Postoperative VAS Pain Scores Research Articles

English

AIM: Aim of our study was to compare the relative effectiveness of gabapentin and clonidine premedication on patients undergoing elective abdominal surgeries under G.A. OBJECTIVE: gabapentine and clonidine have anti-nociceptive properties .This study assess their efficacy in prolonging the analgesic effect intra-operative and postoperative analgesic requirement. MATERIAL AND METHOD: 225 patients of either sex of age between 20-60 years, ASA grade I & II, patient admitted to Hamidia hospital for elective abdominal surgeries under general anaesthesia were included in the study. The patients were randomly allocated into three groups 75 each group I : Control group (patients received placebo tablet at 90 min before the surgery),group II Gabapentin 300 mg tablet orally 90 min before surgery ,groupIII:clonidine150µg tablet orally given 90 min before surgery. Duration of postoperative analgesia, Degree of postoperative pain (VAS score)and added rescue analgesia required in 24 hrs were recorded postoperatively. RESULT: Analysis reveled that there was no difference in the HR, SBP among the three group during the study. Duration of postoperative analgesia, observed from time of reversal to first demand of analgesia in the recovery room was more in group II compared to group I and group III (p-value <0.001, highly significant). Pain perception was highly blunted in groups II compared to group I & group III. Total rescue analgesic requirement during the postoperative 24hrs period was much lower in group II inj Diclofenac compared to group I and group III . ( p-value < 0.001, highly significant).CONCLUSION: Given 90 min before induction of GA oral gabapentin(300 mg) or clonidine(150 µg) preoperatively was effective in lowering postoperative VAS pain score and consumption of analgesics, it was also shows that gabapentin significantly decreases postoperative pain intensity and analgesic consumption after abdominal surgeries.

Multisegmental Spinal-Shortening Osteotomy for the Treatment of Tethered Cord Syndrome: A Retrospective Study of Six Consecutive Cases

Introduction Tethered cord syndrome often presents as low back pain in the early stage and progresses to sensory, motor, bowel, and bladder control dysfunctions. The pathogenesis of tethered cord syndrome is thought to be abnormal longitudinal traction on the caudal end of the spinal cord. Surgical detethering has been considered the gold standard for symptomatic tethered cord syndrome and consistently shown to be effective. However, complications such as cerebrospinal fluid leakage, infection, and neurologic deterioration including motor and bladder function are common. To minimize these complications, vertebral column subtraction osteotomy and pedicle subtraction osteotomy were reported as alternative procedures for the treatment of adult tethered cord syndrome. The concept of the procedures is to reduce neural tension indirectly. We present six consecutive cases with tethered cord syndrome that underwent a modified spinal-shortening osteotomy, which is multisegmental. Materials and Methods We retrospectively reviewed the surgical and radiological data of patients with tethered cord syndrome who underwent multisegmental spinal-shortening osteotomy (MSSO) by one doctor in one of the surgery groups at Changzheng Hospital from July 2009 to July 2013. The average follow-up period was 32 ± 7.5 months. Three patients were male and three were female and the average age at operation was 33 years (range, 16-57 years). MSSO were performed in patients, which required multilevel discectomy and facetectomy. The certain length gap created by the discectomy and facetectomy were then closed with serial compression through the domino connectors. Temporary rods were replaced with permanent rods once final spinal column alignment was achieved. The shortening of the spine was measured at the anterior and posterior borders and the midpoint of the vertebral end plate on the lateral fluoroscopy. Preoperative and postoperative VAS pain scores were evaluated. Results Six patients were followed up for 32 months in average and were included in the analysis. The length of spinal column shortening was 17 ± 1.7 mm. Urinary and sensory dysfunctions (two cases for each) were the most common residual deficits. Two (100%) patients with urological symptoms reported improvements, although deficits remained at the time of last follow-up. Six patients with lower-extremity motor dysfunction improved and six noted complete resolution of preoperative lower-extremity sensory symptoms. Five (100%) reported immediate low back or lower extremity pain relief following MSSO. VAS pain scores of all six patients were greatly improved after surgery. Complete bone union at the osteotomy site was noted in all cases at the time of last follow-up. Conclusion Most of the patients who have undergone MSSO in our study exhibited improvement of urological symptoms, complete recovery of motor functioning, and relief of debilitating back or lower extremity pain. Although many factors preclude a direct comparison of the symptomatic and functional outcomes following traditional surgical detethering compared with MSSO for TCS treatment, the outcomes are grossly similar regarding current literature. We believe that the principal benefits of MSSO over detethering operations will be in preserving the symptomatic and functional neurological improvements with lasting results and potentially obviating the need for future reoperations. However, longer follow-up results are needed from the MSSO series to support this belief. Disclosure of Interest None declared References Agarwalla PK, Dunn IF, Scott RM, Smith ER. Tethered cord syndrome. Neurosurg Clin N Am 2007;18(3):531–547 Alemdaroğlu KB, Atlihan D, Cimen O, Kilinç CY, Iltar S. Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves. Eur Spine J 2007;16(9):1451–1457 Hsieh PC, Stapleton CJ, Moldavskiy P, et al. Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date. Neurosurg Focus 2010;29(1):E6 Kanno H, Aizawa T, Ozawa H, Hoshikawa T, Itoi E, Kokubun S. Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture. Case report. J Neurosurg Spine 2008;9(1):62–66 Kawahara N, Tomita K, Kobayashi T, Abdel-Wanis ME, Murakami H, Akamaru T. Influence of acute shortening on the spinal cord: an experimental study. Spine 2005;30(6):613–620 Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine 2011;15(1):21–27 Miyakoshi N, Abe E, Suzuki T, Kido T, Chiba M, Shimada Y. Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. Spine 2009;34(22):E823-E825 Traynelis VC. Spine shortening of tethered cord. J Neurosurg Spine 2011;15(1):19-20, author reply 20

