Journal articles on the topic 'Analgesia'
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Lukito, Johan Indra. "Kombinasi Analgesik Non-opioid Intravena untuk Tata Laksana Nyeri Akut." Cermin Dunia Kedokteran 50, no. 9 (September 1, 2023): 509–15. http://dx.doi.org/10.55175/cdk.v50i9.868.
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Konsep analgesia multimodal dianjurkan untuk pengobatan nyeri. Paracetamol dan nonsteroidal antiinflammatory drugs (NSAID) umumnya menjadi analgesik dasar, serta dikombinasikan dengan opioid sesuai kebutuhan. Analgesik intravena (IV) dapat menjadi solusi bagi pasien yang tidak dapat menerima analgesik per oral. Kombinasi paracetamol dan ibuprofen IV menunjukkan efek analgesik yang signifikan, dengan manfaat opioid sparing, antipiretik, serta dengan profil keamanan yang relatif baik pada pasien nyeri akut. The concept of multimodal analgesia is recommended for the treatment of pain. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are generally the basic analgesics, and are combined with opioids as needed. Intravenous (IV) analgesics may serve as an alternative for patients who cannot tolerate oral analgesics. The IV combination of paracetamol and ibuprofen for acute pain shows a significant analgesic effect with the benefits of opioid sparing, also with antipyretic effect, and with a relatively good safety profile.
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Fürst, Susanna, Zoltán S. Zádori, Ferenc Zádor, Kornél Király, Mihály Balogh, Szilvia B. László, Barbara Hutka, et al. "On the Role of Peripheral Sensory and Gut Mu Opioid Receptors: Peripheral Analgesia and Tolerance." Molecules 25, no. 11 (May 26, 2020): 2473. http://dx.doi.org/10.3390/molecules25112473.
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There is growing evidence on the role of peripheral µ-opioid receptors (MORs) in analgesia and analgesic tolerance. Opioid analgesics are the mainstay in the management of moderate to severe pain, and their efficacy in the alleviation of pain is well recognized. Unfortunately, chronic treatment with opioid analgesics induces central analgesic tolerance, thus limiting their clinical usefulness. Numerous molecular mechanisms, including receptor desensitization, G-protein decoupling, β-arrestin recruitment, and alterations in the expression of peripheral MORs and microbiota have been postulated to contribute to the development of opioid analgesic tolerance. However, these studies are largely focused on central opioid analgesia and tolerance. Accumulated literature supports that peripheral MORs mediate analgesia, but controversial results on the development of peripheral opioid receptors-mediated analgesic tolerance are reported. In this review, we offer evidence on the consequence of the activation of peripheral MORs in analgesia and analgesic tolerance, as well as approaches that enhance analgesic efficacy and decrease the development of tolerance to opioids at the peripheral sites. We have also addressed the advantages and drawbacks of the activation of peripheral MORs on the sensory neurons and gut (leading to dysbiosis) on the development of central and peripheral analgesic tolerance.
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Tantri, Aida Rosita, Riyadh Firdaus, Hansen Angkasa, Ahmad Pasha Natanegara, and Muhammad A. I. Maulana. "Pre-emptive versus preventive analgesia for postoperative pain: a systematic review and meta-analysis." Universa Medicina 42, no. 2 (June 22, 2023): 227–39. http://dx.doi.org/10.18051/univmed.2023.v42.227-239.
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BackgroundPostoperative pain is a type of nociceptive pain that originates from tissue damage due to trauma caused by surgery. Pre-emptive analgesia is treatment that starts before surgery, to prevent or reduce the establishment of sensitization of dorsal horn neurons caused by tissue injury, the sensitized neurons being supposed to amplify postoperative pain. Pre-emptive analgesia consists of administering analgesic medication before tissue injury, that is, before the reception, transmission, modulation, and nociception of the aggressive stimulus, aiming to prevent hyperalgesia. This review aims to compare the efficacy of pre-emptive analgesia and preventive analgesia in postoperative pain. MethodsArticle searching was done on five databases (PubMed, ProQuest, Scopus, ScienceDirect, ClinicalKey). Hand-searching was also done to find additional articles. We have only included double-blind, randomized, controlled trials (RCT). A total of fifteen articles were included and all were RCT studies comparing pre-emptive analgesia with preventive analgesia. The quality of the included studies was evaluated with Cochrane risk-of-bias assessment tools. Quantitative analysis was performed by Review Manager 5.4. ResultsFifteen studies comprising 830 subjects were included in this study. Our analysis revealed that pre-emptive analgesia significantly improved visual analog scale (VAS)/numeric rating scale (NRS)/verbal rating scale (VRS) 4 hours postoperatively [mean difference (MD) = -0.25, 95% CI: [- 0.49, -0.02]; I2 = 94%]. Unfortunately, pain scoring at 6, 12 and 24 hours after surgery did not differ significantly between pre-emptive and preventive analgesia. Duration of analgesia was comparable between the two groups. Time to rescue analgesics was similar between the two groups, but the pre-emptive group was associated with less analgesic consumption postoperatively than the preventive group. ConclusionPre-emptive analgesia provided better pain relief than preventive analgesia during the short term. Time to rescue analgesics is comparable between both groups, but pre-emptive analgesia is associated with lower amounts of rescue analgesics postoperatively.
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Wellington, Nancy, and Michael J. Rieder. "Attitudes and Practices Regarding Analgesia for Newborn Circumcision." Pediatrics 92, no. 4 (October 1, 1993): 541–43. http://dx.doi.org/10.1542/peds.92.4.541.
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Study objective. To determine attitudes regarding routine use of analgesia for newborn circumcision among primary care physicians in southwestern Ontario. Design. Questionnaire survey conducted among all family physicians and pediatricians belonging to the London Academy of Medicine. The majority of pediatric primary care in this region is provided by family physicians. Setting. Metropolitan center in Southwestern Ontario. Respondents. A questionnaire was mailed to 279 physicians; 171 (61%) responded. Results. Seventy-four (43%) respondents performed circumcisions. Among physicians performing circumcisions, a minority (17; 24%) used any form of analgesia. The most commonly used analgesic (14; 20%) was oral ethanol. Only 3 (4%) physicians used dorsal penile nerve block. The most common reasons listed for not employing analgesia were lack of familiarity with analgesia use among neonates (56%), lack of familiarity with the technique of dorsal penile block (50%), and concern over adverse effects of analgesic drugs (49%) and regional analgesia (44%). Only a small minority of physicians (7; 12%) responded that they believe that neonates do not feel pain, and 20 (35%) believe that neonates do not remember pain. Conclusions. Despite evidence that neonates perceive pain and that there is a physiologic stress response to circumcision which can be reduced if analgesia is employed, the vast majority of physicians performing newborn circumcisions either do not employ analgesics or employ analgesics of questionable efficacy. Lack of familiarity with the use of analgesics among neonates and with dorsal penile block in particular are the most common reasons cited for lack of analgesic use. Educational efforts and research into less invasive techniques of analgesia for newborn circumcision are urgently required.
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Dmytriev, Dmytro, Oleksandr Nazarchuk, and Yuliana Babina. "Metoxifluran, an inhalation analgesic that opens up new possibilities in anesthesia." Pain medicine 8, no. 1-2 (October 4, 2023): 9–16. http://dx.doi.org/10.31636/pmjua.v8i1-2.2.
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Although numerous clinical guidelines for pain management have been published over the past decade, inadequate pain relief remains a major public health problem. Currently, several methods of analgesia are available for the treatment of acute pain, including intravenous analgesia, epidural anesthesia, and oral administration of medications. However, the existing methods of analgesia still do not cover all the needs of proper analgesia, the search for new forms of release, methods of administration and methods of analgesia continues. Currently, non-invasive methods of analgesia are being actively implemented, which include a transdermal delivery system of analgesics (in particular, fentanyl hydrochloride), intranasal and inhalational analgesia, in which the delivery of analgesics is controlled by both the doctor and the patient. The purpose of this article is to review the inhaled analgesic methoxyflurane, which is administered by means of an individual inhaler and is used for the treatment of acute pain.
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Furumoto, Kayo, Kumi Ogita, Tomomi Kamisaka, Asami Kawasumi, Koushi Takata, Noritaka Maeta, Takamasa Itoi, Masakatsu Nohara, Kaori Saeki, and Teppei Kanda. "Effects of Multimodal Analgesic Protocol, with Buprenorphine and Meloxicam, on Mice Well-Being: A Dose Finding Study." Animals 11, no. 12 (November 30, 2021): 3420. http://dx.doi.org/10.3390/ani11123420.
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The anesthetic or analgesic agent of choice, route and frequency of anesthetic or analgesic administration, and stressors induce distress during the perioperative period. We evaluated a multimodal analgesic protocol using buprenorphine and meloxicam on the well-being of mice. Twenty-four Slc:ICR male mice were divided into control, anesthesia + analgesia, and surgery + anesthesia + analgesia groups. Tap water (orally: PO) and water for injection (subcutaneous: SC) were administered to the control group. Buprenorphine was administered twice (SC, 0.1 mg/kg/8 h) and meloxicam was administered thrice (PO, 5 mg/kg/24 h) to the anesthesia + analgesia and surgery + anesthesia + analgesia groups. The mice were subjected to laparotomy and assessed for several parameters. Even in absence of surgical pain, the anesthesia + analgesia group presented the same negative effects as the surgery + anesthesia + analgesia group. This multimodal analgesic protocol for mice was expected to have an analgesic effect on pain associated with laparotomy but was not sufficient to prevent food intake and weight decrease. This does not negate the need to administer analgesics, but suggests the need to focus on and care not only about the approach to relieve pain associated with surgery, but also other types of distresses to minimize negative side effects that may interfere with postoperative recovery in mice.
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Tumanyan, Sergey V., Oleg I. Kit, Elena M. Frantsiyants, Tatiana I. Moiseenko, Oksana V. Oros, and Elizaveta Yu Sugak. "Non-opioid analgesics: New opportunities in early rehabilitation of patients with gynecological cancer." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e17129-e17129. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17129.
