Analgesic Benefit Research Articles

Do transversus abdominis plane (TAP) blocks improve pain after laparoscopic bilateral inguinal hernia repairs beyond the recovery unit? A randomized control trial.

While surgeons agree that perioperative field blocks should be performed for open inguinal hernia surgery, there lacks consensus in the minimally invasive context. Prior small-scale randomized trials study pain scores only up to 24h postoperatively. Thus, we sought to investigate the analgesic benefits of a bupivacaine transversus abdominis plane (TAP) block in the first 4 postoperative days. This is a prospective single-institution randomized control trial involving patients undergoing elective totally extraperitoneal inguinal hernia repairs, who received either a TAP block with bupivacaine 0.25% or saline placebo. Postoperatively, patients completed a pain survey (based on a 0-10 visual analog score) and an opioid/non-opioid pain medication log. Differences were detected using a Wilcoxon rank sum test for continuous variables, and a Fisher's exact test or chi-squared for categorical variables. A total n = 90 patients were included in the per-protocol analysis, of which n = 46 received TAP blocks with bupivacaine versus n = 44 placebo. Patient characteristics were similar between the groups, including recurrent hernias and number of tacks placed (p > 0.05). All cases were bilateral. Postoperatively, pain scores (at rest and with movement) and pain medication use were similar for all postoperative days 1-4. Our study shows no significant difference in pain or opioid requirement within the first 4days postoperatively, suggesting that the analgesic benefits of plain bupivacaine TAP blocks in totally extraperitoneal inguinal hernia repairs do not exist beyond the recovery unit. This will help inform anesthesiologists and patients in discussing risks and benefits of a TAP block in their surgical context.

A Prospective Randomized Controlled Study of Ultrasound-Guided Rectus Sheath Block for Pain Management in Laparoscopic Umbilical Hernia Repair with Intraperitoneal Onlay Mesh.

To evaluate the clinical efficacy and safety of ultrasound-guided rectus sheath block (RSB) in laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (IPOM). A total of 139 patients scheduled for laparoscopic umbilical hernia repair with IPOM were selected and randomly assigned to either the group receiving general anesthesia combined with bilateral rectus sheath block (Group GR, 71 patients) or the group receiving general anesthesia alone (Group G, 68 patients). We monitored the patients' heart rate (HR) and mean arterial pressure (MAP) at four time points: before anesthesia induction (T1), at the start of surgery (T2), during mesh fixation (T3), and upon removal of the laryngeal mask (T4). Postoperative pain levels were evaluated using the Visual Analogue Scale (VAS) at 1 hour (T5), 6hours (T6), and 12hours (T7) after surgery while resting, as well as at 24hours (T8) during activity. We also compared the number of times the patient-controlled intravenous analgesia (PCIA) pump was pressed and the use of additional analgesics within 24hours post-surgery, along with recording any adverse reactions and complications associated with RSB. At time points T2 and T3, the HR and MAP in Group GR were significantly lower than those in Group G (P < 0.05). Additionally, VAS scores at various postoperative intervals were lower in Group GR, with significant differences noted at T5, T7, and T8 (P < 0.05). Group GR also had significantly fewer presses on the analgesia pump within 24hours post-surgery compared to Group G, while the incidence of adverse events was similar between the two groups. Ultrasound-guided RSB is a straightforward and safe technique for laparoscopic umbilical hernia repair with IPOM. It offers clear analgesic benefits and significantly reduces early postoperative pain.

Effect of different regional anaesthesia techniques on postoperative analgesia following percutaneous nephrolithotomy: A systematic review and network meta-analysis

