Intravenous Sodium Valproate Versus Dexamethasone Evaluation for Migraine Headache Pain Control in Acute Setting: A Randomized, Controlled, Double-Blind Study

2021 ◽  
Vol 15 (6) ◽  
pp. 1800-1806
Author(s):  
Hassan Motamed ◽  
Meisam Moezi ◽  
Mohamadreza Dadkhah
Keyword(s):  
Sodium Valproate ◽  
Pain Control ◽  
Migraine Headache ◽  
Secondary Outcome ◽  
Common Disease ◽  
Acute Migraine ◽  
Vas Score ◽  
Dexamethasone Group ◽  
Significant Difference ◽  
Headache Pain

Introduction: Migraine is a common disease in the emergency department (ED), which is capable of imposing limitations on people’s activity and imposing a high cost on the government. There are a lot of common treatments for migraine. In numerous studies, sodium valproate is included, among other treatments. This Study designed for efficacy evaluation of Sodium Valproate versus Dexamethasone in acute migraine headache pain control. Method: A controlled clinical trial has been established for ED patients with compliant of acute migraine headaches. 108 patients were included and categorized into two groups based on a randomized schedule: one with 1200 mg sodium valproate and another with 8 mg dexamethasone in 150 mL normal saline, which was IV infused in 10 minutes. As a primary outcome, pain visual analog scale (VAS) score was determined and compared on arrival and minutes 30, 60 and 120 after intervention, and as a secondary outcome, the percentage of rescue from headache through medication and sustainability of freedom and relief from headache were determined and compared between the two groups. Results: The mean decline of pain VAS score (0–10) in the sodium valproate group was 2.33 SD (1.74) and 3.49 SD (2.56), and in the dexamethasone group, it was 2.20 SD (1.86) and 3.30 SD (2.45) in the first and second hours after intervention, respectively. In each group, they are statistically significant (P < 0.05), even though there was no statistically significant difference between the two groups of study (P > 0.05). In terms of need for rescue medication, in the sodium valproate group, 30/54 (55.6%) people and in the dexamethasone group, 33/54 (61.1%) people used the medication; however, there were no statistically significant differences found between the two groups (P > 0.05). Conclusion: Probably it can be concluded that there is no statistically significant difference between the efficacy of 1200 mg IV sodium valproate compared and 8 mg IV dexamethasone in reducing acute migraine headache Keywords: Sodium valproate, dexamethasone, acute migraine, pain control.

scholarly journals Comparison of the Effect of Dexamethasone and Ketorolac on Pain Control in Elective Foot Surgery

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Amir Sabbaghzadeh ◽  
Faranak Behnaz ◽  
Hamidreza Aslani ◽  
Mahshid Ghasemi
Keyword(s):  
Orthopedic Surgery ◽  
Lower Limb ◽  
Pain Control ◽  
Injection Pain ◽  
Test Results ◽  
Foot Surgery ◽  
Analog Scale ◽  
Vas Score ◽  
Dexamethasone Group ◽  
Significant Difference

Objectives: This study aimed to compare the effect of dexamethasone and ketorolac on pain control in elective foot surgery. Methods: Forty patients visiting Akhtar and Imam Hossein Hospital for lower limb orthopedic surgery were selected. They were randomly divided into two groups: (1) dexamethasone, and (2) ketorolac. The dexamethasone group received eight mg dexamethasone intravenously. Also, 90 mg ketorolac was infused in one liter of normal saline serum for 24 hours for the ketorolac group. Before injection and 2, 4, and 6 hours after the injection, pain control was measured employing the Visual Analog Scale (VAS) score. Corresponding data were then analyzed using the independent t-test. Results: The conclusions revealed that in two and four hours after injection, there was a significant difference between the two groups in the amount of VAS score. That is, the pain was weaker in the ketorolac group than in the dexamethasone group. The findings additionally proved that there was no statistically important difference in pain levels between the two groups six hours after injection. Conclusions: Overall, according to the results of the research, it can be settled that ketorolac is a better drug in foot surgery pain control than dexamethasone.

