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1
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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Kumamoto, Eiichi. "Inhibitory Actions of Clinical Analgesics, Analgesic Adjuvants, and Plant-Derived Analgesics on Nerve Action Potential Conduction." Encyclopedia 2, no. 4 (November 30, 2022): 1902–34. http://dx.doi.org/10.3390/encyclopedia2040132.
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The action potential (AP) conduction in nerve fibers plays a crucial role in transmitting nociceptive information from the periphery to the cerebral cortex. Nerve AP conduction inhibition possibly results in analgesia. It is well-known that many analgesics suppress nerve AP conduction and voltage-dependent sodium and potassium channels that are involved in producing APs. The compound action potential (CAP) recorded from a bundle of nerve fibers is a guide for knowing if analgesics affect nerve AP conduction. This entry mentions the inhibitory effects of clinically used analgesics, analgesic adjuvants, and plant-derived analgesics on fast-conducting CAPs and voltage-dependent sodium and potassium channels. The efficacies of their effects were compared among the compounds, and it was revealed that some of the compounds have similar efficacies in suppressing CAPs. It is suggested that analgesics-induced nerve AP conduction inhibition may contribute to at least a part of their analgesic effects.
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Lydya, Ni Putu, Ni Putu Aryati Suryaningsih, and Ni made Umi Kartika Dewi. "RASIONALITAS PENGGUNAAN ANALGESIK DALAM SWAMEDIKASI NYERI DI KOTA DENPASAR." Jurnal Riset Kesehatan Nasional 5, no. 1 (April 28, 2021): 66. http://dx.doi.org/10.37294/jrkn.v5i1.315.
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Latar Belakang: Nyeri merupakan keluhan terbanyak yang mendorong masyarakat untuk melakukan praktek swamedikasi. Analgesik efektif dan memiliki indeks terapi yang luas, namun dapat berpotensi untuk menimbulkan efek samping yang serius bahkan ketika digunakan dalam dosis yang tepat. Penelitian ini bertujuan untuk mengetahui gambaran terkait rasionalitas penggunaan analgesik dalam swamedikasi nyeri di Kota Denpasar. Metode: Studi ini menggunakan desain cross-sectional dan melibatkan 196 responden yang dipilih dengan consecutive sampling. Data dikumpulkan dengan menyebarkan kuesioner pada enam apotek di wilayah Kota Denpasar dan dianalisis secara deskriptif. Hasil: Penelitian ini menemukan bahwa 50,5% responden menggunakan analgesik secara tidak rasional dalam praktek swamedikasi nyeri. Mayoritas responden yang menggunakan analgesik dalam swamedikasi nyeri adalah perempuan, usia 17-25 tahun, tingkat pendidikan tinggi, bekerja dan memiliki tingkat pendapatan yang rendah. Kesimpulan: Setengah dari total responden menggunakan analgesik secara tidak rasional dalam praktek swamedikasi nyeri. Tingginya ketidakrasionalan penggunaan analgesik dapat menyebabkan peningkatkan biaya pengobatan dan dapat menimbulkan kondisi yang berbahaya. Kata kunci: Penggunaan analgesik, rasionalitas, swamedikasi AbstractBackground: Pain is the most complaints of illness that encourage communities to use analgesics in self-medication practice. Analgesics are effective and have a broad therapeutic index, but may have potentially serious side effects even when they used in the right dosage. This study aimed to determine the rationality of analgesic use in pain self-medication in Denpasar City. Method: A cross-sectional design was used, and involved 196 respondents selected through consecutive sampling. Data were collected from questionnaire distribution in six pharmacies in Denpasar City and analyzed by using descriptive statistics. Result: This study found that 50,5% respondents used analgesics irrationally in pain self-medication practice. The majority of respondents who used analgesics in pain self-medication were females, aged 17-25 years old, high education level, employed, and had low income. Conclusion: Half of the total respondents used analgesics irrationally in pain self-medication practice. High of irrational analgesic use can increase medical costs and lead to dangerous conditions. Keywords: Analgesic use, pain, rationality, self-medication
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Smith, Howard. "Combination Opioid Analgesics." Pain Physician 2;11, no. 3;2 (March 14, 2008): 201–14. http://dx.doi.org/10.36076/ppj.2008/11/201.
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Although there is no “ideal analgesic,” scientists and clinicians alike continue to search for compounds with qualities which may approach the “ideal analgesic.” Characteristics of an “ideal” analgesic may include: the agent is a full agonist providing optimal/maximal analgesia for a wide range/variety of pain states (e.g., broad spectrum analgesic activity), it does not exhibit tolerance, it produces no unwanted effects and minimal adverse effects, it has no addictive potential, it does not facilitate pain/hyperalgesia, it has a long duration, it has high oral bioavailability, it is not vulnerable to important drug interactions, it is not significantly bound to plasma proteins, it has no active metabolites, it has linear kinetics, and it is eliminated partly by hydrolysis to an inactive metabolite (without involvement of oxidative and conjugative enzymes). Investigators have concentrated on ways to alter existing analgesics or to combine existing analgesic compounds with compounds which may improve efficacy over time or minimize adverse effects. The addition of an analgesic with a second agent (which may or may not also be an analgesic) to achieve a “combination analgesic” is a concept which has been exploited for many years. Although there may be many reasons to add 2 agents together in efforts to achieve analgesia, for purposes of this article — reasons for combining an opioid with a second agent to produce a combination opioid analgesic may be classified into 6 major categories: 1.) combinations to prolong analgesic duration; 2.) combinations to enhance or optimize analgesic efficacy (e.g., analgesic synergy); 3.) combinations to diminish or minimize adverse effects; 4.) combinations to diminish opioid effects which are not beneficial (or contrariwise to or enhance beneficial opioid effects); 5.) combinations to reduce opioid tolerance/opioid-induced hyperalgesia; and 6.) combinations to combat dependency issues/addiction potential/craving sensations. Combination opioid analgesics are one avenue which may give rise to “pain pills” with improved analgesic profiles over existing analgesic medications. Key words: Pain, combination opioid analgesic, tolerance, opioid-induced hyperalgesia
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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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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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Bernadeth, Bernadeth, Ezra Oktaliansah, and Indriasari Indriasari. "Efektivitas Analgesik Pascaoperasi pada Pasien Pediatrik di Ruang Pemulihan Rumah Sakit Dr. Hasan Sadikin Bandung Periode Juni–November 2018." Jurnal Anestesi Perioperatif 7, no. 1 (April 30, 2019): 68–84. http://dx.doi.org/10.15851/jap.v7n1.15647.
