Prevention Of Postoperative Pain Research Articles

Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain

Widely used for acute pain management, the clinical benefit from perioperative use of gabapentinoids is uncertain. The aim of this systematic review was to assess the analgesic effect and adverse events with the perioperative use of gabapentinoids in adult patients. Randomized controlled trials studying the use of gabapentinoids in adult patients undergoing surgery were included. The primary outcome was the intensity of postoperative acute pain. Secondary outcomes included the intensity of postoperative subacute pain, incidence of postoperative chronic pain, cumulative opioid use, persistent opioid use, lengths of stay, and adverse events. The clinical significance of the summary estimates was assessed based on established thresholds for minimally important differences. In total, 281 trials (N = 24,682 participants) were included in this meta-analysis. Compared with controls, gabapentinoids were associated with a lower postoperative pain intensity (100-point scale) at 6 h (mean difference, -10; 95% CI, -12 to -9), 12 h (mean difference, -9; 95% CI, -10 to -7), 24 h (mean difference, -7; 95% CI, -8 to -6), and 48 h (mean difference, -3; 95% CI, -5 to -1). This effect was not clinically significant ranging below the minimally important difference (10 points out of 100) for each time point. These results were consistent regardless of the type of drug (gabapentin or pregabalin). No effect was observed on pain intensity at 72 h, subacute and chronic pain. The use of gabapentinoids was associated with a lower risk of postoperative nausea and vomiting but with more dizziness and visual disturbance. No clinically significant analgesic effect for the perioperative use of gabapentinoids was observed. There was also no effect on the prevention of postoperative chronic pain and a greater risk of adverse events. These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients.

The Effect Of Preoperative Gabapentin on Pain Severity After Posterior Urethral Surgery: A Randomized, Double-Blind, Placebo-Controlled Study.

Prevention and treatment of urethroplastic postoperative pain is a major challenge in post-surgery care. gabapentin can treat postoperative pain by preventing excessive sensitivity to the central nervous system. we have tried to compare the effect of gabapentin with the placebo on reducing the pain associated with posterior urethroplasty in patients. This prospective, randomized, double-blind study was scheduled in Shohad e Tajrish hospital where a single dose of Gabapentin was compared with placebo given to patients preoperatively. In this study,100 patients with posterior urethral stricture were included for surgery with 50 patients in each arms .All patients underwent posterior urethroplasty. After surgery, the pain level is assessed and evaluated by the visual analog scale in two hours,four hours, six hours,eight hours, twelve hours, and 24 hours after the operation. In this study, there was a significant difference in the pain level that was evaluated by the visual analog scale in two hours, four hours, six hours, eight hours, twelve hours, and 24 hours after the surgery (p.value <0.001). We also found a significant decrease in morphine consumption in the gabapentin group vs the placebo group. (p.value <0.001) The post-surgery assessments showed significant lower adverse effects such as vomiting, nausea, drowsiness, and pruritus in the gabapentin group vs. placebo group. The consequences of this study revealed that gabapentin effective in controlling posterior urethroplasty postoperative pain, consumption of opioid, nausea, vomiting, drowsiness, and pruritus compared with the placebo group.

Dolor inguinal crónico posquirúrgico. Una revisión narrativa

Inguinodynia or chronic postoperative inguinal pain is a growing problem between patients who undergo surgical repair of an inguinal hernia. The change in results measurement proposed by many authors towards Patient Reported Outcome Measurement has underlined the importance of chronic postoperative inguinal pain, because of the great limitations in everyday life and the huge socioeconomic impact that it causes. In this article a narrative review of the available literature in PUBMED, EMBASE and Cochrane Library is performed and the most relevant aspects about epidemiology, etiology prevention, diagnosis and treatment of chronic postoperative inguinal pain are discussed. A new management algorithm is also proposed. The variability in its incidence and clinical presentation makes diagnosis of chronic postoperative inguinal pain a very challenging issue. There is no standardized therapy and an adequate etiological diagnosis is key point for a successful treatment. There are many treatment options that have to be sequentially used and adjusted to each patient and their clinical features.

