Significant Reduction In Postoperative Pain Research Articles

The Effect of Bupivacaine Infiltration on Postoperative Tubal-Ligation Pain

Infiltration of Bupivacaine 0.5% in postpartum tubal ligation minilaparatomy cases under spinal anesthesia led to significant reduction of postoperative pain and analgesic requirement and increased satisfaction during the first 24 hours and 7 th postoperative day. Objective: To evaluate the effectiveness of subcutaneous and intratubal infiltration of bupivacaine 0.5% in postoperative pain relief. Materials and Methods: Parturients for minilaparatomy tubal ligation under spinal anesthesia in the Fatemieh Hospital of Hamadan who met the necessary criteria and signed written consent to be studied, took part in a double blind randomized clinical trail. After tubal ligation, bupivacaine 0.5% in 25 women (intervention group) and normal saline in another 25 cases (placebo group) was injected in subcutaneous tissue of the abdominal wall and fallopian tubes. Pain (with visual analog scale), analgesic requirement, nausea, vomiting, headache and abdominal cramps were measured in two groups

Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery

As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance analgesia and improve patient outcome after joint replacement surgery. Thirty-seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi-hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi-hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h(-1) was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured. Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R. Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery.

Preemptive analgesia: its role in posterior spine surgery

Purpose of study: Pain relief remains one of the primary goals and responsibilities of spine surgeons. Preemptive analgesia may diminish postoperative pain. The use of preemptive analgesia in other orthopedic surgical procedures, such as knee replacements, has proved effective. However, it has not been determined whether preemptive analgesia has a place in spine surgery. We conducted a prospective, randomized pilot study using preemptive analgesia before posterior fusion in patients undergoing staged circumferential spinal surgery. The purpose of this study was to assess the safety and efficacy of a one-time intrathecal analgesic injection before making a surgical incision during the posterior stage of spinal fusion.Methods used: We used a prospective, randomized, double-blind method. Patients scheduled for circumferential fusion were offered study participation and signed a consent approved by our institutional review board. Patients were randomized to either a treatment or a control group. The treatment group received an intrathecal injection containing 2 cc of 0.75% Marcaine, 1 mg Duramorph, and 5 micrograms of epinephrine. The control group received the same volume of normal saline. After the patients received general anesthesia, the spine surgeon placed the injection above the index level. Surgeons and staff were blinded to study group assignment. Pain was assessed using the Numerical Rating Scale (NRS, 0 to 10) upon arrival and at discharge during postanesthesia recovery and during the hospitalization by research staff unassociated with the clinical care of the patients. Narcotic use for pain control in the immediate recovery room postoperative period was reviewed.of findings: Forty-one patients received preemptive analgesia injections. There were 20 in the treatment group and 21 in the control group. There were 9 men and 11 women in the treatment group with a mean age of 47 years (range, 32 to 74 years). In the control group there were 12 men and 9 women with a mean age of 51 years (range, 28 to 70 years). The treatment group mean pain score on arrival to the recovery room was 3.8 with a standard deviation of 4.514. The control group mean pain score on arrival to the recovery room was 7.7 with a standard deviation of 3.862. The population mean pain score difference is significant (p=.006) at 95% confidence interval. Postoperative pain in the recovery room was more easily managed in the treatment group, as evidence by reduced frequency of narcotic use. There were no complications intraoperatively or postoperatively related to the intrathecal injections.Relationship between findings and existing knowledge: There is no existing literature on the use of preemptive analgesia in posterior orthopedic spine surgery. The preliminary finding of this study suggest preemptive analgesia may be useful in reducing and managing immediate postoperative pain.Overall significance of findings: The preemptive analgesic treatment group had statistically significant reduction of postoperative pain as compared with the control group. The use of preemptive analgesia before posterior spine surgery resulted in less narcotic use in the recovery room. There were no complications related to the use of intrathecal injection in either group.Disclosures: No disclosures.Conflict of interest: No conflicts.

