Postoperative Analgesic Demand Research Articles

Comparison of stented versus non-stented patients of ureteric calculi after intracorporeal lithotripsy

Background: A ureteric stent is a tube that is inserted into the ureter to treat and prevent urinary blockage. Stenting is most commonly used to treat stone disease in the ureter during definitive procedures such as ureteroscopy and extracorporeal shock wave lithotripsy. The stent that remains in place frequently causes urinary tract infection and discomfort in the suprapubic area. We report results of our study which attempted to assess stent-related complaints following semirigid ureteroscopy and intracorporeal lithotripsy.Methods: A total of 70 individuals were randomised to stented(n=35) and non-stented group (n=35) between September 2017 and March 2020. Under spinal anaesthesia URSL was performed. Patients' success, operation time, postoperative pain score, analgesic demand, stent-related symptoms, and risk of ureteral stricture development were all evaluated.Results: There was no statistically significant difference between the two treatment groups in terms of ureteral dilation, intracorporeal lithotripsy, or the incidence of intraoperative and postoperative problems. It was found that non-stented group was cost effective as compared to stented group, Furthermore, removal of the stent using local anaesthesia was more painful than the initial ureteroscopy procedure using regional (spinal) anaesthesia. Postoperative pain in non-stented group (n=6) was less than stented group (n=17).Conclusions: Routine placement of ureteral stent is not necessary in uncomplicated cases of ureteric calculi following ureteroscopy, the decision being made on the basis of intra operative findings, where the risks clearly outweigh the benefits offered by stenting.

Evaluation of ultrasound guided erector spinae plane block efficacy on post operative pain in lumbar spine surgery: a randomized clinical trial.

Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well. Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p<0.05 considered as statistically significant. In all time intervals, pain score in case group was significantly lower than control group. In case group, eight patients demanded rescue analgesic (40%) which was significantly lower than that in control group (15 patients [75%]) (p=0.025). Total amount of meperidine consumption was 57.50±45.95 in control group and 22.50±32.34 in case group (p=0.01) which was higher in control group and statistically significant. ESPB reduces post-operative pain score and opioid consumption, while it does not affect intraoperative bleeding in lumbar spine surgery.

Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

Background &amp; objective: The serratus anterior plane block (SAPB) is a recent technique providing effective perioperative analgesia in thoracic surgeries. This study compared the intra–operative hemodynamics and the perioperative analgesic efficacy of superficial SAPB, to deep SAPB, and to thoracic epidural analgesia in thoracotomies.&#x0D; Methodology: one hundred and eighty lung cancer patients scheduled for thoracotomy were randomly allocated to three groups; TEA group, which received thoracic epidural analgesia, SSPB group receiving ultrasound–guided superficial serratus plane block and DSPB group which received US–guided deep serratus plane block. Baseline and intra–operative hemodynamics and total consumption of intraoperative fentanyl and postoperative morphine was noted.&#x0D; Results: Intra–operative mean arterial pressure (MAP) significantly decreased in the TEA group compared to baseline values, whereas no significant changes were found in either SSPB or DSPB groups. Heart rate (HR) did not show significant changes in any group. The time to postoperative analgesic demand was significantly longer in the SSPB and DSPB groups than in the TEA group (p &lt; 0.001). In the first postoperative hour, TEA group had significantly higher visual analogue scale (VAS) scores than SSPB or DSPB groups at rest and with cough. The total consumption of intraoperative fentanyl and postoperative morphine was comparable among all groups.&#x0D; Conclusion: Pre–operative SSPB and DSPB can provide adequate perioperative analgesia without hemodynamic instability when compared to TEA in thoracotomies.&#x0D; Key words: Deep serratus plane block; Superficial serratus plane block; Thoracic epidural analgesia; Analgesia; Thoracotomy&#x0D; Trial registration: The trial was registered at ClinicalTrials.gov with registration number (NCT 04189120). https://clinicaltrials.gov/ct2/show/NCT04189120&#x0D; Citation: Abdelrahman AS, Al Wasseef MM, Hassan ME, Abdelghafar EM. Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(6):713–721;&#x0D; DOI: 10.35975/apic.v25i6.1690

Dexmedetomidine as an adjuvant to bupivacaine in ultrasound-guided serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgeries

BackgroundThe purpose of this study was the assessment of the analgesic and hemodynamic implications of dexmedetomidine used as an additive to bupivacaine in ultrasound-guided serratus anterior plane (SAP) block for patients undergoing video-assisted thoracoscopic surgeries (VATS ) under general anesthesia.ResultsThe hemodynamic stability was maintained perioperatively with no significant difference of MBP and HR recordings between the two study groups (P > 0.05). The time to 1st postoperative analgesic demand was significantly longer in group BD than in group B (P < 0.05). The postoperative total nalbuphine and rescue ketorolac requirements were significantly lower in group BD than in group B (P < 0.05). The VAS scores were significantly lower in group BD at 8th and 12th h postoperatively than in group B, with no significant difference at 0–6 h and 18–24 h postoperatively (P > 0.05). Ramsay sedation scores were significantly higher in the group BD than in group B in the initial 1st h after surgery (P < 0.05) with no significant difference at the subsequent postoperative recordings (P > 0.05).ConclusionUsing dexmedetomidine (0.5 μg/kg) as an additive to bupivacaine for SAP block prolongs the duration of postoperative analgesia and reduces the postoperative analgesic requirements in the 1st 24 h after VATS without any significant side effects.

Effect of perioperative use of parecoxib on chronic post-surgical pain in elderly patients after hepatectomy: a prospective randomized controlled study

BackgroundChronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients. This study aimed to test the superiority of parecoxib vs. placebo in preventing chronic post-hepatectomy pain in elderly patients under combined general-epidural anesthesia.MethodsA total of 105 elderly patients undergoing hepatectomy under combined general-epidural anesthesia were randomized into the parecoxib or placebo group. The primary outcome was the proportion of patients with CPSP 3 months postoperatively. The secondary outcomes included the Short-Form McGill Pain Questionnaire score in CPSP-positive responders, acute pain intensity, postoperative analgesic demand, inflammatory markers change, and postoperative complications within 28 days.ResultsThe parecoxib group provided a non-significant absolute 9.1% reduction in the rate of CPSP compared to the placebo group (P = 0.34). The average chronic pain visual analog scale in the parecoxib group was lower than that in the placebo group (P = 0.04). Significantly less moderate-to-severe acute pain at rest (P = 0.04) and with coughing (P < 0.001), less patient-controlled epidural analgesia (PCEA) consumption (P = 0.01), and less rescue analgesia (P < 0.001) were observed in the parecoxib group compared to the placebo group. Furthermore, no between-group difference was observed in inflammatory markers (P > 0.05) and postoperative complications (P = 0.65).ConclusionsParecoxib reduced the prevalence of CPSP in elderly patients after hepatectomy under combined general-epidural anesthesia from 44.4 to 35.3% with no statistical significance. Moreover, significantly alleviated CPSP intensity and improved acute pain management were observed.Trial registrationThis study was retrospectively registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn/edit.aspx?pid=56961&htm=4) on August 3, 2020 (ChiCTR-2,000,035,198).

Effect of Ketamine Added to Ropivacaine in Nerve Block for Postoperative Pain Management in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Trial

PurposeNerve blocks are commonly used as a part of multimodal pain relief. It was previously shown that ketamine could enhance the analgesic effect of local anesthetics in nerve blocks. A literature review on adding ketamine to local anesthetics for ameliorating analgesia revealed inconsistencies in analgesic efficiency and safety. This prospective, randomized, double-blind trial was performed to evaluate the antinociceptive effect of mixing ketamine with local anesthetics in a combined femoral and sciatic nerve block (CFSNB) during anterior cruciate ligament (ACL) reconstruction. MethodsSeventy-six patients undergoing preoperative ultrasound-guided CFSNB in ACL reconstruction were enrolled. Patients were randomly assigned to 3 groups: Group RNK received perineural administration of 40-mg ketamine plus 0.375% ropivacaine in 40-mL volume; Group RIK received 40 mL of 0.375% ropivacaine, as well as IV ketamine 40 mg; and Group R received 40 mL of 0.375% ropivacaine. Pain scores were recorded. AUC was calculated based on the pain scores at different times. Duration of CFSNB, postoperative analgesic demand, time to first analgesic demand, and adverse events were also examined. FindingsPerineural ketamine decreased pain scores 20 and 24 h' postoperatively, as well as lowered AUC values (all, P = 0.001). Group RNK had a prolonged time to first analgesic request (P = 0.014), inhibited rebound pain (P = 0.001), and increased satisfactory score at 48 h’ postsurgery (P = 0.001). Perineural ketamine prolonged the duration of sensory block (P = 0.001) with no effect on early mobilization. There were no significant differences between Group R and Group RIK in terms of postoperative pain scores, AUC of different time intervals (P = 0.832 or more), and time to first rescue analgesics (P = 0.585). Compared with the 2 other groups, IV ketamine had a higher incidence of hallucination after operations. ImplicationsPerineural ketamine added to the ropivacaine-enhanced analgesic efficacy of CFSNB with less rebound pain compared with the IV ketamine and control groups. IV ketamine had no effect in potentiating analgesia when a conventional multimodal approach was used in the study. Chinese Clinical Trial Registry: ChiCTR1900023867.

