Effect of Intravenous Acetaminophen and Flurbiprofen on Postoperative Pain after Lumbar Disc Surgery

Aims: Lumbar disc surgery is often associated with moderate to severe postoperative pain. Whether non-steroidal anti-inflammatory drugs or acetaminophen provides effective analgesia following lumbar disc surgery remains controversial. This study aimed to determine whether flurbiprofen produces analgesic effects equivalent to those of acetaminophen after lumbar disc surgery. Study Design: Prospective, randomized, open-label, placebo-controlled trial Place and Duration of Study: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo, Japan, between April 2018 and March 2019. Methodology: We studied 76 patients who underwent elective lumbar disc surgery under general anesthesia. The patients were randomly allocated to one of three groups. Group A (n=25) received 1000 mg of acetaminophen intravenously every 6 h. Group F (n=25) received 50 mg of flurbiprofen intravenously every 6 h. Group C (n=26) received saline intravenously every 6 h as a placebo. Each drug was started before skin closure 18 h after surgery. All patients were anesthetized under total intravenous anesthesia with propofol and remifentanil and received fentanyl before skin closure. Postoperative pain was evaluated using a numerical rating scale (NRS) at 0, 1, 3, 6, 12, 18, and 24 h postoperatively. The patients were administered diclofenac sodium or loxoprofen, as rescue analgesics, as needed. Results: There were no significant differences in patient characteristics among the three groups. There were no significant differences in NRS scores among the three groups during the study period. However, rescue analgesics were administered significantly less frequently in group F than in groups A and C over 12 h and 24 h, respectively. Conclusion: The results of this study showed that flurbiprofen might provide more effective analgesia than acetaminophen following lumbar disc surgery.

Intravenous lidocaine in cancer-related neuropathic pain: case series

Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.

An Overview of Labor Pain: Components and Stages of the Labor Process

Labor pain (LP) is unbearable and a major source of anxiety and stress. Painful uterine contractions cause hyperventilation in the mother, and because of augmented catecholamine concentration, both the mother and her fetus will be hypoxic. Effective analgesia provides protection from difficulties and ensures good results in both the mother and fetus. Hence, the control of pain should form an integral part of labor management at any level. This brief review aims to identify LP and its effects on fetus and mother, stages of delivery and labor process, and components of LP.

A COMPARISION OF INTRATHECAL HYPERBARIC BUPUVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE ALONE IN GYNAECOLOGICAL SURGERIES FOR POSTOPERATIVE ANALGESIA

This study was performed at a tertiary care centre after the approval of the Institutional Ethical Committee and obtaining written informed consent from all patients. Sixty ASA I and II, aged 18- 65yrs, bodyweight 45-70kgs scheduled for gynaecological surgeries under spinal anaesthesia were chosen for the study and were divided into two groups named Group B and Group BN each comprising 30 patients. Group B received 3ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline and Group BN received 3ml of 0.5% hyperbaric bupivacaine with 0.5ml (150mcg) of buprenorphine. Vital parameters like pulse rate, blood pressure, respiratory rate, SpO2 were recorded at 0 (basal) 15, 30, 45, 90 and 180 minutes. Postoperatively heart rate, blood pressure, respiratory rate and SP02 were monitored at 3 ,6 ,12 and 24 hrs. The mean age, height, weight, duration of surgery were comparable. Time of onset of sensory blockade and motor blockade were noted. The time for rescue medication was 909.0±216.9 min in group BN with a range from 690 min to 1500 min and in group B it was 412.0±89.28 min with a range from 130 min to 195 min. Comparing both groups duration of effective analgesia was significantly higher in group BN with P<0.0001.thus, it can be concluded that addition of buprenorphine as an adjuvant in spinal anaesthesia excellently prolongs duration of analgesia in postoperative period with minimal side effects.

