Analgesic Efficiency Research Articles

The comparison of TRANSDERMAL FENTANYL for the management of cancer pain in the adults and the elders

The transdermal fentanyl (TDF) patch has become widely used in the treatment of cancer pain. We aimed to compare the analgesic efficiency, side effects and patient satisfaction of TDF in adult and geriatric patients. The data of 181 patients who were observed in our pain clinic were included in this retrospective study. There were 95 patients in the adult group (Group A) and 86 patients in the geriatric group (Group G). Demographic data, cancer type, duration of pain, side effects, visual analog scale (VAS) score, treatment assessment scale (TAS) score, TDF dosage, and the number of patients in whom therapy has been terminated were recorded. After the usage of TDF, reduction in pain score was observed in both groups (p<0.001). The TAS score was similar between the groups at the end of the first month, but it was lower in Group G in the following months. Constipation, dry mouth, somnolence, and dyspnea were seen more frequently in Group G. Because of these side effects, the number of patients in whom therapy was terminated was higher in Group G. The TDF patch is a good choice for cancer pain treatment for both adult and geriatric patients. Since it was observed that the incidence of side effects was higher in the geriatric patients, they should be treated more carefully.

Development of amitriptyline buccoadhesive tablets for management of pain in dental procedures

Administration of lidocaine and nonsteroidal anti-inflammatory drugs (NSAIDs) as a routine procedure for relief of dental pains by and large is restricted due to some side effects. Amitriptyline (AM) has long been known to exert analgesic activity as a result of blocking the Na+ channels. The objective of the present investigation was to prepare suitable buccoadhesive tablets using cellulose derivatives in order to obtain new formulations containing AM to provide local analgesic action. The tablets were evaluated in terms of physical characteristics, mucoadhesion performance, drug release, and in vivo assessment of analgesic efficiency. Tablets containing higher amounts of high-viscosity hydroxypropylmethyl cellulose (HPMC-K4M) significantly demonstrated enhanced adhesive performances. On the other hand, presence of sodium carboxymethyl cellulose (NaCMC) in formulations including HPMC of lower-viscosity grade (HPMC-E5LV) provided further adhesiveness by increase in viscosity. Rate of drug release from HPMC-E5LV tablets was significantly higher than the HPMC-K4M tablets. Kinetically, patterns of AM release from the tablets fitted best to Higuchi model. Moreover, in a randomized double-blind trial, analgesic efficiency of the prepared bioadhesive tablets was revealed to be satisfactory. It is suggested that applying the topical AM mucoadhesive tablet containing the low amount of drug is a safe and promising alternative to relief the pain in the buccal region.

Postoperative efficacies of femoral nerve catheters sited using ultrasound combined with neurostimulation compared with neurostimulation alone for total knee arthroplasty

Neurostimulation is commonly used to perform femoral nerve block. Ultrasound can be used to identify nerve structures and guide needle placement. The aim of this study was to compare postoperative analgesic efficiency when femoral nerve catheters were sited using ultrasound (in-plane approach) combined with neurostimulation or neurostimulation alone, for total knee arthroplasty. Ninety-three patients were enrolled in this prospective, randomized, blind study to receive a continuous femoral nerve block performed using conventional neurostimulation or ultrasound guidance combined with neurostimulation. The primary endpoint was the postoperative 48 h total local anaesthetic consumption. Other outcomes included visual analogue scale scores at rest, after 12, 24 and 48 h; total oral opioid dose; onset time of femoral block; procedural time; knee flexion and complications. Results are expressed with medians (25-75th percentiles), mean ± SD and n (%), as appropriate. The onset time of sensory and motor block was faster in the ultrasound group [11 (6-17) min] than in the conventional group [16 (11-23) min, P = 0.009]. Total local anaesthetic dose was reduced [299 ± 45 vs. 333 ± 48 ml, (difference = 34.0 ml, 95% confidence interval 15.6-52.5 ml), P = 0.0003] and the time to the first analgesic request was lengthened [11 (7-13) vs. 7 (4-12) h, P = 0.034] in the ultrasound group. Visual analogue scale scores at 12, 24 and 48 h were lower in the ultrasound group as well as visual analogue scale scores during knee flexion at 48 h [14.5 (11.0-23.0) vs. 28.5 (21.0-43.5) mm, P < 0.0001]. Total oral morphine doses were 20 (0-40) vs. 40 (20-60) mg (P = 0.0065). Durations of hospital stay were comparable in both groups. Continuous perineural femoral catheter placement using ultrasound combined with neurostimulation and an in-plane approach reduces total doses of local anaesthetic, morphine consumption and improves postoperative pain management by comparison with neurostimulation alone.

