Postoperative Analgesic Intake Research Articles

Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial.

Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS). This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05). Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.

Heminephrectomy in the pediatric population – single-center comparison of the open versus transperitoneal laparoscopic approach

IntroductionHeminephrectomy is considered the method of choice in the treatment of symptomatic or poorly working moiety of a duplex kidney as well as in oncology.AimThe study aims to retrospectively analyze the laparoscopic approach to heminephrectomy (LHN) in comparison with the open approach (OHN).Material and methodsFrom 2011 to 2020, 28 heminephrectomies were performed in the Clinical Ward of Pediatric Surgery and Urology of the Regional Specialized Children’s Hospital in Olsztyn: 10 with the laparoscopic transperitoneal method (LHN), and 18 with the open method (OHN). The mean age was 37.4 months (1–197 months). In total, 20 patients were female, and 8 were male. Loss of function of the moiety was a prerequisite for surgery. Hydronephrosis, dysplasia of the moiety, and vesicoureteral reflux were the most prevalent in both groups. Data regarding patients were collected based on available medical documentation and retrospectively analyzed.Results and discussionThere was no significant difference between the LHN and OHN groups regarding mean operating time (157 vs 128 minutes; &lt;i&gt;P&lt;/i&gt; = 0.226) and mean postoperative hospital stay (5.20 vs 6.53; &lt;i&gt;P&lt;/i&gt; = 0.64). The refeeding time is comparable and not statistically significant (1.90 vs 1.83 days; &lt;i&gt;P&lt;/i&gt; = 0.555). Postoperative analgesic intake was found to be significantly lower (10.4 vs 17.5 doses, &lt;i&gt;P&lt;/i&gt; = 0.004).ConclusionsBoth open and laparoscopic approaches are safe and feasible in the pediatric population. Both are comparable in operative time, hospital stay and refeeding time. LHN displays a better cosmetic effect and requires significantly lesser analgesic use.

Development and Internal Validation of the Postoperative Analgesic Intake Needs Score: A Predictive Model for Post-Operative Narcotic Requirement after Spine Surgery.

Retrospective Cohort. The aim of this study was to develop a clinical tool to pre-operatively risk-stratify patients undergoing spine surgery based on their likelihood to have high postoperative analgesic requirements. A total of 1199 consecutive patients undergoing elective spine surgery over a 2-year period at a single center were included. Patients not requiring inpatient admission, those who received epidural analgesia, those who had two surgeries at separate sites under one anesthesia event, and those with a length of stay greater than 10 days were excluded. The remaining 860 patients were divided into a derivation and validation cohort. Pre-operative factors were collected by review of the electronic medical record. Total postoperative inpatient opioid intake requirements were converted into morphine milligram equivalents to standardize postoperative analgesic requirements. The postoperative analgesic intake needs (PAIN) score was developed after the following predictor variables were identified: age, race, history of depression/anxiety, smoking status, active pre-operative benzodiazepine use and pre-operative opioid use, and surgical type. Patients were risk-stratified based on their score with the high-risk group being more likely to have high opioid consumption postoperatively compared to the moderate and low-risk groups in both the derivation and validation cohorts. The PAIN Score is a pre-operative clinical tool for patients undergoing spine surgery to risk stratify them based on their likelihood for high analgesic requirements. The information can be used to individualize a multi-modal analgesic regimen rather than utilizing a "one-size fits all" approach.

Effect of final irrigation with sodium hypochlorite at different temperatures on postoperative pain level and antibacterial activity: a randomized controlled clinical study.

Objective To evaluate the effect of final irrigation of root canals with NaOCl solution at different temperatures on postoperative pain level and antimicrobial activity.Methodology 45 patients were randomly divided into three groups using a web program according to the irrigation selected: NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC. First root canal samples were collected before treatment (S1). After chemo-mechanical preparation, final irrigation was performed with the selected irrigant (NaOCl 2ºC, NaOCl 25ºC and NaOCl 45ºC) and second samples were collected (S2). Samples were subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria. The root canal treatments were completed and the participants were given instructions to record postoperative pain levels at 24, 48 and 72 hours, 5 days and 1 week after treatment using a visual analog scale (VAS).Results The reduction in the number of total bacterial cell equivalents from S1 to S2 was statistically significant in all groups (p<0.001). The NaOCl 2˚C group reported significantly less postoperative pain than the NaOCl 45˚C group (p<0.05). Postoperative analgesic intake was significantly higher in the NaOCl 45˚C group than in the NaOCl 2˚C group (p<0.05).Conclusion We conclude that final irrigation with NaOCl at different temperatures results in similar antibacterial effectiveness. Final irrigation with cold NaOCl (2˚C) is better than NaOCl 45˚C when comparing postoperative pain levels.