Effect of Magnesium Sulphate on Postoperative Analgesia Requirements in Caesarean Section - A Retrospective Study in a Tertiary Care Rural Hospital in Midnapore, West Bengal

BACKGROUND Post caesarean section pain requires effective analgesia. Effective analgesia is integral to improvement of quality and patient care among lower segment caesarean section (LSCS) patients. Magnesium, an N-methyl-D-aspartate receptor antagonist along with calcium-channel blocker, has previously been investigated for its analgesic properties. But there is scanty previous literature available for intramuscular magnesium sulphate in the analgesic role in post caesarean mothers. The purpose of this study was to evaluate the effect of existing MgSO4 regimens (among severe pregnancy induced hypertension patients, excluding eclampsia) during early 1st 24 hours’ postoperative analgesic requirements in caesarean section patients comparing to only analgesic group. METHODS It is a retrospective observational study, conducted from January 2019 to June 2020. Patients were randomly selected, normal patients as control = 50 who got post-operative inj. diclofenac 75 mg IM twice a day and rescue analgesia inj. diclofenac 75 mg IM. Test sample comprised of 50 randomly selected severe pregnancy induced hypertension (PIH) patients who got prophylactic inj. magnesium sulphate by Pritchard regimen for 24 hrs. post delivery with 4 gm 20 % inj. magnesium sulphate intravenous with 10 gm 50 % intramuscular in both buttocks as loading dose followed by 5 gm 50 % inj. magnesium sulphate intramuscular 4th hourly for 24 hrs. along with inj. diclofenac 75 mg IM twice a day. Visual analogue scale for pain was noted among both the groups, and were compared for the effect of analgesics in the study groups. RESULTS There was a decrease in analgesic consumption and immediate post-operative pain in the group receiving MgSO4 with analgesic (inj. diclofenac 75 mg), in comparison to control group of inj. diclofenac 75 mg. (P < 0.0001). CONCLUSIONS There was a decrease in analgesic consumption in the group receiving MgSO4 plus analgesic, in comparison to control group (analgesic group). Pain severity assessment 2, 6, 12 and 24 hours post operatively showed that there was a statistically significant decrease in pain scores between the study and the control groups (P < 0.0001). It established the role of magnesium sulphate as an adjuvant analgesic along with diclofenac or other traditionally used pain medications among the post caesarean mothers in early post-operative period. KEYWORDS Analgesia, Pregnancy, Post-Operative Analgesia, Magnesium Sulphate, Lower Segment Caesarean Section (LSCS), Pain Relief, Obstetrics

EFFECT OF PRE-COOLING THE INJECTION SITE ON PAIN PERCEPTION IN PAEDIATRIC DENTISTRY

Objective: To compare the mean Sound, Eye and Motor (SEM) score of pre cooling and topical application atinjection site in pediatric patients. Study Design: A quasi experimental study. Place and Duration of Study: Fatima Jinnah Dental College and Hospital, Karachi, from Sep to Dec 2017. Methodology: Sixty four paediatric patients aged between 8-12 who needed dental anaesthesia were randomlydivided into two groups A and B. Subjects in group A were applied topical anaesthesia at the injection site for one minute before needle penetration and in group B ice pack was applied for the same duration at the injection site. A designed questionnaire based on SEM scale was used to measure the patients‟ reaction. Independent-samples t-test was applied to compare the mean SEM score of both groups by taking p-value ≤0.05 as significant. Results: The mean sound, eye and motor (SEM) score was 5.22 ± 1.718 for group A and 3.28 ± 1.373 for group B;with statistically significant differences between both the groups (p≤0.05). Conclusion: Injection of local anaesthesia at a precooled site results in lesser pain and thus decreased childanxiety levels, more effective analgesia and increased patient comfort.

Is fascia iliaca compartment block or intravenous opioid analgesia better when positioning patients with fractured neck of femur for spinal anaesthesia?

Patients with a fractured neck of femur require effective analgesia to improve positioning before the administration of spinal anaesthetic. This article discusses the evidence to show whether fascia iliaca compartment block or intravenous opioid analgesia is preferable in this situation.