Sole Analgesic Agent Research Articles

Efficacy and safety of esketamine hydrochloride adjunct to sufentanil in non-surgical patients under mechanical ventilation in the ICU (SENSATION trial): protocol for a multicentre, single-blind, randomised controlled trial

IntroductionPain is common in patients receiving mechanical ventilation in the intensive care unit (ICU). Intravenous opioids are recommended as first-line therapy for pain management; however, opioids have adverse side effects....

Intraoperative lidocaine infusion as a sole analgesic agent versus morphine in laparoscopic gastric bypass surgery

BackgroundThe aim of this study was to assess the effect of intra-operative intra-venous (IV) lidocaine infusion compared to IV morphine, on the post-operative pain at rest, the intra-operative and post-operative morphine requirements, the sedation and the Modified Aldrete scores in the post-anesthesia care unit (PACU), the hemodynamic parameters; mean values of the mean blood pressure (MBP) and the heart rate (HR), the peri-operative changes in the SpO2, and the respiratory rate (RR) in laparoscopic Roux-en-y gastric bypass. Sixty patients ˃ 18 years old, with body mass index (BMI) ˃ 35 kg/m2, American Society of Anesthesiologists (ASA) physical status II or III, were randomly divided into 2 groups: the lidocaine (L) group patients received intra-operative IV lidocaine infusion, and the morphine (M) group patients received intra-operative IV morphine.ResultsThe post-operative numeric pain rating scale (NPRS) at rest was statistically significant less in group L than in group M patients, in the post-operative 90 min in the PACU. This was reflected on the post-operative morphine requirements in the PACU, as 26.6% of patients in group M required morphine with a mean total dose of 10.8 mg. The mean values of the MBP and HR recorded after intubation were comparable between patients of both groups, indicating attenuation of the stress response to endotracheal intubation by both lidocaine and morphine. However, the mean values of the MBP and HR recorded after extubation were statistically significant lower in patients of group L, indicating the attenuation of the stress response to extubation by lidocaine. Patients in group M showed statistically significant lower mean values of the MBP; before pneumoperitoneum and after 15 min from the pneumoperitoneum, this was reflected on statistically significant higher mean values of the HR. Patients in group L showed statistically significant lower mean values of the MBP and the HR; at 30 and 45 min from the pneumoperitoneum. Patients in group L showed statistically significant lower mean values of the MBP; 60 min from the pneumoperitoneum, after release of pneumoperitoneum and in the PACU. Patients of both groups showed comparable mean values of the HR after 60 min from the pneumoperitoneum, after release of the pneumoperitoneum and in the PACU. No patient in either groups developed post-operative respiratory depression in the PACU. Patients in group L showed statistically significant higher median sedation score, which was reflected on statistically but not clinically significant less Modified Aldrete score in patients of group L.ConclusionsIn morbid obese patients, the intra-operative IV lidocaine infusion offered post-operative analgesia in the PACU, on the expense of a higher sedation score, which didn’t affect the Modified Aldrete score clinically, with attenuation of the stress response to endotracheal intubation and extubation.Trial registrationsFMASU R16/2021. Registered 1st February 2021, with Clinical Trials Registry (NCT05150756) on 10/08/2021.

Dexmedetomidine versus fentanyl on stress response and pain control in adult patients undergoing laparoscopic surgery

Laparoscopic procedures are widely indicated; however, the ideal approach for pain control remains debatable. This trial compared between the effects of dexmedetomidine and fentanyl infusion on stress response and pain control in patients undergoing elective laparoscopic surgeries. A prospective randomized double-blinded comparative study included 82 adult participants randomly allocated into two equal-sized groups. Group D received 1 µg/kg of intravenous (IV) dexmedetomidine over 10 min as a loading dose just before induction of anesthesia, then 0.2–0.7 µg/kg/h till 10 min before the surgery ends. Group F received 1 µg/kg of IV fentanyl as a loading dose, then 0.2–0.7 µg/kg/h. Primary objective was postoperative analgesic consumption in 24 h. Collected data were heart rate (HR), mean arterial blood pressure (MAP), blood glucose and serum cortisol levels, visual analogue score (VAS), and the perioperative analgesic consumption. Group D consumed significantly less postoperative morphine doses in 24 h (p = 0.003), and 41.5% of Group D patients did not need any postoperative morphine. Group D had better-controlled hemodynamic changes 5 min post-extubation (HR and MAP p = 0.021 and p = 0.022 respectively), showed significantly less postoperative stress response as manifested in the blood glucose and serum cortisol levels 4 h postoperatively (p = 0.006 and p = 0.001 respectively), and less VAS pain scores at early and late postoperative periods. Intraoperative IV dexmedetomidine administration as a sole analgesic agent for patients undergoing elective laparoscopic surgeries serves as a convenient anesthetic approach, since it provided a good postoperative pain control, and reduced the surgical stress response and the perioperative analgesic consumption.

