Intravenous Paracetamol Research Articles

Empyema thoracic in a neonate co-infected with SARS-CoV-2 and staphylococcus arouse successfully treated with fibrinolysis: a brief report

BackgroundEmpyema as a rare cause of respiratory distress in neonatal period has not yet been reported after Corona virus disease 2019 (COVID-19) and even rarely in the context of bacterial infections is age group.Case PresentationThe first neonate of quadruplets, resulting from Cesarean-Section of a 30-year-old mother without a history of previous illness, born at 34 weeks of gestation with a birth weight of 1600 gram. All four newborns were hospitalized; while the first one underwent nasal continuous positive airway pressure (N-CPAP) with a positive end-expiratory pressure of 6 and fractional inspired oxygen of 0.6, due to respiratory distress, noting a respiratory score of five out of 12.She was resuscitated one hour later due to bradycardia and underwent ventilator support. She received a single dose of pulmonary surfactant, intravenous paracetamol, and phenobarbital due to respiratory distress syndrome, Pectus Ductus Arteriosus, and unilateral clonic movements, respectively. In the lack of positive blood culture, she extubated two days later and breast-feeding was started. On day eight, she underwent high flow nasal cannula. On day 12, she suddenly developed respiratory distress, mottling, and abdominal distension, leading to N-CPAP and re-evaluation. The nasopharyngeal sampling for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) real time Polymerase chain reaction and the blood culture for staphylococcus aurous became positive. A large volume pleural effusion including septa and loculation in right hemi-thorax on chest computerized tomography scan and ultrasound was seen, necessitating to thoracotomy, which was not possible due to her general condition. Remdesivir was started and antibiotics changed to a more broad-spectrum coverage. Chest tube was inserted and Alteplase was injected for three consecutive days with beneficial effects. She had no problem for six-month follow up.ConclusionThis was a case of empyema thoracic in the context of SARS-CoV-2 and Staphylococcus arouses co-infection. In our experience, it can be treated by chest drainage and fibrinolysis in neonatal period.

The hypotension caused by intravenous paracetamol in septic shock patients: A single center placebo controlled randomized study

The hypotension caused by intravenous paracetamol in septic shock patients: A single center placebo controlled randomized study

Evaluation of Supervised Machine Learning Algorithms and Computational Structural Validation of Single Nucleotide Polymorphisms Related to Acute Liver Injury with Paracetamol.

To identify single nucleotide polymorphisms (SNPs) of paracetamol-metabolizing enzymes that can predict acute liver injury. Paracetamol is a commonly administered analgesic/antipyretic in critically ill and chronic renal failure patients and several SNPs influence the therapeutic and toxic effects. To evaluate the role of machine learning algorithms (MLAs) and bioinformatics tools to delineate the predictor SNPs as well as to understand their molecular dynamics. A cross-sectional study was undertaken by recruiting critically ill patients with chronic renal failure and administering intravenous paracetamol as a standard of care. Serum concentrations of paracetamol and the principal metabolites were estimated. Following SNPs were evaluated: CYP2E1*2, CYP2E1_-1295G>C, CYP2D6*10, CYP3A4*1B, CYP3A4*2, CYP1A2*1K, CYP1A2*6, CYP3A4*3, and CYP3A5*7. MLAs were used to identify the predictor genetic variable for acute liver failure. Bioinformatics tools such as Predict SNP2 and molecular docking (MD) were undertaken to evaluate the impact of the above SNPs with binding affinity to paracetamol. CYP2E1*2 and CYP1A2*1C genotypes were identified by MLAs to significantly predict hepatotoxicity. The predictSNP2 revealed that CYP1A2*3 was highly deleterious in all the tools. MD revealed binding energy of -5.5 Kcal/mol, -6.9 Kcal/mol, and -6.8 Kcal/mol for CYP1A2, CYP1A2*3, and CYP1A2*6 against paracetamol. MD simulations revealed that CYP1A2*3 and CYP1A2*6 missense variants in CYP1A2 affect the binding ability with paracetamol. In-silico techniques found that CYP1A2*2 and CYP1A2*6 are highly harmful. MD simulations revealed CYP3A4*2 (A>G) had decreased binding energy with paracetamol than CYP3A4, and CYP3A4*2(A>T) and CYP3A4*3 both have greater binding energy with paracetamol. Polymorphisms in CYP2E1, CYP1A2, CYP3A4, and CYP3A5 significantly influence paracetamol's clinical outcomes or binding affinity. Robust clinical studies are needed to identify these polymorphisms' clinical impact on the pharmacokinetics or pharmacodynamics of paracetamol.

