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

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.

2021 ◽  
Vol 15 (6) ◽  
pp. 1800-1806
Author(s):  
Hassan Motamed ◽  
Meisam Moezi ◽  
Mohamadreza Dadkhah

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.


1996 ◽  
Vol 30 (7-8) ◽  
pp. 729-732 ◽  
Author(s):  
Jan T Jørgensen ◽  
Janne Rømsing ◽  
Mette Rasmussen ◽  
Jørn Møller-Sonnergaard ◽  
Lisbeth Vang ◽  
...  

OBJECTIVE: To compare injection pain after subcutaneous administration of four different solution volumes. DESIGN: Double-blind, randomized, prospective, multiple crossover study. SETTING: Steno Diabetes Centre, Gentofte, Denmark. PARTICIPANTS: Eighteen healthy volunteers, 9 women and 9 men, aged 21-30 years. METHODS: The subjects were injected with four different volumes (0.2, 0.5, 1.0, 1.5 mL) of NaCl 0.9%. The study was performed on 2 days with a 1-week washout period between the study days. On each study day the subjects received four injections in each thigh. To evaluate the validity of our pain assessing model the subjects received eight injections of 0.5 mL on one of the study days. Pain assessment was done immediately after each injection using both a 10-cm visual analog scale (VAS) and a six-item verbal rating scale (VRS). RESULTS: A significant difference in pain score on both the VAS (p < 0.05) and the VRS (p < 0.01) was seen between the four injection volumes. The pain was significantly increased with volumes of 1.0 and 1.5 mL. No significant difference in injection pain could be detected between 0.2 and 0.5 mL and between 1.0 and 1.5 mL. No significant period or carryover effect could be detected in the study. A significant correlation between the pain score on the VAS and the pain score on the VRS was found (r = 0.79, p < 0.0001). CONCLUSIONS: The pain of a subcutaneous injection is related to injection volume in the thigh. The results show that increasing the volume from 0.5 to 1.0 mL increases the pain significantly. The findings from this study should be considered when injection preparations for subcutaneous administration are formulated. The volume should generally be less than 1.0 mL if injected into the thigh.


2022 ◽  
Vol 2 (2) ◽  
pp. 222-242
Author(s):  
Zulkifli ◽  
Agustina Br Haloho ◽  
Legiran ◽  
Pirma I.R.M

Introduction: Pain is a problem often encountered in postoperative patients. Study has shown after a procedure, 80% patients experience acute pain. This postoperative pain will affect patient’s quality of life therefore necessitating quick and proper treatment. Tissue trauma during surgery will have influence on body system, including endocrine. One of endocrine system response is cortisol secretion. Cortisol levels may be attenuated by bupivacaine and oxycodone. The aim of this study was to determine the efficacy of bupivacaine0,125% and oxycodone 5 mg on pain perception measured by cortisol in patients undergoing orthopedic surgery of the lower limb. Methods: A randomized clinical trial, double-blind study was performed at Mohammad Hoesin General Hospital in Palembang, South Sumatra, from November to May 2021. There were forty samples and divided into two groups (bupivacaine 0,125% and oxycodone 5 mg). Groups were divided by block randomization by computerized random number generator. Blinding were done by making analgesic has the same packages to prevent knowledge of which intervention is being done. Data were analyzed using independent t-test, ANOVA, Mann-Whitney and Chi Square with SPSS version 22.0. Results: There were no statistically significant differences between the two groups on age, gender, body mass index and duration of surgery. In bupivacaine group, cortisol level decreased from 12.94±6.99 µg/dl to 11.32±5.42 µg/dl meanwhile oxycodone group cortisol levels increased from 11.81±8.47 µg/dl to 11.82±7.56 µg/dl. There were no significant difference between two groups relating to cortisol levels. Conclusions: No significant difference was found on administration of bupivacaine 0,125% and oxycodone 5 mg as epidural analgesia on cortisol level in postoperative orthopedic surgery of the lower limb patient.


2018 ◽  
Vol 11 (6) ◽  
pp. 527-533
Author(s):  
James Gwosdz ◽  
Lattisha Bilbrew ◽  
Daniel Jupiter ◽  
Vinod Panchbhavi

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


2020 ◽  
Vol 23 (2) ◽  
pp. 80-85
Author(s):  
Sang Hoon Chae ◽  
Jae Yeon Won ◽  
Jae Chul Yoo