Paediatric coblation tonsillectomy

Objective: Tonsillectomy has been described using a number of techniques. Recently Coblation Technology has been used to remove tonsils with anecdotal evidence of a reduction in post-operative morbidity. In this study we aim to see if there is any difference in post-operative pain, tonsillar fossae healing and return to a normal diet performing tonsillectomy, using tissue coblation compared with standard bipolar dissection. Methods: A double blind randomised control trial to compare the technique of tissue coblation with standard bipolar dissection to remove tonsils in 38 children on the waiting list for tonsillectomy, with a history of chronic tonsillitis or obstructive tonsils. Results: A significant reduction in post-operative pain was found in the children whose tonsils were removed by tissue coblation ( P<0.0001). More rapid healing of the tonsillar fossae was found in the coblation group. Children who had their tonsils removed by coblation were found to return to their normal diet far sooner than those who underwent bipolar dissection. There were no episodes of primary or secondary haemorrhage in either group. Conclusions: This new technique using tissue coblation for tonsil removal offers significant advantages in the post-operative period, with rapid return to a normal diet and a drastic reduction in analgesic requirements following the surgery.

Classification of biomaterials and their related complications in abdominal wall hernia surgery

The value of the use of biomaterials for the repair of abdominal wall hernias is gaining increasing recognition. The use of synthetic mesh to achieve a tension-free repair has resulted in a significant reduction in postoperative pain, in length of the recovery period, and in the number of recurrences. However, certain physical properties of biomaterials can lead to undesirable consequences. These include increased risk of infection, seroma formation, biomaterial-related intestinal obstruction, and fistula formation and failure of repair due to shrinkage of the mesh. The purpose of this paper is to discuss the mechanism of these problems with special emphasis on pore size, molecular permeation and shrinkage of biomaterials and their effects on infection, seroma formation, and recurrence of mesh repair of abdominal wall hernias.

Bupivacaine and kaltostat reduces post-operative donor site pain

A prospective double blind controlled trial was carried out to examine the differences in post-operative split skin graft donor site pain between sites dressed with three differently treated types of dressing; a dry calcium alginate dressing (Kaltostat Britcair), a saline moistened Kaltostat dressing and a bupivacaine hydrochloride (0.5%) moistened Kaltostat dressing. There was a significant reduction in post-operative pain in the Kaltostat and bupivacaine group (group 3) at 24 and 48 h when compared to the other two groups (p < 0.04). There was no difference in ease of removal of dressings or the quality of wound healing on day 10 between the three groups. This study demonstrates a significant reduction in post-operative pain in bupivacaine soaked Kaltostat without reducing the beneficial effects of Kaltostat on donor site healing and we recommend its use in clinical practice.

The rise and fall of a new anti-inflammatory analgesic

The efficacy of a new non-steroidal anti-inflammatory drug (NSAID), GP 53.633 (GP), was tested versus placebo in a double-blind cross-over study. 24 healthy young individuals with impacted asymptomatic lower third molars, of similar shape and position in the jaw on both sides, underwent surgery on 2 separate occasions. The patients randomly received the active drug at one and placebo at the other operation. A number of subjective and objective assessments were made for paired comparison, including: pain, local temperature, swelling, post-operative bleeding, trismus, adverse effects, preference scores, wound healing, bone regeneration and laboratory examinations. The drug caused a significant reduction of post-operative pain, swelling and trismus. Global therapeutic effect and preference scores were highly in favour of the active drug. In the GP period, there was a statistically significant reduction in Hgb, RBC, lymphocytes and ESR, and an increase in neutrophils 3 days after the operation, compared to placebo. Individual values indicate a potentially clinically relevant effect of GP on Hgb and RBC. The clinical relevance of the changes in neutrophil and lympholyte count, however, is questionable. The drug seemed to have no influence on the other laboratory parameters studied. Adverse effects occurred in 2 patients on GP and in 7 patients on placebo. The drug compares favourably with other NSAID tested in the same model.

Clinical and hematological investigation of Rheumapax ® in surgical removal of impacted wisdom teeth from the mandible

The clinical effect of Rheumapax ® and placebo on postoperative complications after surgical removal of the impacted mandibular third molar has been evaluated in a controlled clinical trial. The investigation included 66 patients in two treatment groups, 32 patients being given Rheumapax and 34 placebo. Hematological tests performed before and 10 days after the operation revealed no adverse reactions. There was a significant reduction of postoperative pain and trismus with Rheumapax in addition to a favorable, though nonsignificant, effect on swelling.