scholarly journals Evaluation of postoperative pain intensity and side effects caused by fentanyl administered during patient-controlled epidural analgesia in elderly patients who undergo laparoscopic-assisted colon surgery for colon cancer

PAIN RESEARCH ◽  
2013 ◽  
Vol 28 (4) ◽  
pp. 219-226
Author(s):  
Seiji Kajiyama ◽  
Takahiro Kato ◽  
Hirotsugu Miyoshi ◽  
Hiroshi Hamada ◽  
Masashi Kawamoto
Keyword(s):  
Colon Cancer ◽  
Side Effects ◽  
Postoperative Pain ◽  
Elderly Patients ◽  
Epidural Analgesia ◽  
Pain Intensity ◽  
Colon Surgery ◽  
Laparoscopic Assisted

scholarly journals HTX-011 effectively reduces postoperative pain intensity and opioid use in the elderly

2021 ◽  
Author(s):  
Tina Yip ◽  
Jia Hu ◽  
Pamela S Hawn ◽  
Amy Yamamoto ◽  
Gary Oderda
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Elderly Patients ◽  
Pain Intensity ◽  
Local Anesthetic ◽  
Extended Release ◽  
The Elderly ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Clinical Trial Registration

Aim: HTX-011 (ZYNRELEF™) is an extended-release, dual-acting local anesthetic containing bupivacaine and meloxicam. In bunionectomy and herniorrhaphy studies, HTX-011 resulted in less postoperative pain and less opioid consumption versus bupivacaine HCl. Here we evaluate HTX-011 in patients aged ≥65 years. Materials & methods: Patients received placebo, bupivacaine HCl or HTX-011 following surgery. End points included pain intensity, total opioid consumption, opioid-free patients and safety. Results: HTX-011-treated patients reported lower postoperative pain through 72 h versus bupivacaine HCl and placebo. Elderly patients administered HTX-011 used fewer opioids versus bupivacaine HCl, and a greater proportion remained opioid-free through 72 h. HTX-011 was well tolerated with a safety profile similar to bupivacaine HCl and placebo. Conclusion: HTX-011 maintained effectiveness and was well tolerated in elderly patients. Clinical Trial Registration: NCT03295721 and NCT03237481

Perioperative Cardiac Morbidity in Elderly Patients with Epidural versus Systemic Analgesia for Hip Fracture Surgery

2014 ◽  
Vol 68 (2) ◽  
pp. 93-100
Author(s):  
Marina Temelkovska-Stevanovska ◽  
Trajkovska Trajanka ◽  
Maja Mojsova-Mijovska ◽  
Marija Jovanovski-Srceva
Keyword(s):  
Hip Fracture ◽  
Side Effects ◽  
Elderly Patients ◽  
Epidural Analgesia ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Hip Fracture Surgery ◽  
Continuous Epidural Analgesia ◽  
Fracture Surgery

Abstract Introduction. Patients with hip fracture are usually older patients. Uncontrolled acute pain and surgical stress in elderly patients may cause increased cardiac morbidity and mortality. Epidural analgesia blocks sympathetic nervous system and reduces the incidence of myocardial ischemia and dysrhythmias as well as the response to stress. Methods. Sixty patients with hip fracture older than 65 years with previously defined high peroperative cardiac risk according to ACC/AHA guidelines were included and were randomly assigned to two groups of 30 patients: SA group-patients with systemic analgesia. niflam 2 × 100 mg/iv and tramadol 1 mg/kg/iv every 8 hours; and EDC group-patients with a continuous epidural analgesia with bupivacaine 0.125%-5 ml/h and fentanyl 3 µg/ml. As end points of the study the incidence of cardiac events in both groups were registered: cardiac death, myocardial infarction, congestive heart failure, unstable angina and new-onset atrial fibrillation. Laboratory parameters and pain intensity were determined in all patients by using Verbal Descriptive Scale. Side effects were also monitored. Results. The epidural analgesia decreased the incidence of peroperative cardiac events in patients with high per-operative cardiac risk for hip fracture surgery (46.6% in SA group vs. 15% in EDC group) and at the same time decreased cardiac mortality (10% in SA group vs. 0% in EDC group). The values of VDS were significantly lower in patients with EDC block versus patients with systemic analgesia in all experimental times and there was a smaller number of side effects. Conclusion. Early administration of continuous epidural analgesia in patients with high peroperative risk with hip fracture decreases the incidence of cardiac morbidity and mortality and provides superior pre- and post-operative analgesia compared to systemic analgesia with minimal side effects.

scholarly journals Role of Ketamine in Multimodal Analgesia Protocol for Bariatric Surgery

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 96 ◽  
Author(s):  
Greta Kasputytė ◽  
Aurika Karbonskienė ◽  
Andrius Macas ◽  
Almantas Maleckas
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Side Effects ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Postoperative Analgesia ◽  
Multimodal Analgesia ◽  
Gastric Plication ◽  
Duration Of Surgery ◽  
Very High