Predicting postoperative pain with neutrophil/ lymphocyte ratio after arthroscopic rotator cuff repair

BackgroundPostoperative pain is well known and usually disturbing complication of arthroscopic shoulder surgery. Inflammation plays an important role in the development and progression of postoperative pain. The aim of this study was to evaluate the predictability of postoperative pain through the correlation of neutrophil/lymphocyte ratio (NLR) with inflammation. In addition, the correlation of parameters such as operative time, tear size, age and gender with postoperative pain was evaluated. MethodsSixty three patients, who underwent arthroscopic rotator cuff repair, were evaluated in this single-center-based retrospective study. The American Society of Anaesthesiologists I and II risk groups were determined as the inclusion criteria. NLR was calculated using preoperative one day hemogram values in all patients. The amounts of analgesic use and Numerical Rating Scale (NRS) scores at the 12th, 24th and 48th hours and on the 3rd and 7th days were recorded. Multivariate linear regression analysis was used to correlate postoperative NRS scores with multiple independent factors, including preoperative NLR, sex, age, tear size, repair type, operative time, block time, postoperative analgesic intake and length of hospital stay. ResultsSixty three patients with a mean age of 59.4 years (range, 40–72 years) were evaluated. The mean tear size was 2.8 cm (range, 1–5 cm), the mean operative time was 84.1 min (range, 35–135 min), the mean duration of block was 7.6 hours (range, 4–12 hours) and the mean length of hospital stay was 1.7 days (range, 1–3 days). There was no significant correlation between age, sex, tear size, repair type, operative time and postoperative NRS (p > 0.2). The preoperative NLR was found to be a strong predictor of postoperative NRS (p < 0.001, rho = 0,864). There was a correlation between the NLR and mean analgesic intake (p = 0,03). The duration of block was decreased in patients with a NLR above 2, while it was prolonged in patients with a NLR below 2 (p = 0.04, rho = −0,725). ConclusionThe preoperative NLR was found to be a strongest factor predicting high acute pain levels after arthroscopic rotator cuff surgery. Likewise, NLR was also predictive of postoperative block time and analgesic consumption.

Efficacy and Safety of Oral Premedication on Pain after Nonsurgical Root Canal Treatment―A Review

Postoperative pain is more likely to arise within a few hours following ischolar_main canal treatment. Patients who have postoperative pain need analgesics that have fewer side effects for relieving the pain. Postoperative discomfort reduction by various preoperative means is a tried and tested method. Here, we predict symptoms that arise after treatment and try to deal with them before they begin. For those patients presenting with preoperative pain, it has been reported that up to 80% of this population will continue to report pain of different degrees even after endodontic treatment. A number of factors concerning the etiology of postoperative pain have been evaluated. The main contributing factors of pain during ischolar_main canal treatment comprises of mechanical, chemical, and microbial injuries to the pulp or periradicular tissues which are induced or exacerbated during treatment. Pretreatment analgesia is providing analgesia to patients before initiation of endodontic treatment, which can decrease the establishment of central and peripheral sensitization and has the potential to reduce postoperative pain and postoperative analgesic intake. Administration of a nonsteroidal anti-inflammatory drug before ischolar_main canal therapy will interfere with the inflammatory process before it begins; therefore, presumably decreasing postoperative pain.

