scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: The role of intercostal block

2013 ◽  
Vol 48 (12) ◽  
pp. 2425-2430 ◽  
Author(s):  
Laura Lukosiene ◽  
Danguole Ceslava Rugyte ◽  
Andrius Macas ◽  
Lina Kalibatiene ◽  
Dalius Malcius ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pediatric Patients ◽  
Postoperative Pain Management ◽  
Intercostal Block

Regional anaesthesia for postoperative pain management after liver resection

2012 ◽  
Vol 19 (3) ◽  
pp. 126-129
Author(s):  
Darius Trepenaitis ◽  
Tadas Česnaitis ◽  
Andrius Macas
Keyword(s):  
Pain Management ◽  
Liver Resection ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Wound Infiltration ◽  
Adequate Treatment

Background. Pain is the most common complication in the postoperative period. If adequate treatment is not taken, it can transform to chronic pain. Postoperative pain brings a lot of social, psychological and financial problems for patients and their families. Materials and methods. This prospective study included 30 patients after laparatomic liver resection operation. Patients were randomly assign­ ed to Infiltrated or Control groups. An infiltration of 40 ml levobupivacaine 0.25% solution to the operation cut edges was performed to the Infiltrated group. The pain was evaluated using the numerical rating scale after 2, 5, 12, 24, 48 hours and 1 month after the operation. Our aim was to determine the effect of local anesthesia in the operation wound. The total usage of morphine and any side effects were registered. Results. A statistically significant reduction in pain was observed in the Infiltrated group in all evaluation periods. Opioids usage was higher in the Control group almost by 4 times and adverse effects were 9 to 1 compared to the Infiltrated group. Conclusions. Surgical wound infiltration with local anesthetic for postoperative pain management after liver resection operations has a positive effect on postoperative pain reduction and leads to lesser usage of opioid analgetics. As a result, there is a less chance of opioids induced adverse effects.

scholarly journals Epidural administration of ketamine or fentanyl with bupivacaine for postoperative analgesia – A comparative study

2014 ◽  
Vol 22 (1) ◽  
pp. 21-25
Author(s):  
Abdullah Al Maruf ◽  
Iqbal Hosain Chowdhury ◽  
Kazi Ashkar Lateef ◽  
Manzoorul Haq Laskar ◽  
Md Mustafa Kamal
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Epidural Administration ◽  
Group A ◽  
Group B ◽  
Post Operative Nausea ◽  
Inguinal Surgery

The purpose of the study was to compare the analgesic effectiveness of epidural administration of ketamine mixed bupivacaine with fentanyl mixed bupivacaine in the management of postoperative pain. This prospective study was carried out in CMH, Bogra in one calendar year from July 2004 to June 2005. For postoperative pain management 100 patients of both sex, age ranging between 20 to 50 years, ASA physical status I and II scheduled for lower abdominal, pelvic and inguinal surgery were included in the study. All patients were divided into two groups. Epidural catheter was inserted in each patient through space between L3 to L2. Surgery was done under epidural anaesthesia in both groups. In group A (n=50) surgery was done with 0.5% bupivacaine and fentanyl (bupivacaine 1.5 ml/segment + fentanyl 2?g/ml). In group B (n=50) surgery was done with 0.5% bupivacaine and ketamine (bupivacaine 1.5ml/segment + ketamine 0.3mg/kg body weight). Epidural analgesia was continued in postoperative ward with 6 ml 0.25% bupivacaine + fentanyl 2?g/ml in group A and with 6 ml 0.25% bupivacaine + ketamine 0.3mg/kg bodyweight in group B, 4 hourly for 24 hours. The efficacy of analgesia was assessed by using Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Mean VAS and mean VRS were less than 3 in both groups, which proved adequate postoperative analgesia. Differences of mean VAS and mean VRS between two groups were statistically not significant. Haemodynamic parameters, respiration and oxygenation were within normal range in both groups. Postoperative complications, like inadequate analgesia, post operative nausea and vomiting (PONV), headache and vertigo were less in both groups. It was observed that epidural administration of both bupivacaine mixed with ketamine and bupivacaine mixed with fentanyl found safe, effective and tolerable for postoperative pain management. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18097 Journal of BSA, 2009; 22(1): 21-25

Breast Surgery

2019 ◽  
pp. 140-144
Author(s):  
Richa Wardhan ◽  
Roy Greengrass
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Chest Wall ◽  
Regional Anesthesia ◽  
Postoperative Analgesia ◽  
Breast Surgery ◽  
Postoperative Pain Management ◽  
Nerve Blocks ◽  
Patients With Cancer ◽  
Immunosuppressant Effect

Breast surgery is commonly performed under general anesthesia. Opioids are often utilized for pain management. Regional anesthesia is superior to opioids in many ways, and opioids are best avoided in patients with cancer due to their immunosuppressant effect. Regional anesthesia can be effectively utilized not only as postoperative pain management but also as intraoperative anesthesia. This chapter discusses anatomic considerations to analgesia in breast surgery, detailing the innervation of the breast and the chest wall. It also discusses techniques for providing surgical anesthesia and postoperative analgesia, focusing on the various regional nerve blocks that are available to achieve anesthesia and analgesia of the breast and the chest wall.

scholarly journals Dexmedetomidine vs. lidocaine for postoperative analgesia in pediatric patients undergoing craniotomy: a protocol for a prospective, randomized, double-blinded, placebo-controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuan Zhang ◽  
Di Bao ◽  
Dongmei Chi ◽  
Lu Li ◽  
Bin Liu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Controlled Trial ◽  
Intervention Group ◽  
Saline Control ◽  
Control Group ◽  
Double Blind ◽  
Double Blinded