Background and Objectives: Acute postoperative pain is one of the most undesirable experiences for a patient in the postoperative period. Many options are available for the treatment of postoperative pain. One of the methods of multimodal analgesia is a combination of opioids and adjuvant agents, such as ketamine. The aim of this study was to evaluate the effect of a pre-incisional single injection of low-dose ketamine on postoperative pain after remifentanil infusion in patients undergoing laparoscopic gastric bypass or gastric plication surgery. Materials and Methods: The prospective, randomized, double-blinded and placebo-controlled trial took place at the Hospital of the Lithuanian University of Health sciences KaunoKlinikos in 2015–2017. A total of 32 bariatric patients (9 men and 23 women) were randomly assigned to receive a single pre-incisional injection of ketamine (0.15 mg/kg (LBM)) (ketamine, K group) or saline (placebo, S group). Standardized protocol of anesthesia and postoperative pain management was followed for all patients. Postoperative pain intensity, postoperative morphine requirements, incidence of side effects and patients’ satisfaction with postoperative analgesia were recorded. Results: Thirty-two patients undergoing bariatric surgery: 18 (56.25%; gastric bypass) and 14 (43.75%; gastric plication) were examined. Both groups did not differ in demographic values, duration of surgery and anesthesia and intraoperative drug consumption. Postoperative pain scores were similar in both groups (p = 0.105–0.941). Morphine consumption was 10.0 (7.0–12.5 mg) in group S and 9.0 (3.0–15.0 mg) in group K (p = 0.022). The incidence of side effects was similar in both groups (p = 0.412). Both groups demonstrated very high satisfaction with postoperative analgesia. Conclusions: Pre-incisional single dose ketamine reduces postoperative opioids consumption, but does not have an effect of postoperative pain intensity and side effects after remifentanil infusions. Very high patient satisfaction is achieved if standard multimodal analgesia protocol with an individual assessment of pain and dosage of medications is followed.

scholarly journals Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery: A Randomized, Controlled, Double-Blinded Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yu Mao ◽  
Yuanyuan Cao ◽  
Bin Mei ◽  
Lijian Chen ◽  
Xuesheng Liu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Elderly Patients ◽  
Pain Intensity ◽  
Gastrointestinal Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Multimodal Analgesia ◽  
Transverse Abdominis ◽  
Intravenous Analgesia ◽  
Double Blinded ◽  
Different Doses

Objective. To assess different doses of nalbuphine with flurbiprofen compared to sufentanil with flurbiprofen in multimodal analgesia efficacy for elderly patients undergoing gastrointestinal surgery with a transverse abdominis plane block (TAPB). Methods. 158 elderly patients scheduling for elective open gastrointestinal surgery under general anesthesia and TAPB were randomly assigned to four groups according to different doses of nalbuphine with flurbiprofen in postoperative intravenous analgesia (PCIA). Postoperative pain intensity, effective pressing numbers of PCIA, and adverse effects were recorded at 6, 12, 24, and 48 hours after surgery. Results. Postoperative pain intensity, effective pressing numbers, and the incidence of postoperative nausea and vomiting (PONV) were similar among the four groups after surgery, while the severity of PONV was decreased in Group L compared with Group S at 6, 12, and 48 h after surgery. No individual experienced pruritus, respiratory depression, or hypotension. Conclusions. Low dose of nalbuphine (15 μg·kg−1·ml−1) combined with flurbiprofen is superior for elderly patients undergoing elective open gastrointestinal surgery with TAPB in terms of the efficient postoperative analgesia and decreased severity of PONV. This trial is registered with NCT02984865.

DISCRIMINATION OF PAIN INTENSITY LEVEL AND SIDE EFFECTS OF POSTOPERATIVE PAIN USING PARAMETERS EXTRACTED FROM THE EVOKED PAIN PATTERN

2009 ◽  
Vol 21 (01) ◽  
pp. 29-38 ◽  
Author(s):  
Jiann-Shing Shieh ◽  
Liang-Yu Chen ◽  
Yeong-Ray Wen ◽  
Jen-Yin Chen ◽  
Wei-Zen Sun
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Medical Center ◽  
Intensity Level ◽  
Novel Technique ◽  
Visual Analog Scales ◽  
Pain Stimulation ◽  
Pain Pattern ◽  
Lockout Interval

The value of evoked potentials (EPs) in the clinical assessment of physiological function has been recognized for some time by those with specialized neurophysiological interests. Based on this concept, we have applied this novel technique for discrimination of pain intensity level and side effects using time-domain parameters extracted from the evoked pain pattern (EPP) in postoperative pain via patient-controlled analgesia (PCA). In conventional PCA systems, each delivery is similar to evoked pain stimulation, and we then count the following demands in a lockout interval. Therefore, the EPP is calculated and averaged from several lockout intervals in a period of time. From this calculation, the evoked parameters of area, latency, and amplitude of each period of time can be easily extracted. A total of 741 cases from 1519 patients at a medical center have been screened and compared with these three parameters using different visual analog scales (VAS) and side effects (SE). The results indicate that the area parameter is a good indicator for higher VAS patients and the variance of latency parameter is a better outcome for interpreting the patients with SE. However, the amplitude parameter shows no significant differences in both VAS and SE groups. Using massive information from clinical trials and a novel technique of evoked pain stimulation algorithm, we demonstrate that evoked parameters (i.e. area and latency) can serve as indicators to assess various clinical evidences, such as VAS and SE associated with postoperative pain.

scholarly journals Clinical Experience with Epidural Morphine

1981 ◽  
Vol 9 (2) ◽  
pp. 129-134 ◽  
Author(s):  
T. A. Torda ◽  
D. A. Pybus
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Epidural Morphine ◽  
Common Cause ◽  
Level Of Consciousness ◽  
Good Pain Relief ◽  
Cause Of Failure ◽  
Fair Degree

Epidural analgesia with morphine sulphate was administered to 130 patients. Of 96 patients with postoperative pain, 74 experienced good analgesia, 14 obtained a fair degree of pain relief, and in eight the method was unsatisfactory. Of the 34 non-operated patients 30 had good pain relief and the method failed in one. The most common cause of failure of analgesia was an incorrectly placed epidural catheter. Urinary difficulties and pruritus were encountered as the principal side-effects. One patient suffered depression of the level of consciousness following epidural drug administration and in one, epidural opiate appears to have contributed to hypotension.

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