Continuous quadratus lumborum block and femoral nerve block for total hip arthroplasty: a randomized study.

Continuous femoral nerve block (FNB) has been effectively used after total hip arthroplasty (THA). Recently the anterior approach to quadratus lumborum block (QLB) has been shown to produce postoperative pain relief after THA. Continuous QLB would benefit from a catheter insertion site that is farther away from the surgical site compared with continuous FNB. In this randomized controlled study, we compared analgesic effects of the two techniques in patients undergoing THA. Thirty patients undergoing THA were randomly allocated into two groups receiving continuous QLB and FNB. Under ultrasound guidance, QLB and FNB were conducted before general anesthesia using 0.25% levobupivacaine 30ml and 0.5% levobupivacaine 15ml, respectively, and a catheter was introduced. Postoperatively, all patients received continuous infusion of 0.125% levobupivacaine at 4ml/h. Postoperative measurements included visual analog scale (VAS) pain scores at rest and on movement, postoperative analgesic demands, cutaneous sensory blockade and adverse events for 48h. Six patients were excluded and 24 patients (13 and 11 patients in QLB group and FNB, respectively) were analyzed. VAS scores on movement at 6h [median (IQR): 67 (41-80) and 38 (22-41) in QLB and FNB groups, respectively, p = 0.008] and 24h [60 (40-80) and 39 (28-64) in QLB and FNB groups, respectively, p = 0.018] were lower with FNB than with QLB. QLB did not produce consistent cutaneous sensory blockade. Analgesic effects of continuous QLB were inferior to those of continuous FNB in patients undergoing THA under the current study condition.

Dexmedetomidine versus lidocaine as an adjuvant to general anesthesia for elective abdominal gynecological surgeries

Study objectiveThe current study was conducted to compare the effect of perioperative administration of intravenous dexmedetomidine versus lidocaine on the perioperative hemodynamic changes, anesthetic consumption, anesthesia induction, and recovery times in patients undergoing elective abdominal gynecological surgeries under general anesthesia.Materials and methodsNinety female patients undergoing elective abdominal gynecological surgeries were enrolled in the current study. Patients were randomly distributed to one of three equal groups: group L received lidocaine (1.5 mg/kg loading, 2 mg/kg/h infusion), group D received dexmedetomidine (1 μg/kg loading, 0.5 μg/kg/h infusion), and group C received isotonic saline 0.9% in the same volume and pattern as the study drugs. Hemodynamic parameters including mean arterial pressure (MAP) and heart rate (HR), anesthetic consumption and induction, recovery times, and time to the first postoperative analgesic demand were recorded.ResultsThe MAP and HR after endotracheal intubation and in the subsequent recordings were significantly lower in group L and D when compared with group C with no significant difference between group D and L. The propofol induction dose and mean end-tidal isoflurane concentration were significantly lower in group L and D when compared with group C and were also significantly lower in group D when compared with group L. The intraoperative fentanyl consumption was significantly lower in group L and D when compared with group C with no significant difference between group D and L. The anesthesia induction time was significantly shorter in group L and D when compared with group C; it was also significantly shorter in group D when compared with group L with no significant difference as regards the anesthesia recovery time and the response time between the three study groups. The time to the first postoperative analgesic requirement was significantly longer in group D and L when compared with group C; it was also significantly longer in group D when compared with group L.ConclusionBoth dexmedetomidine and lidocaine could be a useful adjuvant to general anesthesia in patients undergoing abdominal gynecological surgeries. However, dexmedetomidine has a better sparing effect on intraoperative anesthetic consumption and longer time to the first postoperative analgesic demand than that of lidocaine with no significant difference between both agents on intraoperative analgesic demand.