Evaluation of Outcome Between Excisional Haemorrhoidectomy and Longo's Technique (PPH)

Objective: The introduction of a Longo’s technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time, rapid healing and an early return to full activity. The outcome of Longo’s technique was compared with that of current standard surgery in a randomized controlled study, and followed up two years.&#x0D; Methods: In a prospective randomized study, 140 patients requiring surgical treatment for haemorrhoids grade 2, 3 and 4 were assigned to either MMF (Milligan-Morgan, Park Ferguson) or PPH (Procedure for prolapse and haemorrhoids) 70 each. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded.&#x0D; Results: The Longo’s group had a shorter operating time, less frequent postoperative analgesia intake, and earlier return to normal activity. Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated. After a mean follow-up of 24 months (12-46), recurrent haemorrhoidal symptoms, mostly mild and temporary, were reported after both MMF and PPH (Table-3). Four patients (5.71 %) complained of recurrent prolapse and/or external swelling after PPH, requiring re-do surgery in 3 of them between 18 to 32 months. Recurrent prolapse or external piles were also observed in 5 patients (7.14%) after MMF and re-do surgery was needed in 3 of them between 14 and 41 months. Long term patient's satisfaction after PPH was more or less same like after MMF. None of the patients had anal stenosis, incontinence, fecal urgency or sepsis.&#x0D; Conclusions: Postoperative pain is less after PPH. This advantage disappears if any resection is associated with the stapling. Use of a Longo's technique in the treatment of haemorrhoidal disease promotes rapid healing, shorter hospital stay and early return to normal activities.&#x0D; Journal of Surgical Sciences (2013) Vol. 17 (2) :66-72

Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial.

The effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery. In this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications. Among the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, p<0.0004). Motor and sensory recovery occurred significantly later, and total analgesic consumption was lower in the Dexa than in the Control group. No nerve complication related to intravenous dexamethasone injection was recorded. This study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block. NCT02862327.

Plain bupivacaine versus bupivacaine with adjuvants for ultrasound-guided supraclavicular brachial plexus block in patients undergoing below shoulder upper limb surgeries

Background Adding of an adjuvant to local anesthetics improves the quality of nerve block and reduces the need of postoperative analgesic intake. Aim The aim of this study was to compare the block characteristics of bupivacaine when used alone with those characteristics after using different adjuvants in ultrasound-guided supraclavicular brachial plexus block (US-guided SCBPB) in patients undergoing below shoulder upper limb surgeries. Patients and methods A prospective, double-blinded, randomized, controlled trial. A total of 108 patients undergoing elective upper limb surgeries under US-guided SCBPB were randomly allocated according to the studied solution into four equal groups (n=27): (i) Group C: 30 ml bupivacaine 0.5%+5 ml 0.9% saline. (ii) Group D: 30 ml bupivacaine 0.5%+100 μl dexmedetomidine diluted to 5 ml using 0.9% saline. (iii) Group N: 30 ml bupivacaine 0.5%+10 mg nalbuphine hydrochloride diluted to 5 ml using 0.9% saline. (iv) Group M: 30 ml bupivacaine 0.5%+5 ml of 10% MgSO4. We compared the onset and duration of sensory and motor blockade, hemodynamic stability, sedation, complications and postoperative analgesia. Results There were no significant differences in the times of onset of both sensory and motor blocks between the four groups. The analgesic duration and duration of motor block were significantly longer in all adjuvant groups. The total consumption of paracetamol during the first 24 h was significantly higher in group C. Patients in groups D and M had statistically significantly higher sedation scores at different times during the study. Conclusion Adding either dexmedetomidine, nalbuphine, or magnesium sulfate to bupivacaine in US-guided SCBPB prolongs both sensory and motor blockade. Both dexmedetomidine and magnesium sulfate produces significant sedation when added to bupivacaine.

Single dose oral prednisolone and post-operative endodontic pain.

