Overall Incidence Of Pain Research Articles

VP-102 Tolerability Evaluated by Concomitant Analgesic Medication Usage in Two Phase 3 Trials for Molluscum Contagiosum

Background: Drug tolerability is the degree to which a patient can tolerate a drug's adverse effects. VP-102, a drug-device combination product containing cantharidin (0.7%), a vesicant, is approved for treatment of molluscum contagiosum (molluscum) in patients >2. Local skin reactions (LSRs) are expected, including pain. In Phase 3 trials, 97% of LSRs were mild to moderate. The discontinuation rate due to an adverse reaction was 2.3%:0.5% (drug:vehicle) treated subjects, respectively. This post-hoc analysis evaluated VP-102 tolerability based on analgesic usage over the study course.
 Methods: VP-102 or vehicle was applied to all baseline and new lesions once every 21 days until complete clearance, or up to a maximum of 4 applications. Acetaminophen or ibuprofen were permitted for application site pain and/or other Adverse Reactions.
 Results: Overall incidence of pain at any time for a VP-102 subject was 62.7% (195/311), with the majority [(60.5%),188/311] as mild to moderate. 18.6% (58/311) of VP-102 and 1.4% (3/216) of vehicle treated subjects received an analgesic, including 15.8% (49/311) for an LSR after the first VP-102 application.
 
 Median VP-102 analgesic use for LSR pain (range) was 2 (1-14) days for the entire study, and 2 (1-9) days after the first application. 29% of participants who reported analgesic usage took medication ≤1 day. Analgesic usage for AEs other than LSR pain (≥ 5% of participants) included 6% (19/311) for application site vesicles. There were no treatment-related SAEs reported.
 
 Conclusions: In this largely pediatric population, VP-102 was well-tolerated, with a short duration of elective analgesic use.

PRETREATMENT WITH ONDANSETRON IN PREVENTION OF PAIN ON PROPOFOL INJECTION

Background: Pain on intravenous injection of propofol is seen in almost 70% of patients without any pretreatments. This study was conducted to evaluate the effect of ondanse­tron in reducing the occurrence of pain on intravenous injection of propofol. Methods: Two hundred and thirty-two patients aged between 18- 60 years of either sex belong­ing to ASA status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia at Chitwan Medical College, Bharatpur, Nepal, from from September 1, 2020 to March 31, 2021 were recruited in this study. They were assigned randomly into two groups with 116 participants in each, where Group 1 received 2 ml (4 mg) of ondansetron and Group 2 received 2 ml of 0.9% saline (placebo) intravenously as the pretreatment solution prior to injection of propofol for induction of general anesthesia. The overall incidence of pain in the saline group was 84.5% compared to 48.3% in the ondansetron group (P < 0.001). Result: Pain was of mild intensity in most patients who belonged to the ondansetron group (33.6%) whereas it was of moderate intensity in most participants of the saline group (54.3%). Few patients in the study group experienced severe pain (0.9%) as compared to the placebo group (9.5%) with P < 0.001. Conclusion: Therefore, it was concluded that pretreatment with ondansetron may be a useful intervention in reducing the incidence of pain on intravenous propofol administration without any adverse effects in significant number of patients.

Transcutaneous electrical nerve stimulation for pain during propofol injection: a randomized clinical trial.

Propofol is a short-acting intravenous sedative widely used for procedural sedation and general anesthesia. However, pain during propofol injection is a distressing adverse effect. This study was designed to investigate whether transcutaneous electrical nerve stimulation (TENS) could reduce pain during propofol injection compared to sham TENS. In a randomized controlled trial, 80 patients were allocated to two groups: the active TENS group received electrical stimulation via two electrodes on the venous cannulation site, whereas the sham TENS group received no stimulus. After 20 min following TENS, propofol 0.5 mg/kg pain was injected intravenously and pain was evaluated using a four-point score (0 = none, 1 = mild, 2 = moderate, 3 = severe). Adverse effects associated with TENS were also recorded. The overall incidence of pain during propofol injection was 47.5% in the TENS group and 87.5% in the sham group (P < 0.001). The incidence of moderate pain was significantly lower in the TENS group (7.5%) than in the sham TENS group (42.5%) (P < 0.001). There were no complications associated with TENS. Pre-treatment with TENS significantly reduced the incidence and intensity of pain during propofol injection.