Gradual withdrawal of remifentanil delays initial post-operative analgesic demand after thyroid surgery; double-blinded, randomized controlled trial

BackgroundMismanagement of remifentanil leads to severe side effects such as opioid-induced tolerance and hyperalgesia. Recently studies revealed an alternative withdrawal method to limit these side effects. A gradual withdrawal of remifentanil seems to be associated with less pain. The hypothesis of this double-blinded, randomized controlled trial was that a gradual withdrawal of remifentanil would be associated with less immediate post-operative pain compared to after an abrupt discontinuation of remifentanil in patients who underwent thyroid surgery.MethodsThis double-blinded, randomized controlled trial was conducted in a tertiary level hospital in Brussels (Belgium) from April until August 2017. 34 patients undergoing thyroid surgery were randomized and 29 patients completed the study. After randomization, patients undergoing thyroid surgery were allocated to two groups: one with an abrupt discontinuation of remifentanil after surgery and one with a gradual withdrawal of remifentanil after surgery. The primary outcome was the initial post-operative demand of analgesic medication.ResultsGradual withdrawal of remifentanil was associated with a delayed initial post-operative demand of analgesic medication (P = 0.006). The first morphine bolus was given after 76.3 +/− 89.0 min in the group with a gradual withdrawal of remifentanil versus after 9.0 +/− 13.5 min in the group with an abrupt discontinuation of remifentanil.However, overall morphine consumption, numeric rating scale scores, Ramsay Sedation Scale scores, and quality of recovery scores (QoR-40) were similar in both groups (P > 0.05).ConclusionThough overall morphine consumption, numeric rating scale scores, Ramsay Sedation Scale scores, and quality of recovery scores (QoR-40) are not altered, a gradual withdrawal of remifentanil after thyroid surgery is safe and associated with a delayed initial post-operative demand of analgesic drugs. The withdrawal process does, however, require vigilance and training.Trial registrationClinicaltrials.gov NCT03110653 (PI: Luc Barvais; date of registration: 03/31/2017).

Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non-opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty. Evidence-based systematic review. PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included. Thirty-seven studies met inclusion criteria for this evidence-based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution. Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α-agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost-effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large-scale, multi-institutional, controlled studies are needed to provide definitive recommendations. NA Laryngoscope, 129:E200-E212, 2019.

Neutrophil lymphocyte ratio predicts postoperative pain after orthognathic surgery

Postoperative pain is well known and usually disturbing complication of surgery. Inflammation plays an important role in the development and progression of postoperative pain. We aimed to investigate possible relationship between preoperatively measured neutrophil-lymphocyte ratio (NLR) - as an inflammation marker - and postoperative analgesic demand in patients underwent orthognathic surgery. We retrospectively investigated medical and anesthesia records of 177 patients underwent orthognathic surgery. Demographical data, preoperative NLR, type of surgery, modified Mallampati score, difficulty degree of intubation, duration of surgery, and postoperative analgesic (tenoxicam - as the first drug of choice, paracetamol, tramadol, or pethidine) usage were recorded. A cutoff value of NLR ≥2 was determined for inflammation threshold. Two groups (Group 1 NLR ≥2, Group 2 NLR <2) were compared for analgesic doses, numbers of patients needed analgesic treatment, and other parameters. Mean administered tenoxicam dose was significantly higher in Group 1 than in Group 2 (P < 0.0001). Further, ratio of patients treated with tenoxicam in Group 1 was significantly higher than that in Group 2 (χ2 = 4.779, P = 0.029). Preoperatively measured NLR may help to predict postoperative analgesic demand in patients undergoing orthognathic surgery, and thus sufficient postoperative pain control can be achieved with various preventive treatments taken at the perioperative period such as preemptive analgesia, local anesthetic administration at the end of surgery, or early administration of analgesics.