The effects of post operative analgesia with lornoxicam on gynaecological operation patients

Objective To evaluate the analgesic efficiency and adverse effects of post operative patient-con-trolled intravenous analgesia(PCIA)with lornoxicam and tramadol in patients underwent gynaecologlcal operation.Methods 46 ASA(American Society of Anesthesiologists)Ⅰ-Ⅱ patients who undertook gynaecological operation were divided into two groups:lornoxicam group(group A,n=23)and tramadol group(group B,n=23).Each patient used remifentanil-propofol total intravenous anesthesia and received post-operation analgesia.We assessed the effectiveness by visual analogue scale(VAS)and analgesia satisfication degree at different time points:2,4,8,12 and 24 h after the beginning of analgesia were assessed.The analgesic efficacy of analgesia and the adverse effects during analgesia period were observed.Result The VAS scores of group A in 2,4,8 h were(3.12±0.90),(2.84±1.72)and(3.01±1.69),which were lower than those of group B(P<0.05).The incidences of nausea and vomiting in group A(30.4%and 26.1%)were significantly lower than those in group B(P<0.05)Conclusion Lornoxicam could provide an precise analgesic effect and lower adverse effect and worthy to be popularized. Key words: Lornoxicam; Tramadol; Gynecologic surgical procedures

Analgesic Effects of Intra-Articular Morphine in Patients With Temporomandibular Joint Disorders: A Prospective, Double-Blind, Placebo-Controlled Clinical Trial

A number of reports have shown a direct analgesic effect of opioids by way of the peripheral receptors. Nevertheless, only a very few studies have reported using opioids in the temporomandibular joint (TMJ), and nearly all of them were connected to surgical patient groups. The present study was designed to evaluate the analgesic efficacy and safety of repeated intra-articular morphine applications compared with a local anesthetic and saline solution in the management of TMJ pain. A total of 48 patients with articular pain related to the TMJ were entered in a clinical, prospective, randomized, double-blind, single-center study. The analgesic effect of repeated intra-articular infiltration with morphine (5 or 10 mg morphine sulfite), bupivacaine 0.5% (Carbostesin; AstraZeneca, London, UK), and isotonic saline solution as a placebo in the TMJ was examined. The efficiency after 3 injections of the same substance with an interval of 48 hours between each application was measured using a pain relief scale, visual analog scale, pain intensity scale, and the potential need for accessory peripheral analgesics (paracetamol). All patients showed, independent of the treatment group, pain relief within 60 minutes after the first injection. Patients with saline and Carbostesin reported almost complete pain recurrence before the second injection. At 1 week after the last and third injection, the 10-mg morphine group still showed a distinct effect, with 16.7% reporting complete (no pain) and 41.7% distinct pain relief. In addition, 33.3% had a poor response and 8.3% had no improvement. None of the other groups reported complete improvement; however, 25% of the patients who received 5 mg morphine had distinct pain relief, and 50% had at least poor pain relief. In the Carbostesin group, distinct improvement was reported by 8.3%, with a poor response in 41.7%, and no effect in the remaining 50%. Patients treated with saline had a poor response in 16.7%, but most (83.3%) reported no improvement 1 week after treatment. Independent of the applied substances, initial pain relief can be registered in the TMJ: either from the arthrocentesis effect or at least the placebo effect. Morphine at a dosage of 10 mg showed the best and most long-lasting analgesic efficiency. Morphine, in general (5 and 10 mg), and, with limitations, Carbostesin were more or less efficient for postoperative pain control but without distinct effects in the long term. With regard to our results, we can recommend intra-articular morphine application at a dose of 10 mg for pain management. Carbostesin showed no promising long-term effects.

Bloc sciatique en médecine préhospitalière

Objectives Evaluate the analgesic efficiency of the sciatic nerve block in prehospital care at the time of some severe legs or feet traumas. Patients and methods Retrospective, monocentric study upon a period of time 1998–2008. Results Twenty-three sciatic nerve blocks have been colligated, five by upper way and heighten by lateral popliteal lower way among which fourteen without neurostimulator. The pain decrease evaluated by the EVS at T0 (before block), T1 (10 min after block) and T2 (arriving in emergency department), has been significative, whatever the measure time interval (T0–T1, T0–T2, T1–T2), the ways used and the local anaesthetics given. The analgesia installation was faster when approaching the sciatic nerve block by the upper way and when using a neurostimulator. Only one analgesic failure was observed while doing a lateral popliteal way without neurostimulator. Any complication was reported. Conclusion The sciatic nerve block done in prehospital shows a significant analgesic efficiency which would worth a deeper evaluation and a thought on its introduction in the ED physician's therapeutic gear.