The Effects of Timing of Ankle Blocks in Forefoot, Midfoot, or Hindfoot Reconstruction With the Use of an Ankle Tourniquet

2018 ◽  
Vol 11 (6) ◽  
pp. 527-533
Author(s):  
James Gwosdz ◽  
Lattisha Bilbrew ◽  
Daniel Jupiter ◽  
Vinod Panchbhavi
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Randomized Study ◽  
Comparative Trial ◽  
Vas Score ◽  
Level Ii ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Tourniquet Inflation

Background. Ankle blocks are used in the ambulatory surgery setting to control postoperative pain, which is often worst in the first 24 hours after surgery. We conducted a trial to determine whether the timing of ankle block administration in relation to ankle tourniquet inflation has an effect on perceived pain and narcotic consumption. Methods. A prospective randomized study was conducted between August 2015 and January 2016. Patients were assigned to three groups. In group A, an ankle block was performed before ankle tourniquet inflation; in group B, immediately after ankle tourniquet inflation; and in group C, immediately after ankle tourniquet inflation with additional local anesthetic placed around the incision at the end of the procedure. Pain was assessed by a visual analogue scale (VAS) score, which was recorded at discharge, 24 hours, 48 hours, and 2 weeks after surgery. Narcotic consumption was recorded at 24 and 48 hours after surgery. Results. The only statistically significant difference in mean VAS scores occurred at 24 hours, when patients who received an ankle block after tourniquet inflation with local incisional anesthetic at closure (group C) had a mean VAS score 2.8 points lower (3.5 vs 6.3; P = .025) than those who received only an ankle block after tourniquet inflation (group B). There was no difference in narcotic consumption between groups at 24 and 48 hours. Conclusions. The timing of ankle block in relation to tourniquet inflation did not have an effect on pain control in forefoot, midfoot, and hindfoot reconstruction. The synergistic effect of an ankle block with additional incisional anesthetic at closure, is more effective than ankle block alone and is the ideal combination for postoperative pain control in foot surgery. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial

scholarly journals Peri-operative pain management in hip arthroscopy: a systematic review of the literature

2019 ◽  
Vol 6 (4) ◽  
pp. 353-363
Author(s):  
Jensen G Kolaczko ◽  
Derrick M Knapik ◽  
Michael J Salata
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Hip Arthroscopy ◽  
Pain Control ◽  
Review Of The Literature ◽  
Discharge Time ◽  
Nerve Blocks ◽  
Vas Score ◽  
Significant Difference ◽  
Control Protocols

Abstract The purpose of this article was to review current literature on peri-operative pain management in hip arthroscopy. A systematic review of the literature on pain control in hip arthroscopy published January 2008 to December 2018 was performed. Inclusion criteria consisted of English language or articles with English translations, subjects undergoing hip arthroscopy with documented peri-operative pain control protocols in studies reporting Level I to IV evidence. Exclusion criteria were non-English articles, animal studies, prior systematic review or meta-analyses, studies not reporting peri-operative pain control protocols, studies documenting only pediatric (&lt;18 years of age) patients, studies with Level V evidence and studies including less than five subjects. Statistical analysis was performed to assess pain protocols on narcotic consumption in PACU, VAS score on discharge, time to discharge from PACU and incidence of complications. Seventeen studies were included, comprising 1674 patients. Nerve blocks were administered in 50% of patients (n = 838 of 1674), of which 88% (n = 740 of 838) received a pre-operative block while 12% (n = 98 of 838) post-operative block. Sixty-eight complications were recorded: falls (54%, n = 37), peripheral neuritis (41%, n = 28), seizure (1.5%, n = 1), oxygen desaturation and nausea (1.5%, n = 1) and epidural spread resulting in urinary retention (1.5%, n = 1). No significant differences in narcotic consumption, VAS score at discharge, time until discharge or incidence of complication was found based on pain control modality utilized. No statistically significant difference in PACU narcotic utilization, VAS pain scores at discharge, time to discharge or incidence of complications was found between peri-operative pain regimens in hip arthroscopy.

scholarly journals Efficacy of Duloxetine Compared with Opioid for Postoperative Pain Control Following Total Knee Arthroplasty

2020 ◽  
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Sung Cheol Yang ◽  
Yong In
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Control ◽  
Readmission Rate ◽  
Womac Score ◽  
Postoperative Pain Control ◽  
Vas Score ◽  
Significant Difference ◽  
Total Knee