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e17129 Background: An important principle of analgesia is its effect on each component of the pain formation. The purpose of the study was to improve analgesia in the perioperative period in patients with gynecological cancer. Methods: This prospective randomized study of the quality and effectiveness of various analgesics included 97 patients aged 22-67 years receiving surgery for gynecological cancer. The patients were divided into two groups. Group 1 (n = 47): patient-controlled analgesia with trimeperidine and nonsteroidal anti-inflammatory drugs (NSAIDs); group 2 (n = 50): preemptive analgesia based on lidocaine, magnesium sulphate, nefopam and NSAIDs. Results and pain syndrome were assessed by levels of glucose, cortisol, insulin, lactate, C-reactive protein (CRP), Kerdo autonomic index, visual analogue scale (VAS), levels of personal and reactive anxiety and depression. Results: Analgesic effect of trimeperidine was obtained in 83.3% (p < 0.05). However, the effect was less pronounced, compared to non-opioid analgesics, and did not reduce the psychosomatic component of pain after surgical treatment. In group 2, non-opioid analgesia limited the increase of cortisol, glucose, insulin, CRP and lactate (p < 0.05) providing effective pain relief in the perioperative period. Non-opioid analgesics promoted an optimal analgesic effect, did not cause residual sedation, anxiety, depressive effects and cognitive impairments, which showed their obvious advantage over opioids. Opioid-sparing effect was 96.3% (p < 0.05). Reducing the consumption of narcotic analgesics without worsening the quality of postoperative analgesia and the patient's well-being is an important advantage which allows minimizing the negative effects of opioids, facilitating the early rehabilitation of patients. Conclusions: Non-opioid analgesics can significantly limit endocrine and metabolic changes without worsening the quality of analgesia in the perioperative period.
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Tikuišis, Renatas, Povilas Miliauskas, Narimantas Evaldas Samalavičius, and Giedrė Rudinskaitė. "Epidurinės nejautros poveikis skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos rezekcijos." Lietuvos chirurgija 6, no. 3 (January 1, 2008): 0. http://dx.doi.org/10.15388/lietchirur.2008.3.2152.
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Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 VilniusEl paštas: renatas.tikuisis@loc.lt Įvadas / tikslas Palyginti su sistemine analgezija opiatais, atliekant atviras gaubtinės ir tiesiosios žarnos operacijas, epidurinė nejautra efektyviau malšina skausmą ir ją sukėlus sumažėja pooperacinio žarnų nepraeinamumo dažnis. Šio tyrimo tikslas – nustatyti epidurinės analgezijos poveikį skausmo malšinimui ir žarnyno funkcijos atsitaisymui po gaubtinės ir tiesiosios žarnos operacijų. Ligoniai ir metodai Tyrime dalyvavo 50 ligonių, kuriems buvo atlikta gaubtinės arba tiesiosios žarnos rezekcija. Tai buvo perspektyvusis tyrimas, kuris truko dvejus metus. Atsitiktinės atrankos būdu ligoniai buvo suskirstyti į tiriamąją (T) ir kontrolinę (K) grupes. Po 25 ligonius pateko į kiekvieną grupę. T grupės ligoniams buvo taikyta epidurinė nejautra, o K grupės – švirkščiami narkotiniai analgetikai į veną ir penkis raumenis. Buvo vertinamas narkotinių analgetikų suvartojimas, skausmo intensyvumas po operacijos, žarnyno funkcijos atsitaisymo laikas ir laikas, kai ligonis pradėjo vartoti kietą maistą. Rezultatai Abi grupės pagal operacijos apimtį ir ligonių charakteristiką buvo labai panašios. T grupės ligoniams reikėjo mažiau narkotinių analgetikų, jiems skausmo intensyvumas buvo mažesnis, jų žarnyno veikla atsitaisė anksčiau ir jie anksčiau pradėjo vartoti kietą maistą, palyginti su K grupės ligoniais. Išvada Epidurinės analgezijos metodas yra pranašesnis už intraveninį skausmo malšinimo metodą, taip pat mažiau suvartojama narkotinių analgetikų. Epidurinė analgezija pagreitina žarnyno funkcijos atsitaisymą, todėl ligoniai anksčiau pradeda valgyti kietą maistą po atvirų gaubtinės ir tiesiosios žarnos operacijų. Reikšminiai žodžiai: epidurinė analgezija, intraveninė analgezija, gaubtinės žarnos rezekcija, tiesiosios žarnos rezekcija Influence of epidural analgesia on postoperative pain relief and gastrointestinal recovery after colorectal resection Renatas Tikuišis, Povilas Miliauskas, Narimantas Evaldas Samalavičius, Giedrė RudinskaitėVilnius University, Institute of Oncology, Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: renatas.tikuisis@gmail.com Backgound / objective Epidural analgesia provides superior analgesia with a lower incidence of postoperative ileus as compared with systemic opiate analgesia in open colorectal surgery. The aim of this study was to determine the effects of epidural analgesia on the outcome after colorectal surgery. Patients and methods Fifty patients were enrolled in this investigation. Open colorectal resection was performed for all these patients. The patients were randomly assigned into two groups: the study group (T) and the control group (K). Epidural analgesia was used for 25 patients of group T, and intravenous-intramuscular analgesia was used for 25 patients of group K. Consumption of narcotic analgesics, pain intensity, gastrointestinal recovery time and solid food tolerated time were investigated. Results There were no significant differences in the type of operations and preoperative patients’ characteristics between the groups. Consumption of narcotic analgesics was lower in group T, and analgesia was more effective in the epidural group. The mean time of peristalsis and solid food tolerance was earlier in group T as compared with group K. Conclusion Epidural analgesia provides a significant benefit as regards analgesic consumption, postoperative pain relief and the recovery of gastrointestinal function in patients undergoing open colorectal resection. Keywords: epidural analgesia, intravenous analgesia, colorectal surgery
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Stillman, Mark W., and Alexandra L. Whittaker. "Use and Efficacy of Analgesic Agents in Sheep (Ovis aries) Used in Biomedical Research." Journal of the American Association for Laboratory Animal Science 58, no. 6 (November 1, 2019): 755–66. http://dx.doi.org/10.30802/aalas-jaalas-19-000036.
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Sheep (Ovis aries) are widely used as large animal models in biomedical research. However, current literature on the use of analgesics in sheep generally focuses on an industry or farm level of use. This structured review evaluates use and efficacy of analgesics administered to sheep in a biomedical research setting. Electronic databases were searched with terms related to analgesia in research sheep. After application of exclusion criteria, 29 peer-reviewed publications were evaluated from 1995 to 2018. Drugs used for analgesia in sheep include opioids, α2 agonists, NSAID, local anesthetics, NMDA receptor antagonists, and calcium channel blockers. Opioid agonists have previously been considered short acting and of questionable efficacy in sheep, but newer modalities may provide effective analgesia. NSAID may exhibit an analgesic effect only when inflammatory pain is present and may not be beneficial for use in acute pain models. α2 agonists provide effective yet short-lived analgesia; however, side effects are of concern. Local anesthetics were previously widely used as stand-alone agents, as alternatives to the use of general anesthetics in sheep. These agents have since fallen out of favor as sole agents. Despite this, they provide a valuable analgesic effect when used as adjuncts to general anesthetic regimes. The NMDA antagonist ketamine provided good analgesia and is likely underutilized as an analgesic agent in sheep. Future controlled studies should further evaluate the analgesic properties of ketamine in sheep.
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Arendt-Neilsen, L., P. Bjerring, and J. Nielsen. "Regional variations in analgesic efficacy of EMLA cream. Quantitatively evaluated by argon laser stimulation." Acta Dermato-Venereologica 70, no. 4 (July 1, 1990): 314–18. http://dx.doi.org/10.2340/0001555570314318.
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The effect of EMLA cream (a eutectic mixture of local analgesics) applied for 30, 60, 90 and 120 min on the forehead, cheek, back, cubital fossa, and dorsum of the hand was studied. Analgesic onset, efficacy and duration were evaluated by sensory and pain thresholds to laser stimulation measured before, and 5, 60, 120, and 180 min after the cream was removed from the skin. Cutaneous blood flow was measured and found to be 4-5 times as high on the face as on the other locations. On the forehead the analgesic efficacy decreased with increased application time. For all other locations, efficacy increased with increasing application time. On the back, onset was rapid and sufficient analgesia could be obtained, but analgesias began to wane immediately after removal of the cream. In the cubital fossa and on the hand, onset was tardy, and efficacy continued to increase for 60 min after cream removal, followed by a slow decline. Blood flow, epidermal and dermal thickness are important factors affecting onset, efficacy and duration of EMLA analgesia.
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Williams, Owen D., and Graham Pluck. "The use of methoxyflurane (Penthrox®) for procedural analgesia in the emergency department and pre-hospital environment." Trauma 22, no. 2 (June 3, 2019): 85–93. http://dx.doi.org/10.1177/1460408619850038.
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Background Methoxyflurane is an inhaled analgesic agent licensed in the United Kingdom for the relief of moderate to severe pain in conscious patients with trauma. Methoxyflurane has been widely used by Australian ambulance services since the 1970s. Aims Primary aim: To assess the efficacy of methoxyflurane for procedural analgesia in the emergency department and pre-hospital environment. Secondary aims: to assess the efficacy of methoxyflurane for analgesia in the emergency department and pre-hospital environment; to assess the safety of methoxyflurane as an analgesic. Method A literature search of Medline, EMBASE, CINAHL and Cochrane databases was performed. A total of 59 articles were reviewed. Results One study using methoxyflurane for procedural analgesia in the emergency department was found. Multiple studies demonstrate the use of methoxyflurane for procedural analgesia for painful procedures outside the emergency department. Compared to other analgesics, methoxyflurane provides adequate analgesia. Overall, methoxyflurane is inferior to fentanyl or morphine, but it provides quicker onset analgesia compared to fentanyl and tramadol. It provides similar analgesia to nitrous oxide. Nephrotoxicity is dose dependent. Used in the analgesic doses, the risk of clinically significant kidney injury is negligible. Rare cases of unpredictable, severe hepatitis are reported. Discussion The efficacy of methoxyflurane and its acceptability to patients and clinicians has been shown in a number of studies. As would be expected in any procedural analgesic choice, patient and clinician factors and the procedure planned are all important considerations. Compared to other analgesic agents, methoxyflurane performs favourably with a low chance of adverse events. Conclusion Methoxyflurane is an efficacious analgesic agent in the emergency department and pre-hospital environment. It is easily portable and has a rapid onset. Methoxyflurane is suitable for use in procedural analgesia and as a bridging analgesic agent. Risks to the patient from renal or hepatic injury, cardiorespiratory depression or malignant hyperthermia are low.
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von Plato, Hanna, Vesa Kontinen, and Katri Hamunen. "Efficacy and safety of epidural, continuous perineural infusion and adjuvant analgesics for acute postoperative pain after major limb amputation – a systematic review." Scandinavian Journal of Pain 18, no. 1 (January 26, 2018): 3–17. http://dx.doi.org/10.1515/sjpain-2017-0170.