The effect of zinc lozenge on pain, oedema, and trismus after impacted third molar surgery: A prospective randomized, double-blinded, placebo-controlled study

The postoperative sequelae after third molar surgery include pain, swelling and trismus, Zinc acts as anti-inflammatory agent, can promote wound healing, immune system modulation, tissue repair, and significant reduction in the use of analgesics for oral pain. This study was aimed to evaluate the efficacy of oral zinc lozenge given 30 min before surgery on reducing postoperative sequelae.s: We recruited 70 patients, randomly assigned to two groups: Zinc and Control group, groups received 40mg Zinc lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h.Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whit­ney U test was performed for non-parametric samples. P &amp;#60; 0.05 was considered as statistically significant: The overall incidence of Pain in the Zinc group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P &amp;#62;0.05) better in Zinc group oral zinc lozenge administered 30 minutes preoperatively can significantly reduce complications like pain, swelling, and limited mouth opening after third molar extraction.

The Effect of Flurbiprofen Lozenge on Pain, Oedema, and Trismus after Impacted Third Molar Surgery: A Prospective Randomized, Double-Blinded, Placebo-Controlled Study

Background: The postoperative sequelae after third molar surgery include pain, swelling and trismus, Flurbiprofen is a non-steroidal anti-inflammatory drug (NSAID), and the anti-inflammatory mechanism of Flurbiprofen is thought to involve inhibition of prostaglandin biosynthesis, in common with other NSAIDs. Prostaglandins such as prostaglandin E2 (PGE2) and other inflammatory mediators released in response to pain or non-infectious stimulants trigger a complex inflammatory cascade that contributes to inflamation symptomsThis study was aimed to evaluate the efficacy of oral Flurbiprofen lozenge given 30 min before surgery on reducing postoperative sequelae. Method: We recruited 70 patients, randomly assigned to two groups: Flurbiprofen and Control group, groups received 100mg Flurbiprofen lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h. Statistical Analysis: Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whit-ney U test was performed for non-parametric samples. P &lt; 0.05 was considered as statistically significant. Results: The overall incidence of Pain in the Flurbiprofen group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P &gt;0.05) better in Flurbiprofen group. Conclusion: Oral Flurbiprofen lozenge administered 30 minutes preoperatively can significantly reduce postoperative sequelae after third molar extraction.

Efficacy of Methylprednisolone and Lignocaine on Propofol Injection Pain in Pediatric Surgical Patients: A Randomized Clinical Trial

Background: Mild to severe pain or discomfort on injection of propofol used for the induction of anaesthesia is often observed in pediatric population.&#x0D; Objectives: This study was designed to compare the efficacy of methylprednisolone and lignocaine in reducing the pain of propofol injection in patients scheduled for pediatric surgery.&#x0D; Methods: Total 135 children scheduled for elective surgery were divided into three groups: saline (group S, n=45), lignocaine 20 mg (Group L, n=45) and methylprednisolone 125 mg diluted into 2 ml of distilled water (Group MP, n=45). Drugs were administered after tourniquet application and occlusion was released after 1 min and 25% of the total dose of propofol (2 mg/kg) was administered at the rate of 0.5 ml/s. Pain on propofol injection was evaluated by four-point verbal rating scale. Data were analyzed by using SPSS version 21.&#x0D; Results: The overall incidence of pain was 65.9% in the saline group, 23.8% in the lignocaine group and 30.5% in the methylprednisolone group. Intensity of pain was significantly less in patients receiving methylprednisolone and lignocaine than those receiving saline (p&lt; 0.05).&#x0D; Conclusion: Pre-treatment with intravenous methylprednisolone was found to be as effective as lignocaine in reducing propofol injection-induced pain.&#x0D; DS (Child) H J 2019; 35(1) : 59-62