Minilaparotomy vs laparoscopic hysterectomy for benign gynaecological diseases

Hysterectomy is the most frequent gynaecological procedure carried out with either conventional (abdominal) or minimally invasive surgery (MIS). Despite the advantage of MIS compared with the conventional procedure, it requires extensive training and a long learning curve. Minilaparotomy hysterectomy is an alternative approach that needs no sophisticated and expensive equipment or training. The objective of this study was to compare the perioperative outcomes between minilaparotomy hysterectomy (MH) and laparoscopic hysterectomy (LH) in patients with benign gynaecological diseases. A significantly shorter operative time was obtained in MH. There was no significant difference in blood loss and perioperative complications. However, a higher intraoperative complication (two bladder injuries and one major blood loss) were observed in the LH. Early postoperative VAS pain scores and recovery time were insignificantly different between both groups. Overall patient satisfaction levels and satisfaction scores were found to be similar in both groups, without significant difference.

Butorphanol and propofol intravenous anesthesia for painless induced abortion

Objective To observe clinical efficacy and evaluate safety of butorphanol and propofol intravenous anesthesia for painless induced alortion so as to guide treatment.Methods 240 women undergoing painless induced abortion were randomly divided into three groups,group P adopting propofol only,group F adopting fentanyl and propofol,group B adopting butorphanol and propofol.Observed HR,MAP,SpO2,the dose of propofol,recovery time,intraoperative analgesic effect and postoperative uterine contraction pain VAS score of three groups.Results Compared with group P,HR,MAP,the dose of propofol,intraoperative analgesic effect and postoperative uterine contraction pain VAS score in group F,B were better (P＜ 0.05).SpO2 of group B was higher than that of group F.Conclusion Butorphanol and propofol can be applied in painless induced abortion,worthy of promotion. Key words: Butorphanol; Propofol; Fentanyl; Painless induced abortion

The Effects of Pregabaline on Postoperative Pain and Opioid Consumption Used Perioperatively in Patients Undergoing Modified Radical Mastectomy

In this study, effects of pregabaline on postoperative pain and opioid consumption used perioperatively in patients undergoing modified radical mastectomy(MRM) were investigated. Sixty ASA 1-2 patients scheduled for MRM were included. Patients were randomly divided into two and 30 patients were allocated into each group. Group Pregabaline was given pregabaline 150 mg 1 hr before operation and Group Placebo empty capsule. In both groups, anesthesia induction was obtained by penthotal, fentanyl and rocuronium and maintainence by sevoflurane, N2O and O2. Twelve hr after operation, Group Pregabaline was administered pregabaline 75 mg while Placebo group received empty capsule again. All patients received lornoxicam 8 mg iv 1 hr before end of surgery and ondansetrone 4 mg 30 min before. Patient-controlled analgesia device prepared with morphine was connected to both groups for postoperative analgesia. Postoperative VAS pain scores, hemodynamic parameters, morphine consumption, side-effects like nausea-vomiting, sedation and dizziness were followed and recorded. Demographic parameters were similar. VAS scores were significantly lower in Group Pregabaline at 1, 30 min, 1,4,8 and 12 hr (p<0.05). There was no significant difference in postoperative morphine consumption and need for additional dose, although they were higher in Placebo group. The patients in Placebo group had higher bothersome scores for side-effects. Hemodynamic parameters and other side-effects were similar. In our study, we showed that pregabalin administered perioperatively increased postoperative analgesic efficacy in MRM operations without making significant side effect, but did not change opioid consumption. We think that further studies about this topic must be held with different dose and patient groups.

