The impact of the treatment of chronic pain treatment with transdermal buprenorphine on functional performance and risk of falls in elderly people diagnosed with osteoarthritis

The aim of the study was to evaluate the impact of transdermal buprenorphine on overall functional fitness and the risk for falls in the treatment of chronic pain in elderly patients diagnosed with osteoarthritis. Transdermal buprenorphine was used for 10 days in 60 patients over 64 years old in the treatment of severe chronic pain caused by osteoarthritis. Patients were randomly assigned to 3 groups with a starting dose of 8.75 µg/h, 17.5 µg/h, and 35 µg/h, respectively. On day 1 of the study, the Barthel Index, Instrumental Activities of Daily Living (IADL), Mini–Mental State Examination (MMSE), and the Tinetti balance and gait test were used. On the final day of the study, the Tinetti balance and gait test and the Barthel Index were used again. Pain intensity was evaluated every day with the Brief Pain Inventory – Short Form. No differences in IADL scores between patient groups in baseline assessment were found. An improvement in the Barthel Index overall scores was obtained in all patients with no differences between patient groups. An improvement for both balance and gait in all patient groups of the Tinetti test was found. Regarding balance and overall results, a more significant improvement in group 3 compared to groups 1 and 2 was observed. Transdermal buprenorphine provided satisfactory analgesia regardless of the starting dose of the drug with better toleration of lower initial doses: 8.75 µg/h and 17.5 µg/h compared to a starting dose of 35 µg/h. The treatment of elderly patients with severe chronic pain induced by osteoarthritis with different initial doses of transdermal buprenorphine improved overall physical fitness and reduced the risk for falls. The treatment resulted in satisfactory analgesia with less adverse effects in patients who started with lower initial lower doses of transdermal buprenorphine.

Effectiveness of Pre-Operative Subcutaneous Infiltration of Ketamine for Post-Operative Analgesia and Haemodynamic Attenuation

Background: Ketamine is a noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptor which plays an important role in pain modulation. It decreases acute postoperative pain by inhibiting C fiber activity. Objective: Purpose of this study was to evaluate the effectiveness of preoperative subcutaneous infiltration of ketamine for postoperative analgesia and haemodynamic attenuation. Materials and Methods: This Randomized controlled trial study was conducted among the patients with ASA (Ameracin Society of Anaesthesiologist) grade I & II, planned for major abdominal surgery with upper midline incision. Total 60 patients were selected and allocated into two groups, 30 in each- group A & B. Group A - Patients received subcuteneous wound infiltration with ketamine. Group B - Patients given subcuteneous wound infiltration with bupivacaine. Then haemodynamic status and patient outcome was assessed at different point of time. Results: There was no significant difference between groups in respect of demographic and ASA status. Mean age was found to 38.7±8.53 years. In Group A, 63.3% were ASA I and 36.7% were ASA II. In Group B, 60% were ASA I and 40% were ASA II. It has become evident that satisfactory analgesia can be acheived by subcuteneous wound infiltration with ketamine (in Group-A).The Mean verbal pain score was 5.2±0.47 and 7.4±0.68 in group A & group B respectively. The difference was statistically significant (p<0.05). After 2hrs, mean sedation was found 4.38±0.57 score in group A, but in group B score is reduced and found 3.52±0.27. Mean difference was statistically significant (p<0.05) between two groups. Conclusion: Surgical site infiltration of ketamine is a promising analgesic method in reduction of postoperative pain with minimal sedation and adverse effects. There was significantly prolonged duration of analgesia and better outcome. KYAMC Journal.2021;12(1): 26-31

Memorials to John Snow – Pioneer in anaesthesia and epidemiology

John Snow was an English physician and a founding father of epidemiology, whose name is inextricably linked with tracing the source of the 1854 cholera outbreak in Soho, which killed over 600 people. Despite his recommendation to remove the water pump handle and thus reduce the spread of cholera, his theory of faecal–oral transmission was not widely believed until after his death. Furthermore, he also pioneered substantial achievements in the development of anaesthesia. He studied both chloroform and ether, improving the accuracy of their delivery. In his obstetric practice, he achieved the feat of obtaining satisfactory analgesia with a safer technique and is remembered for administering chloroform to Queen Victoria, during the delivery of her last two children. There are several interesting and unusual memorials to Snow, ranging from replica water pumps, blue plaques and a public house named after him. The most recent new memorial was erected in 2017, in his home town of York, which commemorates his origins and his subsequent contribution to curbing the cholera outbreak. All the memorials commemorate his achievements, which remain relevant today. Public health and epidemiology expertise is required in the current world of the COVID-19 pandemic, where his legacy remains as important as ever.