Background and Aims: The optimal analgesia for percutaneous nephrolithotomy (PCNL) remains uncertain. This study aims to conduct a systematic review and network meta-analysis to compare the efficacy of various analgesic strategies for PCNL. Methods: We searched PubMed, ScienceDirect, ClinicalTrials.gov, MEDLINE, Web of Science, Ovid and EMBASE to identify all relevant randomised controlled trials published up to January 2024. Our review was prospectively registered with PROSPERO (ID: CRD42024504578). The identified methods included erector spinae plane block (ESPB), paravertebral block (PVB), intercostal nerve block (ICNB), quadratus lumborum block (QLB) and local infiltration. Our primary outcomes consisted of 24-h cumulative opioid consumption and the time to first use of opioid medication postoperatively. Secondary outcomes encompassed pain scores at 2, 6, 12 and 24 h postoperatively, as well as occurrences of postoperative nausea and vomiting. Results: Overall, 27 trials met our inclusion criteria. QLB, PVB and ESPB demonstrated significant advantages in reducing 24-h postoperative opioid consumption and providing effective analgesia at all measured postoperative time points within 24 h, compared to the placebo group. However, there was no statistical difference between the three interventions. Similarly, there were no statistical differences in all outcomes between the ICNB and infiltration groups compared to the placebo group. Conclusions: ESPB, PVB and QLB offer significant analgesic benefits for PCNL compared to placebo, with no significant differences in efficacy among them. Due to limited evidence, ICNB and local infiltration were found not to be more effective than placebo.

Analgesic effect of adding modified pectoral nerve block to serratus anterior plane block in modified radical mastectomy: Randomized double-blinded trial

ABSTRACT Objective Acute, severe pain following breast surgery affects about 40% of individuals. It has proven possible to lessen postoperative pain related to modified radical mastectomy (MRM) by developing several thoracic wall blocks. This study evaluated the analgesic benefit of pectoral nerve block type 2 (PECS II) in conjunction with ultrasonography-guided serratus anterior plane block (SAPB) as opposed to SAPB alone in patients undergoing MRM. Methods In this randomized double-blind trial, female patients undergoing MRM under general anesthesia were randomly assigned to the SAPB Group (n = 30) or the Combined Group (n = 30). Along with block-related problems, the total amount of fentanyl consumed during the procedure and the amount of morphine consumed over in the first 24 hours after surgery were noted. During rest and movement, pain was measured using the Numeric Rating Scale (NRS). Results The total intraoperative fentanyl consumption was reduced to 130.7 ± 44.4 µg in the combined group compared to 160.0 ± 53.2 µg in the SAPB group (p = 0.024). Also, postoperative morphine consumption was 1.5 mg (0–6) and 6 mg (3–9) in the two groups, respectively (p = 0.005). The Combined group showed significantly lower scores of NRS at rest and during movement than the SABP group throughout the postoperative period. Conclusion Ultrasound-guided SAPB plus PECS II block provides safer and more efficient analgesia in MRM than SABP alone, as evidenced by decreased postoperative morphine consumption, pain scores, and intraoperative fentanyl consumption.

Assessment of dermal safety of petroleum ether extract from Acorus calamus L

Acorus calamus L (A. calamus), known for its aromatic leaves and rhizomes, is extensively used in traditional medicine to treat digestive issues, inflammation, pain, anxiety, and stress. The petroleum ether extract of A. calamus isolates specific bioactive compounds using petroleum ether, a nonpolar solvent effective in dissolving nonpolar plant compounds. This extract potentially offers antimicrobial, anti-inflammatory, and analgesic benefits. However, research on this extract is limited, necessitating further investigation to determine its safety, efficacy, and medical applications. This study aims to develop more efficient extraction methods for the petroleum ether extract, focusing on sesquiterpenes and isocalamendiol from A. calamus. Additionally, the study will evaluate the extract’s safety for topical use, providing insights into potential side effects and contraindications. This information is crucial for assessing the extract’s suitability for topical treatments and guiding the development of new therapies and products.

Effects of a Multimodal Pain Control Protocol Using 2% Lidocaine Intradermal and Meloxicam Intramuscular on Mitigating Behavioral Castration Pain in Piglets Using a Needleless System