Evaluation of the Effects of Preoperative Dexamethasone Administration on Postoperative Patient Comfort in Laparoscopic Cholecystectomy.

ObjectivePostoperative recovery process following laparoscopic cholecystectomy depends on many factors such as pain, fatigue and exhaustion. The objective of this study was to investigate whether the administration of dexamethasone, a glucocorticoid, has positive effects of postoperative patient comfort in patients who underwent laparoscopic cholecystectomy in our clinic.MethodsPatients who presented to the general surgery clinic of our hospital and scheduled for laparoscopic cholecystectomy due to cholelithiasis were included in this study. Patients in Group 1 received dexamethasone 90 minutes before the skin incision, while patients in Group 2 were given placebo (normal saline). Pain scores, presence of nausea and vomiting in the postoperative period were compared between the study and control groups.ResultsNo statistically significant difference was observed between the groups in terms of incisional pain at rest and in motion and visceral pain at rest at postoperative 6th, 12th and 24th hours. Although there was a difference between the groups in terms of visceral pain in motion at the postoperative 12th and 24th hours, this was not statistically significant (p > 0.05). Although the need for additional analgesics and antiemetic drugs was lower in the study group compared to the control group, the difference between the groups was not statistically significant (p > 0.05).ConclusionWe can expect better results with the use of multimodal analgesic and anti-emetic combination instead of a single agent in studies to be performed about the prevention of postoperative pain, nausea and vomiting.

Clonidine for pain in non-ventilated infants.

Critically ill newborn infants undergo a variety of painful procedures or experience a variety of painful conditions during their early life in the neonatal unit.In the critically ill paediatric and neonatal population, clonidine is prescribed as an adjunct to opioids or benzodiazepines aiming to reduce the doses of these drugs that are required for analgesia or sedation, or to facilitate weaning from mechanical ventilation. It has been shownthat clonidine premedication might have a positive effect on postoperative pain in children. To assess the benefit and harms of clonidine for the prevention or treatment of procedural pain; postoperative pain; or pain associated with clinical conditions in non-ventilated neonates. We used the standard search strategy of Cochrane Neonatal to search the CENTRAL, MEDLINE via PubMed, Embase, and CINAHL to December 2018. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We ran an updated search from 1 January 2018 to 11 March 2020 in CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. Randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing clonidine to placebo or no treatment, opioids, paracetamol, dexmedetomidine, or non-pharmacological pain-reducing interventions for the management of procedural pain, postoperative pain, and pain associated with clinical conditions in preterm and term newborns. Two review authors independently planned to extract data (e.g. number of participants, birth weight, gestational age, modality of administration, and dose of clonidine) and assess the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcome considered was pain: for procedural pain, the mean values of each analgesia scale assessed during the procedure and at one to two hours after the procedure; for postoperative pain and for pain associated with clinical conditions, the mean values of each analgesia scale assessed at 30 minutes, three hours, and 12 hours after the administration of the intervention. We planned to use the GRADE approach to assess the quality of evidence. Our search strategy yielded 3383 references. Two review authors independently assessed all references for inclusion. We did not find any completed studies for inclusion. We excluded three trials where clonidine was administered for spinal anaesthesia. We did not find any studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of clonidine for the prevention or treatment of procedural or postoperative pain, or pain associated with clinical conditions in neonates.

COMPARATIVE STUDY BETWEEN NASAL PACKING WITH CARBOXY METHYL CELLULOSE AND LATEX GLOVED MEROCEL IN THE SAME PATIENT AFTER FUNCTIONAL ENDOSCOPIC SINONASAL SURGERY