Effectiveness of red propolis and Mikania glomerata in bitches´s surgical analgesia

The aim of this research was to evaluate the analgesia provided by red propolis and Mikania glomerata oral administration in 40 female dogs submitted to ovariohysterectomy (OH) compared to standard treatment with no steroidal anti-inflammatory ketoprofen. Through of a doble-blind and randomized study, the animals were divided in four different groups with 10 animals of treatments: control treatment with ketofen (CT), propolis treatment (PT), Mikania glomerata treatment (MT), and propolis-Mikania glomerata treatment (PGT). All pacients received one of these treatments two hours before OH and the pain evaluation was performed 1 (T1), 6 (T6), 12 (T12), and 24 hours (T24) after OH using University of Melbourne Pain Scale and the Glasgow Composite Measure Pain Scale. Glucose levels were also measured at the same times, except at 6 hours after OH (T6). All treatments achieved similar and satisfactory analgesia. During the experiment, only three animals were rescued, two belonging to the PT and another of the MT. Considering the lower rate of complications and no rescue necessity of in PGT and CT treatments, they were considered the most effective and safer. The combined treatment with propolis and Mikania glomerata could be a promising alternative method for OH surgery analgesia in bitches.

Efficacy, Safety And Patient Satisfaction Of A Simple Combination Of Readily Available Medications (Shiv-mix) For Perioperative Analgesia, Hemodynamic Stability And Postoperative Recovery Profile: Case Series And Narrative On Opioid Free Anaesthesia (OFA) In Spine Surgeries

Opioid-free anesthesia (OFA) is an emerging technique, is a boon especially for limited resource settings(LRS) where opioids availability is limited for perioperative pain management. The current study presents use of a combination of easily available medication as part of multimodal analgesia. These medications are easily available to any physician and our experience demonstrates that in addition to providing satisfactory analgesia, use of this combination also provides better hemodynamic stability and excellent post-operative recovery.

Anesthetic quality and cardiovascular and respiratory effects of continuous intravenous infusion of tiletamine-zolazepam in bitches

ABSTRACT: The objective of this study was to evaluate the quality and recovery from anesthesia promoted by the tiletamine-zolazepam (TZ) combination administered intravenously (IV) continuously in bitches pre-medicated with acepromazine. Eight cross-bred, clinically healthy bitches weighing 13.7 ±1.9kg on average were used in this study. After a food fast of 12 h and a water fast of four hours, the animals were treated with acepromazine (0.1mg/kg, intramuscular) and, after 15 minutes, anesthesia was induced with a combination of tiletamine-zolazepam (2mg/kg, IV) immediately followed by continuous IV infusion thereof at a dose of 2mg/kg/h for 60 min. The following parameters were measured in all animals immediately before administration of acepromazine (M15), immediately before anesthetic induction (M0), and at 5, 10, 20, 30, 40, 50, and 60 min after initiation of continuous infusion (M5, M10, M20, M30, M40, M50, and M60): electrocardiography (ECG), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), body temperature (BT), and arterial hemogasometry, with the last performed only at experimental times M15, M0, M30, and M60. A subcutaneous electrical stimulator was used to evaluate the degree of analgesia. Myorelaxation and quality of anesthetic recovery were also assessed, classifying these parameters as excellent, good, and poor. Anesthetic recovery time was recorded in minutes. HR increased significantly at time M10 in relation to that at M-15, and at times M5, M10, M40, and M50 in relation to that at M0. MAP decreased significantly at M20 and M30 compared with the baseline. BT decreased significantly at M50 compared with that at M0, but no hypothermia was observed. RR showed significant reduction at M5, M10, and M20 in relation to that at M-15, and at M5 and M10 in relation to that at M0, and bradypnoea was observed during the first 20 min after anesthetic induction. Significant decreases in the PR interval at times M10, M40, and M50 were observed in relation to that at M15. Amplitude of the R wave showed significant decrease at M20 compared with that at M-15. In the other ECG parameters, no significant difference was observed between the times evaluated. Hemogasometric parameters and analgesia did not show significant alterations. Myorelaxation and quality of anesthetic recovery were considered excellent. Recovery time was 15.1±7.7 min for positioning of sternal decubitus and 45.5±23.1 minutes for return of ambulation. Continuous IV administration of TZ combination does not produce satisfactory analgesia and does not cause severe cardiorespiratory and hemogasometric effects in bitches pre-medicated with acepromazine.