Abstract BackgroundOpioid is known to be effective in pain control after total knee arthroplasty (TKA). However, recently it has become a major concern due to addiction. Duloxetine, the serotonin-norepinephrine reuptake inhibitor, is effective for pain control in osteoarthritis patients. However, no study has compared the efficacy of the two for pain control after TKA. The purpose of this study was to assess the efficacy of duloxetine as an alternative to opioid treatment for postoperative pain management following TKA.MethodsAmong 857 patients, 260 (30.3%) of patients received opioid or duloxetine for pain control for 6 weeks when the pain Visual Analogue Scale (VAS) score was greater than 4 out of 10 at the time of discharge. 121 patients in the Opioid group and 118 in the Duloxetine group were followed up for more than one year. Preoperative and postoperative patient reported outcome measures (pain VAS score, Western Ontario and McMaster Universities OA Index (WOMAC) score, and the rate over the minimum clinically significant difference (MCID) using WOMAC score) were compared. The rate of further drug prescription (opioid or duloxetine) after 6 weeks of first prescription, 30-day readmission rate, and side effects were also investigated.ResultsThere was no significant difference in pain VAS score, WOMAC Pain and Function score, or the rate over MCID at each time point between before and after surgery (all p > 0.05). Fifteen (11.0%) patients in the opioid group and six (4.8%) patients in the duloxetine group were prescribed additional medication after first 6 weeks, showing no significant (p > 0.05) difference in proportion. The 30-day readmission rate and the incidence of side effects were also similar (all p > 0.05).ConclusionDuloxetine has a similar effect to opioid on postoperative pain control. Thus, duloxetine can be considered as an alternative to opioid for postoperative pain control following TKA.Level of evidence:Therapeutic study Level Ⅳ.

scholarly journals Effect of Intravenous Sodium Valproate vs Dexamethasone on Acute Migraine Headache: A Double Blind Randomized Clinical Trial

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0120229 ◽  
Author(s):  
Shahir Mazaheri ◽  
Jalal Poorolajal ◽  
Akram Hosseinzadeh ◽  
Mohammad Mahdi Fazlian
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Sodium Valproate ◽  
Migraine Headache ◽  
Acute Migraine ◽  
Double Blind ◽  
Intravenous Sodium

scholarly journals Paradoxical Hyperalgesia of Supra-orbital and Infra-orbital Nerve Blocks when Anesthetizing the Trigeminal Nerves in Trans-Sphenoidal Endonasal Pituitary Surgery: A Prospective, Randomized, Double-blinded Clinical Trial

2021 ◽  
Author(s):  
Una Sre ◽  
Erik Litonius ◽  
Seema Gandhi ◽  
Pekka Talke ◽  
Oana Maties ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Migraine Headache ◽  
Vascular System ◽  
Pituitary Surgery ◽  
Nerve Blocks ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Headache Pain ◽  
Post Operative Nausea ◽  
Double Blinded

Abstract Background: Pituitary neurosurgery executed via the transsphenoidal endonasal approach is commonly performed for pituitary adenomas. Reasons for prolonged hospital stay include postoperative migraine headache pain and protracted nausea with or without vomiting. Bilateral superficial trigeminal nerve blocks of the supra-orbital V1 and infra-orbital V2 (SION) nerves performed intra-operatively as a regional anesthetic adjunct to general anesthesia were hypothesized to reduce pain exposure and thus 6 hours post-operative morphine PCA (patient-controlled analgesia) use by patients. Methods: 49 patients, following induction of general anesthesia for their transsphenoidal surgery, were prospectively randomized in a double-blinded fashion to receive additional regional anesthesia as either a block (0.5% ropivacaine with epi 1:200,000) or placebo/sham (0.9% normal saline). The primary endpoint was the pain exposure and resulting systemic morphine PCA opioid consumption by the two groups in the first 6-hours post-operatively. The secondary endpoints included (1) incidence of post-operative nausea and vomiting and (2) time to eligibility for PACU discharge. Results: Of the 49 patients that were enrolled, 3 patients were excluded due to protocol violations. Ultimately, there was no statistically significant difference between morphine PCA use in the 6-hours post-operatively between the block and placebo/sham groups. There was, however, a slight visual tendency of the block group for higher pain scores, morphine use p=0.046, and delayed PACU discharge. False discovery rate corrected comparisons at each time point then revealed no statistically significant difference between the two groups. There were no differences between the two groups for secondary endpoints. Conclusion: 6-hour post-operative migraine headache pain after endoscopic trans-sphenoidal pituitary surgery likely has a more complicated mechanism involving more than the superficial trigemino-vascular system and perhaps is neuro-modulated by other brain nuclei. ClinicalTrials.gov NCT04670614, Date of Registration 17/12/2020

scholarly journals Randomised, controlled trial of erenumab for the prevention of episodic migraine in patients from Asia, the Middle East, and Latin America: The EMPOwER study

Cephalalgia ◽  
2021 ◽  
pp. 033310242110241
Author(s):  
Shuu-Jiun Wang ◽  
Artemio A Roxas ◽  
Bibiana Saravia ◽  
Byung-Kun Kim ◽  
Debashish Chowdhury ◽  
...  
Keyword(s):  
Latin America ◽  
Middle East ◽  
Primary Endpoint ◽  
Episodic Migraine ◽  
Acute Migraine ◽  
Efficacy And Safety ◽  
Medication Treatment ◽  
Significant Difference ◽  
Specific Medication ◽  
Secondary Endpoints