DesignA randomised, single centre, double blind placebo controlled clinical trial involving 400 patients.InterventionThe inclusion criteria comprised systemically healthy patients between the ages of 18 and 35 years having mandibular molars with symptomatic irreversible pulpitis, radiographically normal periapical area and no pain on biting or percussion. The study was approved by the Institutional Review Board of Ethics Committee at the School of Dentistry, Cairo University, Egypt. Patients were recruited from the outpatient clinic of the Department of Endodontics.The independent Centre for Evidence Based Dentistry performed sequence generation and allocation concealment. For allocation concealment, two tablets of each medication were placed in sequentially numbered, opaque, sealed containers. Participants and operators were unaware of the assigned group for the duration of the study. Post-graduate students were calibrated to act as operators and supervisors from the department of endodontics evaluated their clinical performance.The participants received 40 mg of prednisolone or placebo tablets 30 minutes before single visit root canal treatment. Patients recorded the pain level 6, 12 and 24 hours after treatment on a 100mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic. If pain persisted an analgesic was prescribed.Outcome measureThe primary outcome was the incidence of postoperative pain at three points; 6, 12 and 24 hrs. The secondary outcomes were pain intensity and the incidence of analgesic consumption. The relative risk reduction (RRR) and the number needed-to-treat (NNT) and their 95% confidence intervals (CI) were used to represent the risk of pain incidence.ResultsOf the 670 patients assessed for eligibility, 400 were included in the study. Only two patients of the 400 were lost to follow-up with 398 patients (prednisolone group = 198; control group = 200) being included in the analysis; 259 were women and 141 men. The mean age was 29.45 -/+ 3.7 years in the prednisolone group and 28.97 -/+3.61 years in the control group. There was no significant difference for mean age (P = 0.164), gender distribution P = 0.123) or tooth type (P = 0.56) between the two groups. The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at six hours, 23.39% (95% CI: 14.75%, 31.16%) at 12 hours and 28.85% (95% CI: 18.08%, 38.20%) at 24 hours. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24 hours (P < 0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and in analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded. The NNT (number needed to treat) was five (95% CI: 4, 9) at six hours, five (95% CI: 4, 8) at 12 hours and four at 24 hours (95% CI: 3, 7).ConclusionsPreoperative oral administration of a single dose of 40 mg prednisolone was beneficial for the control of postoperative pain up to 24hrs after single visit root canal treatment in patients with symptomatic irreversible pulpitis. The incidence of postoperative pain level and the need for postoperative analgesic intake decreased. The non-invasive route and minimal possible adverse events results in a favourable risk benefit-balance.

Comparative Analysis of Radiosurgery and Scalpel Blade Surgery in Impacted Mandibular Third Molar Incisions: a Clinical Trial.

This study aims to compare the outcome of radiosurgically assisted incision technique with the conventional scalpel blade technique in impacted mandibular third molar incisions. On 100 patients (50 patients each in GROUP R and GROUP S) with impacted mandibular third molar, incisions were given using radio surgical and scalpel technique, respectively. Impacted third molars were classified according to Winter's classification. Two types of incisions (Ward's and modified Ward's) were performed. Results were evaluated considering various parameters like surgical ease, field of surgery, odour, bleeding, discomfort/pain, post-operative analgesic intake and healing in both groups. In our study, mean age of patient was 25.30years, 54% were females and 46% males; mesioangular was the most common type of impaction, and the average length of incision was 3.105±0.546cm. There was a significant statistical difference (p<0.01) in the five measure moments (field of surgery, surgical ease, intra-operative bleeding, odour and post-operative analgesic intake at 3-5th day) between the impacted molars operated with scalpel and the ones done with radiosurgery. There was statistically insignificant difference in pain/discomfort, healing and post-operative analgesic intake at 1st and 7-10th day. Radiosurgery was very effective in providing clear field of surgery, surgical ease and created less intra-operative bleeding than scalpel blade surgery making day to day minor oral surgery less stress full and productive.

The effect of preoperative oral administration of prednisolone on postoperative pain in patients with symptomatic irreversible pulpitis: a single-centre randomized controlled trial.

This single-centre randomized, double-blind, placebo-controlled clinical trial assessed the effect of a preoperative, single, oral dose of prednisolone on postoperative pain and postoperative analgesic intake in patients with symptomatic, irreversible pulpitis in mandibular molars. Four hundred participants, randomly assigned to two equal groups, received either 40mg prednisolone or placebo tablets 30min before single-visit root canal treatment. Patients recorded their pain level 6, 12 and 24h after treatment on a 100-mm visual analogue scale. All patients received a sham capsule to take if needed as a postoperative analgesic, and, if the pain persisted, an analgesic was prescribed. The relative risk reduction and 95% confidence intervals (CI) were estimated for binary data. Mann-Whitney U-test was used to compare postoperative pain intensity between groups. The relative risk reduction in pain incidence was 20.31% (95% CI: 12.03%, 27.82%) at 6h, 23.39% (95% CI: 14.75%, 31.16%) at 12h and 28.85% (95% CI: 18.08%, 38.20%) at 24h. Prednisolone had significantly less post-obturation pain intensity compared to placebo at 6, 12 and 24h (P<0.001). The relative risk reduction in sham-capsule intake was 54% (95% CI: 38%, 66%) and of analgesic intake was 55% (95% CI: 3%, 79%). No adverse effects were recorded. Preoperative oral administration of a single dose of 40mg prednisolone was beneficial to control short-term post-obturation pain after single-visit root canal treatment in patients with symptomatic irreversible pulpitis reducing pain incidence after 24h by approximately 30% and postoperative analgesic intake by approximately 55%.