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AbstractBackground and aims:Treatment of pain following major limb amputations is often a clinical challenge in a patient population consisting mainly of elderly with underlying diseases. Literature on management of acute post-amputation pain is scarce. We performed a systematic review on this topic to evaluate the efficacy and safety of analgesic interventions for acute pain following major limb amputation.Methods:A literature search was performed in PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews using the following key words: [(amputation) AND (pain OR analgesi* OR pain relief)] AND (acute OR postoperative). Randomized controlled studies (RCTs) and observational studies investigating treatment of acute pain following major amputations for any indication (peripheral vascular disease, malignant disease, trauma) were included. The review was performed according to the standards described in the PRISMA statement. The Cochrane quality assessment tool was used to evaluate the risk of bias in the RCTs.Results:Nineteen studies with total of 949 patients were included. The studies were generally small and heterogeneous on outcomes, study designs and quality. There were 16 studies on epidural or continuous perineural analgesia (CPI). Based on five RCTs (n=268) and two observational studies (n=49), epidural analgesia decreased the intensity of acute stump pain as compared to systemic analgesics, during the first 24 h after the operation. Based on one study epidural analgesia caused more adverse effects like sedation, nausea and motor block than continuous perineural local anesthetic infusion. Based on one RCT (n=21) and eight observational studies (n=501) CPI seemed to decrease opioid consumption as compared to systemic analgesics only, on the first three postoperative days, and was well tolerated. Only three trials investigated systemic analgesics (oral memantine, oral gabapentine, iv ketamine). Ketamine did not decrease acute pain or opioid consumption after amputation as compared to other systemic analgesics. Gabapentin did not decrease acute pain when combined to epidural analgesia as compared to epidural analgesia and opioid treatment, and caused adverse effects.Conclusions:The main finding of this systematic review is that evidence regarding pain management after major limb amputation is very limited. Epidural analgesia may be effective, but firm evidence is lacking. Epidural causes more adverse effects than CPI. The results on efficacy of CPI are indecisive. The data on adjuvant medications combined to epidural analgesia or CPI is limited. Studies on efficacy and adverse effects of systemic analgesics for amputation pain, especially concentrating on elderly patients, are needed.
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Pulkina, O. N., V. P. Ivanov, V. I. Gurskaya, and E. V. Parshin. "Infiltrative analgesia of the skin flap in children with craniosynostosis after reconstructive surgery on skull bones." Messenger of ANESTHESIOLOGY AND RESUSCITATION 16, no. 6 (January 27, 2020): 37–45. http://dx.doi.org/10.21292/2078-5658-2019-16-6-37-45.
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The objective of the study is to evaluate the effectiveness of analgesia by infiltration of the skin flap with local anesthetic in children with craniosynostosis after reconstructive surgery.Materials and subjects. 50 children with craniosynostosis, who underwent reconstructive surgery on skull bones, were divided into two groups based on the method of postoperative anesthesia: in Group 1(experimental), the infiltration of the skin flap was used within multimodal anesthesia, while in Group 2, it was standard parenteral use of analgesic drugs. In the postoperative period, pain severity was assessed by FLACC scales, the amount of opioid and non-opioid analgesics consumed was assessed by the formalized Analgesiс Assessment Scale (FSA), and non-invasive hemodynamic monitoring (BP, HR) was performed.Results. The statistical analysis of the results revealed significant differences between groups in the assessment results of FSA and FLACC scales. In Group 1, the level of postoperative pain was significantly lower compared to Group 2. The amount of opioid and non-opioid analgesics consumed was also significantly lower in Group 1.Conclusion. The use of the infiltration of the skin flap as part of multimodal analgesia in children with craniosynostosis, after reconstructive surgery on skull bones significantly reduces the intensity of pain and the amount of opioid analgesics consumed in the postoperative period.
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Colclough, MD, George, John T. McLarney, MD, Paul A. Sloan, MD, K. Todd McCoun, MD, Gregory L. Rose, MD, J. S. Grider, MD, and P. Steyn, MD. "Epidural haloperidol enhances epidural morphine analgesia: Three case reports." Journal of Opioid Management 4, no. 3 (January 30, 2018): 163. http://dx.doi.org/10.5055/jom.2008.0021.
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Epidural opioids provide significant postoperative analgesia; however, their use is often limited by side effects such as nausea and pruritus, or they require the addition of epidural local anesthetics with possible side effects of motor block and hypotension. Adjuncts to epidural opioid analgesia would benefit pain management. There is evidence that epidural butyrophenones may enhance opioid analgesics and reduce side effects. The authors present the first reported use of epidural haloperidol to enhance epidural morphine analgesia in three individuals. Pharmacodynamic interactions of haloperidol, which may explain its analgesic efficacy, are summarized.
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Rajoria, Budhram, Mahipal Singh Dhaka, Manisha Malik, and Chetali Das. "Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia." Journal of Applied Pharmaceutical Research 11, no. 2 (June 30, 2023): 6–11. http://dx.doi.org/10.18231/j.joapr.2022.11.2.6.11.
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Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value < 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.
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Rajoria, Budhram, Mahipal Singh Dhaka, Manisha Malik, and Chetali Das. "Comparison of analgesic effect of preoperative intravenous paracetamol v/s ketorolac in laparoscopic cholecystectomy under general anesthesia." Journal of Applied Pharmaceutical Research 11, no. 2 (June 30, 2023): 6–11. http://dx.doi.org/10.18231/j.joapr.2023.11.2.6.11.
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Background: Preemptive analgesia is pain control before inciting a noxious stimulus. Upper abdominal and shoulder tip pain after laparoscopy is probably caused by gas retained in the peritoneal cavity. Pain relievers were given before the incision. Aim: The study was planned to compare the Analgesic effect of pre-operative intravenous Paracetamol versus Ketorolac in laparoscopic cholecystectomy under general anesthesia. The difference in the need for first rescue analgesia and total dose of rescue analgesics in 24 hours postoperative period in both groups was assessed. Methods: This Hospital Based Double Blinded Randomized Interventional Study was carried out in ASA I and II, aged 18 to 60 years in patients undergoing elective laparoscopic cholecystectomy under general anesthesia. Group A received an Intravenous infusion of paracetamol 1gm (100ml) and Group B received an intravenous infusion of ketorolac 30mg (1ml) diluted in 99 ml 0.9% normal saline. In both groups, analgesic was given over a period of 30 minutes, 30 min before induction of general anesthesia. The chi-square test and Student’s t-test were used for the statistical analysis. Results: The time for the demand of the first rescue analgesia was219±81.0 min in group A and 350±175.1min in group B, with a p-value < 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We concluded with our study, pre-emptive analgesia with 30mg ketorolac is better than 1 gm paracetamol. The time for rescue analgesia is prolonged, the number of rescue analgesics demanded is reduced, VAS score was significantly lower when ketorolac was used.
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Kelleci, Yavuz, Ruslan Abdullayev, Beliz Bilgili, Ayten Saraçoğlu, and Tümay Umuroğlu. "Epidural versus intravenous analgesia for pain control in kidney donors, a retrospective cohort study. Is there a kinship relationship?" Eurasian Journal of Anesthesiology and Intensive Care 1, no. 1 (February 12, 2024): 1–5. http://dx.doi.org/10.51271/eajaic-0001.
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Aims: Best care must be provided for live kidney donors, including postoperative pain control. Treatment options include iv intermittent analgesics, iv or epidural patient-controlled analgesia (PCA). In this study we aimed to compare these modalities with respect to their analgesic efficacy. Methods: A retrospective analysis of fifty-eight live donor nephrectomy patients operated in a 7-year-period in a university hospital performed. Investigational Review Board approval has been obtained. Data of the patients’ postoperative analgesia methods, degree of kinship with the recipient, postoperative pain scores, and rescue analgesic and antiemetic use were obtained. Correlation of postoperative pain scores with the analgesia technique was investigated, as well as with the degree of kinship of the donor and recipient. Results: Patient-controlled analgesia provided better postoperative pain control, with the epidural PCA being the best. Moderate to severe pain at 6th postoperative hour in the iv intermittent, iv PCA, and epidural PCA groups was 76, 37, and 14%, respectively. Rescue analgesic use on the day of operation was 32% and 5% in the iv intermittent and iv PCA groups respectively, with no rescue analgesic use in the epidural PCA group. Postoperative antiemetic consumption was also less with the epidural PCA (P=0.024 and P=0.027 for postoperative days 1 and 2, respectively). No correlation was detected between the pain and the degree of kinship. Conclusion: Epidural patient-controlled analgesia provides better postoperative pain control after live donor nephrectomy, compared with intravenous intermittent or patient-controlled analgesia. Postoperative pain scores were not related to the degree of kinship.
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Smith, Howard. "Peripherally-Acting Opioids." Pain Physician 2s;11, no. 3;2s (March 14, 2008): S121—S132. http://dx.doi.org/10.36076/ppj.2008/11/s121.
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Opioids are broad-spectrum analgesics with potent pain-relieving qualities but also with potential adverse effects related to both short-term and long-term therapy. Researchers have attempted to alter existing opioid analgesics, utilize different routes/ formulations, or combine opioid analgesics with other compounds in efforts to improve analgesia while minimizing adverse effects. Exogenous opioids, administered in efforts to achieve analgesia, work by mimicking the actions of endogenous opioids. Endogenous opioids and their receptors are located in the brain (supraspinal areas), spinal cord, and periphery. Although opioids and opioid receptors in the brain and spinal cord have received much attention over many years, peripheral endogenous opioid analgesic systems have only been extensively studied during the past decade. It has been known since 1990 that following injection into the rodent hindpaw, d-Ala2 , N-Me-Phe4 , Gly5 -ol-enkephalin (DAMGO) [a muopioid receptor agonist] probably exerts its antinociceptive effects locally, since the doses administered are too low to have an effect in the central nervous system (CNS). This notion has been supported by the observation that the quaternary compound morphine methyliodide, which does not as readily cross the bloodbrain barrier and enter the CNS, produced antinociception following intradermal administration into the hindpaw, but not when the same dose was administered systemically (subcutaneously at a distant site). With a growing appreciation of peripheral endogenous opioids, peripheral endogenous opioid receptors, and peripheral endogenous opioid analgesic systems, investigators began growing hopeful that it may be possible to achieve adequate analgesics while avoiding unwanted central untoward adverse effects (e.g. respiratory depression, somnolence, addiction). Peripherally-acting opioids, which capitalize on peripheral endogenous opioid analgesic systems, may be one potential future strategy which may be utilized in efforts to achieve potent analgesia with minimal side effects. Key words: Pain, opioids, immune cells, peripherally-acting opioids (PAO), leukocytes, inflammatory pain, peripheral analgesia
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Afify, Noha, and Khaled Gaballah. "The analgesic efficacy of subcutaneous nalbuphine compared with epidural analgesia in abdominal surgeries: A randomized controlled trial." Revista Chilena de Anestesia 52, no. 6 (2023): 604–10. http://dx.doi.org/10.25237/revchilanestv52n6-08.