ABSTRACT Mitigating piglet castration pain is critical to minimize negative experiences and contribute to a positive affective state. A multimodal pain control protocol (needleless 2% lidocaine intradermal/0.4 mg/kg meloxicam intramuscular) was evaluated. Males were administered one of four treatments: (1) needleless lidocaine/meloxicam intramuscular (LM), (2) needleless lidocaine/saline intramuscular (LS), (3) needleless saline/meloxicam intramuscular (SM), and (4) needleless saline/saline intramuscular (SS). Females were sham castrated (SH). Piglets were recorded 24h pre-castration (M1) and 15min (M2), 3h (M3), and 24h post-castration (M4). The Unesp-Botucatu Composite Acute Pain Scale (UPAPS) was used to assess pain behavior. From a treatment standpoint, scores did not differ at M1 (P = 1.00) or M4 (P ≥ 0.36). However, at M2, LS piglets had (P < 0.01) higher scores (3.4) than LM piglets (1.6) and SH piglets had (P ≤ 0.01) the lowest scores (0.02). From a timepoint standpoint, piglets in the LS, LM, SM, and SS groups had (P ≤ 0.05) higher scores at M2 compared with their baseline scores at M1. These results indicate that needleless lidocaine and intramuscular meloxicam offered no analgesic benefit.

Electroacupuncture Mitigates TRPV1 Overexpression in the Central Nervous System Associated with Fibromyalgia in Mice.

Fibromyalgia (FM) is characterized by chronic pain, significantly affecting the quality of life and functional capabilities of patients. In addition to pain, patients may experience insomnia, chronic fatigue, depression, anxiety, and headaches, further complicating their overall well-being. The Transient Receptor Potential Vanilloid 1 (TRPV1) receptor responds to various noxious stimuli and plays a key role in regulating pain sensitivity and inflammation. Thus, targeting TRPV1 may provide analgesic and anti-inflammatory benefits. This study investigates the efficacy of electroacupuncture (EA) in alleviating chronic pain in FM through TRPV1 and its downstream molecules in the central nervous system (CNS). To model FM, we subjected mice to intermittent cold stress (ICS) for three days. The study comprised five rodent groups: Control (CON), ICS, ICS + EA, ICS + Sham EA, and ICS + KO (TRPV1 knockout mice). Our findings revealed that ICS induced allodynia and hyperalgesia in mice by day four, persisting until day 21. EA at 2 Hz and TRPV1 KO significantly decreased both mechanical and thermal hypersensitivity (Withdrawal-Day 14: 2.43 ± 0.19 g; Day 21: 5.88 ± 0.47 g, n = 6, p < 0.05; Latency-Day 14: 2.77 ± 0.22 s; Day 21: 5.85 ± 0.41 s, n = 6, p < 0.05). In contrast, sham EA did not produce significant effects. Additionally, TRPV1 and several pain-related proteins were significantly elevated in the thalamus, somatosensory cortex (SSC), medial prefrontal cortex (mPFC), hippocampus, hypothalamus, cerebellum regions V (CB V), VI (CB VI) and VII (CB VII) after the ICS model. Both EA at the ST36 acupoint and TRPV1 KO mice showed diminished overexpression of pain-related proteins, with the sham EA group showing no significant changes compared to the ICS group. Chronic widespread pain was reduced by EA and TRPV1 KO, with the effects of EA on the TRPV1 pain pathway clearly evident in the CNS after 21 days.

Antivenom Administration After Rattlesnake Envenoming in Arizona Does Not Directly Diminish Pain.

The onset, progression, and severity of pain following rattlesnake envenomation are highly variable between patients. Pain can be severe and persistent, seemingly refractory to opioid analgesics. The ability of antivenom to directly relieve pain has not been well studied. We reviewed poison center charts of rattlesnake envenomations between 1 January 2018, and 31 December 2022. Demographic data as well as details of antivenom usage and pain severity were collected. Patients were coded in one of three categories: without pain (Pain 0), well controlled pain (Pain 1), and opioid refractory pain (Pain 2). A total of 289 patients met the inclusion criteria, with 140 receiving Anavip antivenom and 149 receiving Crofab. Patient characteristics were different between both cohorts. There were no significant differences in the number of Anavip vials used between the Pain 1 and Pain 2 groups. However, patients in the Crofab Pain 2 group received more antivenom compared to Pain 1. Importantly, Pain 3 patients were treated with the highest amount of antivenom in both the Crofab and Anavip cohorts. Despite the higher doses of antivenom used, these patients also experienced the greatest pain. These data suggest that antivenom alone may have minimal analgesic benefits.

The analgesic benefit of rectus sheath block in robotic gynecologic surgery: A retrospective study.