Combined Arthroscopic and Mini-Open Treatment of CAM-Type Femoroacetabular Impingement

ABSTRACT Purpose Osteochondroplasty of the femoral head-neck junction can improve hip pain and function in patients with femoroacetabular impingement. We report our initial series of patients undergoing surgical treatment for symptomatic CAM type femoroacetabular impingement using a combined arthroscopic and mini-open approach. Materials and methods A retrospective chart review of 20 consecutive patients was performed. Seventeen patients had adequate follow-up for inclusion. Preoperative clinical and radiographic characteristics as well as intraoperative findings were obtained from patient records. Postoperative Harris Hip scores and VAS pain scores were recorded at final follow-up. Results At an average of 27.8 months (range 12-48 months), the mean Harris Hip score improved from 64.7 preoperatively to 86.8 (p &lt; 0.001). The mean VAS pain score improved from 4.80 to 1.53 (p = 0.001). Two patients (11.7%) underwent total hip arthroplasty at an average of 15 months postoperatively. Fourteen patients (82%) stated they would have the procedure again. There were no significant complications. Conclusion Surgical treatment of CAM type femoroacetabular impingement using a combined arthroscopic and mini-open anterior hip approach has a low complication rate and improves functional and pain scores at short-term follow-up. Watters TS, Kaufman AM, Solic JM, Stinnett SS, Olson SA. Combined Arthroscopic and Mini-Open Treatment of CAM-Type Femoroacetabular Impingement. The Duke Orthop J 2012;2(1):60-65.

Effect of premedication with mirtazapine versus ondansetron on postoperative nausea and vomiting in breast surgery

BackgroundMirtazapine is a specific serotonergic antidepressant drug. The aim of this study was to compare the efficacy of mirtazapine as PONV prophylaxis with a classic 5HT3 receptor antagonist; ondansetron.MethodsEighty female patients with high PONV risk undergoing prophylactic mastectomy with a standardized anesthetic were randomized to receive either an oral disintegrating tablet (ODT) of mirtazapine 30 mg (group M) or ondansetron 16 mg (group O) 1 h before surgery. Preoperative anxiety level was assessed by state and trait anxiety inventory before taking the study drug and 1 h after. Vital sign variables, the incidence of PONV, the use of rescue antiemetic, complete response, postoperative VAS pain scores, the inverted observer’s assessment of alertness/sedation scale and side effects were compared.ResultsMirtazapine premedication reduced preoperative state anxiety inventory scores (P < 0.01) and the incidence of early nausea and late vomiting (P < 0.05). The percentage of patient having complete responses during the first 24 h after anesthesia was 75% after mirtazapine and 65% after ondansetron prophylaxis. Anesthetic requirements, postoperative pain, sedation scores, and side effects were similar between the two groups.ConclusionMirtazapine prophylaxis reduces preoperative anxiety and the incidence of postoperative early nausea and late vomiting compared with ondansetron, without untoward sedative or cardiovascular effects.

Stellate ganglion blockade for analgesia following upper limb surgery

We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.

Haemorrhoidectomy with Ligasure™vs conventional excisional techniques: meta‐analysis of randomized controlled trials

To compare the use of LigaSure devices with conventional excisional techniques, circular stapling and use of Harmonic Scalpel in patients with symptomatic haemorrhoids and to review literature on LigaSure technology (Valleylab Inc. USA). A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords Ligasure, haemorrhoidectomy, vessel sealing technology. Randomized trials comparing LigaSure with other techniques of excisional haemorrhoidectomy with valid end points were reviewed in the present article and included in a quantitative meta-analysis. There was no significant difference in the proportion of patients cured after Ligasure haemorrhoidectomy or other excisional techniques (P > 0.05). Patients treated with LigaSure had a significantly shorter operative time (P < 0.001), postoperative pain VAS Score (P < 0.001), wound healing time and time-off from work (P < 0.001), than the patients submitted to excisional techniques. Postoperative bleeding did not significantly differ between the two groups (P = 0.056); however, the surgeons observed a reduction of intra- and postoperative bleeding using LigaSure. In comparison to the circular stapler and Harmonic Scalpel the authors found similar postoperative outcomes and a slightly favourable trend for LigaSure regarding postoperative complications, ease of handling and length of the procedure. Our meta-analysis shows that Ligasure haemorrhoidectomy is a fast procedure characterized by limited postoperative pain, short hospitalization, fast wound healing and convalescence.