Efficacy of Intravenous Ibuprofen and Paracetamol on Postoperative Pain and Tramadol Consumption After Arthroscopic Shoulder Surgery: A Prospective, Randomized, Double-blind Clinical Trial.

Efficient pain management following arthroscopic shoulder surgery plays a crucial role in decreasing pain intensity, tramadol consumption, and related side effects. This study primarily aimed to examine the analgesic impact of intravenous (IV) ibuprofen and paracetamol on postoperative pain intensity. In addition, as secondary objectives, the study assesses tramadol consumption, determine the global satisfaction score (GSS), analyze hemodynamic parameters, and investigate tramadol-related side effects. In this study, we enrolled sixty-four patients who were scheduled to undergo arthroscopic shoulder surgery and met the inclusion criteria of having American Society of Anesthesiologists scores between 1 and 3 and falling within the age range of 18 to 85 years. All participants were managed using IV patient-controlled analgesia. These patients were then randomly assigned in a double-blind manner to two groups: one receiving paracetamol (n=32), and the other receiving ibuprofen (n=32). Demographic information, visual analog scale (VAS) and GSS data, hemodynamics, tramadol consumption, and tramadol-related side effects were recorded. There were no significant differences between the two groups regarding demographics, hemodynamics, GSS scores, and tramadol side effects (respiratory depression, pruritus, urinary retention, and nausea and vomiting). VAS scores of the two groups were similar at postoperative 1st, 6th, and 12th hours. However, group ibuprofen significantly reduced the VAS scores at the postoperative 24th hour (p=0.039). On the other hand, the two groups showed no significant differences in GSS scores. Compared with total tramadol consumption during the postoperative 24-hour period, ibuprofen significantly reduced tramadol consumption (p=0.003). The findings of this study indicate a significant reduction in both pain intensity and tramadol consumption when IV ibuprofen was administered 24 hours following arthroscopic shoulder surgery, in comparison with the use of IV paracetamol.

Efficacy of adding nalbuphine to caudal bupivacaine for postoperative analgesia in children undergoing hypospadias repair surgery. Randomized controlled trial

ABSTRACT Background We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery. Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis. Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p < 0.001). The number of patients who needed postoperative supplemental analgesia was significantly lower in the nalbuphine group (p < 0.001). Total paracetamol consumption was significantly higher in the control group (p < 0.001). The FLACC and RASS were significantly lower in the nalbuphine group. Postoperative cortisol levels were lower in the nalbuphine group compared to the control group. Conclusions Adding caudal nalbuphine 0.1 mg/kg to bupivacaine 0.25% provides better postoperative pain control than bupivacaine alone in children undergoing hypospadias repair.

Vaginal Vault Infiltration With Bupivacaine for Postoperative Pain Control After Total Laparoscopic Hysterectomy: A Randomized Control Trial