Efficiency of Bilateral Subcostal Transversus Abdominis Plane Block to Complement General Anaesthesia in Laparoscopic Cholecystectomy

Introduction: Laparoscopic Cholecystectomy is presently a commonly performed surgical procedure. It is needed in both the young and the old; healthy as well as the severely co-morbid. During the surgery, pain is generated at the port site and also from the viscera. Bilateral Subcostal (Upper Quadrant) Transversus Abdominis Plain Block can block the pain from the parietal port sites. This study is to assess the efficiency of Bilateral Subcostal Transversus Abdominis Plane Block as a mode of multi-modal analgesia in the General Anaesthesia administered for Laparoscopic Cholecystectomy. Material and Methods: One hundred patients of ASA 1 or 2 categories in the age group 20 to 60 years from both sex posted for elective Laparoscopic Cholecystectomy was included in the study. Fifty patients each was randomly assigned to two groups ‘A’ and ‘B’. Group A was the control group and did not receive any blocks. The surgery was done solely under General Anaesthesia. In the group ‘B’, Bilateral Subcostal TAP block with 30 ml of 0.25% Ropivacaine was administered from the Block Room. General Anaesthesia in a standardised protocol for the study was administered by a different Anaesthetist who was blinded about the blocks. The extra amount of Fentanyl required per hour to maintain adequate anaesthesia was noted in every patient. Minimum concentration of Sevoflurane demanded by individual patients is also noted. Systolic BP value range of ‘Control BP to an additional 15mm of Hg’ is targeted as adequate anaesthetic depth in this study. Post Operative Analgesia also had a standard protocol for all the patients. The additional dose Inj. Tramadol to control the pain in the 8 post operative hours is also noted. Results: The study demonstrated a statistically significant decrease in the intra operative inhalational anaesthetic and narcotic analgesic demand, in the Group B in which Bilateral Subcostal TAP Block was administered. The decrease in the 8 hour post operative analgesic demand in the Group B was found to be statistically significant.

Intravenous Acetaminophen Effect on Postoperative Narcotic Analgesic Demand after Elective Cesarean Section

Background: Opioid analgesics are the mainstay of the treatment of postoperative pain. Appropriate monitoring of patients receiving opioid analgesics is essential to detect those with side effects such as respiratory depression. The discovery of Acetaminophen as a COX-3 variant may represent a primary central mechanism by which acetaminophen decrease pain. The aim of this study was to assess the effect of intravenous acetaminophen on morphine requirement in post-operation pain after elective cesarean section. M aterials and Methods: In a randomized clinical trial, patients’ candidate for elective cesarean section. In experiment group, intravenous acetaminophen (1000 mg/6 hour) was administered and normal saline to control group. Visual analogue scale (VAS) was measured at 1, 3, 6, 12, and 24 hours post-operation. Besides, Morphine dose requirement were measured during next 24 hours. R es ults: 83 patients were enrolled in the study; which 44 patients assigned in placebo group and 39 in Acetaminophen. Mean Age of placebo group was 29.64±5.55 and Acetaminophen was 30.33±5.50 which was not significantly different (p=0.568). Only at 1 and 3 hours, there was a significant difference between two groups of study. Total dose of morphine requirement was 5.73±2.78 mg/24 h in placebo group and 3.64±2.42 in Acetaminophen group which was significantly different (p=0.001). Conclusion: Intravenous Acetaminophen could decrease post cesarean pain and decrease post operation total morphine requirement particularly at first 3 hours post operation.

Scheduled intravenous acetaminophen reduces postoperative narcotic analgesic demand and requirement after laparoscopic Roux-en-Y gastric bypass

BackgroundIntravenous (IV) acetaminophen has the potential to reduce postoperative narcotic analgesic requirement but this has not been reported in bariatric surgery. As lower dosages could reduce undesirable narcotic side effects, we investigated the opioid-sparing effect of concomitant IV acetaminophen in bariatric surgery. MethodsWe performed a retrospective review of our electronic medical records of laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed for severe obesity between 2011 and 2013. We identified 183 patients that received scheduled IV acetaminophen in addition to morphine sulfate (MSO4) patient-controlled analgesia (PCA). A cohort of 229 patients from the preceding 2 years who were treated with MSO4 PCA but not acetaminophen was used as a historical control. Patient demographic characteristics and narcotic use data were extracted from electronic medical records. Student’s t test or linear regression was used as appropriate (P< .05). ResultsDuring the first 24-hour postoperative period after LRYGB, narcotic analgesic demand (total PCA demand including nondelivery of narcotic due to lock-out) was reduced by 25% with the concomitant use of IV acetaminophen (40.5 versus 30.9 average pushes; P<.05). During the same period, narcotic analgesic dosage requirement was cut down by 20% in the study group (average of 29.9 versus 24.1 mg of MSO4; P<.05). Linear regression analysis confirmed that these changes were independent of age, gender, and body mass index distribution, or type 2 diabetes mellitus. ConclusionScheduled IV acetaminophen reduces the demand for and the requirement of narcotic analgesia after LRYGB. We provide new evidence in support of the routine use of multimodal analgesia that includes scheduled IV acetaminophen in the initial 24-hour period after bariatric surgery.