Analgesic efficacy and safety of four different anesthesia/postoperative analgesia protocols in patients following total hip arthroplasty

Background/Aim. Hip replacement surgery can initiate significant postoperative pain caused by bone alterations, implant, and soft tissue or nerve injuries. Postoperative analgesia using regional techniques has been shown to have numerous advantages over the intravenous use of morphine. However, numerous side effects and complications of postoperative continuous epidural analgesia have been reported recently. The aim of this prospective, randomized study was to investigate whether continuous lumbar plexus block can be a safe and efficacious alternative for postoperative analgesia in comparison with epidural analgesia and patient-controlled analgesia with morphine (PCA morphine) for hip arthroplasty. Methods. This prospective study included 60 patients, scheduled for total hip arthroplasty. Patients were randomized into 4 groups: the group central nerve block ? epidural (CNB), the group peripheral nerve block ? lumbar plexus block (PNB), the group spinal anesthesia-PCA morphine (SAM) and the group general anesthesia-PCA morphine (GAM). The quality of analgesia and side effects (hypotension, nausea, vomiting, urinary retention) were recorded in all groups at 4 h, 12 h, and 24 h after surgery. Pain scores were assessed using Visual Analogue Scale (VAS), both at rest and on moving. Results. Our findings demonstrated that the use of a continuous lumbar plexus block provides effective analgesia at rest and on moving, during 24 h after hip arthroplasty. Pain scores varied significantly among the groups 4 h postoperatively (F = 21.827; p < 0.01), 12 h postoperatively (F = 41.925; p < 0.01) and 24 h postoperatively (F = 33.768; p < 0.01) with the highest scores ? 3 in the GAM group. Patients from the PNB group had satisfactory analgesia, comparable with patients from the CNB group. The incidence of nausea was significantly lower in the PNB group 12 h after the operation (?2 = 9.712; p < 0.01). The incidence of urine retention was significantly different 12 h after the operation, with a presence only in the CNB group, with the incidence of 33.3% (?2 = 16.365; p < 0.01). In all studied groups, the incidence of hypotension was not significantly different postoperatively. Conclusion. Administration of postoperative analgesia using continuous lumbar plexus block produces satisfactory analgesia with a low incidence of side effects when compared to epidural analgesia or parenteral opioids following hip arthroplasty.

Prevention and management of breakthrough pain during neuraxial labour analgesia

While neuraxial analgesia is considered the gold standard for labour analgesia, breakthrough pain can occur and can significantly impair maternal satisfaction. The early identification of breakthrough pain, for example, during epidural delivery suite rounds, is not only important for adequate maternal analgesia, but also in anticipation of using the epidural catheter for other potential obstetric interventions. Identifying patients at high risk for experiencing breakthrough pain enables the anaesthesia provider to adjust their anaesthetic plan. In case breakthrough pain does occur, it should be managed promptly and aggressively, with the goal to restore adequate analgesia within a maximum of 60 minutes. This chapter reviews potential causes of breakthrough pain and strategies that can be used to prevent problems and rescue poorly functioning catheters. Results of rescue interventions should be assessed in a timely fashion and the epidural catheter should be replaced if satisfactory analgesia is not obtained.