Need For Oral Analgesics Research Articles

Results of Fibrin Glue Applied Over the Corneal Surface Immediately After Pterygium Surgery: A Novel Pain Relief Technique.

The aim of this study was to compare the use of fibrin glue on the corneal epitheliectomy site at the end of pterygium surgery versus conventional eye patch regarding pain levels, need for oral analgesic medications, number of days feeling pain, and awakening due to pain after surgery. Forty-eight eyes of 24 patients with bilateral primary pterygium were included in this prospective, randomized, double-masked controlled trial. Each eye of the same patient was randomized to the intervention or control group. The intervention group received 2 drops of fibrin glue in the epitheliectomy site at the end of surgery and an eye patch, whereas the control group was only received an eye patch. Patients returned on the first and seventh days after surgery. Pain intensity (measured using the visual pain analog scale), need for oral analgesics, the number of days the pain lasted, and quality of sleep were assessed during follow-up visits and compared between groups. Comparison analysis accounted for sex, age, pterygium grading, and comorbidities. Visual analog pain scale after surgery was significantly lower in eyes receiving fibrin glue (-1.58; 95% confidence interval: -2.84 to -0.32; P = 0.014). In addition, the intervention group presented a 73% lower chance of using oral analgesics (OR: 0.27; 95% confidence interval: 0.07-0.95; P = 0.041). No difference in the awakenings at night was noted (P = 0.240) nor the mean days of ocular pain in the first week after surgery (P = 0.474). Fibrin glue at the end of pterygium surgery effectively reduces pain and the need for oral analgesics compared with conventional eye patching. This study is the first to describe the results of this strategy.

Exercise-induced urticaria with muscle injury: a case report

Exercise has become an integral part of life in this modern era due to sedentary lifestyle. Although, urticaria patients are being evaluated for all the common triggering factors like food, environmental allergens and infections, an entity called exercise induced urticaria often get missed. Exertional and asymptomatic rhabdomyolysis must be kept in mind during evaluation. A 27 year male patient was diagnosed with severe exercise induced urticaria with muscle injury. Patient developed urticaria within 30 minutes of strenuous exercise. Clinical history was insignificant for any allergen exposure except for clear history of urticaria once weekly after strenuous exercise. Patient also reported need for oral analgesics on the day of strenuous exercise indicating muscle injury. Asymptomatic phase correlated with abstinence of exercise. His lesions gradually got relieved with anti-histamines. Routine blood investigations were normal except elevation of aspartate aminotransferase (AST-354U/L), Lactate dehydrogenase (LDH-619U/L) and normal alanine aminotransferase (ALT-51U/L), altered AST/ALT ratio more than 6. Creatinine kinase (CK) can increase ten folds in healthy individuals following strenuous exercise. Hence, CK was not done for this patient. Aminotransferases may remain elevated even after normalisation of CK up to 2-3 weeks. LDH was done as an additional investigation. Simple routine investigation for altered AST and confirmation with LDH or CK for its source from muscle injury can be done. Severe exercise induced urticaria with muscle injury can be managed with moderation of exercise intensity along with short course of antihistamines owing to the benefit of exercise. This patient was followed up for 2 years and there was no episode of urticaria after stepping down the exercise intensity. Detailed history of exercise duration and intensity is required along with basic investigations for evaluating exercise induced urticaria. A sub-entity called severe exercise induced urticaria with muscle injury must be kept in mind due to the risk of asymptomatic or exertional rhabdomyolysis.

Postoperative Single-shot Epidural Fentanyl and Bupivacaine for Postoperative Analgesia After Lumbar Decompression: A Prospective, Double-blind Randomized Study.

Randomized clinical trial. To evaluate the efficacy of the postoperative single-shot bolus of epidural Fentanyl and Bupivicaine in providing pain relief postlumbar decompression surgery. Despite lumbar decompression's success in alleviating symptoms of sciatica, radiculopathy, and neurogenic claudication, transient back and buttock pain has been a common complaint postoperatively. Providing good postoperative pain alleviation predicts patient's quality of recovery. We performed a randomized, double-blinded, clinical trial. Forty-five patients scheduled for lumbar decompression for a year's period who were randomly assigned to receive a postoperative bolus of 10-mL solution of 50 mcg of Fentanyl, 0.125% Bupivacaine, and 0.9% saline solution via an intraoperatively placed epidural catheter immediately after wound closure, before dressing application. Facial pain scale scores (from 0 to 10) were measured at three time points after surgery (fully awake at recovery room, transfer to ward, first postoperative day). Postoperative need for oral analgesics, time to independent ambulation, associated adverse events, and time to hospital discharge were also evaluated. Pain scores were noted to be significantly lower at all time points in the epidural group (P < 0.001). In turn, they also received less on-demand oral pain medications than those in the control group (P = 0.000). The mean time to ambulation was 0.09 days in the epidural group and 0.91 days in the decompression-alone group (P = 0.000). Criteria for hospital discharge were usually met on Day 0 in the epidural and Day 1 in the control group (P = 0.000). Within the study period, only one infection was noted in the epidural group which necessitated additional lumbar spine surgery (4.3%). No adverse events or complications related to Fentanyl use were observed. A postoperative bolus of Fentanyl and Bupivacaine is effective in reducing early postoperative pain without the related complications of opiod administration. 2.

Postherpetic Pain: More Than Sensory Neuralgia?: Table 1

To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. Case series. Outpatient older adult pain clinic. Five older adults are presented with myofascial pain that developed as a complication of herpes zoster. Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids. Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed.