Objective EMPOwER, a double-blind, randomised, phase 3 study, evaluated the efficacy and safety of erenumab in adults with episodic migraine from Asia, the Middle East, and Latin America. Methods Randomised patients (N = 900) received monthly subcutaneous injections of placebo, erenumab 70 mg, or 140 mg (3:3:2) for 3 months. Primary endpoint was change from baseline in monthly migraine days at Month 3. Other endpoints included achievement of ≥50%, ≥75%, and 100% reduction in monthly migraine days, change in monthly acute migraine-specific medication treatment days, patient-reported outcomes, and safety assessment. Results At baseline, mean (standard deviation) age was 37.5 (9.9) years, 81.9% were women, and monthly migraine days was 8.2 (2.8). At Month 3, change from baseline in monthly migraine days (primary endpoint) was −3.1, −4.2, and −4.8 days for placebo, erenumab 70 mg, and erenumab 140 mg, respectively, with a statistically significant difference for erenumab versus placebo (P = 0.002 [70 mg], P < 0.001 [140 mg]). Both erenumab doses were also significantly superior to placebo on all secondary endpoints, including the proportion of patients achieving ≥50% reduction from baseline in monthly migraine days, change from baseline in monthly acute migraine-specific medication treatment days and change from baseline in the Headache Impact Test-6™ scores. The safety profile of erenumab was comparable with placebo; no new safety signals were observed. Conclusions This study of erenumab in patients with episodic migraine from Asia, the Middle East, and Latin America met all primary and secondary endpoints. A consistent numerical benefit was observed with erenumab 140 mg versus erenumab 70 mg across all efficacy endpoints. These findings extend evidence of erenumab’s efficacy and safety to patients under-represented in previous trials. ClinicalTrials.gov identifier: NCT03333109

scholarly journals Clinical Evaluation of Microendoscopy-Assisted Oblique Lateral Interbody Fusion

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 135
Author(s):  
Tomohide Segawa ◽  
Hisashi Koga ◽  
Masahito Oshina ◽  
Katsuhiko Ishibashi ◽  
Yuichi Takano ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Outcome Measure ◽  
Operation Time ◽  
Secondary Outcome ◽  
Invasive Technique ◽  
Lateral Interbody Fusion ◽  
Surgical Methods ◽  
Significant Difference ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Background and objectives: Oblique Lateral Interbody Fusion (OLIF) is a widely performed, minimally invasive technique to achieve lumbar lateral interbody fusion. However, some complications can arise due to constraints posed by the limited surgical space and visual field. The purpose of this study was to assess the short-term postoperative clinical outcomes of microendoscopy-assisted OLIF (ME-OLIF) compared to conventional OLIF. Materials and Methods: We retrospectively investigated 75 consecutive patients who underwent OLIF or ME-OLIF. The age, sex, diagnosis, and number of fused levels were obtained from medical records. Operation time, estimated blood loss (EBL), and intraoperative complications were also collected. Operation time and EBL were only measured per level required for the lateral procedure, excluding the posterior fixation surgery. The primary outcome measure was assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The secondary outcome measure was assessed using the Oswestry Disability Index (ODI) and the European Quality of Life–5 Dimensions (EQ-5D), measured preoperatively and 1-year postoperatively. Results: This case series consisted of 14 patients in the OLIF group and 61 patients in the ME-OLIF group. There was no significant difference between the two groups in terms of the mean operative time and EBL (p = 0.90 and p = 0.50, respectively). The perioperative complication rate was 21.4% in the OLIF group and 21.3% in the ME-OLIF group (p = 0.99). In both groups, the postoperative JOABPEQ, EQ-5D, and ODI scores improved significantly (p < 0.001). Conclusions: Although there was no significant difference in clinical results between the two surgical methods, the results suggest that both are safe surgical methods and that microendoscopy-assisted OLIF could serve as a potential alternative to the conventional OLIF procedure.

Single Versus Dual Headless Compression Screw Fixation of Scaphoid Nonunions: A Biomechanical Comparison

Hand ◽  
2021 ◽  
pp. 155894472097411
Author(s):  
Luke T. Nicholson ◽  
Kristen M. Sochol ◽  
Ali Azad ◽  
Ram Kiran Alluri ◽  
J. Ryan Hill ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Qualitative Assessment ◽  
Secondary Outcome ◽  
Scaphoid Nonunion ◽  
Compression Screw ◽  
Single Screw ◽  
Headless Compression Screw ◽  
Significant Difference ◽  
Load To Failure ◽  
Headless Compression Screws

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct. Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure. Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( P = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( P = .029). Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.

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