ABSTRACT A viable alternative to total abdominal hysterectomy is total laparoscopic hysterectomy (TLH), which offers abdominal route advantages for women in need of total hysterectomy for benign diseases. Fewer complications, faster recovery, and less pain are ensured by laparoscopy, although this method is not entirely devoid of pain. Reports from various authors indicate that up to 80% of laparoscopic surgery patients require opioid analgesia, which could increase hospital-stay duration and delay mobilization/recovery. Because of these statistics, opioid analgesic usages ought to be minimized, for the aforementioned reasons and also to prevent additional adverse effects. This study was performed to evaluate efficacy of reducing postoperative pain by infiltration of bupivacaine, a long-acting anesthetic agent, into the vaginal vault after TLH. This study was a randomized control trial designed as a 2-arm double-blinded study conducted at a North-Indian Apical Center in the Department of Obstetrics and Gynecology. After written informed consent from all patients, computer-generated randomization software placed them in 1 of 2 groups: group 1, the intervention group (received the infiltration of bupivacaine in the vaginal vault following TLH), or group 2 (the control group). The inclusion criteria were a uterine size of ≤12 weeks' pregnancy and patients requiring TLH with or without bilateral salpingo-oophorectomy for uterine size and benign conditions. Exclusion criteria were contraindication to any medication used by the study, presence of malignancy, history of multiple surgeries, and history of inflammatory disease. Postoperative pain outcome measured in both groups at 1, 3, 6, 12, and 24 hours via a visual analog score was the primary outcome. The secondary outcome was the need for rescue analgesia. A complete profile of each patient was created, using eligibility criteria, body mass index, and demographic profile, and a complete gynecological and physical examination was performed, along with preoperative investigations for fitness to general anesthesia. Per standard protocol, general anesthesia was administered for all surgeries. After vault closure, a fine-tipped aspiration needle was used to administer 10 mL of bupivacaine, which was infiltrated laparoscopically at 2 different locations, approximately 2–4 cm apart. The control group omitted this step. In the first 24 hours after operation, pain was treated using 1 g intravenous paracetamol every 6 hours. For the next 5 days, patients were given nonsteroidal anti-inflammatory drugs (diclofenac) 3 times daily for 5 days. Participants scaled their pain using the visual analog scale (VAS) score at the 1, 2, 6, 12, and 24 hours intervals postsurgery. Scores greater than 4 initiated the distribution of tramadol 50 mg intramuscular. Also recorded were the uterine weight, the operative time, complications, and the amount of operative bleeding. Group 1 patients exhibited VAS scores of less than 4 at 1 hour postsurgery (100%), 3 hours postsurgery (100%), 6 hours postsurgery (97%), 12 hours postsurgery (96.7%), and 24 hours postsurgery (36.7%). The control group VAS scores of less than 4 for the respective times were as follows: 1 hour (93%), 3 hours (86.6%), 6 hours (30%), 12 hours (10%), and 24 hours (3.3%). From these data, it is clear that the infiltration with a local analgesia was effective in reducing postoperative pain. Overall, a feasible and safe option for postoperative pain relief is vaginal cuff infiltration with local anesthetic. A significant increase in the number of women experiencing minimal postoperative pain for 24 hours after laparoscopic hysterectomy took place due to infiltration of the vaginal vault with 10 mL of 0.25% bupivacaine (with no complications). Furthermore, this method reduces requirements of additional opioid/analgesia usage. The beneficial use of local vault infiltration with bupivacaine after TLH within the first 24 postoperative hours is highlighted by this study.

Correlation of pain perception and fentanyl consumption after major abdominal surgery with CGRP 4218T/C polymorphism: A prospective interventional study.

Genetic polymorphisms contribute to patients' variability in pain perception and response to opioid treatment. The present study evaluated the association of calcitonin gene-related peptide (CGRP) 4218T/C polymorphisms with fentanyl consumption over 24 h postoperatively in patients after major abdominal surgery. Eighty-five patients undergoing major abdominal surgery under general anaesthesia were recruited. For postoperative analgesia, epidural fentanyl and intravenous paracetamol were provided. The CGRP 4218T/C genotype was analysed, and the association between the genotype of the patient and the total consumption of fentanyl in the first 24 h after surgery was assessed. The association between different genotypes, the severity of postoperative pain and the side effects of opioids were also studied. Our study population distribution included 52.9% of the T/T genotype (wild homozygote), 35.3% of the T/C genotype (heterozygote) and 11.8% of the C/C genotype (mutant homozygote). Mean (standard deviation) total fentanyl consumption in the first 24 h was found to be highest in the C/C group (212.0 [7.5] μg), followed by the T/T group (182.8 [9.9] μg) and was the least in the T/C group (159.6 [7.5] μg). The C/C group reported higher pain scores in all the study periods. There was no significant difference in the side effects of opioids, such as nausea, vomiting, sedation among different genotypes of CGRP 4218T/C. The polymorphism of CGRP 4218T/C affects postoperative pain perception and analgesic consumption. Patients with the C/C genotype had higher postoperative fentanyl consumption and pain scores.