Optimal dose of methylprednisolone for reduction of propofol injection pain: A randomized, double-blind, placebo controlled study

Introduction and Aims: Propofol (2,6-di-isopropylphenol) used for the induction of anaesthesia often causes mild to severe pain on injection, for which various methods have been tried, but with conflicting results. We designed a placebo-controlled, double-blind study to compare the efficacy of different doses of intravenous methylprednisolone for attenuation of propofol injection pain. Materials and Methods: One hundred twenty adult patients belonging to the American Society of Anaesthesiologists (ASA) physical Status II and III, between 21 and 60 years, scheduled for elective cardiac surgery, were divided into four groups: saline (group S, n=30), methylprednisolone 40mg (Group methylprednisolone 1 MP1, n=30), methylprednisolone 125mg (group methylprednisolone 2 MP2, n=30) and methylprednisolone 250mg (Group methylprednisolone 3 MP3, n=30) diluted into 2ml of distilled water. Study drugs were administered after tourniquet application and occlusion was released after 1 min and 1/4th of the total dose of propofol (2mg/kg) was administered at the rate of 0.5ml per second. Pain on propofol injection was assessed by four-point verbal rating scale. Statistical methods used included Chi-square test/Fisher’s exact test and Student’s t-test. Results: Demographic variables were similar among all the groups. The overall incidence of pain was 70% in the saline group, 53.33% in MP1 and 33.33% in both MP2 & MP3. Pain intensity was significantly less in patients receiving MP2 & MP3 drugs for pre-treatment than those receiving saline (P Conclusions: Pre-treatment with either 125mg or 250mg intravenous methylprednisolone was found to be effective in reducing propofol injection-induced pain. But pre-treatment with 250 mg MP itself was associated with pain during injection. Keywords: Methylprednisolone, Propofol, Pain.

Pain situations among working adults and the educational needs identified: an exploratory survey via WeChat

ObjectivesThe aim of this study is to 1) investigate the pain situation among working adults in China; 2) explore the self-initiate pain reliving strategies applied by working adults; and 3) collect people’s interests and suggestions to the topics of the online pain education program.MethodsThis is an exploratory survey through WeChat. The study was conducted from May 2018 to December 2018. Participants were recruited following the snowball sampling. In total of 664 people were recruited and 502 satisfied the criteria. SPSS was used for data analysis. Descriptive statistical analysis were used to present the utilization of pain treatments and suggested topics. Chi-square test, independent multiple logistic regression and Spearman’s correlation were used to analysis the data.ResultsThe overall incidence of pain among the participants is 45% and higher among female (63%) than male (37%). Neck (68.72%, 4.10 ± 2.31), shoulder (62.56%, 3.78 ± 2.41) and head (49.34%, 4.23 ± 2.52) are reported as the most common and severe pain sites. Working is affected by pain and the results show that there is a negative correlation between pain intensity and work (rs = − 0.194) among the working population. Non-pharmacological treatments (55.77%) were chosen more by pain suffers. Totally 63.39% of participants show interests in the online pain education program and physical and psychological impact of pain is the most suggested topic (22.51%).ConclusionThe pain prevalence is high among working adults in China. Impact of pain on work is a significant problem for the working adults. It is important to identify people at risk and deliver timely intervention to reduce pain. People showed their willingness in joining the online program. Therefore, future online pain education program can be developed.

COMPARATIVE STUDY BETWEEN INTRAVENOUS RAMOSETRON AND DEXAMETHASONE AS PRE-TREATMENT TO ATTENUATE PAIN DURING INTRAVENOUS PROPOFOL INJECTION