Background: Atelocollagen has been studied for restoration of rotator cuff tendon. In this study, we attempted to evaluate the clinical outcome of ultrasound-guided atelocollagen injection in an outpatient clinic for patients with partial rotator cuff tear.Methods: We recruited 42 outpatients who visited our hospital from May 2019 to September 2019. Atelocollagen injection was performed in patients with partial rotator cuff tear diagnosed by magnetic resonance imaging and ultrasound. American Shoulder and Elbow Surgeons (ASES), Constant, Korean Shoulder Score (KSS) and Simple Shoulder Test (SST) scores, and range of motion were assessed before injection and after two months. Statistically, we analyzed the clinical results using the Wilcoxon signed rank test.Results: Finally, 15 patients were enrolled for analysis. There was no significant difference between pre- and post-injection in terms of range of motion, ASES (57.0 vs. 60.4), Constant (56.4 vs.58.9), KSS (64.6 vs.68.5), and pain-visual analog scale (4.2 vs.3.7), except function-visual analog scale (F-VAS; 6.3 vs.7.1) and SST (6.6 vs.6.9). A significant difference was found in SST (P=0.046) and F-VAS (P=0.009). According to the ultrasound results at 2 months, we found hyperechoic materials in three of seven patients. The most common complication of atelocollagen injection was post-injection pain (53%, 8/15).Conclusions: Ultrasound-guided atelocollagen injection for partial rotator cuff tear showed no significant change in terms of clinical outcomes, except for F-vas and SST score. Tendon regeneration was not clear due to the remnants of atelocollagen present at 2-month follow-up ultrasound. There seems to be alarming post-injection pain for 2 to 3 days in the patients who received atelocollagen injection in an outpatient clinic.


2019 ◽  
Vol 6 (4) ◽  
pp. 353-363
Author(s):  
Jensen G Kolaczko ◽  
Derrick M Knapik ◽  
Michael J Salata

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.


2021 ◽  
Vol 12 (5) ◽  
pp. 88-93
Author(s):  
Madhumita Ray ◽  
Chanchal Kumar Dalai ◽  
Shah Newaz Ahmed ◽  
Amita Acharjee

Background: Dexmedetomidine is an alpha2 agonist which shows sedative, analgesic and anti-adrenergic effects and is useful as an adjuvant agent in general anaesthesia (GA) in major surgeries. Aims and Objectives: In this study, we evaluated the analgesic efficacy of intra-operative infusion of dexmedetomidine in alleviating post-operative pain in elective spine surgery using multiple efficacy parameters. Materials and Methods: Patients (n=60) scheduled to undergo elective spine surgery under GA were randomised to receive either dexmedetomidine (treatment arm) or normal saline (control arm) in the intra-operative period. The analgesic efficacy of the drug in the post-operative period was assessed using- the time to first rescue analgesic, total requirement of analgesic, Visual Analog Scale (VAS) score and the number of back-up analgesic required. Results: There was no statistically significant difference in the baseline clinical and demographic characteristics between the two groups. The time to first rescue analgesic, total requirement of analgesic, Visual Analog Scale (VAS) score and the number of back-up analgesic required, were all statistically significant in favour of the treatment arm (P<0.001). Conclusion: Dexmedetomidine provides effective postoperative analgesia and reduces tramadol requirements in elective spine surgery performed under general anaesthesia.


2020 ◽  
Author(s):  
Man Soo Kim ◽  
In Jun Koh ◽  
Keun Young Choi ◽  
Sung Cheol Yang ◽  
Yong In

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.


2021 ◽  
Vol 27 (3) ◽  
pp. 288-301
Author(s):  
Mohsen Saheban Maleki ◽  
◽  
Sepide Sedaghati Ansari ◽  
Fateme Rezaniazave ◽  
Alireza Talai ◽  
...  

Aims: Postoperative shivering is unpleasant and annoying for the patient, occurring in up to 65% of cases undergoing general anesthesia. Various mechanisms were suggested for postoperative shivering. Shivering after anesthesia can cause complications, such as cardiovascular conditions, bleeding, and infection. This study compared the effects of dexamethasone, pethidine, and ketamine on the prevention of shivering after general anesthesia. Methods & Materials: In total, 164 patients with ASA classes one and two in the age range of 20-60 years under general anesthesia with orthopedic surgery, urology, and general surgery were included in the study. This study was a double-blind, randomized, placebo-controlled study. The study patients were divided into 4 groups of 41 subjects. After the induction of anesthesia and before surgery, in the first group, dexamethasone 0.15 mg/kg body weight, in the second group, ketamine 0.5 mg/kg, in the third group, pethidine 0.5 mg/kg, and in the fourth group, normal saline 0.9% were all given in 2 cc volume. After surgery, the examined patients were monitored for visible shivering by the researcher. The obtained data were analyzed using SPSS. Findings: The frequency and severity of shivering were lower in the dexamethasone (P=0.009), pethidine (P=0.004), and the ketamine (P=0.000) groups, compared to the control group. Besides, there was a significant difference between each of these 3 groups and the controls. The frequency and severity of shivering in the dexamethasone group were not significantly different from those of the pethidine group (P=0.565). The frequency and severity of shivering in the dexamethasone and ketamine groups were not statistically significant (P=0.071). The frequency and severity of shivering in the pethidine group with ketamine were not statistically significant (P=0.063). Conclusion: The obtained results indicated that dexamethasone, pethidine, and ketamine were effective in preventing postoperative shivering. There was no difference between these medications in the prevention of postoperative shivering.