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Nyeri merupakan pengalaman sensorik dan emosional yang tidak menyenangkan. Penyebab utama nyeri akut pada anak adalah prosedur pembedahan, trauma, dan penyakit akut. Penilaian nyeri merupakan bagian penting dari manajemen nyeri. Penelitian ini bertujuan mengetahui efektivitas analgesik pascaoperasi pada pasien pediatrik di ruang pemulihan RSUP Dr. Hasan Sadikin Bandung periode Juni-November 2018. Penelitian menggunakan metode deskriptif observasional prospektif terhadap 471 pasien pediatrik pascaoperasi di ruang pemulihan. Subjek penelitian dikelompokkan berdasar atas jenis operasi yang menyebabkan nyeri ringan, sedang, dan berat. Jenis analgesik pascaoperasi yang diberikan dan penilaian nyeri selama di ruang pemulihan dicatat untuk melihat efektivitas analgesik pascaoperasi tersebut. Dari hasil penelitian efektivitas analgesik pascaoperasi pada jenis operasi nyeri ringan sebanyak 181 pasien (99,5%), jenis operasi nyeri sedang sebanyak 231 pasien (98,7%), dan pada jenis operasi nyeri berat sebanyak 53 pasien (96,4%). Simpulan penelitian ini adalah efektivitas analgesik pascaoperasi pada pasien pediatrik di RSUP Dr. Hasan Sadikin Bandung masih kurang efektif karena belum memenuhi target rumah sakit 100% bebas nyeri dan pemberian analgesik juga belum efisien karena masih banyak terdapat ketidaksesuaian antara pilihan analgesik dan derajat nyeri.Effectiveness of Post-Operative Analgesia on Pediatric Patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018Pain is an unpleasant sensory and emotional experience. Pain assessment is an important part of pain management. The main causes of acute pain in children are surgical procedures, trauma, and acute diseases. This study aimed to study the effectuIveness of postoperative analgesics in pediatric patients in the recovery room of Dr. Hasan Sadikin General Hospital Bandung from June to November 2018. This was a prospective observational descriptive study on 471 postoperative pediatric patients in recovery rooms. The research subjects were grouped based on the type of surgery pain, i.e. mild, moderate, and severe. The type of postoperative analgesics given and assessment of pain during the stay in the recovery room were recorded to see the effectiveness of the postoperative analgesic drug. From the results of the study it was identified that the of postoperative analgesics was effective for 181 patients (99.5%) in the mild pain surgery group, for 231 patients (98.7%) in the moderate pain surgery, and for 53 patients (96.4%) in severe pain surgery. It is concluded that the postoperative analgesics provided to pediatric patients at Dr. Hasan Sadikin General Hospital Bandung is still less effective because it has not met the target of 100% pain free set by the hospital and that analgesic administration is also not efficient because there are still many discrepancies in analgesic choices and the degree of pain.
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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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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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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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Jacobs, AM, and F. Youngblood. "Opioid receptor affinity for agonist-antagonist analgesics." Journal of the American Podiatric Medical Association 82, no. 10 (October 1, 1992): 520–24. http://dx.doi.org/10.7547/87507315-82-10-520.
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Analgesic medications are distributed to a variety of receptors within the central nervous system. Activity at these receptors (mu 1, mu, sigma, delta, kappa) results in both the beneficial pain-relieving effects of analgesics as well as undesirable side effects. The mixed agonist-antagonist class of analgesics offers the potential benefit of greater receptor site selectivity while diminishing the incidence of adverse sequelae, such as respiratory depression. Traditionally, it has been suggested that mixed agonist-antagonist medications may be associated with decreased analgesic effectiveness. However, newer agents of this mixed class may result in effective analgesia while diminishing the incidence of side effects.
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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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Kircher, Janeva, Amy L. Drendel, Amanda S. Newton, Sukhdeep Dulai, Ben Vandermeer, and Samina Ali. "Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation." CJEM 16, no. 06 (November 2014): 449–57. http://dx.doi.org/10.1017/s1481803500003468.
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ABSTRACTObjective:Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.Methods:We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.Results:A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.Conclusions:Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.
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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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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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Amaya, Fumimasa, Toyoshi Hosokawa, Akiko Okamoto, Megumi Matsuda, Yosuke Yamaguchi, Shunsuke Yamakita, Tetsuya Taguchi, and Teiji Sawa. "Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review." BioMed Research International 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/641508.
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Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future.
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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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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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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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Priano, James, Brian Faley, Gabrielle Procopio, Kevin Hewitt, and Joseph Feldman. "Adjunct Analgesic Use for Acute Pain in the Emergency Department." Hospital Pharmacy 52, no. 2 (February 2017): 138–43. http://dx.doi.org/10.1310/hpj5202-138.