Background: Propofol as an induction agent has disadvantage of pain on intravenous injection (IV). Objective: The aim of this study was to compare the efficacy of ramosetron and dexamethasone as a pretreatment drug for attenuation of pain due to propofol injection. Methods: This randomized comparative study was conducted at a tertiary care hospital in Eastern India, over a period of one year (March 2016-February 2017). Total 90 American Society of Anesthesiologists (ASA) grade I and II patients were randomly assigned into three groups (30 in each). Group R received 2 ml (0.3mg) of ramosetron, Group D received 2 ml (0.1mg/kg) of dexamethasone, and Group N received 2 ml of 0.9% normal saline. Venous drainage was occluded by using a tourniquet in mid-forearm before injecting the pre-treatment solution and released after 1 min and then 2 ml of propofol was injected over 5 sec. Patients were observed and questioned 15 sec later, if they had pain in the arm or discomfort during drug injection. The pain was scored on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Pearson’s Chi Square test/Fisher's Exact Test and Mann-Whitney U test/Kruskal Wallis Test were used to analyze the results. Results: The overall incidence of pain was 90% in the saline group, 17% in the ramosetron group and 10% in the dexamethasone group. The intensity of pain was significantly less in patients receiving ramosetron and dexamethasone than those receiving saline (P &lt; 0.05). Haemodynamic parameters like heart rate (HR) and mean blood pressure (MBP) were recorded at different points of time. No significant inter group differences in MBP and HR were noted at any point of time. Conclusion: Pre-treatment with intravenous ramosetron and dexamethasone both lead to relief of pain on injection of IV propofol without any significant difference between their effects.

Skin Adhesive Tape versus Non-Absorbable Sutures in Repair of Laparoscopic Incision

Background: Every year several million women have to undergo gynecological surgery. As a result of that they acquire an abdominal scar. Nowadays women of all ages place extreme importance on the appearance of the scar in addition to the symptoms of pain, tenderness and itching. An aesthetically poor scar can have a negative impact on the overall quality of life causing considerable distress, loss of self-esteem and unhappiness. The appearance of the scar is of significant importance and is often the only reminder of surgery. Aim of the Study: to compare between skin adhesive tape (steri-strips) and non-absorbable suture in closure of abdominal laparoscopic port sites. Patients and methods: The current prospective case control study was conducted at Ain Shams University maternity hospital .the participating women were randomly allocated into two arms .Arm (A): women had laparoscopic port sites closed with skin adhesive tape. Arm (B): women had laparoscopic port sites closed withnon- absorbable sutures. Results: A total of 142 women were included. The overall incidence of pain was 0.1%and 0.2%, redness was 8.5% and 23.9%,hotness was 2.8% and 12.7%, discharge was 1.4% and 4.2%, impaired healing was 1.4% and 5.6% and satisfaction was 94.4%and 63.4% in arm A and B respectively. Conclusion: using skin adhesive tape (Steri Strep®) in closure of abdominal laparoscopic port sitesis associated with a decreased risk of wound complications and increased rate of patient satisfaction.

Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults.

