Preemptive Analgesia Research Articles

COMPARISON BETWEEN PRE-EMPTIVE THORACIC EPIDURALANALGESIA VS CONVENTIONAL THORACIC EPIDURALANALGESIA IN PATIENTS UNDERGOING THORACOTOMY IN A TERTIARY CARE CENTRE

Background: Relative effects of timing of providing analgesia, type of surgery of local anaesthetics used for postoperative thoracic epidural analgesia and the possibility of establishment of pre-emptive analgesia as a superior mode for thoracic epidural analgesia are still in grey zone. In this observational study, we evaluated the idea of Pre-emptive thoracic epidural analgesia which can counter the post thoracotomy pain through pain scoring. Objective: To nd out whether pre-emptive thoracic epidural analgesia is superior to conventional postoperative epidural analgesia for post-thoracotomy pain. Study Design: Observational study. Place and Duration of Study: Department of Anesthesiology and Critical Care, Assam Medical College and Hospital, from Januray 2022 to January 2023. Methodology:After ethical committee approval and informed consent from patients, 22 patients undergoing thoracotomy were included in study. Preoperatively thoracic epidural catheter was inserted at T8-9 intervertebral space level. Group P was given 0.5ml/kg of 0.125% bupivacaine before induction of anesthesia; whereas group C was administered 0.5 ml 0.125% bupivacaine after closure of wound in supine position. All patients received thoracic epidural analgesia with a bolus dose of 0.1 ml/kg of 0.125% bupivacaine every 6 hourly post operatively .Visual analog scale (VAS) was used to assess pain severity at 1 and 24 hours postoperatively, both at rest and after cough (R1, R24, C1 and C24 respectively). Data were analyzed with SPSS and Microsoft Excel 2010. Results: There was no statistical difference in demographic prole of both groups in terms of age, gender, American Society of Anaesthesiologists (ASA) status or type of surgery, complications. Pain was signicantly less in group P at 1hour postoperatively (p=0.0001). However, there was no difference in pain severity at rest at 24 hours and with cough at 01 hour or 24 hours postoperatively. Conclusion: Pre-emptive thoracic epidural analgesia provides better pain control in immediate post operative period at rest. However, no such differences were observed in pain scores in immediate post operative period on coughing. No differences were observed at 24 hours at rest or coughing in both the groups

Effect of oral pre-emptive analgesia on pain management after total knee arthroplasty: a protocol for systematic review and meta-analysis

IntroductionTotal knee arthroplasty (TKA) is currently regarded as an effective treatment for knee osteoarthritis, relieving patients’ pain and significantly enhancing their quality of life and activity levels, allowing them to...

How I do VATS segmentectomy: the two-port approach

: The authors describe their bi-portal videoassisted thoracoscopic approach to perform anatomic segmentectomies. Operating room setting and details of individual segmentectomies performed through this approach are described. The approach consists of a 3–4 cm anterolateral utility incision performed at the level of 4th or 5th intercostal space and another 1–1.5 cm incision at the level of the 6–7th intercostal space performed just anterior to the posterior axillary line. In general, a wound protector is applied in the utility incision and a trocarless technique is used in the inferior port. The utility and the inferior incisions are used often interchangeably and the type and sequence of instrument introduced through one or the other port change depending on the type of segmentectomy. In general, for upper lobe segmentectomies, the thoracoscope is introduced in the utility incision, while for lower lobe segmentectomies it is positioned in the inferior port. All procedures start with lung inspection to identify the position of the tumour in relation to the preoperative imaging. A pre-emptive intercostal analgesia is performed. Subsequently, the segmentectomy procedure is performed with individual dissection and division of the segmental hilar structures and final division of the intersegmental plane. A systematic lymph node dissection is always performed.

Nociception Level Index-Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial.