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Background: Analgesia represents a cornerstone for the perioperative management of patients undergoing open abdominal surgery. Epidural analgesia (EPA) is a standard method for pain control in 50%-60% of major abdominal surgeries. Nalbuphine -a synthetic opioid agonist/ antagonist- has equianalgesic properties to morphine but without the undesirable side effects of the pure agonists. Objective: We compared the perioperative analgesic efficacy of subcutaneous nalbuphine and epidural analgesia in abdominal surgeries. Methods: 130 adult patients of both sexes with American Society of Anesthesiologists physical status class I or II aged 20-60 years were randomized into two equal groups. After induction of general anesthesia, the epidural was activated with 18 ml of bupivacaine 0.25% + 2 ml fentanyl (100 Mcg) in group (I), while in a group (II) subcutaneous nalbuphine (0.15 mg/kg) was injected. The time for the first postoperative analgesic request was recorded as the primary endpoint. The cumulative analgesics consumption within the first 24 postoperative hours and drug-related side effects were the secondary outcomes. Results: The time for the first postoperative analgesia request was significantly longer in group II than in group I (10.8 ± 1.34 vs 3.29 ± 0.72 hours) (p < 0.05). There was a significant reduction in postoperative analgesic requirements in group II compared with group I. Group II patients had significantly more sedation levels than group I (p < 0.05). Conclusion: Under the conditions of this study, subcutaneous nalbuphine showed a superior analgesic profile than epidural analgesia for open abdominal surgeries.
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Ambika, Banapura, Mamatha K. R., and Prabha P. "Pentazocine versus pentazocine with piroxicam for postoperative pain relief after cesarean section: an open label, comparative study." International Journal of Basic & Clinical Pharmacology 6, no. 6 (May 23, 2017): 1393. http://dx.doi.org/10.18203/2319-2003.ijbcp20172229.
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Background: The concept of multimodal analgesia was introduced more than a decade ago as a technique to improve analgesia and reduce the incidence of opioid-related adverse events. The rationale for this strategy is the achievement of sufficient analgesia due to the additive or synergistic effects between different classes of analgesics. Objectives of the study was to compare the efficacy and safety of pentazocine and its combination with piroxicam in the management of post cesarean pain.Methods: Cases were randomly assigned to 2 groups of 30 cases each. One group received pentazocine 30mg and another; pentazocine 30mg + piroxicam 20mg. Injections were given intramuscularly, postoperatively after skin closure. Diclofenac 75mg was the rescue analgesia. Primary outcome measure was control of pain, assessed by visual analogue scale (VAS). Secondary outcomes were sedation and time to rescue analgesia. Safety of the drugs was assessed by adverse drug reactions. Data was analysed by student’s t test, analysis of variance and post-hoc test.Results: Multimodal group showed better analgesia compared to unimodal group (p<0001). Drowsiness was the main adverse effect in both treatment groups.Conclusions: Multimodal analgesic combination of pentazocine and piroxicam showed superior analgesic effect with better pain control and longer duration of action compared to pentazocine alone.
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Waechter, Fábio Luiz, José Artur Sampaio, Rinaldo Danesi Pinto, Mário Reis ÁLvares-Da-Silva, and Luiz Pereira-Lima. "A Comparison between Topical and Infiltrative Bupivacaine and Intravenous Meperidine for Postoperative Analgesia after Inguinal Herniorrhaphy." American Surgeon 67, no. 5 (May 2001): 447–50. http://dx.doi.org/10.1177/000313480106700513.
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The purpose of the present study is to compare postoperative analgesia offered by the simple instillation of local anesthetic on the surgical wound, its infiltration with the same local anesthetic, and the use of an intravenous opioid. Sixty patients were divided into the three analgesia groups to be studied: instillation of local anesthetic (Group I), injection of local anesthetic (Group II), and intravenous opioid (Group III). The pain was quantified using the visual analogue scale. It was observed that there was better analgesia in Groups I and II during the first 6 hours postoperatively as compared with Group III ( P < 0.0001). At the end of the 12 hours the three modes of analgesia proved comparable. However, after 24 hours there was better analgesic development in Group I, whereas Group II had greater postoperative morbidity. We conclude that the instillation of local anesthesia provides analgesia during the immediate postoperative period comparable to local infiltration using the same anesthetic. Both regional analgesia methods are more effective analgesics during the first 6 hours than are intravenous opioids. Furthermore the simple instillation of local anesthetic allows better analgesic evolution of the surgical wound after the first 24 hours considering the lower rate of resulting complications.
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Lavand’homme, Patricia, Marc De Kock, and Hilde Waterloos. "Intraoperative Epidural Analgesia Combined with Ketamine Provides Effective Preventive Analgesia in Patients Undergoing Major Digestive Surgery." Anesthesiology 103, no. 4 (October 1, 2005): 813–20. http://dx.doi.org/10.1097/00000542-200510000-00020.
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Background As a broader definition of preemptive analgesia, preventive analgesia aims to prevent the sensitization of central nervous system, hence the development of pathologic pain after tissular injury. To demonstrate benefits from preventive treatment, objective measurement of postoperative pain such as wound hyperalgesia and persistent pain should be evaluated. The current study assessed the role and timing of epidural analgesia in this context. Methods In a randomized, double-blinded trial, 85 patients scheduled to undergo neoplastic colonic resection were included. All the patients received a thoracic epidural catheter, systemic ketamine at a antihyperalgesic dose, and general anesthesia. Continuous infusion of analgesics belonging to the same class was administered by either intravenous or epidural route before incision until 72 h after surgery. Patients were allocated to four groups to receive intraoperative intravenous lidocaine-sufentanil-clonidine or epidural bupivacaine-sufentanil-clonidine followed postoperatively by either intravenous (lidocaine-morphine-clonidine) or epidural (bupivacaine-sufentanil-clonidine) patient-controlled analgesia. Postoperative pain scores (visual analog scale), analgesic consumption, wound area of punctuate hyperalgesia, residual pain, and analgesics needed from 2 weeks until 12 months were recorded. Results Analgesic requirements, visual analog scale scores, and area of hyperalgesia were significantly higher in the intravenous treatment group (intravenous-intravenous), and more patients reported residual pain from 2 weeks until 1 yr (28%). Although postoperative pain measurements did not differ, postoperative epidural treatment (intravenous-epidural) was less effective to prevent residual pain at 1 yr (11%; P = 0.2 with intravenous-intravenous group) than intraoperative one (epidural-epidural and epidural-intravenous groups) (0%; P = 0.01 with intravenous-intravenous group). Conclusion Combined with an antihyperalgesic dose of ketamine, intraoperative epidural analgesia provides effective preventive analgesia after major digestive surgery.
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Ozdemir, Ercan. "The pathophysiological role of serotonin receptor systems in opioid analgesia and tolerance." International Journal of Basic & Clinical Pharmacology 6, no. 2 (January 28, 2017): 217. http://dx.doi.org/10.18203/2319-2003.ijbcp20170312.
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Continuous treatment with opioid analgesics, such as morphine, leads to the development of ant nociceptive tolerance in patients. Although a lot of information about antinociceptive, the pathophysiological mechanisms of tolerance to opioid analgesia are not yet completely understood. Proposed mechanisms for opioid analgesic tolerance comprise down-regulation of opioid receptors, reduction of sensitivity G-proteins, altered intracellular signalling pathway including nitric oxide, adenyl cyclase, and protein kinase C. Numerous physiological and behavioural studies have shown an interaction of the serotonergic system and opioid antinociception. The serotonin (5-HT) receptor system is a necessary component of the spinal and midbrain pain modulation circuit mediating opioid analgesia. Various types of serotonin receptors demonstrate different effects on morphine analgesia. Systemic administration of opioids rise 5-HT levels in the spinal cord dorsal horn and contribute to opioid analgesia in the normal state but reduce that in neuropathic pain via spinal 5-HT3 receptors. Spinal and supraspinal serotonergic neurons may also play a pathophysiological role in the development of morphine analgesic tolerance. Serotonin receptor subtypes show different effects on opioid tolerance. This review paper focus on the current understanding of the role of serotonin receptor systems in opioid analgesia and tolerance.
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P. Sahu, Yajnesh, Sachchidanand Pandey, and Sabita Mohapatra. "Analgesic activity of allopurinol and febuxostat in experimental animals." International Journal of Basic & Clinical Pharmacology 7, no. 4 (March 23, 2018): 603. http://dx.doi.org/10.18203/2319-2003.ijbcp20181005.
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Background: Currently, two classes of analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics are used to manage pain in different clinical situations. Chronic uses of these drugs have various adverse effects like gastric ulceration/bleeding, analgesic nephropathy and respiratory depression, physical dependence, addiction, respectively. Xanthine oxidase inhibitors, used for chronic gout, might have a role in alleviation of pain, as per literature survey. Hence, the present study was carried out to evaluate the potential analgesic activity of allopurinol and febuxostat in different experimental models.Methods: The analgesic activity of allopurinol and febuxostat was assessed by employing two different experimental pain models-tail flick latency model in rats for central analgesia and acetic acid induced writhing model in mice for peripheral analgesia and was compared with tramadol and aspirin.Results: Allopurinol and febuxostat produced significant central and peripheral analgesic effects as is evident from increase in reaction time in tail flick test and inhibition in number of writhes in acetic acid induced writhing test.Conclusions: The results of the present study demonstrate marked analgesic effect of allopurinol and febuxostat.
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Zafeiri, Aikaterini, Rod T. Mitchell, David C. Hay, and Paul A. Fowler. "Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety." Human Reproduction Update 27, no. 1 (October 29, 2020): 67–95. http://dx.doi.org/10.1093/humupd/dmaa042.