562 Retrospective Study on Pain Management Pathway for Patients with Suspected Renal/ Ureteric Colic in a UK Accidents and Emergency Department

Abstract Aim To understand local compliance with the NICE guideline for pain management in suspected renal/ ureteric stones which includes use of NSAIDS, Intravenous Paracetamol and Opioids as first, second and third-line analgesics respectively and not offering antispasmodics. Method This was a retrospective single centre study wherein records of patients suspected to have renal/ ureteric colic between 18th July, 2022 and 30th September, 2022 were retrieved. Patients were identified by their presenting complaints of “loin-to-groin” pain at triage and “working diagnosis” from comprehensive history-taking and examination. We checked the first, second and third-line analgesics administered and, if Buscopan was given. Data was entered into Microsoft Excel and our pain management pathway matched against NICE guideline. Results 78 patients were suspected to have renal/ ureteric colic. M:F = 1.2:1. CT-KUB confirmed 90% to have stones and 3% to have no stones. 6% did not have CT-KUB done because they were young patients and urinalysis showed no microscopic hematuria. One patient self-discharged before CT-KUB was done. Overall, compliance with the NICE pain management guideline for suspected renal/ ureteric stones was full in 22% of cases but poor in 78% of cases. Conclusions Clinicians ability to correctly diagnose renal/ ureteric stones is remarkable. However, the low compliance rate is concerning. This may be due to poor awareness of the NICE guideline or doctors having affinity for certain analgesics as compared to others. This information will be used to explore further with the clinical team, reasons for non-compliance, develop a teaching strategy and perform a re-audit thereafter.

634 Analgesia Use in Acute Renal Colic Patients- Complete Audit Cycle

Abstract Aim Prevalence of renal colic is up to 20% worldwide, with recurrence rates approaching 50% within 10 years- making it a common acute presentation. NICE guidance (NG118) states NSAIDs are first-line analgesia for renal colic, followed by intravenous paracetamol and opiates. Our aim was to assess compliance with NG118 within one acute NHS teaching Trust. Method All patients with renal colic as the primary differential diagnosis during March and April 2022 (1st cycle) and September and October 2022 (2nd cycle) were included. Data was extracted retrospectively from electronic patient records into a pre-designed proforma. Findings from the 1st cycle were presented within local departmental meetings. Posters were also installed reminding clinicians of the analgesic pathway within the relevant clinical areas. Subsequently, a re-audit was performed. Results 90 patients were included (60- 1st cycle, 30- 2nd cycle). There was a significant improvement in compliance between the 1st and 2nd audit cycles (60% versus 83%, p = 0.0193). However in cases of non-compliance, documentation was poor (&amp;gt;70% did not state a reason) during both cycles. Imaging confirmed renal colic in 82% of patients in the 1st cycle and 93% of patients in the 2nd cycle. PR Diclofenac was the most common NSAID prescribed. Conclusions Low-cost, easily reproducible interventions resulted in significant prescribing practice changes. Findings from the latest national renal colic audit (2012-13) showed analgesia compliance in only 69% of cases nationally- similar to our 1st audit cycle results. Disseminating our findings to other hospitals regionally and nationally will hopefully result in better outcomes for renal colic patients.

Maturation of Paracetamol Elimination Routes in Preterm Neonates Born Below 32Weeks of Gestation.