The Use of Inhalational Nitrous Oxide (Entonox) As The Sole Analgesic Agent During Colonoscopy is Feasible and Efficacious in a Substantial Proportion of Patients: A Review of a Surgeon’s Experience

The Use of Inhalational Nitrous Oxide (Entonox) As The Sole Analgesic Agent During Colonoscopy is Feasible and Efficacious in a Substantial Proportion of Patients: A Review of a Surgeon’s Experience

Feasibility of dexmedetomidine as sole analgesic agent during robotic urological surgery: A pilot study.

Background and Aims:Opioid-free anesthesia decreases postoperative nausea and vomiting, emergence agitation, prolonged sedation, ileus, and urinary retention. The feasibility of the use of dexmedetomidine as sole analgesic agent has been shown in patients undergoing bariatric and gynecological laparoscopic surgery. We explored its use for robotic urological surgery.Material and Methods:Thirty patients were randomized to receive either dexmedetomidine (Group D) or fentanyl (Group F) along with total intravenous anesthesia with propofol. The hemodynamic parameters and number of doses of rescue analgesics used intraoperatively and postoperatively were noted. Recovery parameters at the end of surgery were also recorded.Results:The dose of intraoperative rescue fentanyl was not significantly different between groups (P = 0.13). The hemodynamic profile of patients in the two groups was comparable except the heart rate was significantly more in Group D after intubation and at 60 min. The mean arterial pressure was significantly lower after the initial loading dose of study drug in Group D. The recovery profiles were not significantly different between groups.Conclusion:The study reveals that dexmedetomidine has equal analgesic efficacy as fentanyl for intraoperative use and can be used as the sole analgesic agent in patients undergoing robotic urological surgery.

Efficacy of Low-dose Ketamine as Sole Analgesic Agent in Maintaining Analgesia and Intraoperative Hemodynamics During Laparoscopic Gynecological Surgeries.

Background:Ketamine, in low doses, is known to possess intense analgesic properties. The available literature shows wide variation regarding the time and dose of administration of ketamine during surgery.Aim:The aim of this study was to evaluate the effect of intraoperative administration of ketamine when used as sole analgesic in low doses, on hemodynamics and postoperative analgesia in patients undergoing laparoscopic gynecological surgery and compared on the basis of duration of surgery.Settings and Design:This prospective, observational study was conducted from July to December 2015, over a period of 6 months in a tertiary care medical college and hospital.Materials and Methods:Seventy patients between 23 and 55 years planned for laparoscopic gynecological surgery were recruited. Ketamine was given in a dose of 0.5 mg/kg preoperatively and then repeated every ½ hourly in a dose of 0.25 mg/kg throughout the surgery. Hemodynamic parameters, time to the first rescue analgesia and complications were recorded for the first 8 h. Statistical evaluation was done and result expressed as percentage. Paired t-test was employed for the comparison of numerical variables within the group.Results:Seventy percent of the patients did not require any postoperative rescue analgesia during the first 8 h after surgery. None of the patients complained of pain immediately after extubation, and 16% of the patients had minor postoperative complications. The intraoperative hemodynamic profile was significantly altered. Duration of surgery and dose of ketamine required did not affect the duration of analgesia.Conclusion:Ketamine in low dose proved to be an efficacious analgesic even in the long duration laparoscopic gynecological surgeries. It stabilizes intraoperative hemodynamics thereby reducing the requirement of other anesthetic and antihypertensive agents.

IV Paracetamol as a sole agent for postoperative pain relief in adult cardiac surgical patients after median sternotomy