Effectiveness of Preemptive Analgesia Using a Frequency Rhythmic Electrical Modulation System in Patients Having Instrumented Fusion for Lumbar Stenosis

Study DesignA randomized prospective study.PurposeTo assess postoperative analgesic requirements after Phyback therapy preemptively in patients undergoing lumbar stabilization.Overview of LiteratureFrequency Rhythmic Electrical Modulation System is the latest method of preemptive analgesia.MethodsForty patients were divided into two groups. Patients who were to receive tramadol were allocated to "group A" and those who were to receive Phyback therapy were allocated to "group B." In patients with a visual analog scale score of >4 or a verbal rating scale score of >2, 75 mg of diclofenac IM was administered. The amount of analgesic consumption, the bolus demand dosage, and the number of bolus doses administered were recorded. Patient satisfaction was evaluated using the visual analog patient satisfaction scale.ResultsThere were statistically significant differences in the visual analog scale and verbal rating scale scores in the fourth, sixth, 12th, and 24th hours. The number of bolus infusions was significantly lower in group B. The amount of analgesic consumption was higher in group A. There was a significant difference between the two groups in the number of bolus infusions and the total amount of analgesic consumption, and this comparison showed better results for group B.ConclusionsApplication of Phyback therapy reduced postoperative opioid consumption and analgesic demand, and it contributed to reducing patients' level of pain and increased patient satisfaction. Moreover, the application of preemptive Phyback therapy contributed to reducing preoperative pain which may have reduced patient anxiety.

Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study

Background and objectivesSuccess rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. MethodsSixty patients aged between 20 and 65, with body weight between 50 and 100kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30ml 0.5% bupivacaine (Group B) or 30ml 0.5% levobupivacaine (Group L). Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. ResultsDemographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p<0.05). The mean time for first postoperative analgesic demand were 16.6±8.0h in Group B and 14.4±7.3h in Group L (p>0.05). Conclusion30ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia.

A Single-nucleotide Polymorphism in SCN9A May Decrease Postoperative Pain Sensitivity in the General Population

This study aimed to explore the role of a nonsynonymous single-nucleotide polymorphism, 3312G>T, in SCN9A, which was identified in probands with congenital indifference to pain, but which is also present in normal controls, in the prediction of individual baseline pain perception, and postoperative pain sensitivity in the general population. Preoperative pressure pain thresholds and tolerance were measured in 200 patients undergoing pancreatectomy, and the postoperative pain sensitivity and analgesic demand were recorded. These variables were compared according to the SCN9A 3312G>T alleles. Logistic regression analysis was used to test the role of preoperative variables in the prediction of postoperative inadequate analgesia. The 3312Tallele was present in 22 individuals, and the 3312Tallele frequency was 5.5% (22/200). The average patient-controlled analgesia pressing frequency and opioid consumption in 3312G patients was significantly higher than those in 3312T patients (2.70 [SD: 0.84] vs. 2.05 [SD: 0.43], P < 0.001; 100.8 [SD: 40.7] vs. 74.8 [SD: 20.8] ml, P = 0.006). The incidence of inadequate analgesia in 3312G patients was significantly higher than that of patients carrying the 3312Tallele (29.2% vs. 4.5%; P = 0.013). Carrying the 3312Tallele and having a higher pressure pain threshold predicted a lower risk of postoperative inadequate analgesia, with an odds ratio of 0.10 (95% CI: 0.01 to 0.76, P = 0.026) and 0.32 (95% CI: 0.13 to 0.82, P = 0.018), respectively. Patients carrying the SCN9A 3312Tallele presented with lower postoperative pain sensitivity in the presence of a similar surgical pain stimulus, and had a lower likelihood of developing inadequate analgesia than those carrying the 3312Gallele.