Background: Nasal packing after functional endoscopic sinus surgery (FESS) is used as a standard procedure to control the postoperative bleeding, promote the mucosal healing and to prevent synechiae formation, but traditional non-resorbable packs have several disadvantages. The optimum solution to minimize these disadvantages may be accomplished using the new biodegradable packs. Objectives: This study was done to compare between the effect of carboxy methyl cellulose (CMC) foam nasal pack and latex gloved merocel (LGM) nasal pack in the same patient after FESS regarding the prevention of postoperative bleeding, pain and synechiae formation. Patients and Methods: A prospective, randomized, single-blinded controlled study was performed in 35 patients with bilateral chronic rhinosinusitis who were collected from ENT outpatient clinic of Al-HusseinUniversityHospital from Feb. 2019 to Nov. 2019. All patients underwent bilateral FESS by a single surgeon. At the end of the operation, each patient was packed with dissolvable CMC foam nasal pack in one nasal cavity and latex gloved merocel nasal pack in the other side. The hemostatic effect of the CMC foam and latex gloved merocel was assessed during the recovery period. Pain levels were recorded by the patients on a visual analogue scale 2, 6, 12 and 24 hours after surgery and at the time of packing removal. The effectiveness of prevention of synechiae formation was assessed endoscopically 4 and 8 weeks after surgery. Results: There was no statistically significant difference between CMC group and LGM group as regard their effect on control the postoperative bleeding. Only five (14.3%) of the CMC group had primary postoperative bleeding, and it occurred in three (8.6 %) of gloved merocel group. The mean level of patient pain was 0.98 (Range: 0-2) in CMC group, but was 1.65 (Range: 1-3) in latex gloved merocel group which is statistically significant. As regarding synechiae formation, the difference between both groups was statistically insignificant at the 4 weeks period] Two (5.7%) of CMC group and five (14.3 %) of LGM group developed a synechiae [and statistically significant at the 8 weeks period] three (8.6%) of CMC group and nine (25.7 %) of gloved merocel group developed synechiae]. Conclusion: Dissolvable CMC foam nasal pack was associated with very low levels of localized pain, and with low levels of postoperative bleeding and synechia formation.

Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial

BACKGROUND: Post-operative nausea and vomiting (PONV) and pain are a common complications of adult patients undergoing anesthesia, but the incidence of these complications in patients go through laparoscopic cholecystectomy or open appendectomy is unknown.&#x0D; AIM: We conduct this study for comparing the effect of dexamethasone administration with normal saline and with metoclopramide for reducing these undesirable effects.&#x0D; DESIGN: This was a three-armed, parallel-group, double-blind, and randomized controlled clinical trial.&#x0D; METHODS: Seventy-two patients of both genders underwent elective surgeries (laparoscopic cholecystectomy or open appendectomy), randomly assigned to three groups: A dexamethasone-treated (8 mg) group (Group 1) (n = 24), normal saline-treated (100 ml) group (Group 2) (n = 24), and metoclopramide-treated (10 mg) group (Group 3) (n = 24). All nausea, vomiting, and pain episodes were recorded during 24 h after anesthesia in three time periods: 0–4, 4–12, and 12–24 h post-anesthesia.&#x0D; Results: Nausea and vomiting grading scale shows no significant difference when compare dexamethasone (Group 1) with normal saline (Group 2), significant difference when compare dexamethasone (Group 1) with metoclopramide (Group 3), and also significant difference when compare normal saline (Group 2) with metoclopramide (Group 3). Group 1 showed a lower pain score (p &lt; 0.01 and p &lt; 0.0001) compared with pain score recorded by patients of Groups 2 and 3, respectively. Besides that, Group 2 also showed a lower pain score (p &lt; 0.0001) compared with pain score recorded by Group 3 patients.&#x0D; CONCLUSION: Dexamethasone has unimportant effect when compare with normal saline, more effectiveness than metoclopramide in reducing PONV. However, dexamethasone more effective in reducing pain when comparing with normal saline and metoclopramide for patients they underwent laparoscopic cholecystectomy or open appendectomy surgery under general anesthesia.

Comparative study for effectiveness of preemptive analgesia on postoperative pain and swelling following gingivectomy

Comparative study for effectiveness of preemptive analgesia on postoperative pain and swelling following gingivectomy - IJPI- Print ISSN No: - 2581-9836 Online ISSN No:- 2457-0087 Article DOI No:- 10.18231/j.ijpi.2020.006, IP International Journal of Periodontology and Implantology-IP Int J Periodontol Implantol

Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery: A prospective study.

