  
Author(s):  
Luciano Mastronardi ◽  
Marco Pappagallo ◽  
Fabrizio Puzzilli ◽  
Carlo Tatta
Keyword(s):  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Pain Control ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Analog Scale ◽  
Work Time ◽  
Long Term Outcome ◽  
Lumbar Microdiscectomy ◽  
Straight Leg Raising

Abstract OBJECTIVE: Epidural analgesia is a pharmacological technique for operative and postoperative pain control. It has been used with lumbar microdiscectomy to facilitate management of surgical pain, shorten patient recovery time, and increase patient satisfaction with the procedure and the hospital stay. Adcon-L (Gliatech, Inc., Cleveland, OH) (adhesion control in a barrier gel) has been demonstrated to act as a barrier to the development of epidural fibrosis after lumbar procedures, minimizing the formation of fibrotic scar and improving the long-term outcome. In this study, we used Adcon-L as a vehicle to administer 1 mg of morphine epidurally to patients who underwent lumbar microdiscectomy. Our objective was to evaluate the safety and analgesic efficacy of this compound . METHODS: A randomized, controlled, double-blind study was conducted in 100 patients. Patients were randomized to two groups: the morphine-Adcon-L (M-ADL) group (n = 51 patients) or the Adcon-L control group (n = 49 patients). Outcome measures included: 1) a visual analog scale to assess the intensity of spontaneous low back and radicular pain, 2) a straight leg-raising maneuver to assess the degree of leg elevation in relation to evoked sciatic pain, 3) postoperative time to comfortable walking, 4) duration of postoperative hospitalization, 5) required amount of postoperative analgesics, and 6) postoperative work time loss. RESULTS: No intraoperative or postoperative complications were observed. No clinically relevant adverse events, such as urinary retention, respiratory disturbances, or wound infections were reported in the M-ADL group. At the time of hospital discharge, results were as follows: 1) the M-ADL group had significantly lower pain intensity scores (mean value of postoperative visual analog scale, 12.3 mm ± 0.9 in the M-ADL group versus 24.7 mm ± 11.5 in the control group [P < 0.0001]); 2) the M-ADL group consumed significantly less analgesics: 57.4% of M-ADL patients versus 95.9% of controls received analgesics in the hospital, and 23.5% of M-ADL patients versus 55.1% of controls used analgesics at home (P < 0.0001); 3) the M-ADL group had significantly shorter hospital stays (1.37 ± 0.07 d versus 2.53 ± 0.12 d in the control group [P < 0.0001]); 4) the M-ADL group had a significantly higher degree of symptomatic leg elevation in the straight leg raising (mean postoperative straight leg-raising test, 64.41 degrees ± 1.59 versus 57.77 degrees ± 1.85 in the controls [P = 0.02]); and 5) the M-ADL group lost significantly less postoperative work time (21.67 ± 0.92 d versus 29.47 ± 1.18 d in the control group). In addition, at 1 year of follow-up, there was no clinical evidence of late-onset neurological complications. CONCLUSION: The epidural application of the compound M-ADL after lumbar microdiscectomy was found to be safe and effective, and it significantly improved postoperative pain control and return to function.

scholarly journals Subcutaneous Bupivacaine Infiltration Is Not Effective to Support Control of Postoperative Pain in Paediatric Patients Undergoing Spinal Surgery

2021 ◽  
Vol 10 (11) ◽  
pp. 2407
Author(s):  
Anna Danielewicz ◽  
Marek Fatyga ◽  
Grzegorz Starobrat ◽  
Monika Różańska-Boczula ◽  
Magdalena Wójciak ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Deformity ◽  
Pain Control ◽  
Young Patients ◽  
Deformity Correction ◽  
Control Group ◽  
Study Group ◽  
Local Infiltration Analgesia ◽  
Pain Scores ◽  
Paediatric Patients

Spinal deformity corrections in paediatric patients are long-lasting procedures involving damage to many tissues and long pain exposure; therefore, effective pain management after surgical treatment is an important issue. In this study, the effect of inclusion of local infiltration analgesia, as an integral part of the scheme in postoperative pain control, in children and adolescents, subjected to the spinal deformity correction procedure, was assessed. Thirty patients, aged 8 to 17 years, undergoing spinal deformity correction were divided into a study group, receiving a 0.25% bupivacaine solution before wound closure, and a control group (no local analgesic agent). Morphine, at the doses of 0.10 mg/kg of body weight, was administered to the patients when pain occurred. Pain scores, morphine administration, and bleeding were observed during 48 postoperative hours. The pain scores were slightly lower in a 0–4 h period in patients who received bupivacaine compared with those in the control group. However, no differences were observed in a longer period of time and in the total opioid consumption. Moreover, increasing bleeding was observed in the bupivacaine-treated patients (study group) vs. the control. Bupivacaine only modestly affects analgesia and, due to the increased bleeding observed, it should not to be part of pain control management in young patients after spinal deformity correction.