Despite being off-label, intravenous paracetamol (PCM) is increasingly used to control mild-to-moderate pain in preterm neonates. Here we aim to quantify the maturation of paracetamol elimination pathways in preterm neonates born below 32weeks of gestation. Datasets after single dose (rich data) or multiple doses (sparse data) of intravenous PCM dose (median (range)) 9 (3-25) mg/kg were pooled, containing 534 plasma and 44 urine samples of PCM and metabolites (PCM-glucuronide, PCM-sulfate, PCM-cysteine, and PCM-mercapturate) from 143 preterm neonates (gestational age 27.7 (24.0-31.9) weeks, birthweight 985 (462-1,925) g, postnatal age (PNA) 5 (0-30) days, current weight 1,012 (462-1,959) g. Population pharmacokinetic analysis was performed using NONMEM® 7.4. For a typical preterm neonate (birthweight 985g; PNA 5days), PCM clearance was 0.137 L/h, with glucuronidation, sulfation, oxidation and unchanged renal clearance accounting for 5.3%, 73.7%, 16.3% and 4.6%, respectively. Maturational changes in total PCM clearance and its elimination pathways were best described by birthweight and PNA. Between 500-1,500g birthweight, total PCM clearance increases by 169%, with glucuronidation, sulfation and oxidation clearance increasing by 347%, 164% and 164%. From 1-30days PNA for 985 g birthweight neonate, total PCM clearance increases by 167%, with clearance via glucuronidation and oxidation increasing by 551%, and sulfation by 69%. Birthweight and PNA are the most important predictors for maturational changes in paracetamol clearance and its glucuronidation, sulfation and oxidation. As a result, dosing based on bodyweight alone will not lead to consistent paracetamol concentrations among preterm neonates.

A randomized controlled trial of intravenous paracetamol and intravenous tramadol for labour analgesia

Labour pain is among the most excruciating pain experienced by women. Pain relief during labour is expected to reduce maternal stress, improve maternal and perinatal outcome. Paracetamol and tramadol are easily available, inexpensive and easy administeration. The present study compared the efficacy of intravenous paracetamol and intravenous tramadol for labour analgesia. : A randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology, Christian Medical College, Ludhiana including 130 patients divided into two groups. Group A received 1000 mg of intravenous paracetamol and Group B received 100 mg of intravenous tramadol hydrochloride for labour analgesia in active phase of labour (&amp;#62;/= 4 cm cervical dilatation). Pain intensity was assessed by Visual Analogue scale (VAS) before; after 1 and 3 hours of drug administration. Duration of labour, mode of delivery, drug-delivery interval, maternal side effects and neonatal outcomes were also assessed.Total 130 patients with 65 in each group were included. Pain intensity was assessed and it was observed that Mean VAS score was significantly lower after 1 and 3 hours of drug administration in Group A than Group B. Mean duration of 1 stage of labour (210.79+-70.49 minutes) and mean drug delivery interval (4.34 hours) was significantly lower in Group A than Group B (246.95+/-76.09 minutes; 5.17 hours). Maternal side-effects were observed more with tramadol than paracetamol.Intravenous paracetamol is more effective labour analgesic with lesser VAS score, shorter duration of labour, drug delivery interval and with few maternal side-effects.

Challenges in Assessing Blood Pressure in Adults Following Intravenous Paracetamol Infusion in the Emergency Room.

Background and objective The negligible side effects of paracetamol along with its ease of availability have catapulted paracetamol to be a widely used medication in emergency room management to reduce pain and subsequent elevations in blood pressure (BP). Our study aimed to address thechallenges in informed clinical decision-making in the emergency room following paracetamol intravenous infusion. Methods This was a retrospective cross-sectional studyinvolving the extraction of data from electronic medical records of patients who received intravenous paracetamol infusion between January 2022 and May 2022. Demographic information and BP-related data were collected for analysis. Results We initially considered a total of 162 patient records, with 132 of them eventually meeting the inclusion criteria. Among patients receiving paracetamol infusion for 15 minutes or less, 34% showed a drop of 1-5 mmHg in systolic BP (SBP), while 26% experienced a drop of 6-10 mmHg. However, infusion time longer than 16 minutes did not significantly reduce SBP. Diastolic BP (DBP) was not significantly affected by theduration of the paracetamol infusion.Analysis of the drop in SBP revealed no significant associations with age, gender, or ethnicity. Mean arterial pressure (MAP) was not significantly affected by theduration of paracetamol infusion. Conclusion Our findings suggest that intravenous paracetamol infusion does not significantly lower BP in adults in the emergency room, except for infusions ofshorter durations. However, various factors, including infusion rate, patient characteristics, and concomitant medications, may influence BP measurements. The study emphasizes the need for establishing standardized criteria and conducting further research to assess intravenous paracetamol's hemodynamic effects accurately.