Pain on propofol injection is an untoward effect and this condition can reduce patient satisfaction. Intravenous lidocaine injection has been commonly used to attenuate pain on propofol injection. Although many studies have reported that lidocaine was effective in reducing the incidence and severity of pain, nevertheless, no systematic review focusing on lidocaine for preventing high-intensity pain has been published. The objective of this review was to determine the efficacy and adverse effects of lidocaine in preventing high-intensity pain on propofol injection. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), Ovid MEDLINE (1950 To October 2014), Ovid EMBASE (1988 to October 2014), LILACS (1992 to October 2014) and searched reference lists of articles.We reran the search in November 2015. We found 11potential studies of interest, those studies were added to the list of 'Studies awaiting classification' and will be fully incorporated into the formal review findings when we update the review. We included randomized controlled trials (RCTs) using intravenous lidocaine injection as an intervention to decrease pain on propofol injection in adults. We excluded studies without a placebo or control group. We collected selected studies with relevant criteria. We identified risk of bias in five domains according to the following criteria: random sequence generation, allocation concealment, adequacy of blinding, completeness of outcome data and selective reporting. We performed meta-analysis by direct comparisons of intervention versus control. We estimated the summary odds ratios (ORs) and 95% confidence intervals using the random-effects Mantel-Haenszel method in RevMan 5.3. We used the I(2) statistic to assess statistical heterogeneity. We assessed overall quality of evidence using the GRADE approach. We included 87 studies, 84 of which (10,460 participants) were eligible for quantitative analysis in the review. All participants, aged 13 years to 89 years, were American Society of Anesthesiologists (ASA) I-III patients undergoing elective surgery. Each study was conducted in a single centre in high- , middle- and low-income countries worldwide. According to the risk of bias assessment, all except five studies were identified as being of satisfactory methodological quality, allowing 84 studies to be combined in the meta-analysis. Five of the 84 studies were assessed as high risk of bias: one for participant and personnel blinding, one for incomplete outcome data, and three for other potential sources of bias.The overall incidence of pain and high-intensity pain following propofol injection in the control group were 64% (95% CI 60% to 67.9%) and 38.1% (95% CI 33.4% to 43.1%), respectively while those in the lidocaine group were 30.2% (95% CI 26.7% to 33.7%) and 11.8% (95% CI 9.7% to 13.8%). Both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection (lidocaine admixture OR 0.19, 95% CI 0.15 to 0.25, 31 studies, 4927 participants, high-quality evidence; lidocaine pretreatment OR 0.13, 95% CI 0.10 to 0.18, 43 RCTs, 4028 participants, high-quality evidence). Similarly, lidocaine administration could considerably decrease the incidence of pain when premixed with the propofol (OR 0.19, 95% CI 0.15 to 0.24, 36 studies, 5628 participants, high-quality evidence) or pretreated prior to propofol injection (OR 0.14, 95% CI 0.11 to 0.18, 52 studies, 4832 participants, high-quality evidence). Adverse effects of lidocaine administration were rare. Thrombophlebitis was reported in only two studies (OR not estimated, low-quality evidence). No studies reported patient satisfaction. Overall, the quality of the evidence was high. Currently available data from RCTs are sufficient to confirm that both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection. Furthermore, there were no significant differences of effect between the two techniques.

Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised, double-blind, prospective study in adult cardiac surgical patients.

Background and Aims:Propofol (2, 6-di-isopropylphenol) used for the induction of anaesthesia often causes mild to severe pain or discomfort on injection. We designed this double-blind study to compare the efficacy of methylprednisolone and lignocaine in reducing the pain of propofol injection in patients scheduled for cardiac surgery.Methods:A total of 165 adult patients, scheduled for elective cardiac surgery, were divided into three groups: saline (group S, n = 55), lignocaine 20 mg (Group L, n = 55) and methylprednisolone 125 mg diluted into 2 ml of distilled water (Group MP, n = 55). Drugs were administered after tourniquet application and occlusion was released after 1 min and 1/4th of the total dose of propofol (2 mg/kg) was administered at the rate of 0.5 ml/s. Pain on propofol injection was evaluated by four-point verbal rating scale. Statistical methods used included Student's t-test and Chi-square test/Fisher's exact test.Results:The overall incidence of pain was 70.9% in the saline group, 30.9% in the lignocaine group and 36.4% in the methylprednisolone group. The intensity of pain was significantly less in patients receiving methylprednisolone and lignocaine than those receiving saline (P < 0.012).Conclusion:Pre-treatment with intravenous methylprednisolone was found to be as effective as lignocaine in reducing propofol injection-induced pain.

Incidence of postoperative pain after use of calcium hydroxide mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament in the treatment of apical periodontitis.

ObjectiveTo compare the incidence of postoperative pain after the use of calcium hydroxide powder mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament.ParticipantsFifty-five subjects aged 17–60 years with teeth diagnosed to have apical periodontitis.InterventionTwo-visit conventional root canal treatment of seventy teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with thirty-five teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. Incidence of postoperative pain was assessed using the universal pain assessment tool and whether or not analgesic was taken.Main outcome measuredIncidence of post-operative pain.ResultPostoperative pain occurred only at 1-day and 1-week reviews. In the control group, the overall incidence of pain was the same at both review periods (5.7%), while the experimental group showed a slight decrease in incidence between 1-day (17.2%) and 1-week (11.4%) reviews. Incidence of flare-ups was more in the experimental group (11.4%) than in the control group (5.7%). No significant statistical differences between the two groups were observed (p > 0.05).ConclusionThe incidence of postoperative pain was lower in the normal saline treatment group, but the difference was not statistically significant.