Nociception is the physiological response to nociceptive stimuli, normally experienced as pain. During general anesthesia, patients experience and respond to nociceptive stimuli by increasing blood pressure and heart rate if not controlled by preemptive analgesia. The PMD-200 system from Medasense (Ramat Gan, Israel) evaluates the balance between nociceptive stimuli and analgesia during general anesthesia and generates the nociception level (NOL) index from a single finger probe. NOL is a unitless index ranging from 0 to 100, with values exceeding 25 indicating that nociception exceeds analgesia. We aimed to demonstrate that titrating intraoperative opioid administration to keep NOL <25 optimizes intraoperative opioid dosing. Specifically, we tested the hypothesis that pain scores during the initial 60 minutes of recovery are lower in patients managed with NOL-guided fentanyl than in patients given fentanyl per clinical routine. We conducted a randomized, single-center trial of patients having major abdominal open and laparoscopic surgeries. Patients were randomly assigned 1:1 to intraoperative NOL-guided fentanyl administration or fentanyl given per clinical routine. The primary outcome was pain score (0-10 verbal response scale) at 10-minute intervals during the initial 60 minutes of recovery. Our secondary outcome was a measure of adequate analgesia, defined as a pain score <5, assessed separately at each interval. With a planned maximum sample size of 144, the study was stopped for futility after enrolling 72 patients from November 2020 to October 2021. Thirty-five patients were assigned to NOL-guided analgesic dosing and 37 to routine care. Patients in the NOL group spent significantly less time with a NOL index >25 (median reduction [95% confidence interval {CI}] of 14 [4-25] minutes) were given nearly twice as much intraoperative fentanyl (median [quartiles] 500 [330, 780] vs 300 [200, 330] µg), and required about half as much morphine in the recovery period (3.3 [0, 8] vs 7.7 [0, 13] mg). However, in the primary outcome analysis, NOL did not reduce pain scores in the first 60 minutes after awakening, assessed in a linear mixed effects model with mean (standard error [SE]) of 4.12 (0.59) for NOL and 4.04 (0.58) for routine care, and estimated difference in means of 0.08 (-1.43, 1.58), P = .895. More intraoperative fentanyl was given in NOL-guided patients, but NOL guidance did not reduce initial postoperative pain scores.

Efficacy of Tramadol as Pre-emptive Analgesia in Mandibular Impacted Third Molar Surgery

Introduction: The pre-emptive analgesia is an alternative for treating postsurgical pain. It is given before the painful stimulus begins to prevent or reduce the development of any ‘’memory’’ of the pain stimulus in the nervous system. Objective: To investigate the existence of pre-emptive analgesic efficacy of Tramadol for impacted mandibular third molar surgery. Materials and methods: This was a prospective study carried out in Oral &amp; Maxillofacial Surgery Department; Dhaka Dental College &amp; Hospital.100 patients were included and were randomly divided into two groups. Study group received injection Tramadol 50mg, 20 minutes before surgery. Control group did not receive pre-emptive analgesic. Study parameters included (1) Pain intensity scores, (2) Time to 1st rescue analgesia and (3) Total number of analgesics consumed during the 5 post-operative days. Results: Study group reported considerable pain relief in the day of surgery at hours 1, 3 and 5 with significantly lower pain intensity scores. When the mean time to first rescue analgesic was assessed, study group reported a longer pain free interval with the mean time being 7.46±1.11 hours for study and 2.43±1.72 hours for control group. Patients in the control group consumed maximum number of rescue analgesics during the 5 post-operative days and Tramadol proved more efficient by consuming fewer rescue analgesics [p&lt;0.001]. Conclusion: Tramadol has significant pre-emptive analgesic efficacy.

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery.