Various pain control strategies for pain relief of cardiac surgical patients after median sternotomy were tried include central neuraxial blockade or selective nerve blocks, and drugs such as opioids, and non-steroidal anti-inflammatory drugs (NSAIDS). Paracetamol (Perfalgan, Bristol Meyers Squibb) is available in IV formulation and is being used in many centers as an adjunct to analgesia regimen. In our practice, we have found that IV paracetamol stared at regular intervals after shifting the patient to cardiac surgical ICU(CSICU), helps in significantly reducing the analgesic requirement consequently patients become less sedated after cardiac surgery. After ethics committee approval, and informed patient consent, we did a prospective cohort study of 52 adult cardiac surgical receiving IV paracetamol as the primary pain control agent. A standard anesthesia and analgesia technique was used for all the patients. Postoperatively IV fentanyl infusion was continued at 1 mcg/kg/h till extubation. IV paracetamol was started 30 min before extubation given 1 g (over 30 min) IV and continued 6 h till next 72 h or till chest tube removal. Pain control was assessed by visual analogue scale (VAS) and target VAS value of 3 or less than three was considered adequate. VAS was assessed at extubation, at 3, 6, 12, 24, 36 and 48 h after extubation. The regimen was considered successful if only two or less than two doses of IV fentanyl and/or less than 4 doses of oral tramadol were required to supplement IV paracetamol postoperatively. The patient age ranged from 24 to 78 years, 8 of them were female, CABG was performed in 14 patients, AVR in 8 patients, CABG plus MVR in 6 patients, CABG plus AVR in 10 patients, MVR plus RFA in 6 patients, ASD closure in 4 patients and pulmonary valve implantation in 2 patient. We found that paracetamol was successful as the sole analgesic agent in 38 patients (73%), in 10 patients (19.2%) IV paracetamol was primary regimen (with fentanyl/tramadol as adjunct) and in 4 patients (7.6%) patients IV paracetamol regimen was unsuccessful in pain relief. IV Paracatamol may be used as a sole agent for pain relief with successful results after median sternotomy in selected patients in which opioids, NSAIDS or regional blocks are not indicated or produce undesirable side effects. The results need to be reproduced in a larger group of patients and after determining equipotent doses of opiods, case control studies should be done to evaluate the effects of IV paracetamol after median sternotomy.

Epidural clonidine, bupivacaine or methadone as the sole analgesic agent after thoracotomy for lung resection

Department of Anaesthesia and Critical Care Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel

Analgesia in the Intensive Care Unit: Pharmacologic and Pharmacokinetic Considerations

Morphine is the preferred analgesic agent for the critically ill patient. Fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability or for patients manifesting symptoms of histamine release with morphine or morphine allergy. Hydromorphone is an acceptable alternative to morphine for patients with significant adverse affects from morphine or severe renal dysfunction. Meperidine and intravenous codeine should be avoided if at all possible. APAP and NSAIDs may be useful in the management of acute pain secondary to their opioid-sparing effects. Use of nonopioid analgesics may reduce the dose of opioid required for adequate pain control and help to minimize opioid-induced side effects. NSAIDs should be used only when the benefit-to-risk ratio is favorable. APAP should be used as an adjunct but not as the sole analgesic agent in critically ill patients. Regardless of which agent or agents are used to optimize pain control, it is imperative that caregivers recognize that the optimal analgesic dose and regimen vary widely between patients. Based on the pharmacokinetics and pharmacodynamics of the agent(s) selected, enough time for an adequate trial should be allowed before switching to other agents. Employing these principles optimizes the use of medications in the management of the complex physiologic response to pain.

Analgesic and Hemodynamic Effects of Intrathecal Clonidine as the Sole Analgesic Agent During First Stage of Labor: A Dose-Response Study

Analgesic and Hemodynamic Effects of Intrathecal Clonidine as the Sole Analgesic Agent During First Stage of Labor: A Dose-Response Study

Epidural Clonidine Used as the Sole-Analgesic Agent During and After Abdominal Surgery

DE KOCK, M.; WIEDERKHER, P.; LAGHMICHE, A.; SCHOLTES, J. -L.; Gibbs, John M. M.D., F.A.N.Z.C.A. Author Information

Ketorolac and Strabismus Surgery

In Response: We appreciate the comments by Munro et al. regarding our study of vomiting and analgesic requirements after pediatric strabismus surgery [1]. Those authors have expressed concern about our lack of postoperative opioid supplementation, similar group pain scores, and an emetogenic anesthetic regimen. The analgesic requirements for strabismus surgery, including the routine use of opioids, remain unclear. In previous studies, opioids have been administered pre-, intra-, or postoperatively or not at all. We undertook our study because of previous clinical observations: 1) many of our patients were comfortable after receiving rectal acetaminophen as their sole analgesic agent, and 2) there was a much greater incidence of postoperative vomiting in those patients receiving fentanyl intraoperatively. In contrast, Weir et al. [2] found that nearly 50% of their patients receiving paracetamol suppositories required supplemental opioid analgesia. We stand by our pain scores and postoperative acetaminophen requirements, which indicate no significant differences between the saline, ketorolac, and fentanyl groups. The incidence of postoperative vomiting was 100% greater in the saline placebo (33.3%) compared to the ketorolac group (16.7%); however, the difference trended toward, but did not reach, statistical significance (P = 0.08). It is possible that we did not have enough power to detect a significant difference between those groups and that a larger population sample might have shown ketorolac to be significantly better than placebo at reducing postoperative vomiting. Finally, the effect of nitrous oxide on the incidence of postoperative vomiting is unclear and requires further study. Howard G. Mendel, MD Linda M. Sundt, MD Marc C. Torjman, MEd Department of Anesthesiology Jefferson Medical College Thomas Jefferson University Philadelphia, PA 19107