The comparision of effects intraoperative tramadol and ketamine usage for postoperative pain relief in patient with tonsillectomy

We aimed to compare the effects of ketamine and tramadol administered intraoperatively on postoperative pain and analgesic demand in children undergoing tonsillectomy operations. Ninety children undergoing tonsillectomy, aging 5-15 years old, with ASA I - II , were included in this study. Cases were arranged in three groups and given standardized general anesthesia. After coagulation, ketamine (0.5 mg.kg-1) was administered intravenously (iv) in the ketamine group, and tramadol iv (2 mg.kg-1) was given in the tramadol group and the control group received a physiologic iv. The duration of anesthesia, duration of operation, and length of stay in the PACU were recorded. NRS and CHEOPS scales were used to assess postoperative pain. Paracetamol (15 mg.kg-1) was given rectally in the first 6 hours (hrs) and orally over the subsequent 6 hrs, if NRS greater than 3 and CHEOPS greater than 8 were observed. All data were recorded concerning the initial and total dosage of analgesic and the presence of complications within 24 hrs. Demographic data, duration of anesthesia, duration of operation, and duration of stay in the PACU were similar between groups (p>0.05). The number of patients requiring additive analgesic was higher in the control group. No differences were found between the tramadol and ketamine groups (p>0.05). Additional analgesic was given earlier in the control group (p<0.05), but the need for additional analgesic was similar in tramadol and ketamine groups (p>0.05). Paracetamol dosage was significantly higher in the control group (p<0.05), but similar between the tramadol and ketamine groups (p>0.05). The frequency of nausea and vomiting was found to be significantly higher in tramadol and ketamine groups compared to the control group (p<0.05). Postoperative pain was effectively managed using 2 mg.kg-1 tramadol and 0.5 mg.kg-1 ketamine in pediatric tonsillectomies.

Pre-incisional, post-incisional and combined pre- and post-incisional local wound infiltrations with lidocaine in elective caesarean section delivery: A randomised clinical trial

The objective of this study was to compare maternal and fetal outcomes in caesarean deliveries receiving pre-incisional, post-incisional or combined pre- and post-incisional local wound infiltrations with lidocaine. In a randomised, double-blind clinical trial, candidates for elective caesarean section received local wound infiltration with an anaesthetic mixture including 1% lidocaine pre-incisionally (n = 94), post-incisionally (n = 92) or both (n = 95). Postoperative pain, duration of analgesia, number of postoperative rescue analgesic demands, time to ambulation, time of first breast-feeding and neonatal Apgar score were compared. Main outcome variables were comparable between the pre- and post-incisional groups. Pain scores and duration of analgesia were significantly lower in the mixed group. Time of breast-feeding and number of analgesic demand were significantly lower in ‘mixed’ group than those in pre- and post-incisional groups, respectively. The other variables were comparable. Combined pre- and post-incisional local wound infiltration in post-caesarean pain relief is superior to each one alone.

Postoperative Analgesic Effects of Wound Infiltration With Tramadol and Levobupivacaine in Lumbar Disk Surgeries

Wound infiltration with local anesthetics may improve postoperative analgesia. Tramadol has been shown to have effects similar to those of local anesthetics. The purpose of this study was to investigate the effects of wound infiltration with levobupivacaine and tramadol on postoperative analgesia for lumbar discectomies. Eighty adult patients who were scheduled to undergo elective lumbar discectomy operations were included in the study. Patients were randomly allocated to 4 groups: wound infiltration with 100 mg levobupivacaine (group L), 2 mg/kg tramadol (group T), 2 mg/kg tramadol plus 100 mg levobupivacaine (group LT), and saline (group C). Pain scores with the visual analog scale, patient-controlled analgesic consumption (pethidine), time to first analgesic treatment, and side effects were assessed during the postoperative period. The time to first analgesia was earliest in group C (11.3±2.2 min), followed by group L (163.0±216.3 min) and group T (803.2±268.4 min) (P<0.001). None of the patients in group LT required postoperative analgesic supplementation, and the visual analog scale scores were <3 at all measurement times (P<0.05). Postoperative opioid consumption was 196.0±71.6 mg in group C, 129.0±78.3 mg in group L, and 37.0±35.4 mg in group T (P<0.001). The incidence of side effects was lower in group LT than in the other groups. Wound infiltration with combined levobupivacaine and tramadol resulted in elimination of postoperative analgesic demand and reduction in the incidence of side effects. We conclude that infiltration of the wound site with combined levobupivacaine and tramadol provides significantly better analgesia compared with levobupivacaine or tramadol alone.