Vitreoretinal surgery (VRS) is one of the most widely performed precise procedures in ophthalmic surgery; the majority of cases are carried out under regional anaesthesia (RA) only. However, in specific situations (such as when the patient fails to cooperate with the operator for various reasons), general anaesthesia (GA), alone or in combination with GA (combined general-regional anaesthesia, CGR), is the only safe way to perform VRS. While monitoring the efficacy of an intraoperative rescue opioid analgesia (IROA) during surgery (assessing the adequacy of anaesthesia (AoA)) may be challenging, the surgical pleth index (SPI) is a useful tool for detecting the reaction to noxious stimuli and allows for the rational titration of opioid analgesics (AO) during surgery. The current study investigated the influence of the SPI-based titration of fentanyl (FNT) in combination with various pre-emptive analgesia (PA) techniques on intraoperative pain perception during various stages of VRS performed under AoA. A total of 176 patients undergoing VRS under GA were enrolled in the study. They were randomly assigned to one of the five following study arms: Group GA (control group)-patients who received general anaesthesia alone; Group PBB-GA with preprocedural peribulbar block (with 0.5% bupivacaine and 2% lidocaine); Group T-GA with preventive, topical 2% proparacaine; Group M-GA with a preprocedural intravenous infusion of 1.0 g of metamizole; and Group P-GA with a preprocedural intravenous infusion of 1.0 g of paracetamol. The whole procedure was divided in four stages: Stage 1 and 2-preoperative assessment, PA administration, and the induction of GA; Stage 3-intraoperative observation; Stage 4-postoperative observation. the SPI values were monitored during all stages. The occurrence of nociception (expressed as ∆SPI >15) during various manipulations in the surgical field was observed, as were cumulative doses of rescue analgesia, depending on the PA administered. During the course of VRS, rescue FNT doses varied depending on the stage of surgery and the group investigated. The majority of patients, regardless of their group allocation, needed complementary analgesia during trocar insertion, with Group GA patients requiring the highest doses. Likewise, the highest cumulative doses of IROA were noted during endophotocoagulation in Group GA. Preventive PBB and topical anaesthesia were proven to be most efficient in blunting the response to speculum installation, while topical anaesthesia and paracetamol infusion were shown to be more efficient analgesics during endophotocoagulation than other types used PA. In the performed study, none of the PA techniques used were superior to GA with FNT dosing under the SPI with respect to providing efficient analgesia throughout the whole surgery; there was a necessity to administer a rescue OA dose in both the control and investigated groups.

Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study.

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Dexmedetomidine or Fentanyl, Which One Is Better as an Adjunct Drug in Epidural Anesthesia and Causes More Postoperative Pain Reduction? A Comparative Study, a Randomized Clinical Trial.

This study compared dexmedetomidine to fentanyl as an adjunct to ropivacaine for epidural anesthesia in patients undergoing femoral neck fracture surgery. A total of 56 patients in two different groups with dexmedetomidine and fentanyl underwent the epidural anesthesia method by ropivacaine. This study compared the onset and duration of sensory block, duration of motor block, visual analog scale (VAS) analgesia, and sedation score. The VAS and hemodynamics (e.g., heart rate and mean arterial pressure) were measured every 5 to 15 minutes, then every 15 minutes to the end of the surgery, and then in the 1st, 2nd, 4th, 6th, 12th, and 24th hours after surgery. In the fentanyl group, the onset time of the sensory block was longer (P < 0.001), and the duration of the block was shorter than in the dexmedetomidine group (P = 0.045). In the fentanyl group, the onset time of motor block was longer than in the dexmedetomidine group (P < 0.001). The mean highest VAS score for each patient in the dexmedetomidine group was 4.9 ± 0.6, compared to the fentanyl group (5.8 ± 0.9), with a significant difference between the two groups (P < 0.001). The sedation score was higher from the 30th minute (P = 0.01) to the 120th minute (P = 0.04) in the patients of the dexmedetomidine group than in the fentanyl group. Side effects, such as dry mouth, hypotension, and bradycardia, were more common in the dexmedetomidine group, and nausea and vomiting were more common in the fentanyl group; however, there were no differences between the groups. There was no respiratory depression in both groups. This study presented that dexmedetomidine as an adjuvant in epidural anesthesia for orthopedic femoral fracture surgery shortens the onset time of sensory and motor block, increases analgesia length, and prolongs anesthesia. Sedation with dexmedetomidine is better than fentanyl, with fewer side effects, and more effective as preemptive analgesia.