2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Anton Budhi Darmawan ◽  
Dwi Utami Anjarwati

Background: Chronic suppurative otitis media (CSOM) is one infectious disease of the middle ear, most commonly caused by Pseudomonas aeruginosa. A high number of patients come to the ENT outpatient clinic with active benign type of CSOM. The bacteria Pseudomonas aeruginosa is capable of producing biofilm which protects itself from penetration of antibiotics, and therefore creates resistance towards antibiotics and difficult to eradicate. Objective: The aim of this study was to compare the sensitivity levels of chloramphenicol, polymyxin-neomycin, cyprofloxacin and ofloxacine against Pseudomonas aeruginosa in patients with active benign type CSOM in ENT clinic. Method: The method used was across sectional study on 25 patients, from August 2010 until December 2010. Samples were taken withear swab and then put on sensitivity test to chloramphenicol, polymyxin-neomycin, cyprofloxacin andofloxacine using the diffusion disc method. The analysis used in this study was Cochran test. Results: Results showed a significant difference in sensitivity among chloramphenicol (38,70%), polymyxinneomycin(83,87%),cyprofloxacin(90,32%)andofloxacin(58,06%)withp=0,000(p<0,05).PostHocanalysisusing the Mc Nemar indicated that there were significant differences in sensitivity betweenpolymyxin-neomycin to chloramphenicol with p=0,000 (p<0,05), ciprofloxacin to chloramphenicol andciprofloxacin to ofloxacine with p= 0,002, but there were no significant differences between cyprofloxacinto polymyxin-neomycin with p=0,687, polymyxin-neomycin to ofloxacin p=0.057 and ofloxacin tochloramphenicol p=0,109.   There were significant differences in antibiotic ear dropssensitivity to Pseudomonas aeruginosa in patients with active benign type of CSOM. Cyprofloxacin andpolymyxin-neomycin were more sensitive than ofloxacin and chloramphenicol. Keywords: Pseudomonas aeruginosa, active benign type of chronic suppurative otitis media, antibioticear drops.  Abstrak :  Latar belakang: Otitis media supuratif kronik (OMSK) merupakan penyakit infeksi kronik telinga tengah yang sering dijumpai di klinik THT. Penyebab tersering OMSK adalah bakteri Pseudomonasaeruginosa. Pseudomonas aeruginosa mempunyai kemampuan untuk membentuk biofilm yangmelindunginya dari penetrasi antibiotik sehingga menimbulkan resistensi terhadap antibiotik dan sulituntuk eradikasinya. Tujuan: Untuk mengetahui perbandingan tingkat sensitivitas kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin terhadap isolat Pseudomonas aeruginosa padapasien OMSK benigna aktif di klinik THT RSMS. Metode: Metode yang digunakan adalah crosssectional terhadap 29 pasien OMSK di klinik THT RSMS periode bulan Agustus 2010 - Desember2010. Pengambilan sampel dilakukan dengan swab telinga. Uji sensitivitas terhadap kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin dilakukan dengan metode cakram secara difusi.Analisis yang digunakan dalam penelitian ini adalah Cochran dan analisis post hoc. Hasil: Didapatkansensitivitas kloramfenikol sebesar 38,70%, polimiksin-neomisin sebesar 83,87%, ciprofloksasin sebesar90,32% dan ofloksasin sebesar 58,06% dengan p=0,01 (P<0,05), yang menunjukkan adanya perbedaansensitivitas yang bermakna antara kloramfenikol, polimiksin-neomisin, ciprofloksasin dan ofloksasinterhadap Pseudomonas aeruginosa. Analisis post hoc menggunakan Mc Nemar menunjukkan bahwaterdapat perbedaan sensitivitas yang bermakna antara tetes telinga polimiksin-neomisin terhadapkloramfenikol, dan ciprofloksasin terhadap kloramfenikol p=0,000 (p<0,05), serta terdapat perbedaanyang bermakna antara tetes telinga ciprofloksasin terhadap ofloksasin, p=0,002, tetapi tidak terdapatperbedaan yang bermakna antara ciprofloksasin terhadap polimiksin-neomisin, p=0,687, polimiksinneomisinterhadap ofloksasin p=0,057, dan kloramfenikol terhadap ofloksasin p=0,109. Kesimpulan:Terdapat perbedaan sensitivitas yang bermakna tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada pasien OMSK benigna aktif. Ciprofloksasin dan polimiksin-neomisin tetes telinga mempunyai sensitivitas yang lebih baik dibanding ofloksasin dan kloramfenikol. Kata kunci: Pseudomonas aeruginosa, otitis media supuratif kronik, tetes telinga antibiotik 


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