In-Office Thermachoice III Ablation: A Comparison of Two Anesthetic Techniques

Background: Patient comfort and safety are prerequisites for office procedures. Study objective: comparison of the fentanyl transdermal patch with injection of local anesthesia for intraoperative/postoperative pain from in-office Thermachoice III ablations. Methods: Single-center prospective randomized (1:1) cohort study. Primary endpoint: intraoperative and postoperative VAS pain scores (0 as no pain, 10 as extreme pain). Secondary endpoints: patient satisfaction between cohorts and adverse events. Results: 41 patients were randomized [21 patch protocol (FP), 20 injection protocol (IP)]. For patch users, the median VAS scores were 2.60 (range 1–4) intraoperatively and 3.30 (range 2–5) postoperatively (p = 0.09, CI = –0.8 to 0.4), with the most common adverse events being nausea (62%) and vomiting (38%). Compared to injection, there was no significant difference in intraoperative VAS score (FP median VAS = 2.60, IP median VAS = 2.59; p = 0.15, CI = –0.05 to 0.48), but a significant difference postoperatively (FP median VAS = 3.30, IP median VAS = 6.0; p = 0.01, CI = –2.6 to –1.4). Less NSAIDs were used postoperatively with the FP. At 24 h, more FP patients were ‘very satisfied’ or ‘satisfied’ than IP patients. Conclusion: Patch intraoperative VAS pain scores are comparable to uterine block scores; postoperative VAS pain scores were statistically lower with the FP. FP resulted in more favorable ‘satisfaction’ rates compared to IP.

Preemptive intraarticular tramadol for pain control after arthroscopic knee surgery

The purpose of this study was to determine the effectiveness of intraarticular (ia) bupivacaine and tramadol injection and preemptive intraarticular tramadol in providing pain control after arthroscopic knee surgery. Following local research ethics committee approval, 60 patients were assigned in a randomized manner into three groups: Group I received ia 20 ml of 0.25 % bupivacaine at the end of the operation, Group II received ia 20 ml of 0.25 % bupivacaine and 100 mg of tramadol at the end of the operation and Group III received ia 100 mg of tramadol diluted in 20 ml of saline solution 30 minutes before skin inscision and 20 ml of 0.25% bupivacaine at the end of the operation as well. Analgesic duration, total analgesic consumption and postoperative VAS pain scores recorded at rest and with movement were significantly lower and patient satisfaction was significantly higher in Group II and III, compared to Group I. Total analgesic consumption and the number of patients requiring supplementary analgesics were significantly lower in the preemptive tramadol group compared to the postoperative tramadol group. In conclusion, preemptive ia tramadol provided effective and reliable pain control after artroscopic knee surgeries and may be preferred to postoperative administration.

A long-term evaluation of arthroscopy of the temporomandibular joint using holmium YAG laser

The aim of this in vivo study was report the long-term results of arthroscopic laser surgery for treatment of TMJ internal drangements (Wilkes class II-III). This report included 45 patients (42 women and 03 men) with an average age of 36.7 years old (14 to 66 years). There were 69 joints involved. The criteria for inclusion were patients who had complained of TMJ pain and dysfunction and had remained refractory to nonsurgical treatment for at least 3 months without resolution of the problem. All patients filled out a questionnaire preoperatively and postoperativelly for assessment of their signs and symptoms. The range of interincisal opening was measured preoperatively and at 1, 7, 30, and 60 days after the surgery. The postoperative questionnaire, radiographic evaluation, and the last measure of range of motion were performed with one year or more after the surgical procedures. The preoperatively and postoperativelly scores were compared and tested for statistically significant differences by the paired t-test (P>0.05). Forty-five patients (69 joints) have been followed postoperativelly for an average of 28.6 months. Maximal interincisal opening improved from a mean of 25.95mm to 35.91mm (+9.96mm) in seven days after the surgery; to 39.86mm (+3.95mm) after thirty day and; to 40.92mm (+1.06mm) after 60 days. The last measurement of maximal interincisal opening made after one year or more showed a mean of 42.15mm. All postoperative VAS pain scores showed a statistical significant improvement (p<0.05). The overall success rate for arthroscopy arthroplasty with Holmium YAG laser was 93.3% (42 of 45 patients) in a mean follow-up of 28.6 months. No complications were observed. Based on the results we can conclude that arthroscopic arthroplasty with Holmium laser is a safe and effective tool for the treatment of TMJ internal derangements.