Effects of pretreatment with esmolol and lidocaine on injection pain and rocuronium-induced withdrawal response.

We aimed to compare the effectiveness of esmolol 1 mg/kg and lidocaine 1 mg/kg for injection pain and for the prevention of rocuronium-induced withdrawal response. We enrolled a total of 81 patients in the study. Patients were randomly assigned to receive either 10 mL of 0.9% NaCl (Group P), esmolol 1 mg/kg (Group E), or lidocaine 1.0 mg/kg (Group L). A subparalyzing dose of rocuronium 0.05 mg/ kg was administered to all patients and its effects were recorded. Anesthesia was induced with intravenous propofol and intravenous rocuronium 0.5 mg/kg in all groups. The withdrawal movements of the patient groups were subsequently graded. There was a statistically significant difference in overall incidence of pain in group E and L compared to the placebo group after administrating the subparalyzed dose (no pain response: Group E = 81.5%, Group L = 77.8%, Group P = 14.8%) (P < 0.001). After intravenous administration of an intubating dose of rocuronium, the esmolol group had a significantly lower incidence of withdrawal movement than the other groups (no response: Group E = 81.5%, Group L = 63%, Group P = 22.2%) (P < 0.001). We found that esmolol significantly attenuates rocuronium-induced withdrawal movement and also reduces pain when used at subparalyzing doses.

English

BACKGROUND: Pain following injection of Propofol occurs in 28-90 % of patients. Various methods have been used to reduced the pain on intravenous injection of propofol namely administration of drugs like alfentanil, metoclopramide, pretreatment with intravenous lignocaine, pretreatment with intravenous ketamine etc., AIMS: In this study, we aimed to evaluate and compare the effect of pretreatment of ketamine and lignocaine on propofol injection pain. STUDY DESIGN: Randomised controlled study. METHODS: 120 patients of ASA grade I and II of both sexes between 18-60 years of age group scheduled for various elective surgical procedures, were randomly allocated into three groups of 40 each by envelope method using random number table. Patients of Group K (n=40) received ketamine 10 mgs (1 ml), Patients of Group L (n=40) received lignocaine 10 mgs (1 ml) and patients of Group S (n=40) received 0.9% normal saline (1 ml). In all these patients injection propofol (1%) was administered intravenously over a period of 5 seconds. 15 seconds later patients were asked about the presence of injection pain. RESULTS: Pain on Injection of propofol was assessed using the Verbal categorical scoring system. Asked the patient to grade pain as no pain, mild pain or severe pain. They were score as 0, 1, or 2 respectively. The overall incidence of pain in control group (normal saline group) was 80%, Incidence of pain in ketamine group was 20 %, incidence of pain in lignocaine group was 30%. When compared between these two groups, ketamine significantly reduces pain as compared to lignocaine, which was not statistically significant (P>0.05). CONCLUSION: We conclude that both ketamine and lignocaine are effective in reducing the pain of intravenous injection of propofol, However ketamine is superior to lignocaine.

Lidocaine/Tetracaine Medicated Plaster

The lidocaine/tetracaine medicated plaster comprises a lidocaine/tetracaine 70 mg/70 mg patch and a controlled heat-assisted drug delivery pod that increases the diffusion of lidocaine and tetracaine into the dermis. Following a 1-hour application period, systemic absorption of lidocaine or tetracaine from the plaster was minimal. The lidocaine/tetracaine medicated plaster provided effective pain relief for adult (including elderly) patients undergoing minor dermatological procedures and for adult and paediatric patients undergoing vascular access procedures. In randomized, double-blind clinical trials, patient-reported median pain scores were significantly lower with the lidocaine/tetracaine medicated plaster than with an identical plaster containing placebo in patients undergoing minor dermatological or vascular access procedures. Furthermore, patient-reported median pain scores were significantly lower with the lidocaine/tetracaine medicated plaster than with a lidocaine/prilocaine cream in patients undergoing vascular access procedures. In a large, randomized, double-blind trial in paediatric patients undergoing venipuncture, the overall incidence of pain was significantly lower with the lidocaine/tetracaine medicated plaster than with a lidocaine/prilocaine plaster. The lidocaine/tetracaine medicated plaster was well tolerated, with the most frequent treatment-related adverse events resolving spontaneously.