Acute postsurgical pain, probably including acute neuropathic pain (ANeP), starts at the early postoperative period, and chronic postsurgical pain including chronic neuropathic pain (CNeP) persists at least 3 months after surgery. Although it must be important for prevention and treatment of acute and chronic postoperative pain to reveal the time course of postoperative neuropathic characteristics, a neuropathic pain profile after surgery has not been evaluated.Pain status at the surgical site in adult patients who underwent video-assisted thoracic surgery (VATS) for lung cancer was prospectively assessed until 12 months after surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire until 6 days after surgery and the DN2 questionnaire throughout the study.Twenty-seven patients were enrolled in this study. Pain intensity at surgical sites were significantly higher at 1 and 6 days after surgery during resting state, and were also significantly higher at 3, 6, and 12 months after surgery during movement than those before surgery. The incidence of ANeP was 33.3% at 1 day, and 18.5% at 6 days after surgery. The incidence of CNeP decreased to 12.5% at 3 months, 5.0% at 6 months, and 0.0% at 12 months after surgery. The number of neuropathic characteristics, assessed by DN2 scores, significantly increased at 1 and 6 days after surgery, compared to those before surgery. DN2 scores at 3, 6, and 12 months after surgery, however, showed no significant differences compared to those before surgery.In patients with acute postsurgical pain, 20% to 30% of patients show ANeP characteristics, and the incidence of CNeP gradually decreases after VATS in patients with chronic postsurgical pain.

Analysis of clinical efficacy and safety of intravenous use of diclofenac for the prevention of postoperative pain: current status and strategic aspect

The aim of the work is to analyze and systematize the literature data regarding the current state and strategic aspect of intravenous use of diclofenac for the prevention of postoperative pain, namely clinical efficacy and safety.Materials and methods. Studies were conducted using databases on the Internet: PubMed; Food and Drug Administration, European Medicines Agency. It has used retrospective, logical, research methods, content analysis.Results. Conducted clinical data analysis indicates that diclofenac sodium, when administered intravenously, has an opioid-saving effect, is effective in patients experiencing acute postoperative pain, or as part of a multimodal analgesic strategy to achieve perioperative pain control. This increases the possibility of relief of pain and promotes accelerated rehabilitation after surgery, reduces the need for opiates. The incidence of side effects with intravenous diclofenac was similar to that seen with other treatments. New opportunities of the strategic aspect of intravenous use of diclofenac is related to the use of Dyloject, Hospira Inc., USA, which has improved solubility, shorter administration time than infusion. The incidence of thrombophlebitis on treatment with Dyloject was less pronounced compared to Voltarol.Conclusions. Thus, the experience of clinical intravenous use of diclofenac sodium for the prevention of postoperative pain has confirmed its efficacy, favorable safety profile and the ability to reduce the need for opiates. The promising strategic aspect is the creation of domestic diclofenac sodium preparations for intravenous administration, which have improved solubility, shorter administration time than infusions and have no additional safety risk

Effectiveness of Ketoprofen Suppositoria as Preemptive Analgesia for Postoperative Pain in Patients Undergoing Elective Surgery with General Anesthesia

Introduction: Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk deep vein thrombosis, fast recovery, and reduced cost of care. Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period, has the potential to be more effective than a similar analgesic treatment initiated after surgery. As a part of multimodal analgesia, the use of NSAIDs should always be considered for acute postoperative pain management. NSAIDs can be used preoperatively as a part of the preemptive regimen and for postoperative pain control to increase the efficacy of opioids and reduce its side effects. Material and Method: This research was experimental research with a case-control design of the study. The samples separated into two groups, the first group got ketoprofen suppository before the induction, and the second group didn’t get the ketoprofen suppository The intensity of pain measured with the Numeric Rating Scale (NRS) or Wong-Baker Faces Pain Scale was the variable studied at different postoperative times (30 min, 60 min, 120 min, 2-6 hours, 6-12 hours). The total amount of rescue analgesics (fentanyl) and side effects were other variables of this study. Result and Discussion: The result is ketoprofen suppository as preemptive analgesia administrations can reduce postoperative pain. Numeric Rating Scale was significantly lower in the ketoprofen group compared to the control group (p &lt; 0,05) at 30 min, 60 min, 230 min, 2-6 hours, 6-12 hours. The number of postoperative analgesics needed in the recovery room was significant differences among both groups (p &lt; 0,05). Conclusion: Preemptive analgesia in patients who underwent an operation with general anesthesia with ketoprofen suppository was effectively in blocking noxious stimuli and central sensitization, with subsequent prevention of acute postoperative pain.