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Abstract BACKGROUND Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics. Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing foetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals. OBJECTIVE AND RATIONALE This review provides a detailed and objective overview of research in this field. We consider the global prevalence of OTC analgesia during pregnancy, explain the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, and review current research on exposure associations with offspring health outcomes. SEARCH METHODS A comprehensive English language literature search was conducted using PubMed and Scopus databases. Different combinations of key search terms were used including ‘over-the-counter/non-prescription analgesics’, ‘pregnancy’, ‘self-medication’, ‘paracetamol’, ‘acetaminophen’, ‘diclofenac’, ‘aspirin’, ‘ibuprofen’, ‘in utero exposure’, ‘placenta drug transport’, ‘placental transporters’, ‘placenta drug metabolism’ and ‘offspring outcomes’. OUTCOMES This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory and reproductive defects. This is in contrast to other studies which report no associations. WIDER IMPLICATIONS The high prevalence and the challenges of reporting exact consumption rates make OTC analgesia during pregnancy a pressing reproductive health issue globally. Even though some healthcare policy-making authorities have declared the consumption of some OTC analgesics for most stages of pregnancy to be safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.
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GM, Divya, Nagesha KA, Rashmi HD, Kumar GS, Devi AK, and Airani HV. "Effect of dexamethasone as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia in subjects undergoing lower segment cesarean section." Journal of Medical and Scientific Research 12, no. 1 (January 3, 2024): 72–76. http://dx.doi.org/10.17727/jmsr.2024/12-13.
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Background: Inadequate pain relief after caesarean section is a common problem in every part of the world. Transversus abdominis plane (TAP) block provides adequate post-operative pain relief following abdominal surgeries. TAP block duration is limited to effect of administered local anesthetics. Hence, adjuvant medications are added to local anaesthetic (LA) to prolong the effect of TAP block. The primay objective of this study was to analyse the analgesic effect of dexamethasone added to levobupivacaine in comparison with analgesic effect of levobupivacaine alone in TAP block. The secondary objectives are to analyse the number of supplemental analgesic requirements in the first 24 hrs after surgery and to analyse the duration of postoperative analgesia which is time to first analgesic request from the time of TAP block. Methods: 116 women scheduled for lower segment cesarean section (LSCS), belonging to ASA physical status 2 or 3, aged between 18 and 35 years, under SAB were recruited. Ultrasonogram (USG) guided TAP block was performed on each side after the completion of the surgery. Subjects in group L (n = 58) received TAP block on each side with 20 ml of 0.375% levobupivacaine and group LD (n = 58) with 19 ml of 0.375% levobupivacaine + 1ml (4mg) of dexamethasone. They were evaluated for pain at 10min, 30min, 45min, 1hour, 2hrs, 4hrs, 8hrs, 12hrs and 24hrs after the block using visual analog scale (VAS) score. Duration of postoperative analgesia and requirement of rescue analgesia were also analysed. Results: The post-operative visual analogue scale (VAS) scores were lower in group LD at 8, 12 and 24 hrs (p < 0.05). Mean duration of analgesia was significantly prolonged in group LD with lesser requirement of rescue analgesics (p < 0.05) up to 24 hrs. Conclusion: Dexamethasone (4 mg) as an adjuvant to levobupivacaine in USG guided TAP block reduces post-operative pain scores prolongs the duration of analgesia and decreases demands for rescue analgesics.
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Zia, A., R. MacDonald, S. Moore, J. Ducharme, and C. Vaillancourt. "MP34: Assessment of pain management during transport of intubated patients in a prehospital setting." CJEM 19, S1 (May 2017): S76—S77. http://dx.doi.org/10.1017/cem.2017.200.
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Introduction: While methods have been developed to assess pain and provide analgesia to hospitalized intubated patients, little is known about current EMS practices in providing similar care during air and land medical transports. Therefore, we sought to determine if opioid analgesia is provided to intubated patients during transportation in out-of-hospital setting. Methods: We conducted a health record review examining electronic records of intubated patients transported by Ornge in 2015. Ornge is the exclusive provider of air and land transport of critically ill patients in Ontario, Canada with over 18,000 transports per year. We identified cases using Ornge’s database and selected intubated patients meeting inclusion criteria. A standardized data extraction form was piloted and used by a single trained data extractor. The primary outcome was frequency of administration and dose adequacy of an opioid analgesic. Secondary outcomes included: choice of analgesics used (fentanyl, hydromorphone or morphine), adverse events, and impact of age, sex, or reason for transfer on pain management. We present descriptive statistics. Results: Our strategy identified 500 potential cases, of which 448 met our inclusion criteria. Among those 448 patients, 154 (34.4%) were females, 328 (73.4%) received analgesia and 211 (64.3%) received more than one dose during transport (median frequency of 2 doses, IQR=1 to 3). The average transport time was 148 minutes and repeated dosing (>1 repeat dose) occurred primarily (45.5%) in transports of over 180 minutes. Fentanyl was the most commonly used analgesic (97.6%) and most commonly used dose was 50 micrograms (51.8%). Adverse events occurred in 8 (2.5%) patients with 5 patients having new hypotension (MAP <65 mm Hg). There was no significant difference in administration of analgesia based on patient’s age or sex (68.8% of females and 75.3% of male patients received analgesia). Interestingly, 30.8% of patients repatriated to originating-hospital received analgesia compared to 72.3% of patients receiving analgesia for all other reasons for transfers. Conclusion: More than 73% of intubated patients transported by Ornge received an opioid analgesic, most commonly fentanyl. We found no clinically relevant difference in the administration of analgesics based on age, sex or reason for transfer other than home repatriation.
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Klukowski, Mateusz, Rafał Kowalczyk, Grzegorz Górniewski, Paweł Łęgosz, Marek Janiak, and Janusz Trzebicki. "Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture." Ortopedia Traumatologia Rehabilitacja 19, no. 5 (October 31, 2017): 0. http://dx.doi.org/10.5604/01.3001.0010.5825.
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Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthesiology and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective analgesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who received a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was performed under ultrasound guidance, and systemic analgesics were administered according to a standardized protocol. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.
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Rajshekhar Wali, Reema, Gajendra Singh, and Gurulingappa A. Patil. "COMPARISON OF PRE-EMPTIVE PARACETAMOL AND PARACETAMOL-DICLOFENACCOMBINATION FOR POSTOPERATIVE PAIN AFTER SURGERIES UNDER GENERAL ANESTHESIA - A SINGLE-BLINDED RANDOMIZED CONTROL STUDY." International Journal of Advanced Research 11, no. 05 (May 31, 2023): 499–505. http://dx.doi.org/10.21474/ijar01/16905.
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Background: Postoperative pain control is a critical component of patient care. Effective pain control can improve patient comfort and reduces the risk of complications. Multimodal analgesia is one of the approaches used for postoperative pain control. The idea of combining analgesics is to reduce the side effects of each drug yet effectively deal with postoperative pain. The present study aimed to compare the time for the first analgesia request and compare the total amount of analgesic consumption in the two groups in the postoperative period in the first 24 hrs. Methods: The present study was a single-blinded randomized control study, done in the Department of Anesthesiology, MRMC, and Basaveshwar Teaching and General Hospital, Kalaburgi, Karnataka State. Patients undergoing surgeries under General Anaesthesia with ASA I/II categories were randomly allocated to two groups. Group A n=25 patients with Tab. Paracetamol oral(2gm). Group B n=25 patients with Tab. Paracetamol oral(1gm). + Inj Diclofenac 75mg IM. Postoperative NRS and first demand for rescue analgesia and total consumption of analgesic in two groups were compared. Results: The mean values of NRS scores were found to be lesser in group B as compared to group A indicating better pain control in group B as compared to group A. The time for 1st analgesia request was seen in 60% of group A in 2nd hour and 32% in 1st hour. Time for 1st analgesia request was seen in 60% of patients in group B in the 3rd hour and 20% in the 2nd hour. The overall consumption of analgesics at the end of 24 hours was greater in Group A as compared to Group B. Conclusion: Pre-emptive analgesia with inj. diclofenac is more effective when compared to a tab. paracetamol group alone in post-operative analgesia following elective surgeries. It can further improve the quality of multimodal analgesia during the post-operative period and can reduce the hospital stay and financial burden on the patient. Both paracetamol and diclofenac drugs are safe to provide analgesia in the postoperative period without any major significant side effects.
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Weicker, S. A., B. J. Tuyp, and S. Wormsbecker. "P157: Pain management post-emergency department discharge: how are analgesics being consumed by patients with ongoing pain?" CJEM 20, S1 (May 2018): S113. http://dx.doi.org/10.1017/cem.2018.355.
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Introduction: Pain management is a cornerstone of emergency department (ED) practice, yet ongoing pain after ED discharge and return visits for inadequate analgesia are common. Over-the-counter (OTC) acetaminophen and nonsteroidal anti-inflammatory drugs are widely accepted first line agents for mild to moderate pain. Previous research has not investigated how patients actually consume such agents after discharge, and if they consume them synergistically and at sufficient doses for optimal analgesia. We sought to determine the proportion of patients in ongoing pain post-discharge that were utilizing analgesics as well as the type and dose of agent(s) used. Methods: Adults presenting to our ED with an acutely painful musculoskeletal complaint during research assistant hours were eligible for enrollment. After excluding non-English speakers as well as admitted, pregnant/breastfeeding, and chronic pain patients, consenting subjects completed in-person questionnaires during their ED stay and a follow-up telephone interview 2-3 days later. Results: 158 individuals were approached during the study period, of which 99 enrolled. 78 completed follow-up. At follow-up, 71 (91%) individuals experienced ongoing pain with a median score of 5 (interquartile range (IQR) 3-6) on an 11-point scale. 48 (67%) of patients still in pain consumed analgesics in the preceding 24 hours. The most commonly used agents were acetaminophen by 18 individuals (38% of analgesic users), ibuprofen by 16 (33%), and naproxen by 9 (19%). 29 respondents (60% of analgesic users) were using solely oral OTC analgesics. Only 15 (31% of analgesic users) used multiple agents concurrently, and 11 (23%) used prescription opioids. Acetaminophen was used at a median daily dose of 1500mg (IQR 1000-2000mg), much lower than that recommended for maximal analgesia (4000mg). Ibuprofen daily doses (1200mg, IQR 800-1300mg) were slightly lower than typical recommended doses (1600mg, 400mg every 6 hours). Conclusion: Only two-thirds of patients with ongoing pain at 2-3 days post-ED discharge were consuming analgesics, most commonly acetaminophen and ibuprofen. Of patients using analgesics, less than one-third used multiple agents. OTC medications are not used by most patients at doses for maximal analgesia. It may be possible to reduce pain burden and repeat-visits in discharged ED patients by optimizing the use of OTC analgesics.