Role of Intervenous Paracetamol as Preemptive Analgesic for Laparoscopic Cholecystectomy

Objective: The purpose of this study was to evaluate the comparative effectiveness of preemptive paracetamol against placebo for laparoscopic cholecystectomy. Methods: After the approval from Institute review board, this randomized control trial was conducted at Department of Anesthesia, KTH, Peshawar, from 1st August 2020 to 31st January 2021. A total of 60 patients of both gender undergoing laparoscopic cholecystectomy were included in the study. Patients of Group A (n=30) received I.V Paracetamol 10mg/kg (100ml) and Group B (n=30) received 100 ml of Normal saline 10 min before skin incision. Efficacy was noted as per operational definition and noted. Results: Mean age of patients in group A and B was 34.200±5.56 and 35.900±6.28 years. Mean duration of complain in group A and B was 11.333±3.53 and 10.366±2.51 months. Mean duration of procedure in group A and B was 70.533±10.95 and 72.666±10.58 minutes. Females were predominant in the present study, with 66.7% females in group A while 60% in Group B. 22 of the patients in Group A (73.30%) had success, whereas only 10 of the patients in Group B (33.30%) did so (P= 0.002). Practical implication: this study will help to demonstrate either paracetamol can be used as analgesic in laparoscopic cholecystectomy Conclusion: In conclusion, our research shown that paracetamol had an analgesic impact on cholecystectomy patients shortly after surgery. Keywords: Laparoscopic cholecystectomy, Paracetamol, Placebo, Efficacy

Effect of Preemptive Multimodal Analgesia Regimen on Post-operative Epidural Demand Boluses in Lower Limb Orthopaedic Surgeries.

Introduction Excruciating pain is associated with lower limb orthopaedic surgeries involving femoral shaft fractures. Postoperative pain management is still ineffective in low-resource settings where the use of epidural and opioid-free analgesia is impractical. Literature is scarce with respect to the effect of a preemptive multimodal analgesia regimen on the requirement of postoperative epidural demand boluses.Hence, the present study aimed to evaluate the effectof pre-emptive multimodal analgesia in reducing the requirement of epidural demand boluses postoperatively, and to find out the time required to receive the first epidural bolus. Material and methods This double-blinded randomized control study included 48 subjects. Patients aged 18-60 years with lower limb fractures requiring surgery under combined spinal-epidural anesthesia were included. Patients were divided into two groups through random allocation. Group A: Preemptive multimodal group received intravenous paracetamol 1 g, IV diclofenac 75 mg diluted in 100ml NS, IV tramadol 50mg diluted in 100ml NS and tab pregabalin 75 mg orally, 30 mins before surgery. Group B:Placebo group received 3 pints of 100ml NS IV and tab ranitidine 150 mg, 30 mins before surgery. Intraoperatively, combined spinal-epidural anaesthesia was administered taking all theaseptic precautions. Visual analogue scale (VAS) was recorded immediately on shifting to a postoperative room, and then at 1, 4, 8, 12, and 24 hr for both groups. Epidural boluses (10 ml of 0.125% bupivacaine with 2 μg/ml of fentanyl) were given whenever the patient's visual analogue scale was more than 4. The time at which the first epidural bolus was required by the patient was recorded. The total number of epidural boluses given over 24 hours based on VAS was recorded for both, the preemptive and placebo groups. If the patient still complained of pain, IV diclofenac 75 mg was given if the VAS was more than 4, while IV diclofenac 75 mg along with IV tramadol 50 mg was given if the VAS was more than 6. Patient satisfaction with anesthesia care, in general, was assessed 24 hrs postoperatively. Results A total of 48 subjects were included in the study. During the immediate-postoperative period, and at 8, 12 and 24 hr, the median VASwas significantly low in group A as compared to group B. A significant increase in the demand for epidural bolusimmediate-postoperatively was observed in group B (70.83%) compared to group A (4.17%) (p-value of <0.001).At 8 hr, 12hr, and 24hr, patients in group A found a significantly less need for epidural boluses compared to Group B. The mean total number of epidural boluses taken in group A was significantly less compared to group B (1.79 ± 0.41 VS 3.33 ± 0.48, p-Value <0.001). In group A, all patients reported no requirement for diclofenac and tramadol. In group B, 8.33% required diclofenac 75 mg, while the remaining 91.66% had no requirement for diclofenac and tramadol. The difference in patient satisfaction with anaesthesia care in general between the two study groups was found to be significant with a p-value of 0.027. Patients in Group A were very satisfied compared with those in group B. Conclusions The study found that the pre-emptive multimodal analgesia group had better postoperative pain control because they required fewer epidural boluses and no extra analgesics postoperatively. This group was more satisfied with the anaesthesia care in general.

