The hemodynamic and analgesic efficacy of subcutaneous dexmedetomidine versus Marcaine 0.5% in postoperative pain management following herniorrhaphy

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

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Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy

Pain ◽

10.1016/0304-3959(94)00166-c ◽

1995 ◽

Vol 61 (1) ◽

pp. 145-153 ◽

Cited By ~ 60

Author(s):

Kimberly A. Sutters ◽

Jon D. Levine ◽

Suzanne Dibble ◽

Marilyn Savedra ◽

Christine Miaskowski

Keyword(s):

Single Dose ◽

Pain Management ◽

Postoperative Pain ◽

Analgesic Efficacy ◽

Postoperative Pain Management ◽

Efficacy And Safety ◽

Intramuscular Ketorolac

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Opioid-induced Loss of Local Anesthetic Potency in the Rat Sciatic Nerve

Anesthesiology ◽

10.1097/aln.0000000000001239 ◽

2016 ◽

Vol 125 (4) ◽

pp. 755-764 ◽

Cited By ~ 6

Author(s):

Qing Liu ◽

Michael S. Gold

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Peripheral Nerve ◽

Analgesic Efficacy ◽

Morphine Tolerance ◽

Compound Action Potential ◽

Postoperative Pain Management ◽

Complete Recovery ◽

Acute Administration ◽

Underlying Mechanisms

Abstract Background Previous evidence suggests that opioid-tolerant patients are less responsive to local anesthetics (LAs) for postoperative pain management. Methods To determine whether this apparent loss of LA potency is due to an intrinsic change in the peripheral nerve, the effect of systemic morphine was assessed on the potency of lidocaine-induced block of the compound action potential in isolated rat sciatic nerves. Analgesic efficacy was assessed with the heat withdrawal assay. Results While acute administration of 10 mg/kg morphine had no detectable influence on lidocaine potency, seven daily subcutaneous injections of morphine produced a three-fold decrease in potency (EC50 for block A and C waves for naive rats were [mean ± SD] 186 ± 32 μM [n = 6] and 201 ± 31 μM [n = 6], respectively, vs. 608 ± 53 μM [n = 6] and 613 ± 42 μM [n = 6], respectively [P < 0.001], in nerves from rats that had received seven daily injections of morphine [10 mg/kg]). This loss in potency was both dose-dependent and injection number dependent, such that the magnitude of the loss of lidocaine potency was significantly (n = 6; P < 0.01) correlated (r2 = 0.93) with the development of morphine tolerance. Interestingly, despite the complete recovery of analgesic efficacy within days after cessation of morphine administration, the morphine-induced decrease in lidocaine potency was fully manifest even 35 days after the last morphine injection. Coadministration of naloxone (1 mg/kg, intraperitoneally), but not of naloxone methiodide (1 mg/kg, subcutaneously), with each of seven daily injections of morphine blocked the decrease in lidocaine potency. Conclusions These preclinical data suggest that the morphine-induced decrease in LA potency is due, at least in part, to the intrinsic changes in the peripheral nerve. Identification of the underlying mechanisms may suggest strategies for more effective postoperative pain management in the growing population of opioid-tolerant patients.

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Comparative Study on Efficacy of Ketorolac and Pethidine for Postoperative Pain Management

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v7i1.24682 ◽

2019 ◽

Vol 7 (1) ◽

pp. 27-32

Author(s):

Laxmi Shrestha ◽

Bishal Joshi ◽

Anjan Palikhey ◽

Kushal Bhattarai

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Rating Scale ◽

Analgesic Efficacy ◽

Early Mobilization ◽

Postoperative Pain Management ◽

Sedation Score ◽

Analgesic Effects ◽

Postoperative Setting ◽

Hourly Basis

INTRODUCTION: Postoperative pain management is essential for early mobilization and rehabilitation to enhance recovery and to reduce morbidity. Ketorolac and pethidine are two most common analgesics used in the postoperative setting for pain management. MATERIAL AND METHODS: Sixty patients (n=60) of age group 18-60 years who undergone various surgical procedures were divided randomly into two groups (T1 and T2). T1 group received inj. ketorolac 5 mg/kg IM and T2 group received pethidine 1.5 mg/kg IM body weight respectively on 6 hourly basis for 48 hours postoperatively. Patients were assessed in the recovery room for pain according to Visual Analogue Scale (VAS), Verbal Rating Scale (VRS) and Sedation Score after 1, 6, 12, 18, 24 and 48 hours of drug administration. Analgesic efficacy was measured using VAS and VRS. Safety of the drugs was assessed by using Sedation Score. RESULTS: Ketorolac showed equianalgesic effect as pethidine estimated by VAS score at 18th and 48th hour. In other periods of observation, pethidine exhibited better analgesic effects than ketorolac. However, ketorolac shows less incidence of sedation compared to pethidine. CONCLUSION: This study showed that postoperative pain during the first 48 hours can be relieved by either ketorolac or pethidine. Ketorolac appeared safer than pethidine while pethidine appeared more effective analgesic than ketorolac in the management of postoperative pain.

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