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Purpose Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups. Methods A retrospective chart review of adult patients who presented to the ED at a large academic medical center and received IV morphine or hydromorphone for acute pain was conducted. Patients were analyzed according to initial opioid received and presence or absence of adjunct nonopioid analgesics. Results A total of 102 patient charts were analyzed. Adjunctive nonopioid analgesics were ordered on 38% of patients. Patients who received an adjunct nonopioid analgesic received a smaller mean initial opioid dose than those who did not (4.73 vs 5.48 MEU, p = .08). Initial pain score reduction on the 11-point Numeric Rating Scale (NRS) did not differ between patients who received adjunct analgesics versus those who did not (3 vs 4, p = .75). Patients who received adjunct analgesics were associated with a decreased ED LOS (294 vs 342 minutes, p = .04). Conclusion A small proportion of patients with acute pain received a nonopioid analgesic in conjunction to IV opioids. Further studies are warranted to assess the impact of adjunct analgesics for patients with acute pain.
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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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Sarmanayeva, R. R., G. R. Abuzarova, N. M. Bychkova, V. E. Khoronenko, and S. V. Kuznetcov. "The possibilities of using xenon therapy in patients with severe cancer pain." Meditsinskiy sovet = Medical Council, no. 9 (July 30, 2020): 265–70. http://dx.doi.org/10.21518/2079-701x-2020-9-265-270.
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In accordance with the clinical recommendations of the World Health Organization and the Ministry of Health of the Russian Federation, the main analgesics for the treatment of chronic cancer pain are non-opioid and opioid analgesics, given stepwise in combination with co-analgesics and adjuvant drugs. As a rule, this stepwise scheme of painkilling is effective in most cases. However, 20-30% of patients cannot achieve an acceptable level of pain relief despite the use of these analgesics in combination. Is there another way to help such patients? Interventional methods of analgesia are an option, yet not all patients agree to invasive methods due to the possible side effects and unavailability of these methods. In these cases other mechanisms of analgesia are required, such as NMDA receptor antagonists, which reduce opioid tolerance and hyperalgesia. Still not all the drugs of this group can be applied in our practice. Analgesic properties of nitrous oxide can only be found in high anesthetic doses. Another option is metadon, but it is forbidden and cannot be used in our country. Still one more option is ketamine, which has severe side effects. In our clinical practice we decided to use xenon, which has NMDA inhibition effects. Its analgesic effect and safety have been confirmed in numerous studies. This publication aims to demonstrate a successful clinical case when we used xenon and oxygen inhalations course for the treatment of a severe cancer pain with a patient who had been taking morphine by mouth.
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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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I. Raut, Harsha, Geeta N. Lodhi, and Deepika P. Kalode. "A REVIEW ON ANALGESIC HERBAL." International Journal of Advanced Research 9, no. 01 (January 31, 2021): 1126–32. http://dx.doi.org/10.21474/ijar01/12400.
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Analgesics are the substances which are used in pain, without losing consciousness. The word analgesic derives from Greek an- (without) and algos (pain). Analgesic drugs act in various form on the central nervous systems and peripheral nervous system. Various sources of analgesic drugs synthetic analgesic and natural analgesic, natural analgesics like opoid analgesics, Aloevera Barbedensis, Glycyrrhiza glabra, Zingiber Officinale, Eugenia caryophyllata, Cinnamomum camphora, Matricaria pubescens etc. This review gives information about different analgesic obtained from natural sources.
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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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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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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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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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Al-Jasim, Ameer, Alaa A. Aldujaili, Ghaith Al-Abbasi, Hasan Al-Abbasi, and Saif Al-Sahee. "Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot from a Teaching Hospital in a Developing Country." Surgery Journal 08, no. 03 (July 2022): e232-e238. http://dx.doi.org/10.1055/s-0042-1755623.
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Abstract Background Pain relief can be achieved by diversity of methods with analgesics being the basic form of treatment. Analgesic safety and clinical effectiveness are the core factors in determining the analgesic of choice. One adverse effect of concern with opioids is the postoperative ileus (POI). Objective In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI. Methods This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus. Results Sixty-nine percent of patients received a combination of opioids and nonopioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development (p=0.001). Conclusions A mix of analgesics (opioids and nonopioids) was the most common regimen at our center. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10–30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.
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Xu, Jiajie J., Sarah E. Thurston, Tyler J. Robinson, June F. Escara-Wilke, Stephanie Daignault-Newton, Tara L. Martin, Evan T. Keller, and Jill M. Keller. "Effects of Analgesics on Tumor Growth in Mouse Models of Prostate Cancer Bone Metastasis." Journal of the American Association for Laboratory Animal Science 60, no. 3 (May 1, 2021): 341–48. http://dx.doi.org/10.30802/aalas-jaalas-20-000060.
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Murine models of tumor development often require invasive procedures for tumor implantation, potentially causing pain or distress. However, analgesics are often withheld during implantation because of concerns that they may adversely affect tumor development. Previous studies examining the effects of analgesics on the development and metastasis of various tumor lines show that the effect of analgesics depends on the tumor line and analgesic used. A blanket statement that analgesics affect the general growth of tumors is not adequate scientific justification for withholding pain relief, and pilot studies or references are recommended for each specific tumor cell line and treatment combination. In this study, we evaluated the effects of 2 commonly used analgesics on tumor growth in 2 models of prostate cancer (PCa) bone metastasis. We hypothesized that a one-time injection of analgesics at the time of intratibial injection of tumor cells would not significantly impact tumor growth. Either C57BL/6 or SCID mice were injected subcutaneously with an analgesic (carprofen [5 mg/kg], or buprenorphine [0.1 mg/kg]) or vehicle (0.1 mL of saline) at the time of intratibial injection with a PCa cell line (RM1 or PC3, n = 10 to 11 per group). Tumor growth (measured by determination of tumor burden and the extent of bone involvement) and welfare (measured by nociception, locomotion, and weight) were monitored for 2 to 4 wk. Neither carprofen or buprenorphine administration consistently affected tumor growth or indices of animal welfare as compared with the saline control for either cell line. This study adds to the growing body of literature demonstrating that analgesia can be compatible with scientific objectives, and that a decision to withhold analgesics must be scientifically justified and evaluated on a model-specific basis.