Application of sequential multimodal analgesia before and after impacted mandibular third molar extraction: Protocol for a randomized controlled trial

BackgroundSeveral analgesics have been applied under various protocols to control the moderate-to-severe postoperative pain caused by the surgical extraction of an impacted mandibular third molar. However, a consensus on optimal pain management while minimizing side effects is yet to be reached. MethodsThis multi-center, prospective, double-blind, randomized controlled trial aims to evaluate the efficacy and safety of sequential multimodal analgesia combined with postoperative zaltoprofen along with multiple preemptive analgesics. A total of 80 participants with bilateral impacted mandibular third molar from two hospitals were randomized into two groups. Two surgical extractions were performed at one-month intervals, and in a crossover design, celecoxib or tramadol/acetaminophen was administered before one extraction and placebo before the other extraction. Following extraction, all subjects took zaltoprofen for 5 days. The outcome measures included pain at specific times, time and intensity of the first pain onset after extraction, need of rescue drugs, and occurrence and frequency of side effects. ConclusionsThis ongoing clinical trial was designed to provide evidence regarding a new protocol for effective postoperative pain management of a commonly performed surgical extraction. The results of this study will provide guidance to clinicians regarding the timing and combination of oral analgesics in various oral surgeries performed under local anesthesia. Trial registrationKCT0005450, registered on October 7, 2020.

Preemptive Levetiracetam Decreases Postoperative Pain: A Double-Blind, Randomised, Control Trial.

Background Previously many studies have found the use of anti-epileptic drugs such as pregabalin, carbamazepine, and gabapentin in pain management. In addition, levetiracetam (LEV), an effective anti-epileptic drug, has shown analgesic effects in animal models. We aimed to evaluate the effect of oral LEV as pre-emptive analgesia in patients who underwent laparoscopic cholecystectomy under general anaesthesia and postoperative fentanyl requirements. Material and methods Forty-two patients of the American Society of Anaesthesiologists (ASA) grade I and II of either gender posted for elective laparoscopic cholecystectomy surgery were included in this double-blind, randomised, placebo-controlled study. Patients were divided into two equal groups of 21 each to receive either tablet LEV 500 mg or a matching placebo tablet, given 1 hour before surgery. Postoperative pain was assessed by a visual analogue scale (0-100 mm), where 0 meant no pain and 100, worst pain. In addition, patients received IV fentanyl as rescue analgesia during the first 24 hours of the postoperative period. Results Nineteen patients in the LEV group and 20 in the placebo group completed the study. Patients in the LEV group had significantly lower pain scores at all time intervals except 0 hours and reduced fentanyl consumption postoperatively in the first 24 hours (p<0.05). Side effects were comparable in both groups. Conclusion A single, preoperative dose of oral LEV 500 mg significantly decreases post-surgical pain and fentanyl demand as rescue analgesia in elective laparoscopic cholecystectomy.

Effects of Early Weight-Bearing Treadmill Training Combined with Pre-Emptive Analgesia on Femoral Fracture Recovery.