(834): Topical sterile lidocaine patch to reduce postoperative pain and decrease need for oral analgesics after inguinal herniorrhaphy

We designed a sterile lidocaine patch for application to a closed wound to reduce pain and systemic analgesic use after inguinal herniorrhaphy. We conducted a double-blind placebo(P)controlled parallel, dose-response study comparing the daily application of a 3.5% lidocaine patch to a 10% lidocaine patch for 48 hours after surgery. 221 subjects who underwent unilateral herniorrhaphy using a tension-free mesh were randomized to one of three patches. Anesthesia was general or spinal and no local anesthetic was injected at closure to determine the time of onset of the lidocaine in the patch. Rescue medication was oral methimazole, a short-acting analgesic. Pain intensity (PI) was assessed at time points for up to 48 hours. The AUC for PI from 2-48 hours was P 109, 3.5% 102, and 10% 89,(p=0.05). The AUC for PI from 2-24 hours was P 63, 3.5% 60, and 10% 52 (p= 0.045) and from 24-48 hours was P 47, 3.5% 42, and 10% 34 (p= 0.03). The pain reduction for 10% vs. P from 2 to 48 hours was 19%, from 2-24 hrs was 18% and from 24-48 hours was 27%. The number of rescue analgesic doses over the 48 hours was P 101, 3.5% 81, 10% 65 (p= 0.01), a reduction of 36%(10% patch vs. placebo). The lesser magnitude of AUC in the first 24 hours indicates the onset of the lidocaine patch is 2 to 3 hours. The safety of a 10% lidocaine patch was demonstrated by a single wound infection and no effect on wound healing. A 10% sterile lidocaine patch applied daily over the wound was shown to be safe and effective in reducing post operative pain after inguinal herniorrhaphy. Most importantly, a decrease in the use of oral rescue analgesic after surgery, thereby reducing post-operative side effects. We designed a sterile lidocaine patch for application to a closed wound to reduce pain and systemic analgesic use after inguinal herniorrhaphy. We conducted a double-blind placebo(P)controlled parallel, dose-response study comparing the daily application of a 3.5% lidocaine patch to a 10% lidocaine patch for 48 hours after surgery. 221 subjects who underwent unilateral herniorrhaphy using a tension-free mesh were randomized to one of three patches. Anesthesia was general or spinal and no local anesthetic was injected at closure to determine the time of onset of the lidocaine in the patch. Rescue medication was oral methimazole, a short-acting analgesic. Pain intensity (PI) was assessed at time points for up to 48 hours. The AUC for PI from 2-48 hours was P 109, 3.5% 102, and 10% 89,(p=0.05). The AUC for PI from 2-24 hours was P 63, 3.5% 60, and 10% 52 (p= 0.045) and from 24-48 hours was P 47, 3.5% 42, and 10% 34 (p= 0.03). The pain reduction for 10% vs. P from 2 to 48 hours was 19%, from 2-24 hrs was 18% and from 24-48 hours was 27%. The number of rescue analgesic doses over the 48 hours was P 101, 3.5% 81, 10% 65 (p= 0.01), a reduction of 36%(10% patch vs. placebo). The lesser magnitude of AUC in the first 24 hours indicates the onset of the lidocaine patch is 2 to 3 hours. The safety of a 10% lidocaine patch was demonstrated by a single wound infection and no effect on wound healing. A 10% sterile lidocaine patch applied daily over the wound was shown to be safe and effective in reducing post operative pain after inguinal herniorrhaphy. Most importantly, a decrease in the use of oral rescue analgesic after surgery, thereby reducing post-operative side effects.

Efficacy and safety of nonpreservedketorolac ophthalmic solution in postoperative ocular pain following radial keratotomy

Purpose: To Investigate the efficacy and safety of nonpreserved ketorolac tromethamine 0.5% ophthalmis solution in relieving pain following radial radial-keratotomy (RK) Setting: Multicenter clinical trial. Methods: Topical ketorolac was compared with its Vehicle in a double-maskedrandomized, parallel-group study involving, 170 RK patients. Patients were treated with nonpreserved ketorolac 0.5% ophthalmic solution or the vehicle 4 times daily beginning immediately after surgery and continuing for 3 days or or until they no longer had ocular pain. Results: At several, intervals, patients treated with ketorolac reported significantly greater pain relief and less pain intensity than patients treated with the vehicle. The time required for patients to first report “complete relief” or “no pain” was shorter in the ketorolac than in the vehicle group ( P ≤ .006). Patients in the ketorolac group used less escape medication (acetaminophen), ( P ≤ .001) and had fewer sleep difficulties ( P ≤ .031), fewer symptoms of ocular discomfort ( P ≤ .028), and less difficulty performing activities of daily living ( P = .048). Patients treated with ketarolac experienced the same low rate of treatment-related adverse events as those treated with the vehicle and exhibited the same improvement in visual acuity and manifest refraction. Conclusions: Nonpreserved ketorolac tromethamme 0.5% opthalmic solution wassignificantly more effective than, and as safe as the vehicle in alleviating the postoperative pain associated with RK. This resulted in significant improvement in patient quality of life and less need for oral analgesics suggesting that topical ketorolac is an approprnate treatment option for ocular pain following RK.

Epifoam after childbirth for perineal pain

Epifoam (Stafford-Miller) is an aerosol foam promoted for the relief of perineal pain and discomfort following tears and episiotomies at childbirth. The manufacturer claims that it is a ‘unique and effective topical treatment which relieves perineal pain locally’ and that its use should reduce the need for oral analgesics, so helping the breast-fed baby.