COMPARATIVE STUDY OF THE EFFICACY OF INTRAVENOUS PARACETAMOL AND DEXMEDETOMIDINE ON POST-OPERATIVE ANALGESIC AND HEMODYNAMICS FOR PATIENTS UNDERGONE UPPER LIMB SURGERY

Background: Comparative study of the efficacy of intravenous paracetamol and dexmedetomidine (DMED) on post-operative analgesic and hemodynamics for patients undergone upper limb surgery. Multimodal analgesia is recommended to reduce the stress response and prevent post-operative pain. Intravenous paracetamol and intravenous DMED are both effective components in respect of multimodal analgesia. Methods: The present prospective randomized, double-blind, controlled study was performed on eighty American Society of Anesthesiologists (ASA) Grade I and Grade II physical status patients aged 18–65 years, of both genders, were selected for elective upper limb orthopedic surgical procedure under general anesthesia. Group P (paracetamol) patients were given 1 g paracetamol intravenously 30 min before surgery. Group D patients, 100 μg DMED/20 mL normal saline, was administered intravenously 30 min before surgery. Post-operative hemodynamic variables, post-operative pain scores (Visual Analogue Scale score), need for rescue analgesics and post-operative complication were recorded and treated accordingly. Results: In both groups, females were in the majority with ASA grade I in the majority of the cases in both groups. Mean heart rate, mean arterial pressure, and Visual Analog Score for pain were comparable between the groups were compared at different time intervals (2, 4, 6, 12, 18, and 24 h) (p&gt;0.05). Regarding complications Nausea, vomiting, itching and stomach irritation was in 17.5%, 15.0%, 7.5% and 20.0% for group D and for group P nausea and vomiting was in 15.0% and 10.0% and no other complication occurs in group D. Conclusion: Pre-emptive administration of paracetamol is a cost-effective and safe method of providing post-operative analgesia for patients undergoing upper limbs surgery.

Effects of mobilization within the first 4 h following anatomical lung resection with thoracotomy.

Thoracic incisions are very painful and complicated incisions. Many analgesic drugs including opioids are used to relieve pain in patients. We hypothesized that early mobilization and patient-centered strategy after lung resection reduce the incidence of perioperative complications and postoperative pain. We conducted a retrospective study on patients who underwent lung resection via thoracotomy and were mobilized in the first 4h postoperatively. Mobilization was defined as standing and walking at least 100m from the bed. If orthostatic hypotension occurred, mobilization was postponed for 30min. Analgesic treatment needs, walking distance, co-morbidity, hospitalization, postoperative complications within 30 days, and drainage and discharge times of patients were analyzed. The lobectomy with thoracotomy was performed in 48 patients. Thirty-six patients were male. The rate of additional systemic diseases was 58.3%. Forty patients walked in the first 3 h postoperatively. The mean walking distance was 140 ± 38.5m. The rate of orthostatic hypotension was 8.3%. The routine analgesic treatment included intravenous paracetamol 3g and dexketoprofen 100mg daily. In this study, 18% of patients received narcotic analgesics. Thromboembolic event and arrhythmia did not develop in any patient. The most common complication was prolonged air leaks (18.8%). Mobilization within the first 4h following anatomical lung resection is feasible and safe. Early mobilization provided pain relief after lung surgery and reduced the use of narcotic analgesics and cardiovascular complications. The article is the first study about walking in first hours after pulmonary lobectomy with thoracotomy in the thoracic surgery literature.

