scholarly journals The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Alireza Kazemeini ◽  
Mojgan Rahimi ◽  
Mohammad Sadegh Fazeli ◽  
Seyedeh Adeleh Mirjafari ◽  
Hamid Ghaderi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Adult Patients ◽  
Time Interval ◽  
Random Allocation ◽  
Anal Surgery ◽  
Significant Difference ◽  
Group 3

Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients.Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups.Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P<0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P<0.05).Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.

scholarly journals A comparison of the effect of dexamethasone and pethidine for prevention of shivering after spinal anesthesia in caesarean section: randomization clinical trial

2018 ◽  
Vol 5 (9) ◽  
pp. 2646-2650 ◽  
Author(s):  
Hamideh Gholami ◽  
Yousef Moradi ◽  
Zaher Khazaei ◽  
Shahrzad Tehrani
Keyword(s):  
Clinical Trial ◽  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Saline Group ◽  
Elective Cesarean Section ◽  
Double Blind ◽  
Dexamethasone Group ◽  
Postanesthetic Shivering ◽  
Significant Difference

Background: Postanesthetic shivering is one of the most common complications and problems after operations. Medications and drugs can be used to prevent postanesthetic shivering. The aim of this study is to compare the effects of Dexamethasone and Pethidine in preventing postanesthetic shivering after spinal anesthesia in Iranian women undergoing caesarean section. Method: This double-blind randomized clinical trial was performed in 66 pregnant women who were referred to Ayatollah Moosavi Hospital in Zanjan, Iran for elective cesarean section, from December 2011 to November 2012. All participants who have ASA I-II were randomly classified into three groups: Dexamethasone receivers (Group A), Pethidine receivers (Group B), and Normal Saline receivers (Group C). Data were collected and analyzed using SPSS16 software. IRCT registration number of this study is IRCT201112198469N1. Conclusion: Although statistically there was no significant difference between the three groups of Dexamethasone, Pethidine and Normal Saline receivers regarding shivering reduction; clinical complication rate in Dexamethasone group was lower comparedto Pethidine and Normal Saline groups. Results: There was no significant difference between three groups regarding shivering reduction. There were 11 (72.5%) trembling cases in Normal Saline group, 6 cases (27.3%) in Dexamethasone group, and 12 cases (54.5%) in Pethidine group.

scholarly journals Spinal Anesthesia and Spinal Anesthesia with Subdiaphragmatic Lidocaine in Shoulder Pain Reduction for Gynecological Laparoscopic Surgery: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Zahra Asgari ◽  
Mahroo Rezaeinejad ◽  
Reihaneh Hosseini ◽  
Masoumeh Nataj ◽  
Maryam Razavi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Surgery ◽  
Spinal Anesthesia ◽  
Primary Outcome ◽  
Pain Perception ◽  
Pain Reduction ◽  
Time Interval ◽  
Significant Difference ◽  
Gynecological Surgical Procedures ◽  
Vas Scores

Objective. The aim of this study was to compare the effectiveness of spinal anesthesia with subdiaphragmatic lidocaine at the beginning of surgery versus spinal anesthesia in pain reduction for gynecological laparoscopic surgery. Methods. This was a clinical trial conducted in Arash Hospital, Tehran, Iran. Eighty-four patients were randomized to either spinal anesthesia with subdiaphragmatic lidocaine, spinal anesthesia, or general anesthesia (GA). The primary outcome was patients’ pain perception during surgery, 2, 4, 6, and 12 hours after surgery, and prior to discharge and was assessed by visual analogue scale (VAS). Results. The results showed that there are no significant changes in pain perception over time in none of the three groups (F(4,76) = 0.37, P=0.82). The severity of pain experienced by patients at all-time interval after surgery was similar between groups [F(2,79) = 0.54, P=0.58]. Conclusion. The use of subdiaphragmatic lidocaine at the beginning of surgery combined with spinal anesthesia was not associated with a statistically significant difference in patients’ postoperative VAS scores compared to spinal anesthesia and GA during and after gynecological surgical procedures. The study was registered in Iranian Registry of Clinical Trial by the number of IRCT2016022226698N1.

scholarly journals The Effect of Adding Lidocaine to Patient Controlled Analgesia with Morphine on Pain Intensity after Caesarean Section with Spinal Anesthesia: A Double-Blind, Randomized, Clinical Trial