With the growing adoption of robotic techniques in gynecologic surgery, the advantages of minimally invasive procedures over traditional open surgery, such as reduced postoperative pain and quicker recovery, are clear. Yet, establishing an effective multimodal analgesic regimen remains a challenge. This retrospective study from a tertiary care center aimed to assess the analgesic efficacy of the rectus sheath block (RSB) on postoperative pain and opioid consumption after robotic gynecologic surgery. Between June 2022 and March 2023, 20 patients who underwent robotic gynecologic surgery were evaluated. Key parameters included postoperative visual analog scale scores, opioid consumption, and postoperative nausea/vomiting instances. Anesthesia protocols were standardized, with postsurgical pain management involving RSB and a patient-controlled analgesia device filled with morphine. Patients showed an average morphine intake of 8.2 ± 5.09 mg over the initial 24 hours postsurgery. During mobilization, average pain scores were consistently low, with no correlation identified between opioid consumption and age or body mass index. 40% of patients reported postoperative nausea on the first day, and no complications linked to the RSB were observed. The study underlines the potential of integrating RSB in a multimodal analgesic regimen after robotic gynecologic surgery. Its application may lead to reduced opioid consumption and more efficient postoperative pain management. Further randomized controlled trials are recommended to validate these findings.

Anatomical Location of Rib Fractures and Associated Analgesic Benefits Achieved From Serratus Anterior Plane Blocks: A Spatial Point Pattern Analysis.

Anatomical Location of Rib Fractures and Associated Analgesic Benefits Achieved From Serratus Anterior Plane Blocks: A Spatial Point Pattern Analysis.

Comparative Study between Ultrasound Guided Modified Pectoral Nerve Block (PECSΙΙ) versus Ultrasound Guided Serratus Anterior Muscle Plane Block for Analgesia Following Modified Radical Mastectomy

Abstract Background Modified pectoral nerve (PECSII) and serratus plane blocks have been recently used for analgesia in breast surgery, but evidence comparing their analgesic benefits is limited. This comparative study aims to examine the analgesic efficacy and safety profile of ultrasound-guided PECSII versus serratus block in patients undergoing modified radical mastectomy (MRM) for breast cancer. Objective To evaluate and compare the effect of both PECS II block versus and Serratus anterior block in patients undergoing modified radical mastectomy surgery. Patients and Methods The duration of analgesia and effect on hemodynamics parameters were evaluated. Moreover, undesirable side effects were studied. Thirty-six patients were randomly allocated into two equal groups (18 patients): group (A) and group (B). Group (A): received a PECSII block with 30 mL of bupivacaine 0.25%. Group (B): received a serratus anterior plane block (SAPB) using the same volume of 30 ml bupivacaine 0.25%. All patients were clinically assessed and routine preoperative investigations were done: CBC, Coagulation profile, liver function tests, kidney function tests, fasting blood sugar and ECG. The initial vital data were measured after applying the standard monitoring including pulse oximetry, non-invasive blood pressure and ECG. Results This study demonstrated that PECSII and serratus blocks have comparable analgesic properties in patients undergoing modified radical mastectomy. Both blocks were comparable in postoperative pain intensity, postoperative morphine consumption, and intraoperative fentanyl requirement. The two blocks were comparable in hemodynamics, and VAS score. The two blocks were associated with hemodynamic stability, and high satisfaction scores. The absence of major complications characterizes both blocks. Conclusion This study confirms that PECSII and serratus blocks provide similar adequate analgesia following modified radical mastectomy.

Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial

ObjectiveTo evaluate if prehospital administration of fentanyl and intranasal ketamine, compared to fentanyl alone, improves early pain control after injury. MethodsWe conducted a prehospital randomized, placebo-controlled, blinded, parallel group clinical trial from October 2017 to December 2021. Participants were male, aged 18-65 years, receiving fentanyl to treat acute traumatic pain prior to hospital arrival, treated by an urban fire-based EMS agency, and transported to the region’s only adult Level I Trauma Center. Participants randomly received 50mg intranasal ketamine or placebo. The primary outcome was the proportion with a minimum two-point reduction in self-described pain on the Verbal Numerical Rating Scale thirty minutes after study drug administration assessed by 95% confidence interval overlap. Secondary outcomes were side effects, pain ratings, and additional pain medications through the first three hours of care. ResultsIn the 192 enrolled, 89 (46%) were White, 36 [27, 53] (median [IQR]) years old, with 103 receiving ketamine and 89 receiving placebo. There was no difference in the proportion experiencing improved pain 30-minutes after treatment (46/103 [44.7%] ketamine vs. 32/89 [36.0%] placebo, difference in proportions 8.7% [95% CI -5.1% to 22.5%]. p=0.22) or at any timepoint through three hours. There was no difference in secondary outcomes or side effects. ConclusionsIn our sample, we did not detect an analgesic benefit of adding 50mg intranasal ketamine to fentanyl in prehospital trauma patients.

Evaluation of Immediate Release Tri-Layer Tablets for Analgesic and Antiulcer Properties in Experimental Animals.

Using animals as a test subject, we aimed to determine whether tri-layer tablets filled with ibuprofen and ranitidine had any effect on pain or ulcers. The effectiveness against ulcers caused by acetic acid and cold stress was tested. Six rats made up each of the four groups that were randomly assigned. As a control, I was given a solvent and placed in the group. The second group served as the control, while groups III and IV were used to evaluate 100 mg and 200 mg tri-layer tablets, respectively. The oral gavage method was used to administer all medications. It was shown that the number of writhing was 5.12 in the T2 group compared to the control group, indicating a decrease in the medication-treated groups. The heated technique demonstrated the substantial analgesic activity of the medication under examination. After 120 minutes, the drug-treated groups had a latency time that was 9.8 seconds longer than the control group. Treatment with the experimental medicine lowered the ulcer index in an ulcer model generated by acetic acid. T2 had a value that was 0.43 lower than the control group. T2 group showed a significant reduction in ulcer index to 0.33 in ulcers generated by cold restraint stress. This study provides support for the use of multilayered tablets in the treatment of pain and ulcer disorders, since it demonstrated the analgesic and antiulcer benefits of the test medicine in animal models. More studies to determine the exact mechanism are necessary.

The impact of different music genres on pain tolerance: emphasizing the significance of individual music genre preferences

Music is a promising (adjunctive) treatment for both acute and chronic pain, reducing the need for pharmacological analgesics and their side effects. Yet, little is known about the effect of different types of music. Hence, we investigated the efficacy of five music genres (Urban, Electronic, Classical, Rock and Pop) on pain tolerance. In this parallel randomized experimental study, we conducted a cold pressor test in healthy volunteers (n = 548). The primary outcome was pain tolerance, measured in seconds. No objective (tolerance time) or subjective (pain intensity and unpleasantness) differences were found among the five genres. Multinomial logistic regression showed that overall genre preference positively influenced pain tolerance. In contrast, the music genres that participants thought would help for pain relief did not. Our study was the first to investigate pain tolerance at genre level and in the context of genre preference without self-selecting music. In conclusion, this study provides evidence that listening to a favored music genre has a significant positive influence on pain tolerance, irrespective of the kind of genre. Our results emphasize the importance of individual music (genre) preference when looking at the analgesic benefits of music. This should be considered when implementing music in the clinical setting.

Perioperative Analgesic and Sedative Effects of Cannabidiol in Cats Undergoing Ovariohysterectomy.

The aim of this study was to evaluate the perioperative analgesic and sedative effects of oral CBD in cats undergoing ovariohysterectomy. Twenty-two cats were assigned to receive either oral cannabidiol oil (2 mg/kg, CBD group, n = 12) or placebo oil (0.1 mL/kg, Placebo group, n = 10) 60 min before the premedication. The anesthetic protocol included dexmedetomidine/meperidine, propofol, and isoflurane. Intravenous fentanyl was given to control cardiovascular responses to surgical stimulation. Pain was assessed at 0.5, 1, 2, 4, 6 and 8 h post-extubation using the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite-measure pain scale. Sedation scores were assessed at the same timepoints and at 15 min after the premedication. Morphine was administered as rescue analgesia. Higher sedation scores were recorded in the CBD group at 15 min after premedication (p = 0.041). Intraoperatively, more cats required fentanyl in the Placebo group than in CBD group (p = 0.028). The pain scores did not differ between groups, except at 0.5 h post-extubation when lower scores were detected in the CBD group (p = 0.003-0.005). Morphine was required in 100% of the animals in both groups. CBD increased preoperative sedation and decreased intraoperative analgesic requirements, with minimal evidence of postoperative analgesic benefits over the placebo.