A Comparative Study of Bilateral Infraorbital Nerve Block with Intravenous Pentazocine on The Immediate Postoperative Pain Management Following Cleft Lip Repair in Infants

Purpose: Comparative evidence of the effectiveness of bilateral infraorbital nerve block for immediate postoperative pain management in infants after cleilorrhaphy especially in Africans is lacking. This study aimed to compare the efficacy of bilateral infraorbital nerve block using Bupivacaine with intravenous Pentazocine for the control of immediate postoperative pain in an infant age group following cleft lip repair. Methods: This was a prospective randomized controlled clinical study. The sampled population was patient aged 3 to 12 months undergoing cleft lip repair at a tertiary health facility in Lagos, Nigeria. Study patients were randomly allocated to either group 1 (Bupivacaine infraorbital nerve block) or group 2 (intravenous Pentazocine). Primary outcome was the duration of analgesia following the administration of both drugs. Assessment of immediate postoperative pain was done using the FLACC (Face, Leg, Activity, Cry, Consolablity) pain scale. Scoring was done at hourly intervals postoperatively, observing the child for 1 minute at each hour and rescue analgesia (intravenous paracetamol) given when FLACC score exceeds 3. The duration of analgesia was the time of from administration of the intervention to the time rescue analgesia was administered. Calculated sample size was 20 participants per group. Descriptive and comparative statistics were computed using SPSS and the p-value was set at &lt;0.05. Results: Analysis of result included 44 participants. Mean age was 5.2 months and 52.5% were females. The mean duration of analgesia in the Bupivacaine group was 291.80 ± 95.4 minutes i.e 4 hours 52 minutes and that of Pentazocine group was 151.50 ± 24.9 minutes i.e 2 hours 32 minutes. This difference was statistically significant (p=0.001). At the 3rd hour, 75% of participants in the Pentazocine group received rescue analgesia, in contrast to only 10% in the Bupivacaine group. Only participants in the Bupivacaine attained the 8th hour. Conclusion: A bilateral infraorbital nerve block with 0.5% plain Bupivacaine at 2mg/kg provided a longer duration of analgesia in the postoperative period in comparison with intravenous Pentazocine 0.5mg/kg in an infant age group following cleft lip repair.

Postoperative analgosedation with dexmedetomidine in combination with paracetamol in pediatric cardiac surgery

BACKGROUND: Although the principles of postoperative multimodal analgesia have been discussed in several articles, this issue remains insufficiently studied in pediatric cardiac surgery.&#x0D; AIM: To increase the effectiveness of postoperative analgosedation in children after heart surgery by combining intravenous dexmedetomidine and paracetamol.&#x0D; MATERIALS AND METHODS: Prospective, nonrandomized, controlled study (n = 65, 24 yr). Elective heart surgeries were performed in children with congenital heart defects, such as ventricular and/or interatrial septal defect and tetralogy of Fallot, under cardiopulmonary bypass and general anesthesia. Patients were divided into two groups according to the type of postoperative analgesia: group 1, main (n = 35): 30 min after surgery, infusion of dexmedetomidine with a loading dose of 1.0 g/kg/h or 10 min, then infusion of 0.8 g/kg/h during the day against the background of planned analgesia with paracetamol (15 mg/kg, intravenously) 2 h after surgery and then every 8 h during the day; group 2, comparisons (n = 30), 0.3 mg/kg morphine, intramuscularly. The effectiveness of postoperative analgosedation in children was analyzed using the Richmond scale and FLACC + hemodynamics, acid-base balance, blood gases, cortisol, glucose, and blood lactate.&#x0D; RESULTS: Sufficient stabilization of the main hemodynamics and respiratory indicators confirmed the adequacy of postoperative analgosedation in group 1 patients. There was a 14% drop in heart rate, specific peripheral resistance, and mean arterial pressure. There was no respiratory depression observed, and the decrease in blood pressure and heart rate was hemodynamically modest. Postoperative stability of blood lactate, glucose, and cortisol levels demonstrated the absence of major metabolic diseases and emotional and physical stress in the main group of children. The transfer of 74.3% of the first group's patients to the specialized department 42.3 5.5 h after the procedure decreased costs and strain on the intensive care unit staff.&#x0D; CONCLUSIONS: Dexmedetomidine combined with paracetamol provides an adequate level of sedation, suppresses extubation irritations, prevents psychomotor agitation, and provides sufficient analgesia.

Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. A prospective, randomized, and double-blind comparative study. At a single-institution tertiary referral cardiac center. The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. Children were allocated randomly to 1 of 3 groups. Group A (n=65) and group B (n=64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n=64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n=60), B (n=60), and C (n=60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p=0.07). LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.

Laparoscopic management of ovarian cysts during pregnancy under urgent situations.

Majority of adnexal masses are incidental findings during pregnancy and resolve spontaneously. They may complicate pregnancy due to haemorrhage, cyst rupture and ovarian torsion. Laparoscopy is the preferred surgical intervention owing to shorter operative time, quicker recovery and lower post-operative pain. However, safety and feasibility of laparoscopic surgery in the management of ovarian cysts in pregnant women is challenging especially at advanced gestational ages and in urgent situations. In this retrospective study, a total of 48 cases of urgent laparoscopic surgeries were evaluated in the first and second trimesters of pregnancy between March 2018 and March 2021 in Al-Zahra Hospital, Tabriz, Iran. The operations were ended in all patients successfully. The mean operation time was 45 min. There were no foetal maternal complications. All pregnancies had been terminated after 37 weeks of gestation. Oophorectomy had been performed in six patients and six other patients needed blood transfusion. Ovarian torsion was the most common reason for emergency surgery and mature teratoma was the most commonly reported pathology. Tocolytic therapy was required in six patients, and all of the patients were prescribed 50 mg of injectable progesterone twice daily for 10 days after surgery. The mean intra-abdominal pressure was equal to 15 mmHg and the mean end-expiratory carbon dioxide (CO 2 ) pressure was 36 mmHg. Intravenous paracetamol was used to relieve post-operative pain. The mean hospitalisation time was 1.63 days. Most of the ovarian cysts can be managed laparoscopically with ensured safety and lower morbidity even in emergency situations at advanced gestational ages.

Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial.

Introduction Septorhinoplasty operates on the nose's bone and cartilage and is ensued by severe postoperative pain. Objective The objective of this study is to evaluate the effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methods A total of 150 patients undergoing septorhinoplasty were randomly assigned into 3 groups with 50 patients in each group. The control group (group A) was administered 100 ml saline solution; the paracetamol group (group B) was administered 1,000 mg of IV paracetamol in 100 ml of saline solution; and the ibuprofen group (group C) was administered 800 mg of IV ibuprofen in 100 ml of saline solution before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using the visual analogue scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results In comparison with group A, the score in the VAS of groups B and C was statistically lower in all the time intervals ( p < 0.05). In the 1 st and 6 th hours postoperatively, group C's score in the VAS in was lower than that of group B ( p < 0.05). In the control group, total opioid consumption was highest in all time intervals ( p < 0.05). In group C, total opioid consumption was significantly lower than in group B in the 0 to 6 and 6 to 12 hours intervals. ( p < 0.05). Conclusion The single-dose preemptive administration of ibuprofen has a more profound postoperative analgesic effect than paracetamol in the first 6 hours after septorhinoplasty. After the first 6 hours postsurgery, there is no difference between ibuprofen and paracetamol in terms of analgesic effect.

How Effective Is Intrawound periarticular Cocktail Injection and Postoperative Intravenous Paracetamol for Analgesia and Early Mobilization after Total Knee Arthroplasty (TKA)

How Effective Is Intrawound periarticular Cocktail Injection and Postoperative Intravenous Paracetamol for Analgesia and Early Mobilization after Total Knee Arthroplasty (TKA)