The effect of pre-emptive analgesia plus early weight-bearing treadmill training (EWBTT) on healing and motor function recovery of femoral shaft fracture is not clear. A total of 60 SD male rats were randomly allocated into 4 groups: group A (pre-emptive analgesia with EWBTT), group B (pre-emptive analgesia with delayed weight-bearing treadmill training, DWBTT), group C (pre-emptive analgesia with no weight-bearing), and group D (EWBTT with no pre-emptive analgesia). All rats were molded by internal fixation with Kirschner wire after right femoral shaft fracture. In groups A, B, and C, tramadol was intramuscularly injected 15 minutes before surgery. EWBTT was performed at day 1 postoperatively in groups A and D, and DWBTT was performed at day 14 postoperatively in group B. Oblique plate test was accomplished to assess hindlimb motor function recovery of rats in each group. Status of fracture healing was assessed through digital radiography (DR). Hematoxylin-eosin (HE) staining and immunohistochemistry of bone morphogenetic protein-2 (MBP-2) and vascular endothelial growth factor (VEGF) in callus were performed to explore fracture healing. The expression of BMP-2 and VEGF protein in quadriceps femoris muscle was detected by Western blot technique and mRNA expression of BMP-2 and VEGF in callus ascertained via reverse transcription-polymerase chain reaction (RT-PCR) technique. For oblique plate test, rats in group A outperformed those in groups B and C at all time points after operation. DR image revealed that large numbers of callus growth, blurred fracture line, and obvious continuous callus passing through the fracture line can be found in group A at day 28 postoperatively, which is the best healing status among all groups. HE staining of callus confirmed the optimal effect of healing for rats in group A. VEGF and BMP-2 expression by immunohistochemistry showed a significantly higher positive score for callus in group A while those in group C being the lowest at all time points postoperatively. Significantly higher expression level of VEGF and BMP-2 protein was detected in quadriceps femoris muscle from group A, which exceeded those in all other groups at all time points. RT-PCR testing proved the highest expression of BMP-2 and VEGF mRNA in callus of rats from group A, significantly higher than those of other groups. Both pre-emptive analgesia and EWBTT can effectively invoke the expression of VEGF and BMP-2 and promote recovery of hindlimb locomotor function in rats with femoral fracture, and the combination of them leads to more superior results.

Retracted: Effects of Early Weight-Bearing Treadmill Training Combined with Pre-Emptive Analgesia on Femoral Fracture Recovery.

[This retracts the article DOI: 10.1155/2023/8498062.].

Efficacy of preventive nalbuphine and dexmedetomidine analgesia for post-operative pain in endoscopic sinus surgery: A randomized controlled study

Background: Chronic sinusitis, nasal polyps, and other sinus-related illnesses are common conditions that can be treated with endoscopic sinus surgery (ESS). However, some patients may experience pain or discomfort after the procedure. Pre-emptive analgesia is a method used to reduce post-operative discomfort and the need for painkillers. Recently, there has been growing interest in studying the potential use of nalbuphine and dexmedetomidine as preventative analgesics in ESS. Aims and Objectives: This study aimed to determine the effectiveness of nalbuphine and dexmedetomidine in reducing post-operative pain and opiate use in ESS patients, a randomized controlled trial. Materials and Methods: Ninety patients were randomly selected and given nalbuphine, dexmedetomidine, or a placebo before anesthesia induction. Pain ratings, opioid use, and adverse effects were monitored during the post-operative period. Results: The results showed that both nalbuphine and dexmedetomidine significantly reduced post-operative pain ratings and opioid usage compared to the placebo. Dexmedetomidine was found more effective than nalbuphine in reducing pain, and patients who received it experienced less nausea and vomiting in the first few days after surgery. However, the occurrence of sedation or respiratory depression was not significantly different among the groups. Conclusion: The study concludes that nalbuphine and dexmedetomidine can effectively reduce post-operative pain and opiate use in ESS patients as preventative analgesia. Dexmedetomidine may be a better option due to its superior analgesic effect and lower incidence of nausea and vomiting. These findings may lead to improved pain management and patient satisfaction following ESS procedures.

Retracted: Efficacy of Different Preemptive Analgesia on Postoperative Analgesia, Oxidative Stress, and Inflammatory Response after Gynecological Laparoscopic Surgery.

[This retracts the article DOI: 10.1155/2021/4233716.].

A Comparative Study Between Oral Pregabalin and Gabapentin in Prolongation of Postoperative Pain Relief after Spinal Anaesthesia