Pre-emptive Analgesia for Postoperative Pain Relief in Children – Role of Paracetamol

This prospective clinical study was carried out in the Dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka, during the period of May 2003 to July 2003. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain of pain and to produce smooth recovery after surgery by decreasing immediate postoperative pain in children by a simple, safe acceptable drug. The children scheduled for tonsillectomy under general anaesthesia were recruited in this study. The analgesic efficiency of rectal paracetamol in two doses, 25 mg/kg bodywt.(Gr-P25) and 50 mg/kg. bodywt. (Gr-P50) were compared with Diclofenac Sodium suppository 1mg/ kg body weight (Gr-D) given half an hour before induction of anaesthesia. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale). Heart rate and blood pressure were stable in Gr-P50 and Gr-D. Time of first demand of analgesic was delayed in Gr-P50 and Gr-D. Total paracetamol consumption in 24 hours was less in Gr-P50(181±14.25) and Gr-D (212±25) than Gr-P25(318± 26.39). Total duration of analgesia in Gr- P50 (657±9.94) mins. and in Gr- D(502±10.63) mins. and in Gr-P25(288±23.17) mins. Pre-emptive high dose rectal paracetamol appears to be more effective than diclofenac sodium suppository for postoperative analgesia in children undergoing tonsillectomy. Journal of BSA, Vol. 18, No. 1 &amp; 2, 2005 p.9-16

Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options

Gastrointestinal (GI) side effects such as nausea and vomiting are common following opioid analgesia and represent a significant cause of patient discomfort and treatment dissatisfaction. This review examines the mechanisms that produce these side effects, their impact on treatment outcomes in chronic pain patients, and counteractive strategies. A number of mechanisms by which opioids produce nausea and vomiting have been identified. These involve both central and peripheral sites including the vomiting center, chemoreceptor trigger zones, cerebral cortex, and the vestibular apparatus of the brain, as well as the GI tract itself. Nausea and vomiting have a negative impact on treatment efficacy and successful patient management because they limit the effective analgesic dosage that can be achieved and are frequently reported as the reason for discontinuation of opioid pain medication or missed doses. While various strategies such as antiemetic agents or opioid switching can be employed to control these side effects, neither option is ideal because they are not always effective and incur additional costs and inconvenience. Opioid-sparing analgesic agents may provide a further alternative to avoid nausea and vomiting due to their reduced reliance on mu-opioid signalling pathways to induce analgesia. Nausea and vomiting side effects limit the analgesic efficiency of current opioid therapies. There is a clear need for the development of improved opioid-based analgesics that mitigate these intolerable effects.

Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy

The aim of the study is to evaluate the analgesic efficiency of perioperative magnesium sulphate infusion in patients undergoing laparoscopic cholecystectomy (LC). In a randomized, double-blind trial study, 83 patients were divided into two groups. Group MT received 50 mg/kg i.v. magnesium sulphate in 100 ml of 0.9% normal saline and Group T received the same volume of isotonic saline during the intraoperative period. The cumulative post-operative tramadol consumption was measured to assess the analgesic effect using a patient-controlled analgesia device. Pain intensities at rest and while coughing were evaluated at 0, 2, 4, 8, 12, and 24 h post-operatively. The pain scores in Group MT were significantly lower than Group T at 0, 4, and 12 h post-operatively. The average of visual analogue scale at rest and during cough during 24 h post-operatively was found to be statistically significant between groups. The total dose of tramadol the 24-h period in Group MT and Group T was found to be 281.34 +/- 90.82 and 317.46 +/- 129.59, respectively. Per-operative 50 mg/kg magnesium sulphate infusion is effective in reducing post-operative pain in patients undergoing LC.