Effectiveness of different doses of dexmedetomidine on intraoperative haemodynamic profiles and postoperative pain in patients undergoing abdominal surgery at Dilla University Referral Hospital, Ethiopia, 2024: a double-blind randomized controlled trial.

Abdominal surgery stands as one of the most frequently conducted procedures across surgical specialties, accounting for up to half of surgery-related expenses. Hemodynamic instability emerges as a significant concern during anaesthesia and surgery, provoked by the stress of intubation, surgical incision, and anaesthetic agents. Following abdominal surgery, pain is an inevitable consequence, typically managed with opioid-based analgesia. However, the adverse effects associated with opioids often overshadow their analgesic benefits, particularly in the context of abdominal surgery. Consequently, there exists a necessity to explore and assess alternative non-opioid pain management options post-abdominal surgery as part of a broader strategy to reduce opioid usage. The primary aim of this investigation is to assess the effectiveness of varying doses of dexmedetomidine in regulating intraoperative hemodynamics and alleviating postoperative pain in patients undergoing abdominal surgery. Ethical clearance and institutional review board were obtained from the ethical clearance committee of Dilla University College of Medicine and Health Sciences with protocol unique number of duirb/008/22-01. Our trial has been prospectively registered on the Pan African Clinical Trial Registry with a unique identification number for the registry PACTR202208813896934. Statistical package and analysis were performed by using SPSS version 25. The distribution of data was checked by using Shapiro-Wilk test and the homogeneity of variance was checked by Levene's test. Analysis of variance (ANOVA) and Kruskal-Wallis H test were used for normally distributed continuous data and non-normally distributed or non-parametric data, respectively. P value less than 0.05 with a power of 90% was considered statistically significant. There was a statistically significant increase in mean SBP in the control group at the different critical time points (P<0.05), as compared to the baseline value, while there was no significant difference in mean systolic blood pressure (SBP) between the baseline and all other levels for group 2 and group 3. A statistically significant increase in mean arterial pressure (MAP) was detected in the control group at immediately after intubation (P=0.009) as compared to the baseline value, while a statistically significant reduction in mean heart rate (HR) was observed in group 3 at 15th min after infusion and at 30th 30 min after induction compared to baseline with a P value of 0.002 and 0.008, respectively.Conclusion:Perioperative low-dose infusion of dexmedetomidine at the rate of 0.4mcg/kg/h is a useful anaesthesia adjuvant to control hemodynamic stress response to critical periods. It is wise to use this infusion dose as part of general anaesthesia to achieve better hemodynamic stability.

Effectiveness Of Moringa Oleifera And Ginger Extract On The Intensity Of Dysmenorrhea In Adolescent Girls

Dysmenorrhea is one of the most common gynecological problems experienced by adolescence girls. Introduction to non-pharmacological treatment of dysmenorrhea in adolescence girls is required to reduce the risks arising from dysmenorrhea with pharmacology that has side effects on the body. Moringa Oleifera and Ginger Extracts are non-pharmacological therapies that have analgesic and anti-inflammatory benefits. To find out the comparison of the effectiveness of Moringa Oleifera and Ginger Extracts against the intensity of dysmenorrhea in adolescent girls. The research methodology was a Study Case Literature Review of dysmenorrhea with the Numeric Rating Scale (NRS) before and after the intervention. There was a decrease in the intensity of dysmenorrhea in the two respondents. The comparison result was that Ginger Extract was more effective (83.3%) than Moringa Oleifera Extract (50%) in reducing the intensity of dysmenorrhea. We expected that Moringa Oleifera and Ginger Extracts could be an alternative in handling both prevention and non-pharmacological treatment of dysmenorrhea.

Comparative Analysis of Ketorolac and Parecoxib for Postoperative Pain Management in Uvulopalatopharyngoplasty.