Background: Management of pain and its complications in postoperative period still a major challenge. Generally,the pathophysiology and treatment of postoperative pain and neuropathic pain have been considered as separateand distinct, though, there is considerable overlap in their pathophysiology.Materials &amp; Methods: The present study was designed as randomized, double blinded, parallel group, open labeltrial to compare the efficacy of pregabalin and gabapentin as preemptive analgesics in surgery below umbilicusunder spinal anaesthesia. This study was conducted under the Department of Anesthesiology, in the R.G. KarMedical College &amp; Hospital, Kolkata. Sixty two patients, aged between 20-50 yrs, ASA grade I and II, scheduled toundergo infra umbilical surgery, were randomly divided into 2 groups. In group G (n=31) they received 1200 mggabapentin, in group P (n=31) they received 300 mg pregabalin capsules, orally with sips of water, 1 hour beforethe induction of anesthesia. Routine monitoring in the form of NIBP, Pulse oxymetry and ECG were instituted onarrival in Operation Theatre. All patients were preloaded with 10 ml/kg lactated Ringer’s solution before beingadministered spinal anesthesia. Spinal anesthesia was instituted with 3 ml of 0.5% bupivacaine (15 mg) at L3 – L4/ L4 - L5 level.Results: All the groups were comparable in respect to demographic data, ASA physical status, the mean durationof surgery and the type of surgeries performed between them. In the 24 hrs of post-perative period the mean VASscores at rest of Groups P was always significantly lower than those of Group G. The time to first dose of rescueanalgesic was compared between the groups, as in Group G (gabapentin group) rescue analgesic was given after9.41±1.84 hrs, while in Group P (pregabalin group) rescue analgesic was required after 15.38±3.52 hrs. Hence, ascomparison of pregabalin and gabapentin could be made for these parameters, and it was possible to come to aconclusion as the superiority of pregabalin over gabapentin.Conclusion: In conclusion, a single oral dose of pregabalin given preoperatively provides better postoperative pain control and decreases postoperative rescue analgesic consumption compared to single dose of gabapentin,based on lower mean VAS scores at rest.

Efficacy of Lornoxicam as a Pre-emptive Analgesic in Mandibular Third Molar Surgery - A Comparative Study.

The most common complication following third molar surgery is pain. The purpose of the study is to determine the efficacy of lornoxicam as a preventive analgesic in patients undergoing surgical removal of impacted mandibular third molars. This study included 26 participants aged 18-28 years with bilateral symmetrical third molars. Group A, the control group, received lornoxicam 8 mg 1 h after surgery, whereas Group B, the study group, received lornoxicam 8 mg 1 h before surgery. All patients were evaluated for pain at the 1st, 2nd, 4th, 6th, 8th and 12th post-operative hours. The number of rescue analgesics taken within 24 h of the procedure, as well as the first occurrence of pain postoperatively, was recorded and analysed. Using the Mann-Whitney U-test and Friedman's analysis, the resulting data were statistically analysed. When Group B was compared to Group A, there was a significant difference in pain reduction levels in the immediate post-operative hours. When compared to Group A, Group B had a lower need for rescue analgesics within the first 24 h postoperatively. Following mandibular third molar surgery, pre-emptive use of lornoxicam is effective in reducing post-operative pain and reducing the need for rescue analgesic consumption.

A comparison of postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) versus standard opioid anesthesia using intravenous tramadol (2 mg/kg) for preemptive analgesia in abdominal surgeries under general anesthesia

A comparison of postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) versus standard opioid anesthesia using intravenous tramadol (2 mg/kg) for preemptive analgesia in abdominal surgeries under general anesthesia

Effects of oxycodone hydrochloride and dezocine on hemodynamics and levels of inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia

We aimed to compare the effects of oxycodone hydrochloride and dezocine on hemodynamics and inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia. A total of 246 patients were divided into group A and B (n=123). Hemorheology indices were recorded 5 min after anesthesia (T0), 1 min after pneumoperitoneum (T1), when position was changed 5 min after pneumoperitoneum (T2), 15 min after pneumoperitoneum (T3), 1 min (T4) and 5 min (T5) after position was restored. Visual analogue scale scores 1, 2, 6, 12, 24 and 48 h after operation were recorded. Postoperative adverse reactions and visceral pain were observed. The expression levels of inflammatory factors were detected by enzyme-linked immunosorbent assay 12 h after operation. Compared with group A, group B had higher heart rate and mean arterial pressure at T2, lower central venous pressure and cardiac output at T1-T3, and higher systemic vascular resistance at T1-T5 (P<0.05). The incidence rate of pain syndrome in group A was lower (P<0.05). Group A had lower tumor necrosis factor-alpha and interleukin-6 expression levels and higher interleukin-10 level than those of group B (P<0.05). For gynecological laparoscopic surgery, oxycodone preemptive analgesia has superior outcomes to those of dezocine.