Treatment of fever and pain with paracetamol infusion after caesarean section

Treatment of fever and pain with paracetamol infusion after caesarean section

One-pot synthesis of a new potential analgesic over bifunctional palladium/amberlyst catalysts

(−)-(2 S,3 S)-1-Dimethylamino-3-(3-methoxy-phenyl)-2-methyl-pentan-3-ol hydrochloride was directly dehydroxylated to the new opioidic (−)-(2 R,3 R)-[3-(3-methoxy-phenyl)-2-methyl-pentyl]-dimethyl-amin hydrochloride over Pd containing Amberlyst-15. The obtained product exhibits pronounced analgesic efficiency. Two reaction steps are involved in this one-pot synthesis: dehydration of the starting tertiary alcohol followed by hydrogenation of the obtained olefin ( Z + E)-( S)-[3-(3-methoxy-phenyl)-2-methyl-pent-3-enyl]-dimethyl-amine hydrochloride. The dehydration of the alcohol occurs only in the presence of an Amberlyst resin as solid acid catalyst, which also serves as support for the hydrogenation component Pd. Surprisingly, only such a relatively simple well known Pd/Amberlyst system provides excellent results for this complicated one-pot conversion. Other acidic heterogeneous catalysts did not show catalytic performance for this kind of reaction. The various reaction parameters of this one-pot dehydroxylation reaction were optimized using a statistical test design program.

Évaluation de l'analgésie postopératoire par bloc continu iliofascial après chirurgie pour remplacement de prothèse totale de hanche : étude pilote

Objective To assess the analgesic efficiency of a continuous iliofascial nerve sheath block after total hip arthroplasty replacement (RPTH). Study design open and prospective pilot study. Patients and methods Before induction of general anaesthesia (GA), an iliofascial catheter was inserted (group KT, n = 11) or not (group NKT, n = 10). In the KT group, 30 ml of ropivacaïne 4,75 mg/ml (maximum dose) were injected, and 14 mg/h of ropivacaïne 2 mg/ml were infused during the first 48 postoperative hours. All patients underwent a standardized GA and a multimodal postoperative analgesia with a intravenous PCA morphine, paracetamol and tramadol during the first 48 hours. Postoperative pain assessment which was achieved using visual analogic scores (VAS) at rest (EVAr) and on movement (EVAm), total morphine consumption, and side effects were collected during the first 48 hours. Statistical analysis was performed using a Mann and Whitney test for the quantitative values and a chi 2 exact test for the qualitative values. Data are expressed as median [interquartile range]. Results Total morphine consumption was lower in the KT group with a total amount of 26 mg [11–48] versus 77.5 mg [55–91] ( p = 0.007) at h48. EVAr and EVAm were lower in the KT group at h4, h8, h24, h36 for the EVAr and during the 48 postoperative hours for EVAm. Three patients experienced nausea and/or vomiting in the KT group versus 6 in the NKT group ( p = 0.05). Conclusion After RPTH surgery, continuous iliofascial block reduces morphine consumption; provide a better pain relief at rest and on movement than IV multimodal analgesia alone.

Intravenous magnesium sulphate decreases postoperative tramadol requirement after radical prostatectomy*

The purpose of this study was to assess whether the addition of intravenous magnesium sulphate (Mg) at the induction of anaesthesia to a balanced anaesthetic protocol including wound infiltration, paracetamol and tramadol resulted in improved analgesic efficiency after radical prostatectomy. We conducted a randomized, double-blind, controlled study. Thirty ASA I or II males scheduled to undergo radical retropubic prostatectomy with general anaesthesia were prospectively assigned to one of the two groups (n = 15 each). The Mg group (Gr Mg) received 50 mg kg-1 of MgSO4 in 100 mL of isotonic saline over 20 min immediately after induction of anaesthesia and before skin incision. The patients in the control group (Gr C) received the same volume of saline over the same period. At the time of abdominal closure, wound infiltration with 190 mg (40 mL) of ropivacaine was performed in both groups. Pain was assessed by a 10-point visual analogue scale in the recovery room starting from the time of tracheal extubation. Standardized postoperative analgesia included paracetamol and tramadol administered via a patient-controlled analgesia device. In the postoperative period, both groups experienced an identical pain course evolution. Cumulative mean tramadol dose after 24 h was 226 mg in the magnesium group and 446 mg in the control group (P < 0.001). Postoperative nausea occurred in two patients in each group. Two vs. eight patients required analgesic rescue in magnesium and control groups, respectively (P = 0.053). This study shows that intravenous magnesium sulphate reduces tramadol consumption when used as a postoperative analgesic protocol in radical prostatectomy.