Fascia Iliaca Block for Postoperative Pain Control After Hip Arthroscopy: A Systematic Review of Randomized Controlled Trials

2021 ◽  
pp. 036354652199671
Author(s):  
John-Rudolph H. Smith ◽  
Matthew J. Kraeutler ◽  
Laura E. Keeling ◽  
Anthony J. Scillia ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Control Group ◽  
Controlled Trials ◽  
Analgesic Consumption ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Fascia Iliaca Block

Background: Various analgesic modalities have been used to improve postoperative pain in patients undergoing hip arthroscopy. Purpose: To systematically review the literature to compare the efficacy of the fascia iliaca block (FIB) with that of other analgesic modalities after hip arthroscopy in terms of postoperative pain scores and analgesic consumption. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase up to April 2020 to identify randomized controlled trials that compared postoperative pain and analgesic consumption in patients after hip arthroscopy with FIB versus other pain control modalities. The search phrase used was “hip arthroscopy fascia iliaca randomized.” Patients were evaluated based on postoperative pain scores and total postoperative analgesic consumption. Results: Five studies (3 level 1, 2 level 2) were identified that met inclusion criteria, including 157 patients undergoing hip arthroscopy with FIB (mean age, 38.3 years; 44.6% men) and 159 patients among the following comparison groups: lumbar plexus block (LPB), intra-articular ropivacaine (IAR), local anesthetic infiltration (LAI), saline placebo, and a no-block control group (overall mean age, 36.2 years; 36.5% men). No significant differences in pain scores were reported in the postanesthesia care unit (PACU) between the FIB and LPB (3.4 vs 2.9; P = .054), IAR (7.7 vs 7.9; P = .72), control group (no FIB: 4.1 vs 3.8; P = .76); or saline placebo (difference, –0.2 [95% CI, –1.1 to 0.7]). One study reported significantly higher pain scores at 1 hour postoperation in the FIB group compared with the LAI group (5.5 vs 3.4; P = .02). Another study reported significantly greater total analgesic consumption (in morphine equivalent dosing) in the PACU among the FIB group compared with the LPB group (20.8 vs 17.0; P = .02). No significant differences were observed in total PACU analgesic consumption between FIB and other analgesic modalities. Conclusion: In patients undergoing hip arthroscopy, the FIB does not appear to demonstrate superiority to other forms of analgesics in the immediate postoperative period. Therefore, it is not recommended as a routine form of pain control for these procedures.

scholarly journals Intra-Articular Bupivacaine Injection is An Ideal Method for Postoperative Pain Control in Children with Supracondylar Humeral Fracture

2021 ◽  
Author(s):  
Qian Wang ◽  
Jingxin Zhao ◽  
Yu Wang ◽  
Man He
Keyword(s):  
Treatment Group ◽  
Postoperative Pain ◽  
Pain Control ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Control Group ◽  
Postoperative Pain Control ◽  
Supracondylar Humeral Fracture ◽  
Fractures In Children ◽  
Supracondylar Humeral Fractures

Abstract Objective: Supracondylar humeral fracture is the most common fracture in children. Currently there are a large number of studies on supracondylar humeral fractures addressing the epidemiology of supracondylar fractures, injury mechanisms, treatments and complications, however there are few studies on how to control the pain in children after fractures and operation. Therefore, we retrospectively analyzed the effectiveness of an intra-articular injection of 0.25% bupivacaine on pain control after CRPP of supracondylar humeral fractures in children. To our knowledge, this is the largest study on the use of an intra-articular injection for pain control after surgery for supracondylar humeral fractures.Methods: This clinical trial was designed to evaluate the efficacy of intra-articular injection of 0.25% bupivacaine as a postoperative pain control in children with supracondylar humeral fractures who underwent closed reduction and percutaneous pinning (CRPP).Subjects (n = 120) were randomized to treatment with 0.25% bupivacaine (treatment group) (n = 60) or no injection (control group) (n =71). After surgery, all patients were prescribed Ibuprofen for analgesia. The Ibuprofen doses and the times of administration were recorded. The Faces Pain Scale-Revised (FPS-R) scores were blindly recorded during postoperative day 1.Results: The results suggested that the use of intra-articular injection of 0.25% bupivacaine improved pain control and decreased the need for Ibuprofen on postoperative day 1. FPS-R scores were also significantly lower in the treatment group as compared with those of the control group. No intra-articular injection-associated complications were reported. Conclusion: Therefore, the intra-articular injection of bupivacaine significantly improves postoperative pain control following CRPP of supracondylar humeral fractures in children.

Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade

2020 ◽  
pp. 112070002095024
Author(s):  
Efi Kazum ◽  
Ehud Rath ◽  
Amir Shlaifer ◽  
Zachary T Sharfman ◽  
Hal D Martin ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Recovery Room ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Analgesic Consumption ◽  
Pain Scores ◽  
Group 2 ◽  
Group 1

Introduction: Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures. Methods: 52 patients were included in this comparative cohort study. Group 1 consisted of 20 patients who received preoperative peri-acetabular blockade and postoperative intra-articular blockade. The control group (Group 2), consisted of 32 patients who received only preoperative peri-acetabular blockade. Postoperative pain was recorded via visual analogue scale (VAS) pain scores, analgesic consumption, and pain diaries for 2 weeks postoperatively. Results: Postoperative VAS pain scores were significantly lower in the experimental group at the 30-minute recovery room assessment (VAS scores Group 1: 1.1; Group 2: 3.00, p = 0.034). Other than the 30-minute recovery room assessment, VAS pain scores, narcotic medication consumption, and non-narcotic analgesic consumption did not differ between the 2 groups at any time point in the study period. Conclusions: This study did not demonstrate significant clinical benefit for patients who receive postoperative intra-articular blockade in addition to preoperative peri-acetabular blockade with bupivacaine 0.5%. We recommend the use of preoperative peri-acetabular bupivacaine blockade without intra-articular blockade postoperatively for pain control in the setting of hip arthroscopy surgery.

Protocolization of Post-Transforaminal Lumbar Interbody Fusion Pain Control with Elimination of Benzodiazepines and Long-Acting Opioids

Neurosurgery ◽  
2019 ◽  
Vol 86 (5) ◽  
pp. 717-723
Author(s):  
Jason H Boulter ◽  
Brian P Curry ◽  
Nicholas S Szuflita ◽  
Charles A Miller ◽  
Joseph Spinelli ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Opioid Use ◽  
Postoperative Pain Control ◽  
Single Level ◽  
Pain Scores ◽  
Control Regimen ◽  
Long Acting

Abstract BACKGROUND The opioid epidemic continues to worsen with a concomitant increase in opioid-related mortality. In response, the Department of Defense and Veterans Health Agency recommended against the use of long-acting opioids (LAOs) and concurrent use of opioids with benzodiazepines. Subsequently, we eliminated benzodiazepines and LAOs from our postoperative pain control regimen. OBJECTIVE To evaluate the impact of removing benzodiazepines and LAOs on postoperative pain in single-level transforaminal lumbar interbody fusion (TLIF) patients. METHODS A retrospective cohort study of single-level TLIF patients from February 2016-March 2018 was performed. Postoperative pain control in the + benzodiazepine cohort included scheduled diazepam with or without LAOs. These medications were replaced with nonbenzodiazepine, opioid-sparing adjuncts in the −benzodiazepine cohort. Pain scores, length of hospitalization, trigger medication use, and opioid use and duration were compared. RESULTS Among 77 patients, there was no difference between inpatient pain scores, but the -benzodiazepine cohort experienced a faster rate of morphine equivalent reduction (−18.7%, 95% CI [−1.22%, −36.10%]), used less trigger medications (−1.55, 95% CI [−0.43, −2.67]), and discharged earlier (0.6 d; 95% CI [0.01, 1.11 d]). As outpatients, the −benzodiazepine cohort was less likely to receive opioid refills at 2 wk (29.2% vs 55.8%, P = .021) and 6 mo postoperatively (0% vs 13.2%, P = .039), and was less likely to be using opioids by 3 mo postoperatively (13.3% vs 34.2%, P = .048). CONCLUSION Replacement of benzodiazepines and LAOs in the pain control regimen for single-level TLIFs did not affect pain scores and was associated with decreased opioid use, a reduction in trigger medications, and shorter hospitalizations.

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