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Moulin, Dwight. "Opioid Analgesics in the Management of Neuropathic Pain." Pain Research and Management 5, no. 1 (2000): 89–91. http://dx.doi.org/10.1155/2000/734239.
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The role of antidepressants and anticonvulsants in the management of neuropathic pain has been well established. However, up to 50% of patients obtain inadequate pain relief with the use of either or both of these agents; in this subpopulation, an opioid analgesic may be beneficial. There is clear evidence that opioid analgesics are efficacious in the management of neuropathic pain, but there is controversy as to the balance between analgesia and adverse effects. Opioid treatment may require higher doses than other kinds of drug therapies, thereby increasing the risk of opioid-related side effects. Psychological dependence or addiction, however, is not usually an issue in pain management with opioid analgesics. The extant literature strongly suggests the trial of an opioid analgesic in the management of neuropathic pain if adjuvant analgesics fail to provide adequate pain control. Failure of one opioid warrants a trial of another opioid because their effectiveness can vary among patients; the results are based on physiochemical properties of the drug and idiosyncratic reactions of the patient. Neuropathic pain can be a difficult problem to manage, and sometimes the use of an opioid analgesic can make the difference between bearable and unbearable pain so that patients can get on with their lives.
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Badzi, Caroline D., and Mercy M. Ackumey. "Factors influencing use of analgesics among construction workers in the Ga-East municipality of the Greater Accra region, Ghana." Ghana Medical Journal 51, no. 4 (February 7, 2018): 156–63. http://dx.doi.org/10.4314/gmj.v51i4.3.
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BACKGROUND: Analgesics also known as painkillers are widely used for pain relief. There are severe health implications associated with excessive use of analgesics. This paper examines factors influencing the use of analgesics among construction workers in the Ga-East Municipality (GEM) of the Greater Accra region of Ghana.METHODS: This is a cross-sectional study involving 206 construction workers randomly sampled from 7 construction sites in the GEM. A structured questionnaire was used to elicit responses on knowledge of analgesics, types of analgesics used and factors influencing the use of analgesics. Chi-square test analysis was used to examine factors influencing analgesic use.RESULTS: The majority of workers were aged between 15 to 44 years (89.8%) and 51.9 percent of respondents had completed Junior high school. Many respondents (68.0%) used Brand 1 a locally manufactured analgesic with paracetamol, aspirin and caffeine as the active ingredients and 31.6 percent of respondents had no knowledge of possible side effects of continuous use of analgesics. Chi square analysis showed that age was significantly associated with use of analgesics (p<0.01). Knowledge of the types of analgesics, dosage and side effects did notinfluence use (p>0.05). Television and radio advertisements influenced use of analgesics (p<0.01).CONCLUSION: Knowledge on analgesic use and knowledge of probable serious side effects was inadequate. Pharmacists and chemists involvement in education of clients of the side effects of analgesics is highly recommended to minimise misuse. The Food and Drugs Authority should regulate the proliferation of advertisements for analgesics in the media.Funding: None declaredKeywords: analgesics, NSAIDs, construction workers, over-the-counter drugs, OTC
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Smith, Howard S. "Opioids and Neuropathic Pain." July 2012 3S;15, no. 3S;7 (July 14, 2012): ES93—ES110. http://dx.doi.org/10.36076/ppj.2012/15/es93.
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Opioids are broad spectrum analgesics that may be beneficial to alleviate the intense perception of algesia in patients suffering with pain. They have been one of the most controversial analgesics, in part because of their potential for addiction. Opioids or any currently available analgesic will not provide effective analgesia for every patient with chronic neuropathic pain (NP), but overall opioids are considered to be a second or third line class of analgesics that may provide reasonable analgesia to some patients with chronic NP. Although opioids may alleviate chronic NP, overall, NP tends to be less opioid responsive than nociceptive pain. The mechanisms that may contribute to neuropathic pain may simultaneously also contribute to diminishing the antinociceptive properties of opioids for neuropathic pain. Some of these mechanisms may also contribute to analgesic tolerance and/or opioid-induced hyperalgesia. Hyperalgesia consequently to nerve insult and opioidinduced analgesic tolerance, may both involve the N-methyl-D-aspartate (NMDA) receptor and share part of intracellular events producing a state of neural hyperexcitation. Conversely, opioid therapy may contribute to nociceptive processes that may be involved in neuropathic pain such as opioid-induced cholecystokinin release. Furthermore, within NP, peripheral NP appears to be the most opioid responsive, followed by spinal NP while supraspinal NP tends to be the least responsive to opioids. Although, there is no robust evidence that any specific opioid agent is better than any other opioid at effectively treating NP, it is conceivable that some opioids/opioid-like analgesic agents may be particularly well suited to alleviate NP in certain patients suffering from neuropathic pain. Key words: Pain, neuropathic, opioids, oxycodone, methadone, buprenorphine, tramadol, tapentadol
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Paull, D. R., I. G. Colditz, C. Lee, S. J. Atkinson, and A. D. Fisher. "Effectiveness of non-steroidal anti-inflammatory drugs and epidural anaesthesia in reducing the pain and stress responses to a surgical husbandry procedure (mulesing) in sheep." Australian Journal of Experimental Agriculture 48, no. 7 (2008): 1034. http://dx.doi.org/10.1071/ea08050.