Chiral Recognition of D‐Kyotorphin by Lipidic Membranes: Relevance Toward Improved Analgesic Efficiency

D-Kyotorphin (D-KTP), the most potent isomer of the endorphin-like dipeptide kyotorphin (KTP), is a good drug candidate for the treatment of chronic pain and is thought to be involved in receptor-mediated processes. According to the "membrane catalysis" model, ligands interact with membrane lipids to attain high local concentrations in the receptor vicinity and to adopt the necessary conformation for docking. Therefore, the interaction and recognition of D-KTP by membranes is potentially important to its increased analgesic effect. In spite of the neutral net charge of D-KTP at pH 7.4, fluorescence spectroscopy reveals that the interaction with large unilamellar vesicles is more extensive than was observed for KTP. The tyrosine residue interacts extensively with rigid membranes, with a location and well-defined orientation in the bilayer. This suggests not only that D-KTP meets the structural constraints needed for receptor-ligand interaction in a manner similar to that of KTP, but also that the stronger membrane interaction and ability to discriminate rigid membrane domains might contribute to its improved analgesic effect.

The analgesic efficiency of continuous femoral nerve blockade after total hip arthroplasty (THA) is not improved by the use of a stimulating catheter

The analgesic efficiency of continuous femoral nerve blockade after total hip arthroplasty (THA) is not improved by the use of a stimulating catheter

Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I

In complex regional pain syndrome (CRPS) many clinical symptoms suggest involvement of the central nervous system. Neuropathic pain as the leading symptom is often resistant to therapy. In the present study we investigated the analgesic efficiency of repetitive transcranial magnetic simulation (rTMS) applied to the motor cortex contralateral to the CRPS-affected side. Seven out of ten patients reported decreased pain intensities. Pain relief occurred 30 s after stimulation, whereas the maximum effect was found 15 min later. Pain re-intensified increasingly 45 min after rTMS. In contrast, sham rTMS did not alter pain perception. These findings provide evidence that in CRPS I pain perception can be modulated by repetitive motor cortex stimulation.

Agents physiques antalgiques: Données cliniques actuelles

Analgesic electrotherapy is now based on more consistent scientific data; the biological action of the electric current, of the electromagnetic radiations and of the mechanical vibrations is better approached. But the randomized control trials still provide contradictory results concerning the analgesic efficiency of the cryotherapy, the TENS, the pulsed electro-magnetic fields, the ultrasound and laser therapy, the shock waves; iontophoresis, short waves, microwaves, infrasound vibrations are very few investigated. The analgesic electrotherapy cannot be recommended nor prohibited; physical agents represent only therapeutic options. On the basis of the scientific data and of their personal experience, the therapists can use them. More controlled clinical investigations of higher methodological levels are still required.

Neuraxial opioids for labour analgesia: analgesic efficiency and effect on labour

Neuraxial opioids have changed the practice of obstetric anaesthesia and analgesia dramatically. Excellent analgesia with minimal side effects started an era of ever increasing numbers of women who opt for the 'painless birth experience'. Several papers have been reported during 2001 that examine analgesic efficacy, maternal side effects, and effect on foetal well-being of epidural and spinal opioids. Foetal bradycardia following intrathecal opioid analgesia, an increasingly popular technique, has attracted particular attention over the past few years. The present review addresses recently reported work that, according to the author, is key to this field.

Analgesic effect of olipiphate on mouse model of chemical stimulation of peritoneum.

We studied the analgesic effect of olipiphate, a product of lignin, against writhing provoked by intraperitoneal injection of acetic acid. Paracetamol was used as the reference drug. Both agents dose-dependently decreased the number of motor reactions caused by the irritant. Olipiphate possessed analgesic activity and efficiency comparable with those of paracetamol, but produced a more long-lasting effect.

Comparison of Ketamine and Pethidine in Experimental and Postoperative Pain

The analgesic efficiency of ketamine and pethidine was compared in experimental ischemic pain and postoperative pain after oral surgery. Naloxone 1.6 mg or placebo was given 5 min before the analgesic drug. The subjects recorded their pain on a visual analogue scale. Both ketamine 0.3 mg/kg and pethidine 0.7 mg/kg were effective as analgesics against the two types of pain studied. Naloxone prevented the analgesic effect of pethidine, but had no effect on ketamine analgesia. The results are in accordance with the hypothesis that the analgesic effect of ketamine is mediated by a non-opioid mechanism, possibly involving PCP-receptor-mediated blockade of the NMDA-receptor-operated ion channel.