The Transversus Abdominis Plane Block, When Used as Part of a Multimodal Regimen Inclusive of Intrathecal Morphine, Does Not Improve Analgesia After Cesarean Delivery

The transversus abdominis plane (TAP) block has been shown to provide analgesia for lower abdominal wall incisions. We evaluated the efficacy of the TAP block for post-cesarean delivery (CD) patients used as a part of a multimodal regimen. Women undergoing elective CD under spinal anesthesia were randomized to receive the TAP block with ropivacaine (n = 50) or placebo (n = 50), in addition to a standard postoperative analgesic regimen inclusive of intrathecal opioids. At the end of the surgical procedure, all the patients received bilateral TAP blocks under real-time ultrasound guidance, with either 20 mL of ropivacaine 0.375% or saline, on each side. Each patient was assessed at 6, 12, 24, and 48 hrs postoperatively, and again 6 weeks after the surgical procedure. The primary outcome was the difference in visual analog scale pain scores with movement at 24 hrs postpartum. Other outcomes assessed were analgesic consumption, maternal satisfaction, and incidence of adverse effects. One hundred women were recruited, and 96 completed the study. The mean (SD) visual analog scale pain scores on movement at 24 hrs were not different between the ropivacaine and placebo groups (3.4 [2.4] and 3.2 [2.2] cm, respectively, P = 0.47). The pain scores at other times, and the supplemental opioid consumption, were also similar between the 2 groups. The overall incidence of pain at 6 weeks postpartum was 8.3%. The TAP block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve the quality of post-CD analgesia.

Comparison of effect of premixed lidocaine in propofol with or without ketorolac pretreatment with placebo on reducing pain on injection of propofol: A prospective, randomized, double-blind, placebo-controlled study in adult Korean surgical patients

Background: Pain on injection of propofol is a common adverse event. Objective: The aim of this study was to investigate the effect of a combination of ketorolac pretreatment and premixed lidocaine in propofol compared with placebo on propofol injection pain. Methods: In this prospective, randomized, double-blind, placebo-controlled study, Korean patients scheduled for elective plastic surgery were randomized to 1 of 3 groups. Group A received 15 mg ketorolac in saline IV as pretreatment. Groups B and C received 3 mL saline IV as pretreatment. Sixty seconds after pretreatment, groups A and B received a mixture of lidocaine 1% in propofol 1% at a 1:10 ratio and group C received propofol 1% alone. Pain during propofol injection was assessed on a 4-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). Results: Ninety patients (41 men, 49 vvomen; mean age, 41.7 years; mean weight, 63 kg) completed the study. The overall incidence of pain on propofol injection was significantly lower in groups A (16.7%) and B (36.7%) than in group C (83.3%; both, P < 0.001). There was no significant difference in the incidence of pain between groups A and B. However, the patients in group A reported a significantly lower incidence of moderate (0% vs 33.3%; P < 0.001) and severe pain (0% vs 20%; P = 0.024) compared with those in group C. There were no significant differences in the incidences of moderate and severe pain between the B and C groups. Conclusions: In this Korean population, premixed lidocaine in propofol with or without ketorolac pretreatment was associated with significantly less pain when compared with placebo. The combination of ketorolac pretreatment and premixed lidocaine in propofol was more effective in decreasing the incidence of moderate or severe pain compared with placebo.