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In this study, we examined the potential of several widely used non-steroidal anti-inflammatory drugs (NSAIDs) and other analgesics to reduce pain and stress in sheep after surgery. Because mulesing involves a greater degree of tissue trauma than other surgical husbandry procedures such as castration or tail-docking, it provides a more rigorous and conservative test to identify potentially useful analgesic strategies in sheep. Merino lambs (5 weeks of age) were randomised into eight treatment groups: (1) carprofen; (2) flunixin; (3) ketoprofen; (4) buprenorphine; (5) xylazine; (6) lignocaine epidural; (7) saline control; (8) sham control. The NSAIDs were administered 1.5 h before mulesing, buprenorphine 0.75 h and xylazine and lignocaine 0.25 h before mulesing. Pain- and discomfort-related behaviours were recorded for 12 h after mulesing, and plasma cortisol concentrations were measured before mulesing and 0.5, 6, 12, 24 and 48 h after mulesing. The results indicated that no single analgesic treatment provided satisfactory analgesia during both the surgical mulesing procedure and the ensuing period of pain associated with the inflammatory phase. However, there were indications that two NSAIDs (carprofen and flunixin) showed good potential as analgesics during the inflammatory phase. A combination of short- and long-acting analgesics may be needed to provide more complete pain relief. In conclusion, the administration of some NSAIDs offers the potential for good analgesia in sheep for the inflammatory phase following the tissue trauma of surgical husbandry procedures. Other analgesic options need to be considered if the acute stress response to the procedure is to be reduced.
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Saraghi, Mana, and Elliot V. Hersh. "Three Newly Approved Analgesics: An Update." Anesthesia Progress 60, no. 4 (December 1, 2013): 178–87. http://dx.doi.org/10.2344/0003-3006-60.4.178.
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Abstract Since 2008, three new analgesic entities, tapentadol immediate release (Nucynta) diclofenac potassium soft gelatin capsules (Zipsor), and bupivacaine liposome injectable suspension (EXPAREL) were granted US Food and Drug Administration (FDA) approval to treat acute pain. Tapentadol immediate-release is a both a mu-opioid agonist and a norepinephrine reuptake inhibitor, and is indicated for the treatment of moderate to severe pain. Diclofenac potassium soft gelatin capsules are a novel formulation of diclofenac potassium, which is a nonsteroidal anti-inflammatory drug (NSAID), and its putative mechanism of action is through inhibition of cyclooxygenase enzymes. This novel formulation of diclofenac allows for improved absorption at lower doses. Liposomal bupivacaine is a new formulation of bupivacaine intended for single-dose infiltration at the surgical site for postoperative analgesia. Bupivacaine is slowly released from this liposomal vehicle and can provide prolonged analgesia at the surgical site. By utilizing NSAIDs and local anesthetics to decrease the transmission of afferent pain signals, less opioid analgesics are needed to achieve analgesia. Since drug-related adverse events are frequently dose related, lower doses from different drug classes may be employed to reduce the incidence of adverse effects, while producing synergistic analgesia as part of a multimodal analgesic approach to acute pain.
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Ridderikhof, Milan L., Donica V. Lodder, Susan Van Dieren, Philipp Lirk, Helma Goddijn, J. Carel Goslings, and Markus W. Hollmann. "The relationship between patient factors and the refusal of analgesics in adult Emergency Department patients with extremity injuries, a case-control study." Scandinavian Journal of Pain 20, no. 1 (December 18, 2019): 87–94. http://dx.doi.org/10.1515/sjpain-2019-0077.
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AbstractBackground and aimsPrevious studies have described the phenomenon of oligo-analgesia in Emergency Department patients with traumatic injuries, despite the high prevalence of pain among these patients. Besides aspects related to health care staff, patient related factors might also play a role in suboptimal pain treatment, however evidence is scarce. Therefore, the objective of the current study was to evaluate patient related factors in adult patients refusing offered analgesics during an Emergency Department presentation with extremity injuries.MethodsThis was a case control study in the Emergency Department of a level 1 Trauma Centre. Cases were defined as adult patients with an extremity injury who declined analgesia, when offered. They were matched to controls from the same population, who accepted analgesics, in a 1:2 ratio using gender as matching variable. Primary outcome was difference in NRS pain score. Secondary outcomes were the relationship between categorical severity of pain scores and refusal of analgesics, exploration of independent predictors of analgesia refusal utilizing multivariate logistic regression and the evaluation of eight beliefs among patients who refuse analgesics.ResultsBetween August 1st and 31st 2016, a total of 253 patients were eligible for inclusion of whom 55 declined analgesic treatment. They were included as cases and matched to 110 controls. Difference in median NRS pain score was significant between the groups: 5.0 (IQR 3.0–8.0) vs. 8.0 (IQR 6.0–9.0), respectively (p < 0.01). Nearly 20% of patients with severe pain declined analgesics, compared to 41% with moderate and 69% with mild pain (p < 0.01). The NRS pain score was the only independent predictor of refusal of analgesic treatment with a mean Odds Ratio of 0.67 (95%-CI 0.54–0.83). Most common patients’ beliefs were that pain medication should be used in extreme pain only, fear of decreasing the doctor’s ability to judge the injury and fear of addiction to analgesics.ConclusionsPain severity is the single independent predictor of refusal of analgesia, however the following patient beliefs are important as well: pain medication should be used in extreme pain only; fear of decreasing the doctor’s ability to judge the injury and the fear of becoming addicted to pain medication.ImplicationsIn case patients refuse offered analgesics, the health care provider should actively address patient beliefs that might exist and lead to suboptimal pain treatment.