2019 ◽  
Vol 7 (12) ◽  
pp. 1946-1950 ◽  
Author(s):  
Ali Habibi ◽  
Abbas Alipour ◽  
Afshin Gholipour Baradari ◽  
Abdolmajid Gholinataj ◽  
Mohammad Reza Habibi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Caesarean Section ◽  
Pain Intensity ◽  
Normal Saline ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Patient Controlled Analgesia ◽  
Patients Satisfaction ◽  
Significant Difference

BACKGROUND: Caesarean section is one of the commonest gynaecological surgeries. AIM: Given the importance of pain relief after caesarean section surgery as well as contradictions in the studies conducted on intravenous lidocaine analgesic effects, this study aimed to evaluate the effect of adding lidocaine to patient-controlled analgesia (PCA) with morphine on pain intensity after caesarean section surgery. MATERIAL AND METHODS: In a double-blinded, randomised clinical trial, 80 women who were scheduled for caesarean section surgery with spinal anaesthesia at Sari Imam Khomeini Hospital in 2017 were randomly assigned into two intervention and control groups. After surgery, all patients were connected to a morphine PCA pump. The PCA solution (total volume = 100 ml) in intervention group contained 50 ml of 2% lidocaine and 30 mg (3 ml) of morphine in 47 ml normal saline. In the control group, the PCA pump contained 30 mg (3 ml) of morphine, and the rest (97 cc) was normal saline. Patients' pain intensity was assessed at 2, 4, 6, 12, 18 and 24 hours after surgery using a visual analogue scale (VAS). Additionally, their postoperative nausea and vomiting, duration of hospitalisation, duration of ileus relapse after surgery, and patients' satisfaction after surgery were evaluated. Data were analysed using SPSS version 22 software.RESULTS: The mean and standard deviation of pain intensity in all patients at the intervals of 2, 4, 6, 12, 18 and 24 hours after surgery were 5.91 ± 1.57, 4.97 ± 1.55, 3.84 ± 1.60, 3.54 ± 1.45, 2.56 ± 1.70 and 0.94 ± 1.70, respectively. Data analysis revealed that, regardless of the groups, postoperative pain intensity significantly decreased (P < 0.0001). However, there were no significant differences between the two groups in terms of mean postoperative pain intensity at any time interval (p > 0.05). Also, there was no significant difference between the two groups in terms of frequency of receiving the diclofenac suppositories after the surgery (p > 0.05). Additionally, there was no statistically significant difference between the two groups in terms of postoperative nausea and vomiting, duration of hospitalisation, duration of postoperative ileus relapse and patients' satisfaction (p > 0.05).CONCLUSION: Based on the results of this study, it seems that adding lidocaine to PCA with morphine, compared with morphine PCA alone, do not have a significant effect on reducing the pain intensity after cesarean section using spinal anaesthesia. Although, further studies with larger sample size are warranted.

scholarly journals Comparative evaluation of postoperative pain intensity after single-visit and multiple-visit retreatment cases: a prospective randomized clinical trial

2018 ◽  
Vol 21 (1) ◽  
pp. 26 ◽  
Author(s):  
Hatice Miray Uyan ◽  
Keziban Olcay ◽  
Mutlu Özcan
Keyword(s):  
Postoperative Pain ◽  
Repeated Measures ◽  
Control Group ◽  
Periapical Lesions ◽  
Single Visit ◽  
Group 4 ◽  
Multiple Visit ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2

<p><strong>Objective:</strong> This study was designed to evaluate postoperative pain after endodontic retreatment. <strong>Material and Methods:</strong> Asymptomatic, multi-rooted molar &amp; premolar teeth requiring retreatment with 2–5 mm periapical lesions were included. Seventy-eight teeth were randomly placed in four groups (n=20): single-visit (control, group 1), Ledermix (group 2), metronidazole, ciprofloxacin, minocycline mixture (group 3), calcium hydroxide (group 4). The postoperative pain was recorded using a VAS at 6, 12, 24, and 48 h after retreatment. Statistical evaluation was performed using Two-Way Repeated Measures ANOVA and Tukey test. <strong>Results:</strong> Mild pain occurred in 67.5%, moderate in 30%, and flare-ups in 2.5%, and there was a significant difference between the groups (p&lt;0.01). Significantly lower postoperative pain was observed in TAP and CaOH<sub>2 </sub>groups(p&lt;0.05). In the 6, 12, and 24 h intervals, there was a significant difference in the pain levels (p&lt;0.05). <strong>Conclusion:</strong> TAP and CaOH<sub>2</sub> are effective for reducing postoperative pain after retreatment.</p><p><strong>Keywords</strong></p><p>Intracanal medicaments; Multiple-visit; Postoperative pain; Retreatment; Single-visit.</p>