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Polushin, Yuriy Sergeyevich, Irina Vladimirovna Vartanova, Vitaliy Fedorovich Bezhenar, Yuriy Mikhaylovich Korostelev, and Irina Viktorovna Golub. "EVALUATION OF COMBINED NEFOPAM HYDROCHLORIDE AND KETOPROFEN IN THE TREATMENT OF POSTOPERATIVE PAIN IN PATIENTS WITH ENDOMETRIOSIS." Journal of obstetrics and women's diseases 61, no. 6 (December 15, 2012): 48–53. http://dx.doi.org/10.17816/jowd61648-53.
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Conducted a study to assess the effectiveness of a new centrally acting analgesic nefopam hydrochloride (Acupan). Included 45 patients who underwent laparoscopic surgical treatment of endometriosis of varying severity. Found that pre-emptive analgesia with nefopam and ketoprofen is more effective in patients with endometriosis, I–II severity. In patients with endometriosis stage III application ketoprofen and nefopam significantly improved the quality of postoperative analgesia and reduced the need for narcotic analgesics. In patients with severe endometriosis (IV stage), this scheme was inadequate.
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Liu, Ling, Guoqing Zhao, Yuchang Dou, Longyun Li, Peng Chen, Tao Li, and Ming Gao. "Analgesic effects of perioperative acupuncture methods: A narrative review." Medicine 102, no. 43 (October 27, 2023): e35759. http://dx.doi.org/10.1097/md.0000000000035759.
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Postoperative pain occurs immediately after surgery. The most common perioperative analgesic methods are nerve block, patient-controlled intravenous analgesia, and patient-controlled epidural analgesia. However, overuse of opioid analgesics can cause many adverse reactions including excessive sedation, respiratory inhibition, postoperative nausea, and vomiting. In recent years, many clinical trials have shown that perioperative acupuncture has unique advantages in patients. Perioperative acupuncture can relieve intraoperative pain, improve postoperative pain management, reduce postoperative nausea and vomiting, and shorten the length of hospital stay. This study aimed to confirm the analgesic effect of perioperative acupuncture by reviewing studies on the different methods of perioperative acupuncture and their analgesic effects. The cited literature was searched in English and Chinese from PubMed, China National Knowledge Infrastructure, and Wanfang data, using the following keywords: “perioperative pain,” “acupuncture,” “electroacupuncture,” and “perioperative analgesia.” Studies published from 2005 to 2023 were included. All retrieved papers were read in detail. Perioperative acupuncture has benefits in reducing postoperative pain and opioid need. Although analgesic drugs are still the primary means of postoperative pain control, acupuncture provides a safe analgesic supplement or alternative. This review aimed to assist practitioners in choosing appropriate perioperative acupuncture methods by summarizing the recent literature on the role of different acupuncture approaches for perioperative pain management.
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Praveen kumar Shekhrajka and Dhaval kumar C Patel. "Comparison of Fascia Iliaca Block with Intravenous Paracetamol, as Postoperative Analgesic Method for Femur Surgery." Academia Anesthesiologica International 5, no. 1 (May 22, 2020): 13–16. http://dx.doi.org/10.21276/aan.2020.5.1.3.
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Background: Postoperative pain is extremely unpleasant which causes severe discomfort to the patient as well as it increases the anxiety, hospital stay so overall total burden. Objectives: Comparison of efficacy between fascia iliaca block with intravenous paracetamol, as postoperative analgesic method after femur surgery. Simultaneously requirement of other analgesics in the first 24 hours.Subjects and Methods:Prospective longitudinal study conducted in patients belonging to age group of 18 to 65 years posted for femur surgeries. All patients were received Intrathecal injection of 3.5 ml of 0.5% hyperbaric bupivacaine and divided into two groups. After completion of surgery Group I received the Fascia Iliaca block with thirty ml of 0.25% of injection bupivacaine and Group II received injection Paracetamol one gram intravenously. Duration of analgesia, time from block / iv PCM to 1st rescue analgesia, number of patients as well as total doses of required rescue analgesics in 1st 24 hours were observed postoperatively.Results:From One hour onwards at all the time interval, mean pain scores was less in FIB group as compared to PCM group(p<0.001). In FIB group 15 (42%) patients had more than 24 hours and 11(32%) patients had 12-24 hours of analgesia, where as in PCM Group not a single patient had more than 12 hours of analgesia. In FIB group only 20 (57%) patients required rescue analgesic as compared to 35 (100%) patients in PCM group.Conclusion:In FIB insertion point is away from femoral vessels and can be provided without nerve stimulator. Post-operative it is extremely crucial to provide analgesia specially initial 24 hours. FIB can provide prolong duration of analgesia, so helps in early mobilization and early rehabilitation as well as it also reduces opioid requirements. Thus, Fascia iliaca block is an effective, easy and affordable method for postoperative analgesia and can be used safely as a part of multimodal approach to pain relief after femur surgery.
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Whitley, Gregory Adam, and Richard Pilbery. "Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review." British Paramedic Journal 4, no. 3 (December 1, 2019): 24–34. http://dx.doi.org/10.29045/14784726.2019.12.4.3.24.
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Introduction: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain.Methods: We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis.Results: From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting.Conclusion: Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting.
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Guadie Ahebir, Yitayal, Abebaw Misganew, Amare Anley Beyable, Samuel Debas Bayable, and Yohannes Godie Ashebir. "The Practice of Multimodal Analgesia Technique for Patients Undergoing Surgery under General Anaesthesia in Debre Markos Compersive Specialized Hospital Debre Markos, East Gojjam, Ethiopia, 2022. A Cross-Sectional Study." Annals of Emergency Surgery 8, no. 1 (January 20, 2024): 1–6. http://dx.doi.org/10.47739/2573-1017.emergencysurgery.1038.
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Background: Practice guidelines for preoperative pain management recommend that multimodal analgesic therapy should be used for postsurgical patients. This method uses different analgesic agents, which may target different components of pain transmission to improve post-operative analgesia and decrease reliance on opiate-based medication. The practice of Multimodal analgesia includes the combined use of neuraxial blockage regional anesthesia and systemic medications and has been shown to reduce opioid use and side effects in surgical patients. However, the proportion of patients who receive this evidence-based approach is unknown. To assess the practice of multimodal analgesia among patients undergoing surgery under general anesthesia at Debere Markos Compressive Specialized Hospital, Northwest Ethiopia, 2022. Methods: After obtaining ethical approval a hospital-based cross-sectional study was conducted from February 22 to May 10, 2022, in Debere Markos Compressive specialized hospital. Data was collected, prospectively using questionnaires from anesthetists, nurses in the recovery room, and anesthesia record sheets. Patients were considered to have multimodal analgesia if they received two or more analgesics. Descriptive statistics were performed to identify the practice of multimodal analgesia. Results: A total of 200 participated in our study. We observed the practice of multimodal analgesia in patients who had undergone surgery under general anesthesia in the study period was 47%. Opiod is the most widely administered analgesia. It was given to 81.5% of patients. The practice of multimodal analgesia in emergency surgery was found to be 61.7%. During the study period, multimodal analgesia was more practiced among Bsc anesthetists and it was found to be 42.5%. The practice of multimodal analgesia in PACU was found to be 9%. Conclusion and Recommendation: The practice of multimodal analgesia for surgical patients in Debre Markos Specialized Compressive Hospital is underutilized. Anesthesia professionals should use a multimodal approach for preoperative pain management for all surgical patients. The Department of Anesthesia should develop a guideline for the treatment of perioperative pain.
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Nandanwankar, Niteen, and Abdullah MF. "EVALUATION OF TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK WITH INJ.BUPIVACAINE 0.25% FOR POST-OPERATIVE ANALGESIA IN INGUINAL HERNIA REPAIR SURGERY." PERSPECTIVES IN MEDICAL RESEARCH 7, no. 3 (January 5, 2020): 30–37. http://dx.doi.org/10.47799/pimr.0703.06.
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Background: TransversusAbdominis Plane(TAP)Block is a regional analgesictechnique. It provides postoperative analgesia after lower abdominal surgery. The purpose of our study was to evaluate effectiveness of TAP block to provide effective postoperative analgesia in patients undergoing inguinal hernia repair surgery. Method: Total 60 patients undergoing inguinal hernia surgery were randomized toundergo TAP block with bupivacaine (n = 30) versus normal saline (n = 30)control group. All patients received a standard spinal anaesthesia with standardmonitoring. A TAP block was performed using 20 ml 0.25% bupivacaine on the side ofsurgery or 20 ml saline at the end of surgery. Each patient was followed uppostoperatively at 0, 30 min, 60 min, 2 hr, 4, 6, 8, 12, 18 and 24 hours in PACU. Rescue analgesics inj. Diclofenacwere offered to any patient whocomplained of pain (VAS Score ≥4). Time of rescueanalgesia, total analgesic consumption and any other complications wereassessed. Result : There was a significantly longer time to the first request for rescue analgesic in bupivacaine group. (507.77 ± 10.38 min) compared to NS group.(110.87±14.2min) Total diclofenacconsumptionwas significantly higher in Group S than Group B (82.75 ± 23.2 mg vs193.97 ± 37.6 mg). Conclusion : TAP block provides better postoperative analgesia in patient undergoing inguinalhernia repair surgery . It prolongs the duration of postoperative analgesia and significantly reduces the total analgesic consumption up to 24 hrs postoperatively
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Sharma, Sagun, Pankaj Baral, Parasmani Shah, and Asmita Rayamajhi. "Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries." Journal of Nepalgunj Medical College 21, no. 2 (December 31, 2023): 17–21. http://dx.doi.org/10.3126/jngmc.v21i2.62779.
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Introduction: Pain is associated with higher perioperative morbidity in fracture patients. Fascia iliaca compartment block is a simple, inexpensive, and effective method of analgesia for femoral fracture surgeries. Many adjuvants have been used with local anaesthetics to prolong post-operative analgesia.
Aims: To assess the effects of dexamethasone as an adjuvant to fascia iliaca compartment block on prolongation of post-operative analgesia in patients undergoing femoral fracture surgeries.
Methods: Seventy patients aged, 18-65 years with American Society of Anaesthesiologist-Physical Status I and II, undergoing femoral fracture surgery, were randomly assigned to two groups, n=35 each, who received standard subarachnoid block. Ultrasound guided Fascia iliaca compartment block was given after completion of surgery with 20ml of 0.35% ropivacaine + 2ml normal saline to group one or 20ml of 0.35% ropivacaine + 2ml dexamethasone(4mg/ml) to group 2. Total duration of analgesia and total rescue analgesic requirement in the first post operative day were noted after successful block.