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AlSaeed, Maryam Jamal, and Dalia Ahmed Elmaghraby. "Assessing the Knowledge of Analgesic Drugs Utilization during Pregnancy among Women in Saudi Arabia: A Cross-Sectional Study." International Journal of Environmental Research and Public Health 18, no. 14 (July 12, 2021): 7440. http://dx.doi.org/10.3390/ijerph18147440.
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Background: Pain is a common compensation mechanism in pregnant women that they may face during gestation due to physiological changes. Paracetamol and non-steroidal anti-inflammatory drugs are the most administered analgesic drugs worldwide. Therefore, safety and efficacy are important measures for the use of analgesics during pregnancy. Objective: Assess the knowledge of analgesic drug utilization among Saudi pregnant women. Method: We conducted a self-administered survey with an electronic questionnaire via Google Drive among a sample of 406 Saudi women. Results: About half of the respondents took analgesics during the first trimester, and 52.5% of women have used analgesics at least once without any medical advice during their gestation. Most participants agreed that paracetamol is the safest and effective analgesic drug during pregnancy, yet 61.8% of women are not aware that analgesics could be detrimental to the fetus if inappropriately administered in the third trimester. Conclusion: Participants have a good perception of the safest and most effective analgesic drug during pregnancy, but they have poor knowledge about analgesics’ side effects.
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Fish, David, Fiona Bell, Clare O’Connell, Alison Walker, Laura Evans, and Shammi Ramlakhan. "PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A16.3—A17. http://dx.doi.org/10.1136/emermed-2021-999.40.
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BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.
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Augustinsson, Annelie, Elisabeth Franze, Martina Almqvist, Margareta Warrén Stomberg, Carina Sjöberg, and Pether Jildenstål. "Red-Haired People’s Altered Responsiveness to Pain, Analgesics, and Hypnotics: Myth or Fact?—A Narrative Review." Journal of Personalized Medicine 14, no. 6 (May 29, 2024): 583. http://dx.doi.org/10.3390/jpm14060583.
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Red hair has been linked to altered sensitivity to pain, analgesics, and hypnotics. This alteration may be impacted by variants in the melanocortin-1 receptor (MC1R) gene, which are mainly found in redheads. The aim of this narrative review was to explore and present the current state of knowledge on red hair and its plausible associations with altered responsiveness to pain, analgesics, and hypnotics. Structured searches in the PubMed, CINAHL Complete, and Scopus electronic databases were conducted. Evidence suggests that women with red hair have an increased sensitivity to pain. Conversely, data also indicate a higher pain tolerance in homozygous carriers of MC1R variant alleles. Varied responses to analgesia have been reported, with both increased analgesic responsiveness in homozygous carriers of MC1R variant alleles and less analgesia in redheads. Data indicate an increased need for hypnotics in redheads. However, failed attempts to find statistical associations between red hair and altered responsiveness to hypnotics are also evident. Even though there seems to be an association between red hair and an altered responsiveness to pain, analgesics, and/or hypnotics, the results of this narrative review are inconclusive. Further research studies with larger populations and MC1R testing are needed.
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Wani, Shubham, Rekha Gour, and Anant K. Patel. "In-vivo Pharmacological Evaluation of Analgesic Activity of Ethanolic Extract of Doronicum hookeri Clarke Rhizomes in Wistar Rats." Journal of Drug Delivery and Therapeutics 14, no. 1 (January 15, 2024): 9–12. http://dx.doi.org/10.22270/jddt.v14i1.6168.
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A number of plants are used traditionally in different medical conditions by practitioners of traditional medicines but their claim is not yet evaluated scientifically in laboratory animals. Based on the ethnomedical claims made by the Unani health practitioners, the Clarke rhizomes of Doronicum Hookeri was evaluated for analgesics activity in rats to confirm its claim. The successive plant extraction was carried out using Soxhlet apparatus by employing ethanol as a solvent of the dried rhizomes of Doronicum Hookeri. The % yield of extracted compound was 28.27% w/w. The qualitative preliminary phytochemical screening revealed the presence of alkaloids, saponins, tannins, flavonoids, glycosides, phenolic content, terpenoids and volatile oils in the rhizomes of ethanolic extract of D. Hookeri. The extract was orally administered in rats at low dose and high dose (200 mg/kg, 400 mg/kg) and was evaluated using Eddy’s Hot Plate Method in rats for analgesics activity. Diclofenac sodium (50 mg/kg) and was taken as a standard drug. The maximum possible analgesia % of ethanolic extract of rhizomes of D. Hookeri were found to be highest at a dose of 400mg/kg which showed 68.95% and 80% analgesia at 45 minute and 60 minute which when compared to Diclofenac sodium showed 73.28% and 85.71% at 45 minute and 60 minutes. The analgesic efficacy of ethanolic extract of rhizomes of D. Hookeri showed significant analgesic activity (p<0.04) in dose dependent manner at different time intervals of 0, 15, 30, 45 and 60 min. This asserts ethnomedical claims of some tribes regarding the analgesic activity of this plant.
Keywords - Analgesics, eddy’s hot plate, D. Hookeri, Diclofenac sodium.
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Viswanath, Menaka, Ravikrishna Kalathur, and K. Shanthini. "Evaluation of Efficacy of Transversus Abdominis Plane Block and Systemic Analgesia for Post-Operative Pain in Total Abdominal Hysterectomy: A Comparative Study." Academia Anesthesiologica International 5, no. 2 (December 16, 2020): 9–13. http://dx.doi.org/10.21276/aan.2020.5.2.2.