A Double-Blind Randomized Study Evaluating the Effect of Intra-Alveolar Chlorhexidine Gel on Alveolar Osteitis After Removal of Mandibular Third Molars

The main purpose of the present investigation was to determine whether intra-alveolar chlorhexidine (CHX) gel is an effective preventative treatment for alveolar osteitis (AO), as has been strongly suggested by previous investigators. Another goal was to evaluate whether there is a correlation between the use of analgesics during the postoperative week and the development of AO, a correlation that could be a supplement to the commonly used diagnostic criteria for AO. A double-blinded randomized study was performed to assess whether intra-alveolar administration of CHX decreases AO. To achieve this objective, the extraction and postoperative course of 100 impacted mandibular third molars were studied. Ninety-seven percent of teeth operated on had a diagnosed pathology. The extraction alveoli were treated with CHX or placebo. The intake of analgesics was recorded for 7 days after the operation. Statistically important differences in AO between the control and experimental groups were not found. The intake of analgesics reflected the occurrence of AO with a high degree of importance. The present study did not verify that application of CHX gel improves healing after removal of impacted third molars. The patients' postoperative analgesic intake reflected the development of AO.

Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery

The goal of this study was to evaluate the efficacy of single- and multi-dose (5-day) clindamycin therapy for the prevention of inflammatory complications in patients undergoing lower third molar surgical extraction with bone removal. Patients who qualified for the prospective, randomized, double-masked, placebo-controlled trial were randomly divided into three groups: (1) single dose of oral clindamycin administered preoperatively (single-dose group); (2) clindamycin administered preoperatively with continued therapy for 5 days (5-day group); and (3) a placebo group. The following parameters were evaluated on the first, second and seventh days postsurgery: trismus, facial swelling, body temperature, lymphadenopathy, alveolar osteitis and subjective pain sensations. There were 86 patients (31 in the single-dose group, 28 in the 5-day group and 27 in the placebo group) enrolled in the study. There were no statistically significant differences in postoperative inflammatory complications in patients during the first and second days postsurgery. A statistically significant variation in body temperature was reported on the seventh day. Analysis of the postoperative analgesic intake did not show statistically significant differences between examined groups. Clindamycin applied in a single preoperative dose of 600 mg with or without subsequent 5-day therapy does not demonstrate efficacy in prophylaxis for postoperative inflammatory complications after third molar surgery.

Randomized clinical trial of conventional cholecystectomy versus minicholecystectomy

The main argument for laparoscopic cholecystectomy in preference to open cholecystectomy appears to be based on less traumatic incisions inflicted on the abdominal wall. To investigate the effects of different incision lengths on patients following elective open cholecystectomy, a randomized clinical study was conducted. In this study 130 patients were randomly assigned to undergo either open cholecystectomy through a transverse subcostal incision of mean length 5.8 cm, so called minicholecystectomy (65 patients), or to undergo conventional cholecystectomy through a paracostal incision of mean length 13.1 cm (65 patients). The perception of pain after operation was measured by a visual analogue scale. To register late complications the mean(s.d.) hospitalization period after operation was extended to 11.5(1.2) days in the minicholecystectomy group and 15.4(2.5) days in the conventional cholecystectomy group. The perceived pain and analgesic requirements were found to be similar in both groups. Twelve of 65 patients in the minicholecystectomy group and four of 65 in the conventional cholecystectomy group developed wound haematoma. On the basis of this prospective randomized study, the hypothesis that a smaller incision length on the abdominal wall could lower the level of perceived pain, and therefore decrease the postoperative analgesic intake after minicholecystectomy, could not be confirmed.