Results:The demographic information for the two groups was comparable. The duration of postoperative analgesia was prolonged in patients receiving dexamethasone adjuvant (541 ± 167 vs. 638± 165 mins, p = 0.018; Mean difference -97). Patients receiving dexamethasone adjuvant required significantly less postoperative rescue analgesics for the first 24 hours (tramadol 88 ± 32 vs 65 ± 23 mg, p = 0.001; Mean difference 23).
Conclusion: Dexamethasone, added to Fascia Iliaca Compartment Block, as an adjuvant, significantly prolongs the postoperative analgesic effect thereby, reducing the need for rescue analgesic in the first postoperative day.
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Sekulovski, M., B. Simonska, G. Mutafov, V. Alexandrov, and L. Spassov. "Bilateral ultrasound-guided abdominal peripheral block in tap plane, tap - block." Trakia Journal of Sciences 18, no. 4 (2020): 344–49. http://dx.doi.org/10.15547/tjs.2020.04.009.
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INTRODUCTION: Bilateral ultrasound-guided peripheral block (TAP - block) in the plane between the inner oblique abdominal muscle and the transversal abdominal muscle – TAP plane, is a regional anesthesia technique by infiltration of a local anesthetic, provides analgesia for operations involving the anterior abdominal wall. The analgesic effectiveness of the block decreases the consumption of opioid analgesics and non-steroidal anti-inflammatory drugs. AIM: In this study, we evaluated the intraoperative analgesic efficacy of bilateral TAP - block and the consumption of opioid analgesics in patients undergoing bilateral laparoscopic inguinal hernia repair. METHODS: The study was conducted with 35 patients, who were randomized into two groups. In the control group (group I), there are patients who received general anesthesia (GA), and experimental group (group II), were patients who have received general anesthesia and a bilateral tap block (GA + TAP). RESULTS: Patients with TAP-block (group II) have significantly lower fentanyl consumption compared to group I. CONCLUSION: Multimodal approach for the simultaneous administration of general anesthesia with a TAP block provides effective intraoperative analgesia and significantly reduces the perioperative consumption of opioid analgesics.
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Feng, Dachang, Zhaofa Liu, Haitao Chen, and Huanhuan Wang. "Clinical Efficacy and Safety of Ibuprofen plus Traction, Reposition, and Hip Spica Cast in the Treatment of Developmental Dysplasia of the Hip." Evidence-Based Complementary and Alternative Medicine 2022 (August 9, 2022): 1–6. http://dx.doi.org/10.1155/2022/1213133.
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Objective. To assess the clinical efficacy and safety of ibuprofen plus traction, reposition, and hip spica cast in the treatment of developmental dysplasia of the hip (DDH). Methods. Between January 2019 and July 2020, 60 children with DDH treaded in department of orthopedics of our institution were assessed for eligibility and recruited. They were assigned at a ratio of 1 : 1 to receive either traction + reposition + hip spica cast plus analgesia pump (observation group) or traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen (control group). The outcome measures included clinical efficacy, pain scores, unexpected pain calls, the dosage of analgesia pump, and adverse events. Results. The two groups had similar clinical efficacy ( P > 0.05 ). The patients given oral ibuprofen were associated with significantly lower pain scores at 24 h and 72 h postoperatively versus those without oral ibuprofen ( P < 0.05 ). Analgesics with oral ibuprofen resulted in fewer unexpected pain calls versus analgesics without oral ibuprofen within 72 h postoperatively ( P < 0.05 ). The application of oral ibuprofen in the analgesia pump showed great improvement in lowering the dosage of analgesia pump versus the absence of ibuprofen ( P < 0.05 ). The incidence of adverse events was similar between the two groups of patients ( P > 0.05 ). Conclusion. Traction + reposition + hip spica cast plus analgesia pump and oral ibuprofen effectively mitigated postoperative pain in children with DDH and reduces analgesic drug dosage with a high safety profile.
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Tewari, Abhinav, and Ajit Kumar Singh. "Comparative evaluation of caudal tramadol and fentanyl when mixed with bupivacaine in paediatric age group." International Journal of Research in Medical Sciences 8, no. 4 (March 26, 2020): 1445. http://dx.doi.org/10.18203/2320-6012.ijrms20201340.
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Background: A caudal block is commonly performed block for postoperative analgesia pediatric surgeries. Duration can be enhanced by addition drugs like fentanyl, tramadol, clonidine midazolam etc to local anesthetics helps in decreasing the requirement of postoperative analgesics. This study was conducted to assess the analgesic efficacy of tramadol or fentanyl when mixed with bupivacaine in pediatric patients for surgeries below the umbilicus.Methods: Fifty children of ASA I and ASA status, between 2 to 12 years of age, of both sexes underwent elective surgeries below umbilicus were selected and randomly divided into groups of 25 each. One Group, T (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with tramadol 1mg/ kg and other Group F (n = 25) received 0.75 ml/kg of 0.25% bupivacaine with Inj fentanyl 1μg/kg. Assessment of analgesia and any side effects after caudal injection to the first administration of analgesia were recorded for both the groups in next 24 hours following objective pain scores. Duration of analgesia and requirement of additional rescue analgesics was noted.Results: The Mean duration of analgesia recorded longer in Group T (18.26±6.1 hours) as compared to Group F (10.0+/- 2.68 hrs.) and no significant haemodynamic changes or adverse effect noted between 2 groups.Conclusions: Addition of tramadol, 1mg/kg to bupivacaine 0.25% for caudal anesthesia in children undergoing surgeries below umbilicus, enhances and prolongs postoperative analgesia compared to caudal fentanyl 1μg/kg and bupivacaine 0.25% alone.
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K, Ripon, M. R., Rab, M. A, Mridha, M. K. I, Shaheen, N, and Sheikh, M. A. "Efficacy of Tramadol as Pre-emptive Analgesia in Mandibular Impacted Third Molar Surgery." Scholars Journal of Applied Medical Sciences 11, no. 02 (February 12, 2023): 352–56. http://dx.doi.org/10.36347/sjams.2023.v11i02.012.
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Introduction: The pre-emptive analgesia is an alternative for treating postsurgical pain. It is given before the painful stimulus begins to prevent or reduce the development of any ‘’memory’’ of the pain stimulus in the nervous system. Objective: To investigate the existence of pre-emptive analgesic efficacy of Tramadol for impacted mandibular third molar surgery. Materials and methods: This was a prospective study carried out in Oral & Maxillofacial Surgery Department; Dhaka Dental College & Hospital.100 patients were included and were randomly divided into two groups. Study group received injection Tramadol 50mg, 20 minutes before surgery. Control group did not receive pre-emptive analgesic. Study parameters included (1) Pain intensity scores, (2) Time to 1st rescue analgesia and (3) Total number of analgesics consumed during the 5 post-operative days. Results: Study group reported considerable pain relief in the day of surgery at hours 1, 3 and 5 with significantly lower pain intensity scores. When the mean time to first rescue analgesic was assessed, study group reported a longer pain free interval with the mean time being 7.46±1.11 hours for study and 2.43±1.72 hours for control group. Patients in the control group consumed maximum number of rescue analgesics during the 5 post-operative days and Tramadol proved more efficient by consuming fewer rescue analgesics [p<0.001]. Conclusion: Tramadol has significant pre-emptive analgesic efficacy.
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Taliercio, Salvatore, Brian Sanders, Stratos Achlatis, Yixin Fang, Ryan Branski, and Milan Amin. "Factors Associated With the Use of Postoperative Analgesics in Patients Undergoing Direct Microlaryngoscopy." Annals of Otology, Rhinology & Laryngology 126, no. 5 (February 1, 2017): 375–81. http://dx.doi.org/10.1177/0003489417693862.
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Objective: Morbidity associated with suspension laryngoscopy has been well documented. However, standard of care with regard to postoperative analgesia has not been described, and anecdotal evidence suggests wide variability with regard to postoperative narcotic and non-narcotic recommendations. We sought to quantify the postoperative course following suspension microlaryngoscopy by relating patient-based and intraoperative measures with analgesic use. Methods: Body mass index (BMI), Friedman tongue position (FTP), and Mallampati scores as well as laryngoscope type, number of attempts required for optimal visualization, and suspension time were documented in 50 consecutive patients undergoing routine suspension microlaryngoscopy. Postoperative symptoms and analgesic use was queried on postoperative days 1, 3, and 10. Results: In this cohort, 62.5% employed postoperative analgesia. However, only 20% required narcotics. No difference in suspension time was identified in those taking analgesics (33.0 vs 37.3 minutes, P = .44). In addition, no relationship between procedure type and the need for analgesia was noted. The majority of patients (76%) described sore throat persisting for 3 postoperative days; 36% reported sore throat persisting beyond postoperative day 3. Conclusions: The majority of patients undergoing microlaryngoscopy reported discomfort, but symptoms were largely ameliorated with over-the-counter analgesics. Routine prescription of narcotics following routine suspension laryngoscopy may be unnecessary.
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Das, Chetali, Rajni Mathur, and Srishti Kukreja. "Clinical comparison of analgesic efficacy of addition of injection dexamethasone 8mg to 20ml 0.5% levobupivacaine in ultrasonography assisted supraclavicular brachial plexus block." Journal of Applied Pharmaceutical Research 10, no. 4 (December 31, 2022): 14–18. http://dx.doi.org/10.18231/j.joapr.2022.10.4.14.18.
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Background: Ultrasonography-assisted supraclavicular block is an efficacious and practical method and allows us to use a lower volume of local anesthetic in compactly arranged brachial plexus. The study envisioned evaluating the analgesic and anesthetic effects of Inj. dexamethasone (8mg) as an adjuvant to 0.5% levobupivacaine to determine the time for first rescue analgesia and number of rescue analgesics needed in 24 hours duration in brachial plexus blockade in adult patients listed for upper limb surgeries. Results: This prospective randomized double-blind interventional study was carried out in ASAI and II, aged 20 to 55 years. In group A (n=30) Inj. Levobupivacaine 20ml and Inj. Normal saline 2ml was given. In group B (n=30) Inj. Levobupivacaine 20ml and Inj. Dexamethasone 2ml was given. The time for the demand of the first rescue analgesia was 431.50 ± 46.15 minutes in group A and 749.38 ± 62.41 minutes in group B, with a p-value < 0.001. The demand for rescue analgesics was more in Group A in contrast to Group B. Conclusion: We deduce with our study, with the addition of dexamethasone, the time for rescue analgesia is prolonged, and the number of rescue analgesic demands is reduced, with a faster onset and extended duration of both sensory and motor block.