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Introduction: Management of post-operative Pain is gaining considerable attention with pain being recognized as the fifth vital sign. Post- operative pain management remains unresolved as pain is individualized and varies with surgery. The aim is to evaluate the analgesic efficacy of transverses abdominis plane block by continuous catheter technique and systemic analgesia for post-operative pain in total abdominal hysterectomy. Subjects and Methods: This randomized controlled trial was done in patients undergoing total abdominal hysterectomy via Pfannenstiel incision. Patients were assigned into 2 groups, systemic analgesics group (n=25) and TAP block group (n=25) randomly. Results: Out of 50 patients, 25 patients had systemic analgesics and 25 patients had TAP block. Demographics and surgical procedure times were comparable. Mean VAS pain score with coughing on day 1 and 2 in systemic analgesics group was 3.96 and 2.07 and in TAP block group were
0.7 and 0.3. Meantime taken to mobilize the patient after the surgery in the systemic analgesics group was 30.7 hours and in TAP block group was 22.4 hour. 18 patients needed rescue medication in the systemic analgesics group, and 9 patients required rescue medication in the TAP block group. In group 16 patients with systemic analgesics had post-operative nausea and vomiting, and 5 patients in group block TAP. Conclusion: Continuous TAP block provides better pain relief, denoted by lower visual analogue scores and better recovery profile enhancing recovery in patients undergoing abdominal hysterectomy.
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Salgado-García, Daniel, Agustín Díaz-Álvarez, José Luis González-Rodríguez, María Rocío López-Iglesias, Eduardo Sánchez-López, Manuel Jesús Sánchez-Ledesma, and María Isabel Martínez-Trufero. "Comparison of the Analgesic Efficacy between Levobupivacaine 0.25% and Ropivacaine 0.375% for PENG (Pericapsular Nerve Group) Block in the Context of Hip Fracture Surgery of Elderly Patients: A Single-Center, Randomized, and Controlled Clinical Trial." Journal of Clinical Medicine 13, no. 3 (January 29, 2024): 770. http://dx.doi.org/10.3390/jcm13030770.
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Previous studies have compared levobupivacaine versus ropivacaine in various peripheral nerve blocks in terms of block duration, quality of analgesia, and onset time, but this has not occurred in the PENG block. Here, a single-center, randomized, and controlled clinical trial is presented. One hundred and twenty patients older than 65 years suffering from hip fractures and surgically treated at our institution under spinal anesthesia were eligible for participation; of them, one hundred and eight were analyzed. Patients were randomized to receive ultrasound-guided PENG blocks using 20 mL of either 0.25% levobupivacaine or 0.375% ropivacaine (both of which are equipotent concentrations). The primary endpoint was to compare the analgesic duration (time to first rescue) and analgesic quality (pain scores using the VAS, PAINAD, and AlgoPlus scales) between the groups. Secondary endpoints included comparing the onset time, describing the need for and type of rescue analgesics, and possible associated adverse effects. There were no statistically significant differences in analgesic duration between levobupivacaine (median 861.0, IQR 960) and ropivacaine (median 1205.0, IQR 1379; p = 0.069). Likewise, the quality of analgesia and onset time were comparable among the groups. A small number of patients required opioids as rescue analgesics (4.6%). The possible associated adverse effects included postoperative infection (11.1%) and delirium (2.8%).
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Blacklock, J. Bob, Gary L. Rea, and Robert E. Maxwell. "Intrathecal Morphine during Lumbar Spine Operation for Postoperative Pain Control." Neurosurgery 18, no. 3 (March 1, 1986): 341–44. http://dx.doi.org/10.1227/00006123-198603000-00015.
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Abstract The analgesic requirements and bladder function of 5 patients who received 1 mg of intrathecal morphine during lumbar spine operation are compared to those of 10 control patients. No analgesics were used by the treatment group for the first 24 hours postoperatively. The test group subsequently required twice the amount of analgesics during the 2nd through 5th days after operation compared to controls. All 5 patients who received intrathecal morphine developed urinary retention for 24 to 36 hours. The brief duration of analgesia, the increased narcotic use after the effects of the morphine dissipated, and urinary retention after a single intraoperative dose of intrathecal morphine suggest caution in using this technique.
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P., Shanmukananda, Shwetha H., Veena D. R., and Poorvi M. "A cross sectional questionnaire based study on self medication practice of analgesics among MBBS students at Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka." International Journal of Basic & Clinical Pharmacology 9, no. 4 (March 24, 2020): 633. http://dx.doi.org/10.18203/2319-2003.ijbcp20201190.
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Background: Self medication with analgesics is prevalent worldwide due to easy procurement of over the counter drugs. Present study was done to assess knowledge, attitude, practice and perception of self medication of analgesics among MBBS students at Dr. B. R. Ambedkar Medical College, Bengaluru, Karnataka.Methods: A cross-sectional study was conducted on 5th term MBBS students of Dr. B. R. Ambedkar Medical College, Bengaluru in November 2019. A pre-designed validated questionnaire was used to collect information on knowledge, attitude, practice and perception of self medication of analgesics. Data was analysed using descriptive statistics.Results: 83.3 % of 5th term MBBS students practiced self medication with analgesics. Majority of students had some knowledge on self medication with analgesics. Common reason for using analgesic self medication was headache (59.7%) and nonsteroidal antiinflammatory drugs (90%) were commonly used analgesics. Analgesics were used for quick relief (73.3%) and source of information was from medical textbooks (61.6%). Students stopped taking analgesics after symptoms disappeared (75%). Students agreed that self medication is acceptable for medical students (63.3%) and medical license is required for better administration of drugs (51.3%).Conclusions: This study has found that self medication with analgesics was common among undergraduate medical students for minor illness. It is necessary to create awareness and educate students regarding dangers of analgesic self medication.