Abstract Background Postoperative pain is a common problem that occurs in pediatric patients following neurosurgery which may lead to severe complications. Dexmedetomidine is a commonly used adjuvant medicine in craniotomy owing to its sedative, amnestic, analgesic, and neuroprotective properties. Besides, studies suggest that lidocaine has similar effects on sedation, analgesia, and neuroprotection. Both two adjuvants can reduce postoperative pain after neurosurgery in adults. However, it is still unknown whether dexmedetomidine or lidocaine can reduce postoperative pain in children undergoing craniotomy, and if yes, which is a better medicine choice. Therefore, we aimed to compare the effect of dexmedetomidine vs. lidocaine on postoperative pain in pediatric patients after craniotomy. Methods/design We will perform a randomized (1:1:1), double-blind, placebo-controlled, single-center trial. Children aged 1–12 years scheduled for craniotomy will be eligible for inclusion. The 255 recruited participants will be stratified by age in two strata (1–6 years and 7–12 years), and then each stratum will be equally randomized to three groups: group D (infusion of dexmedetomidine [intervention group]), group L (infusion of lidocaine [intervention group]), and group C (infusion of normal saline [control group]). Patients will be followed up at 1 h, 2 h, 4 h, 24 h, and 48 h after surgery. The primary outcome will be total sufentanil consumption within 24 h after surgery. Discussion In this clinical trial, we expect to clarify and compare the postoperative analgesic effect of dexmedetomidine vs. lidocaine infusion on pediatric patients undergoing craniotomy. We believe that the results of this trial will provide more choices for postoperative analgesia for the pediatric population. Trial registration Chinese ClinicalTrials.gov ChiCTR1800019411. Registered on 10 November 2018

scholarly journals Intravenous Acetaminophen use in Postoperative Pain Management

2014 ◽  
Author(s):  
Selvi Kumar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Adverse Effects ◽  
Acute Pain ◽  
Postoperative Pain Management ◽  
Multimodal Approach ◽  
Intravenous Acetaminophen ◽  
Group 2 ◽  
Group 1

<p>Surgery is a most common source of acute pain and effective postoperative pain management is crucial for wound healing and recovery. Opiods are the mainstay for acute pain management but have various adverse effects including death. The multimodal approach involves the use of multiple drugs with varying mechanism of action to achieve optimal pain relief with less adverse effects. Intravenous acetaminophen (IVAPAP) is a new addition to the multimodal approach that appears to afford effective pain relief with a low risk profile. The purpose of this research study was to examine the impact of IVAPAP use in multimodal pain management on decreased opioid consumption and decreased average length of hospital stay in the post colectomy population. A comparative two group retrospective chart review was conducted, with a total of 72 charts meeting the inclusion criteria. Group 1(n=36) study subjects who received IVAPAP for pain management were compared to Group 2(n=36) subjects who had not received IVAPAP after colectomy. Results demonstrated that Group 1, those who had received IVAPAP, used less opioids during the postoperative period as compared to those in Group 2 who had not received IVAPAP; there was no difference in length of stay between the groups. Further research related to the use of multimodal pain management strategies in general, and related to IVAPAP in particular, is indicated. Recommendations and implications for advanced practice nursing are presented and discussed.</p>

scholarly journals A Comparison between Bupivacaine Alone and Bupivacaine with Tramadol in Epidural Block for Postoperative Pain Management

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Saadia Khaleeq ◽  
Azib Ali ◽  
Sahir Shafiq ◽  
Muhammad Muazzam Butt ◽  
Mudassar Aslam ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Pain Score ◽  
Postoperative Pain Management ◽  
Epidural Block ◽  
Vas Score ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: This study was designed to compare the mean pain score with bupivacaine versus tramadol plus bupivacaine in patients undergoing surgery under general anesthesia. Randomized Controlled Study. Anesthesia department of SIMS medical college/Services Hospital, Lahore. Duration is 13 months from 20th August2017 till 24th September 2018. Method: 80 patients aged 20-60 years of ASA I & II status, undergoing elective surgery were selected. Patients were randomly divided into two groups (Group A and B) of 40 each, using random numbers table. An epidural catheter was placed at L3-L4 intervertebral level. Group A was given 30 ml of 0.125% bupivacaine and Group B was given 25mg Tramadol plus 0.125% bupivacaine mixture in the same volume. General anesthesia was induced with IV Propofol 2mg/kg and atracurium 0.5mg/kg. After recovery from anesthesia, patients were shifted to HDU. Post-operative pain was assessed using the 10-point VAS score. Injection nalbuphine 0.1mg/kg was given as rescue analgesic when VAS score became more than 4. Results: The mean age of patient in Group A was 37.5 ± 9.1 years and 38.6 ± 7.0 years in Group B. Mean BMI in Group A was 33.2 ± 4.3 and 32.2 ± 4.2 in Group B. The mean pain score after 12 hours of surgery was 3.6 ± 0.8 in Group A and 1.5 ± 0.9 in Group B, p value was significant. Conclusion: Thus, the present study concludes that epidural administration of tramadol as adjuvant with bupivacaine is more effective in postoperative pain relief as compared to bupivacaine alone. Key Words: Bupivacaine, Epidural, Postoperative pain, Tramadol. How to Cite: Khaleeq S, Ali A, Shafiq S, Butt M M, Aslam M, Jehangir MU. A Comparison between Bupivacaine alone and Bupivacaine with Tramadol in epidural block for postoperative pain management. Esculapio.2021;17(1): page number. Esculapio.2020;16(04):101-104.

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