Randomised clinical trial comparing the perioperative analgesic efficacy of oral tramadol and intramuscular tramadol in cats

2021 ◽  
pp. 1098612X2110404
Author(s):  
Sébastien H Bauquier
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Analgesic Efficacy ◽  
Randomised Clinical Trial ◽  
Rescue Analgesia ◽  
Exact Test ◽  
Pain Scores ◽  
Significant Difference ◽  
American Society ◽  
Induction Of Anaesthesia

Objectives The aim of this study was to evaluate the analgesic efficacy of oral tramadol in cats undergoing ovariohysterectomy. Methods Twenty-four female domestic cats, American Society of Anesthesiologists class I, aged 4–24 months, were included in this positive controlled, randomised, blinded clinical trial. Cats admitted for ovariohysterectomy were allocated to group oral tramadol (GOT, n = 12) or group intramuscular tramadol (GIMT, n = 12). In GOT, tramadol (6 mg/kg) was given orally 60 mins, and saline was given intramuscularly 30 mins, before induction of anaesthesia. In GIMT, granulated sugar in capsules was given orally 60 mins and tramadol (4 mg/kg) intramuscularly 30 mins before induction of anaesthesia. In both groups, dexmedetomidine (0.007 mg/kg) was given intramuscularly 30 mins before induction of anaesthesia with intravenous propofol. Anaesthesia was maintained with isoflurane in oxygen, and atipamezole (0.037 mg/kg) was given intramuscularly 10 mins after extubation. The UNESP-Botucatu multidimensional composite scale was used to conduct pain assessments before premedication and at 20, 60, 120, 240 and 360 mins post-extubation or until rescue analgesia was given. To compare groups, the 60 min postoperative pain scores and the highest postoperative pain scores were analysed via a two-tailed Mann–Whitney test, and the incidences of rescue analgesia were analysed via a Fisher’s exact test; P <0.05. Results There was no significant difference between groups for the 60 min ( P = 0.68) pain scores. The highest postoperative pain score was higher for GIMT compared with GOT ( P = 0.04). Only two cats required rescue analgesia, both from GIMT. The incidence of rescue analgesia was not significantly different between groups ( P = 0.46). Conclusions and relevance In the present study, preoperative administration of oral tramadol at 6 mg/kg to cats provided adequate analgesia for 6 h following ovariohysterectomy surgery.

Safe Out-of-Hospital Treatment of Chest Pain Without Direct Medical Control

1996 ◽  
Vol 11 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Mara McErlean ◽  
Nancy Raccio-Robak ◽  
Joel M. Bartfield ◽  
Daniel Hermes
Keyword(s):  
Chest Pain ◽  
Adult Patients ◽  
Categorical Variables ◽  
Hospital Treatment ◽  
Time Interval ◽  
Medical Control ◽  
Physician Contact ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractIntroduction:The use of direct medical control (DMC) in the out-of-hospital setting often is beneficial, but has the disadvantage of consuming emergency medical services (EMS) resources.Hypothesis:Uncomplicated, nontrauma, adult patients with chest pain can be treated safely and transported by paramedics without DMC.Methods:Retrospective chart review of all nontrauma, adult patients with chest pain treated in a combined rural and suburban EMS system during a 2-year period (December 1990 through November 1992) was conducted. Before November 1991, DMC was mandatory for all patients with chest pain. Beginning 01 November 1991, if a patient had resolution of pain either spontaneously, with administration of oxygen, or after a single dose of nitroglycerin, DMC was at the discretion of the paramedic. Using the above criteria for inclusion, three study groups were defined: Group 1, before protocol change; Group 2, after protocol change without DMC; and Group 3, after protocol change when physician contact was obtained, but not required. These groups were compared for the following parameters: 1) scene time; 2) time to administration of first dose of nitroglycerin; 3) time interval between measurement of vital signs; 4) oxygen use; 5) intravenous access; and 6) electrocardiographic monitoring. Continuous and categorical variables were analyzed by multivariate and univariate analysis of variance and chi-square tests, respectively.Results:Of 308 nontrauma, adult patients with chest pain, 71 met inclusion criteria in Group 1, 40 in Group 2, and 34 in Group 3. No statistically significant differences were identified in any of the study parameters.Conclusion:Adult patients with chest pain who have no other symptoms or complicating conditions can be treated appropriately by paramedics without DMC.