Background/Objectives: Uvulopalatopharyngoplasty (UPPP) is a prevalent surgical procedure for treating obstructive sleep apnea. Effective postoperative pain management is crucial for patient comfort and recovery. This study aimed to compare the analgesic efficacies of parecoxib and ketorolac in patients undergoing UPPP. Methods: A prospective, randomized, double-blind study was conducted on 83 patients who received either parecoxib (40 mg intravenously every 12 h) or ketorolac (30 mg intravenously every 8 h) for 2 days following UPPP. Postoperative pain and swallowing discomfort were assessed using visual analog scales (VASs) at 4, 24, 48, and 72 h. The time to resume eating and adverse reactions were also recorded. Results: At 24 and 48 h postoperatively, the mean VAS score was significantly higher in the ketorolac group compared to the parecoxib group (5.0 ± 2.3 vs. 3.6 ± 2.2, p = 0.005 and 3.9 ± 2.2 vs. 2.5 ± 1.7, p < 0.001, respectively). However, no significant difference in the mean VAS scores was observed between the two groups at 72 h postoperatively. With regards to postoperative swallowing pain, the ketorolac group exhibited significantly higher mean VAS scores than the parecoxib group at 4, 24, 48, and 72 h postoperatively. Conclusions: Intravenous parecoxib may offer superior analgesic benefits in the early postoperative period, particularly in alleviating swallowing pain, compared to ketorolac in UPPP procedures.

Use of Baclofen Premedication as an Analgesic Adjuvant in Patients Undergoing Percutaneous Nephrolithotripsy: A Placebo-Controlled, Double-Blind Randomized Trial.

Baclofen, a clinically available GABAB receptor agonist, produces nonopioid analgesia in multiple models of pain but has had limited studies related to perioperative pain control.The present study seeks to study effects of baclofen on postoperative pain measures and opioid use in adult patients subjected to percutaneous nephrolithotomy (PCNL). Using a placebo-controlled, double-blind methodology, a single 10 mg oral dose of baclofen or placebo was given prior to a surgery in 34 patients undergoing PCNL.Standardized intraoperative and postoperative protocols related to opioid use were followed.Use of postoperative opioids in the post-anesthesia care unitand for the first 24 hours following surgery were recorded as were pain scores and other medication use. There was a significant positive correlation in the use of postoperative opioids in patients who had a preceding history of opioid use.However, there were no significant differences in opioid use which could be attributed to baclofen.There were also no differences in postoperative vital signs, side effects or other medication use. Analgesic benefits of preoperative baclofen were not observed at the dose employed.Safety of the drug was observed.

Effect of music therapy on pain and anxiety during third molar surgery

Music therapy has been used with promising results to reduce pain and anxiety in surgical specialties. It is suggested to reduce anxiety and pain perception during dental surgeries and thereby improving clinical outcomes. Aim: The aim of this study is to determine whether listening to music during trans-alveolar mandibular third molar extraction reduces pain perception and anxiety. Methods: One hundred and forty-six adult participants were randomized into music and non-music groups, with each group comprising seventy-three participants. Each participant had trans-alveolar third molar extraction with or without music intervention depending on the group randomly assigned. Pain scores of participants were measured at one minute after consent, during and after administration of local anaesthetic, during osteotomy, after tooth delivery, and one minute after flap closure. Postoperative pain scores were recorded at one-hour, 3-hour, 6-hour, 24-hour and 48-hour after the last stitch. Pre- and post-operative anxiety scores were also recorded. Descriptive statistics was used to describe sociodemographic data. Student t-test was used to compare the mean of quantitative variables between the groups while chi-square test was used to compare proportions and to investigate association between categorical variables. The statistical significance was defined at p&lt;0.05. Results: The study showed similar sociodemographic characteristics, baseline clinical features and duration of surgery between groups. Pain score peaked during local anaesthetic administration (p = 0.254) and at 3 hours after surgery (p = 0.170) but no statistically significant difference was observed in the mean pain score. The mean anxiety scores also revealed no statistically significant differences. Conclusion: Music was found to add no significant anxiolytic and adjunctive analgesic benefit to participants who underwent third molar surgeries in this study.