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Slack, Jeanne F., and Margaret Faut-Callahan. "Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care." AACN Advanced Critical Care 2, no. 4 (November 1, 1991): 729–40. http://dx.doi.org/10.4037/15597768-1991-4013.
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Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care
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Yanuka, Michael, Dror Soffer, and Pinchas Halpern. "An interventional study to improve the quality of analgesia in the emergency department." CJEM 10, no. 05 (September 2008): 435–39. http://dx.doi.org/10.1017/s1481803500010526.
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ABSTRACTObjective:We sought to document the adequacy of acute pain management in a high-volume urban emergency department and the impact of a structured intervention.Methods:We conducted a prospective, single-blind, pre- and postintervention study on patients who suffered minor-to-moderate trauma. The intervention consisted of structured training sessions on emergency department (ED) analgesia practice and the implementation of a voluntary analgesic protocol.Results:Preintervention data showed that only 340 of 1000 patients (34%) received analgesia. Postintervention data showed that 693 of 700 patients (99%) received analgesia, an absolute increase of 65% (95% CI 61%–68%), and that delay to analgesia administration fell from 69 (standard deviation [SD] 54) minutes to 35 (SD 43) minutes. Analgesics led to similar reductions in visual analog pain scale ratings during the pre- and postintervention phases (4.5 cm, SD 2.0 cm, and 4.3 cm, SD 3.0 cm, respectively).Conclusion:Our multifaceted ED pain management intervention was highly effective in improving quality of analgesia, timeliness of care and patient satisfaction. This protocol or similar ones have the potential to substantially improve pain management in diverse ED settings.
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Sorokina, L. S., D. V. Fomina, M. A. Semenkova, and A. A. Eremenko. "Efficiency and safety of Tapentadol with immediate release for postoperative analgesia in cardiac surgery patients." Messenger of ANESTHESIOLOGY AND RESUSCITATION 20, no. 3 (June 17, 2023): 45–51. http://dx.doi.org/10.24884/2078-5658-2023-20-3-45-51.
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The objective was to evaluate the efficacy and safety of the use of a tablet form of Tapentadol central analgesic for postoperative analgesia in cardiac surgery patients.Materials and methods. In the observational study, the scheme of postoperative analgesia of the tablet form of Tapentadol with immediate release was evaluated. The drug was used in 20 patients after various cardiac surgical interventions. The intensity of the pain syndrome during the patient’s motor activity (cough, deep breath) and at rest was assessed on a 100 mm visual analogue scale (VAS). As an additional objective criterion for the effectiveness of analgesia, the method of incentive spirometry was used. Analgesia was performed for 2 to 4 postoperative days. Basic analgesia: tablet form of Tapentadol of 50 mg 2 times a day. Additional analgesia: Ketoprofen «on demand» intravenously at a dose of 100 mg (depending on the severity of the pain syndrome at VAS > 40 mm). Therapy was started in the ICU, then, continued after transfer to the specialized surgical department.Results. On the second postoperative day, the average pain intensity was higher, within 30 mm of VAS (mild pain), however, 35% of patients had high values (from 50 to 70 mm), and therefore additional Ketoprofen analgesia at a dose of 100 mg was required. In the following postoperative days, after the removal of drains, the average severity of the pain syndrome was lower, within 15–17mm according to VAS and additional anesthesia was not required. The analgesic effect of Tapentadol had a positive effect on the respiratory function with an increase in maximum inspiratory lung capacity (MILC) by 1.5 times from the beginning of the study. Adverse events typical of opioid analgesics, such as nausea, weakness, drowsiness, intestinal paresis, were noted in a minimal number of patients and passed without discontinuation of the drug.Conclusion. The high analgesic effect has been demonstrated, as well as a good safety profile of using the minimum daily dose of the tablet form of the drug Tapentadol in the early postoperative period after cardiac surgery.
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Orazaliyev, Kairat, Nurakhim Tazhimuratov, Andrey Shin, Aibek Khamitzhanov, Yerlan Zharmukhambetov, and Raimbek Baltabay. "Analysis of the Effectiveness of Intraoperative Local Infiltration Analgesia in Knee Replacement." Traumatology and Orthopаedics of Kazakhstan 71, no. 1 (2024): 30–34. http://dx.doi.org/10.52889/1684-9280-2024-1-71-30-34.
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The problem of postoperative pain after knee replacement is a significant problem that worsens the condition of patients and impedes the activation and rehabilitation of patients. To prevent the development of severe pain after knee replacement, local infiltration analgesia has been proposed, including an anesthetic drug, a non-steroidal anti-inflammatory drug and adrenaline.Purpose of the study: to evaluate the effectiveness of local infiltration analgesia in knee replacement with assessment of postoperative pain.Methods. A single-center retrospective study examined the outcomes of 81 patients with knee osteoarthritis who were scheduled for primary knee replacement between January 2022 and December 2023. Patients in the main group (40 people) were administered a single dose of local infiltration analgesia intraoperatively, while patients in the control group (41 people) did not. The results were compared in terms of postoperative pain and narcotic analgesic consumption in both groups.Results. Patients in the study group had significantly lower pain scores from the first postoperative day (VAS was 3.05) to the fourth postoperative day (2.75) compared with the control group (5.06 and 3.2) (p<0.001) . The consumption of narcotic analgesics in the main group was also much lower compared to the control group.Conclusions. The use of local infiltration analgesia during surgery can effectively reduce postoperative pain and the need for narcotic analgesics in patients with knee replacement.Key words: endoprosthetics, infiltration analgesia, knee joint, postoperative pain.
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Ilangovan, Vijaysundar, Thanga Tirupathi Rajan Vivakaran, D. Gunasekaran, and D. Devikala. "Epidural tramadol via intraoperatively placed catheter as a standalone analgesic after spinal fusion procedure: An analysis of efficacy and cost." Journal of Neurosciences in Rural Practice 08, no. 01 (January 2017): 055–59. http://dx.doi.org/10.4103/0976-3147.193535.
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ABSTRACT Objective: This was a prospective analysis of epidural tramadol as a single analgesic agent delivered through intraoperatively placed epidural catheter for postoperative pain relief after spinal fusion procedures in terms of efficacy and cost. Materials and Methods: Twenty patients who underwent spinal fusion procedures were included in the study. After completion of the procedure, an epidural catheter was placed at the highest level of exposed dura and brought out through a separate tract. Postoperatively, tramadol was infused into the epidural space via the catheter at a dose of 1 mg/kg diluted in 10 ml of saline. The dosage frequency was arbitrarily fixed at every 6 h during the first 2 days and thereafter reduced to every 8 h after the first 2 days till day 5. Conventional intravenous analgesics were used only if additional analgesia was required as assessed by visual analog scale (VAS). Results: Patients’ VAS score was assessed every 4 h from the day of surgery. Patients with a VAS score of 6 or more were given additional analgesia in the form of intravenous paracetamol. Of the twenty patients, eight patients needed additional analgesia during the first 24 h and none required additional analgesia after the first 24 h. The median VAS score was 7 within the first 24 h and progressively declined thereafter. Epidural tramadol was noted to be many times cheaper than conventional parenteral analgesics. Conclusion: Epidural tramadol infusion is safe and effective as a standalone analgesic after open spinal fusion surgery, especially after the 1st postoperative day. Intraoperative placement of the epidural catheter is a simple way of delivering tramadol to the epidural space. The cost of analgesia after spinal fusion surgery can be reduced significantly using epidural tramadol alone.
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Mohamed, Sahar A. "Dexmedetomidine as an Adjunctive Analgesic with Bupivacaine in Paravertebral Analgesia for Breast Cancer Surgery." Pain Physician 5;17, no. 5;9 (September 14, 2014): E589—E598. http://dx.doi.org/10.36076/ppj.2014/17/e589.
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Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 µg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 µg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P < 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P < 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P < 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 µg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects. Key words: Dexmedetomidine, paravertebral block, postoperative analgesia, breast cancer surgery
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Gola, Wojciech, Szymon Bialka, Aleksander J. Owczarek, and Hanna Misiolek. "Effectiveness of Fascia Iliaca Compartment Block after Elective Total Hip Replacement: A Prospective, Randomized, Controlled Study." International Journal of Environmental Research and Public Health 18, no. 9 (May 4, 2021): 4891. http://dx.doi.org/10.3390/ijerph18094891.
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Objective: An assessment of the feasibility of fascia iliaca compartment block (FICB) combined with nonopioid analgesics and patient controlled analgesia (PCA), oxycodone, in the perioperative anaesthetic management for elective total hip replacement (THR). Design: A randomised, single-center, open-label study. Setting: A single hospital. The study was conducted from October 2018 to May 2019. Participants: In total, 109 patients were scheduled for elective total hip replacement. Interventions: Postoperative FICB with 0.375% ropivacaine in conjunction with nonopioid analgesics (paracetamol, metamizole, and pregabalin) and oxycodone as rescue analgesia. Measurements: Pain intensity was measured using the Numeric Pain Rating Scale (NRS) at rest and during rehabilitation, the total dose of postoperative oxycodone required, the occurrence of opioid-related adverse events, patient hospitalisation time, and level of satisfaction. Follow-up period: 48 h. Main Results: A total of 109 patients were randomised into two groups and, of these, 9 were subsequently excluded from the analysis (three conversions to general anaesthesia, two failures to perform FICB, four failures to use the PCA pump). Patients in the FICB group received standard intravenous analgesia with FICB, and those in the control group were managed with standard intravenous analgesia only. Pain level measured with NRS was significantly lower at rest and during rehabilitation in the FICB group. Oxycodone use in the first 48 h was significantly higher in the control group (p < 0.001); additionally, the time to the first dose of rescue analgesia was significantly shorter (p < 0.001). In the control group, there was a higher rate of side effects and a significantly longer hospitalisation time (p < 0.001). Similarly, higher satisfaction with the applied analgesic treatment was noted in the FICB group. Conclusions: FICB in elective THR treatments is an effective form of analgesia, which reduces the need for opioids, the number of complications, the length of hospitalisation, and which ensures a high level of patient satisfaction with the analgesic treatment used. Trial registration: ClinicalTrials.gov No. NCT04690647.