scholarly journals Comparison of Hemodynamic Response following Spinal Anesthesia between Controlled Hypertensive and Normotensive Patients Undergoing Surgery below the Umbilicus: An Observational Prospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Leake Gebrargs ◽  
Bereket Gebremeskel ◽  
Bacha Aberra ◽  
Assefa Hika ◽  
Yusuf Yimer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cohort Study ◽  
Spinal Anesthesia ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Study Groups ◽  
Categorical Variables ◽  
Time Interval ◽  
Significant Difference

Background. Hypotension and bradycardia are the most common complications associated with spinal anesthesia and more common in patients with a history of hypertension. Regular use of antihypertensive medications can prevent these complications. The occurrence of hypotension under spinal anesthesia among controlled hypertensive and normotensive patients with age 40 years and above is still debated. The objective of the study was to compare blood pressure and heart rate changes following spinal anesthesia between controlled hypertensive and normotensive patients undergoing surgery below the umbilicus at Black lion hospital, Addis Ababa, Ethiopia, 2020. Method. A hospital-based prospective cohort study was conducted. A total of 110 elective patients with controlled hypertension (55) and normotensive (55) patients who underwent surgery with spinal anesthesia at black lion hospital during the study period were included. The sample was selected using a systematic random sampling technique. Continuous data of independent and dependent variables were analyzed using an independent sample t-test for normally distributed and Mann–Whitney U-test for nonnormally distributed between the study groups. Categorical variables between the study groups were analyzed using the chi-square test. Descriptive data were displayed using tables and figures. For continuous and categorical variables, a p value <0.05 was considered statistically significant. Results. The incidence of hypotension in the controlled hypertension group (23.6%) was higher than the normotensive group (7.3%) with p value of 0.018. The occurrence of bradycardia was seen to be 12.7% in each group with a p value >0.05. There was a statistically significant difference in the mean systolic blood pressure, mean arterial pressure, mean heart rate, and vasopressor consumption at the measurement time interval between controlled hypertension and normotensive groups. Conclusion. Under spinal anesthesia, patients with controlled hypertension are more likely to develop hypotension than normotensive patients, but on the occurrence of bradycardia, there was no statistically significant difference between the two groups.

Intravenous Ondansetron for Attenuation of Post Spinal Anesthesia Hypotension

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Saeed Mohamed Ibrahim ◽  
Rania Mahrous Aly Hussien ◽  
Hazem Mohamed Sabry Abdel Aziz Ahmed
Keyword(s):  
Spinal Anesthesia ◽  
Local Anesthetic ◽  
Normal Saline ◽  
Demographic Data ◽  
Randomized Study ◽  
P Value ◽  
Anthropometric Measures ◽  
Double Blind ◽  
Induced Hypotension ◽  
Significant Difference

Abstract Background Spinal Anesthesia is a common type of anesthesia used during many surgical procedures. This regional technique can be accomplished by administering an intrathecal dose of hyperbaric local anesthetic solution. The local anesthetic within the subarachnoid space can block sensory, motor and sympathetic pathways. Objectives The Purpose of this study was to find out the effectiveness of prophylactic administration of intravenous ondansetron for attenuation of spinal anesthesia induced hypotension in non-obstetric spinal anesthesia surgeries. Patients and Methods Therefore, A prospective double-blind, placebo-controlled, randomized study was found to be the most suitable design in order to achieve the study objectives. A total of 90 patients males & females included in the study, aged 20-40 years, and were divided equally into two groups: Group A received 8 mg ondansetron diluted in volume of 10 cm normal saline 5 minutes prior to spinal anesthesia. Group B received a placebo of 10 cm normal saline 5 minutes prior to spinal anesthesia. Results There was no statistically significant difference found between the two studied groups regarding demographic data, anthropometric measures, ASA score and total time of surgery. There was statistically significant increase in the incidence of hypotension immediately after spinal and at 5 min in placebo group than ondansetron group with p-value = 0.026 and 0.014 respectively. Conclusion The present study demonstrated that, among patients who received spinal anesthesia with bupivacaine for elective for surgeries below umbilicus, prophylactic intravenous ondansetron 8mg iv 5 mins prior to spinal anesthesia reduced spinal anesthesia induced hypotension decreases in SBP, MAP, and heart rate. Ondansetron did not have a significant effect on DBP. Ondansetron did not have a significant effect on DBP. The incidence of nausea and vomiting was lower following the administration of ondansetron, and vasopressor use and dosages were reduced.

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

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