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Tay, Wilson, and Kok-Yuen Ho. "The Role of Interventional Therapies in Cancer Pain Management." Annals of the Academy of Medicine, Singapore 38, no. 11 (November 15, 2009): 989–97. http://dx.doi.org/10.47102/annals-acadmedsg.v38n11p989.
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Cancer pain is complex and multifactorial. Most cancer pain can be effectively controlled using analgesics in accordance to the WHO analgesic ladder. However, in a small but significant percentage of cancer patients, systemic analgesics fail to provide adequate control of cancer pain. These cancer patients can also suffer from intolerable adverse effects of drug therapy or intractable cancer pain in advance disease. Though the prognosis of these cancer patients is often very limited, the pain relief, reduced medical costs and improvement in function and quality of life from a wide variety of available interventional procedures is extremely invaluable. These interventions can be used as sole agents or as useful adjuncts to supplement analgesics. This review will discuss interventional procedures such as epidural and intrathecal drug infusions, intrathecal neurolysis, sympathetic nervous system blockade, nerve blocks, vertebroplasty and the more invasive neurosurgical procedures. Intrathecal medications including opioids, local anaesthetics, clonidine, and ziconotide will also be discussed. Key words: Intractable pain, Intrathecal analgesia, Neurolysis
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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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Surowicz, Dawid, Dominik Gałuszka, Agnieszka Martyka, Karolina Penar, Krystian Wolanin, and Angelika Poznańska. "TREAT MENT OF PAIN DURING EMERGENCY MEDICA L SERVICES." Emergency Medical Service 7, no. 2 (2020): 135–45. http://dx.doi.org/10.36740/emems202002110.
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Introduction: Pain, while undertaking medical rescue operations, is a common complication of injuries or a symptom of disease entities of internal medicine. Equipping emergency medical teams with painkillers from various groups, gives broad opportunities to fight pain at the pre-hospital stage. The manner of using medicines is regulated by law in the form of an executive regulation to the Act on State Emergency Medical Services, which specifies the type and route of their administration. When undertaking analgesic treatment, one should be aware of the contraindications to the use of individual medications, possible complications of their use, and methods of combining analgesics and co-analgesics as part of multimodal analgesia. The consequence of using medicines may be their impact on the work of the circulatory and respiratory systems, hence it is necessary to observe the patient’s cardiopulmonary stability during medical emergency operations at the call site, during transport and in the Hospital Emergency Department. The aim: This article aims to systematize the knowledge of painkillers available to the paramedic and methods of assessing pain intensity according to the following scales: numerical, verbal, visual-analog and picture for pediatric patients with whom it is possible to make logical contact. Conclusions: 1. Basic emergency teams are equipped with drugs from the following groups: nonsteroidal anti-inflammatory drugs, non-opioid analgesics and opioid analgesics. Thanks to them, it is possible to effectively and noticeably reduce pain at the stage of providing medical emergency services. 2. Despite properly undertaken pain therapy with available means and methods, it may not be possible to completely eliminate pain and clearly determine its etiology at the pre-hospital stage. 3. Available scales allow proper assessment of pain intensity in both pediatric and adult patients. 4. In complex cases, pain should not go away, it is necessary to use multimodal analgesia by combining analgesics of different groups, or to include in analgesic therapy co-analgesics, which, due to the weakening of the impact of a potential cause of pain, may determine the effectiveness of therapy. 5. Establishing the etiology of pain due to the numerous potential pathologies that cause it requires careful assessment of the patient at the stage of providing medical emergency services and the implementation of a full and properly conducted physical examination.
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Verthein, Uwe, Sven Buth, Anne Daubmann, Marcus-Sebastien Martens, and Bernd Schulte. "Trends in risky prescriptions of opioid analgesics from 2011 to 2015 in Northern Germany." Journal of Psychopharmacology 34, no. 11 (July 17, 2020): 1210–17. http://dx.doi.org/10.1177/0269881120936544.
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Introduction: Due to their euphoric and sedative effects, opioid analgesics have high potential for abuse and dependence. In the last decade in the USA and many Western European Countries the prescription rates of opioid analgesics have steadily increased. Objective: This study describes 5-year trends in the prescription of opioid analgesics and risk indicators such as duration, dose and ‘doctor shopping’ in Northern Germany. Methods: The annual rates of opioid analgesic prescriptions have been analysed for patients with statutory health insurance processed by the North German Pharmacy Data Center for the years 2011–2015. A distinction was made between non-cancer patients and cancer patients, and different groups according to prescription duration and dose level. Results: Between 2011 and 2015, the annual number of patients with opioid analgesic prescriptions increased from 500,000 to 550,000. About half of non-cancer-patients (85% of the total sample) and cancer patients received opioid analgesics for 90 days or less. The rates for long-term prescriptions (⩾9 months) ranged between 6–7% for non-cancer patients and 7–8% for cancer patients. Between 1.2–1.8% received opioid analgesics in doses of more than two defined daily doses. The majority of non-cancer patients with opioid analgesic prescriptions were female. The average age of non-cancer patients was 66 years. About 80% of non-cancer patients with first opioid analgesic prescription received World Health Organization step II medication. Conclusion: For the first time, this study provides comprehensive patient-related analyses of opioid analgesic prescriptions in Germany over a 5-year period. Despite a slight increase in the overall number of opioid analgesic prescriptions, an epidemic spread of opioid analgesics cannot be observed.