Immediate One-Stage Implant-Based Breast Reconstruction after Conservative Mastectomy: Sub-Pectoral or Pre-Pectoral? A Proposal for a Randomized Multicentric Trial to Define Indications and Outcomes.

Background: Implant-based breast reconstruction (IBR) is the most common reconstructive procedure after mastectomy. During the last 10-15 years, the introduction of Acellular Dermal Matrices (ADMs)/synthetic meshes has driven a change in practice from complete submuscular implants to sub-pectoral implants. In the last 5-7 years pre-pectoral IBR with complete ADM/mesh cover gained popularity as an alternative to sub-pectoral IBR and is considered the procedure of choice in athletic, active women. Avoiding disturbance of muscular structures has the theoretical advantages of reduced post-operative pain and operative time and prevention of animation deformity. However, long-term outcomes are still not available and possible disadvantages of pre-pectoral IBR might be increased palpability of implant edges and upper pole wrinkling, possibly leading to more revisional surgery.

Medications Used for Prevention and Treatment of Postoperative Endodontic Pain: A Systematic Review.

Objective:Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain.Methods:A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies.Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events.Study appraisal and synthesis methods: The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports.Results:After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis.Limitations: A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain.Conclusion:Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.

Combination of Articaine and Ketamine V/S Articaine Alone After Surgical Extraction of Impacted Third Molars.

Objective:Local anesthetics are the most effective drugs available for the management of pain while performing operative procedures. This study was performed to compare the clinical efficacy of treatment with local anesthetic articaine (4%) with ketamine and local anesthetic articaine alone (4%) for the relief or prevention of postoperative pain, swelling, and trismus after the surgical extraction of impacted mesioangular third molars.Materials and Methods:Sixty patients undergoing the extraction of impacted mesioangular mandibular third molars were included in the study. The patients were randomly divided into two groups: local anesthetic alone (LAA) and local anesthetic plus ketamine (LAK).Results:Facial swelling following surgery on postoperative days was significantly lower in the LAK group than in the LAA group on 3rd and 7th postoperative days (P < 0.05). Mouth opening on the postoperative days was significantly greater in the LAK group than in the LAA group on 3rd and 7th postoperative days (P < 0.05). The pain scores on the visual analog scale at 30 min and 1 h, 4 h, 12 h, and 24 h after the surgery were significantly higher in the LAA group than in the LAK group and there was no significant difference in heart rate, oxygen saturation, and blood pressure in both the groups.Conclusion:In this present study, the effect of articaine with ketamine in comparison with articaine alone intraoperatively and postoperatively was observed, and it revealed that the combination of articaine with ketamine produced good local anesthesia and provide good postoperative analgesia with less swelling and significantly less trismus.

Effect of Chinese Propolis as an Intracanal Medicament on Post-Operative Endodontic Pain: A Double-Blind Randomized Controlled Trial.

Propolis is a potent anti-microbial and natural anti-inflammatory by-product obtained from the beehive. Studies have demonstrated the superior biocompatibility and anti-microbial properties of propolis as compared to calcium hydroxide. However, its effect on postoperative endodontic pain is unknown. Therefore, this study aimed to investigate the impact of Chinese propolis paste as an intracanal medicament on postoperative endodontic pain intensities compared with calcium hydroxide (control) at different time intervals in necrotic teeth with periapical radiolucency. Eighty patients with single-rooted necrotic teeth with visible periapical radiolucency were recruited and randomly allocated to either the calcium hydroxide or propolis groups. After chemo-mechanical preparation and intracanal medicament insertion, patients were given the VAS (visual analogue scale) to record pain scores. Inter-group data were compared and analyzed using two-way repeated measure ANOVA (Bonferroni test). A p-value of < 0.025 was considered significant. In total, >78% of the patients experienced no or only mild post-operative pain in both the groups at all time intervals, without any significant difference in pain scores between the two groups (p > 0.025). An overall flare-up rate of 14.8% was found. The results suggest that either of these medicaments can be used as an inter-appointment medication for the prevention of postoperative pain in necrotic cases.

Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery.

Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery.

Postoperative Analgesic Efficacy of Preemptive and Postoperative Lornoxicam or Tramadol in Lumbar Disc Surgery.

To compare preemptive and postoperative analgesic efficacy of tramadol and lornoxicam administered before anaesthesia induction in lumbar discectomy. This randomised, double-blind trial was conducted on 60 ASA I and II patients undergoing lumbar discectomy. Group L (n=30) received 3×8 mg day-1 lornoxicam, and Group T (n=30) received 3×1.5 mg kg-1 day-1 tramadol. A verbal rating scale (VRS), the duration of effective analgesia, the number of additional analgesics used, adverse effects and patient satisfaction were evaluated at the postoperative 30th minute and 1st, 2nd, 4th, 6th, 8th, 12th and 24th hours. There were no significant differences between Groups L and T regarding demographic and clinical characteristics, the number of additional analgesics and the duration of effective analgesia, adverse effects and patient satisfaction. VRS scores of the patients in Group T were significantly higher than those in Group L at the postoperative 30th minute (p=0.050) and the 1st hour (p=0.005). Lornoxicam, which was used for preemptive and postoperative analgesia in lumbar disc surgery, had provided adequate and effective analgesia such as tramadol. Moreover, preemptive analgesia was quite effective in prevention and treatment of postoperative pain.

Efficacy of Duloxetine on the Duration of Spinal Anesthesia and Acute Post-Operative Pain after Hip Surgery Prospective Randomized Controlled Study

AbstractBackground: Prevention and treatment of post-operative pain continue to be a major challenge in post-operative care. Preemptive analgesia has been shown to be effective in reducing the severity of post-operative pain. Serotonin and norepinephrine are involved in the modulation of endogenous analgesic mechanisms, Duloxetine is a selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) mainly used in the treatment of depression, anxiety and chronic pain. The analgesic effect of duloxetine is believed to result from increased activity of serotonin (5-HT) and Norepinephrine (NE) within the CNS.Aim of Study: The aim of this study was to evaluate the efficacy of pre-operative duloxetine on the duration of spinal anesthesia, severity of post-operative pain, and total analgesic consumption.Methods and Material: Sixty patients aged 18-60 years, ASA I-II, scheduled for elective hip surgery were randomized into two equal groups: Duloxetine group (Group D): 30 patients received duloxetine 60mg on two divided doses 30mg every 12h for three days before the operation, 2h pre-operative and 12h after the surgery. Control group (Group C): 30 patients received placebo capsules by the same way as duloxetine group.Measurements: Demographic data (age, Body Mass Index (BMI), sex), Hemodynamic (HR, MAP), duration of surgery, duration of spinal anesthesia, post-operative pain was assessed by the Visual Analog Scale (VAS) at 0, 2, 6, 12, 24 and 48h after the surgery, the time at which rescue analgesia was given and total analgesic consumption in 48h was recorded.Results: There was no significant difference between both groups as regards to demographic data, hemodynamics (HR & MAP), duration of surgery and duration of spinal anesthesia. VAS score was significantly lower in in Group D than Group C. Time till administration of first rescue analgesia was significantly prolonger in Group D than Group C.Conclusions: We conclude from this study that pre-operative administration of oral duloxetine 60mg daily divided into two doses 30mg every 12hr for 3 days significantly decreases post-operative pain and total analgesic consumption and improve patient psychology with a significant reduction in associated side effects but has no effect on the duration of spinal anesthesia.

Effectiveness of Reflexology in Prevention of Post-Operative Pain After General Surgery

Effectiveness of Reflexology in Prevention of Post-Operative Pain After General Surgery

Effect of submucosal dexamethasone injections in the prevention of early and late post-operative pain, trismus and oedema associated with mandibular third molar extractions: a systematic review and meta-analysis

Effect of submucosal dexamethasone injections in the prevention of early and late post-operative pain, trismus and oedema associated with mandibular third molar extractions: a systematic review and meta-analysis