RETRACTED: Pretreatment with flurbiprofen axetil, flurbiprofen axetil preceded by venous occlusion, and a mixture of flurbiprofen axetil and propofol in reducing pain on injection of propofol in adult Japanese surgical patients: A prospective, randomized, double-blind, placebo-controlled study

Pain on injection of propofol is a common clinical problem. Flurbiprofen axetil, an injectable prodrug of flurbiprofen, with or without venous occlusion has been reported to reduce this pain. A search of the existing literature did not identify comparative studies of 3 different techniques, including pretreatment with flurbiprofen axetil, flurbiprofen axetil preceded by venous occlusion, and mixture of propofol and flurbiprofen axetil, for reducing pain on injection of propofol. The aim of this study was to compare the effectiveness of these 3 different techniques of flurbiprofen axetil administration in reducing pain on injection of propofol. This prospective, randomized, doubleblind, placebo-controlled study was conducted at the Department of Anesthesiology, Ushiku Aiwa General Hospital, Ibaraki, Japan. Japanese elective surgical patients, aged 20 to 65 years, were enrolled and were randomly divided into 6 groups: the control group received placebo (saline) before administration of IV propofol 0.5 mg/kg; the flurbiprofen group was pretreated with IV flurbiprofen axetil 50 mg before injection of propofol 0.5 mg/kg; the tourniquet control group received placebo (saline) with a tourniquet for 2 minutes followed by administering propofol 0.5 mg/kg; the tourniquet flurbiprofen group was pretreated with flurbiprofen axetil 50 mg with a tourniquet for 2 minutes followed by administering propofol 0.5 mg/kg; the mixed control group was induced with a mixture of placebo (saline) and propofol 0.5 mg/kg; and the mixed flurbiprofen group was induced with a mixture of flurbiprofen axetil 50 mg and propofol 0.5 mg/kg. Immediately after administering propofol into the largest vein of the hand through a 20-gauge intravenous cannula, an investigator blinded to group assignment asked the patient to assess pain intensity at the injection site using a 4-point verbal rating scale: 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Adverse effects (AEs) at the injection site (pain, edema, wheal, or inflammation) were assessed by the investigator for 24 hours after surgery using spontaneous reporting and patient interview. One hundred fifty-five patients were assessed for inclusion. A total of 150 patients (71 males, 79 females; mean [SD] age, 41 [10] years; mean [SD] height, 161 [9] cm; mean [SD] body weight, 58 [9] kg) were enrolled and completed the study. Each treatment group comprised 25 patients. No significant differences in the demographic characteristics were observed among the 6 groups. The overall incidence of pain on injection of propofol was 92% (23 of 25 patients) in the control group versus 60% (15/ 25) in the flurbiprofen group (P = 0.009); 84% (21/25) in the tourniquet control group versus 32% (8/25) in the tourniquet flurbiprofen group (P = 0.001); and 92% (23/25) in the mixed control group versus 80% (20/25) in the mixed flurbiprofen group (P = NS). The median pain score was significantly lower in the flurbiprofen group (1) compared with the control group (2) (P = 0.002); this score was significantly lower in the tourniquet flurbiprofen group (0) compared with the tourniquet control group (2) (P = 0.001); the score was comparable between the mixed control and mixed flurbiprofen groups (2 vs 2, respectively; P = NS). The incidence and severity of pain on injection of propofol were significantly less in the tourniquet flurbiprofen group compared with the flurbiprofen group (both, P < 0.05). No AEs at the injection site were observed or reported. In this study of adult Japanese surgical patients, pretreatment with flurbiprofen axetil 50 mg preceded by venous occlusion was found to be more effective in reducing pain on injection of propofol than the other flurbiprofen axetil administration strategies tested.

Effect of Diclofenac Pretreatment on Pain during Propofol Injection

In a randomized, double-blind, controlled trial, 120 ASA 1 or 2 patients were allocated to receive diclofenac or normal saline as pretreatment to assess their effect on incidence and severity of pain during propofol injection. Diclofenac in two different doses, i.e. 25 mg and 15 mg, was tried for this purpose. The overall incidence of pain did not significantly differ among the groups, but the incidence of moderate to severe pain following propofol injection was significantly less in patients who received diclofenac 25 mg (P = 0.0017) or 15 mg (P = 0.0363) than in those who received saline. However, the diclofenac itself was associated with mild pain in some patients.