scholarly journals The Effect of Dezocine Combined with Oxycodone in the Treatment of Advanced Lung Cancer with Bone Metastasis and Severe Cancer Pain on the Numerical Rating Scale Score of Patients

2021 ◽  
Vol 83 (s5) ◽  
Author(s):  
Chunmei Yan ◽  
Yan Liu
Keyword(s):  
Lung Cancer ◽  
Bone Metastasis ◽  
Cancer Pain ◽  
Scale Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Advanced Lung Cancer ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

scholarly journals Efficacy of Ultrasonography Guided Erector Spinae Plane Block for Perioperative Analgesia in Percutaneous Nephrolithotomy

2021 ◽  
Vol 8 (13) ◽  
pp. 830-834
Author(s):  
Srinivas Kalabhavi ◽  
Revanasiddappa A Kanagali ◽  
Bhuvanesa Nanjappa ◽  
Ravi Bhat ◽  
Promod Makanavar
Keyword(s):  
Scale Score ◽  
Percutaneous Nephrolithotomy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Erector Spinae ◽  
Secondary Outcome ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
Group A ◽  
Group B

BACKGROUND Erector spinae block is a paraspinal, fascial block that targets the ventral, dorsal rami and rami communications of spinal nerves. The present study was conducted to know the efficacy of ultrasound guided erector spinae block (ESP) block in preoperative analgesia among patients with percutaneous nephrolithotomy (PCNL) attending a tertiary care hospital. METHODS The study was carried out on 596 patients from Jan 2015 to Jan 2020 who were indicated for PCNL. They were divided into two groups, group A (ESP = 373) and group B (intravenous-IV analgesia = 273). In the group A (N = 373), after induction of general anaesthesia, ESP block with 0.5 % bupivacaine and 1 / 200,000 epinephrine (single shot) was given at lower thoracic level (T10 - 12) and IV analgesia was given in group B. All patients were monitored for supplemental opioid requirement intraoperatively as assessed by their haemodynamic status (baseline change in heart rate-HR & mean arterial blood pressure-MAP). The primary outcome of the study was consumption of tramadol in 24 hrs. Pain assessment every 2-hour pre- and post-operatively using numerical rating (NR) scale was considered as the secondary outcome. Categorical outcomes were compared between study groups using chi-square test / Fisher's exact test; Pvalue of < 0.05 was considered statistically significant using IBM SPSS. RESULTS Most of them in group A were free of pain for 24 hours postoperatively with numerical rating scale score of < 3 and did not require any postop rescue analgesics. Only 1 patient showed numerical rating scale score of 4 around 16 hrs. after the surgery and was given tramadol. Supplemental opioid analgesic was not required by any of the patients during the entire intraoperative period. CONCLUSIONS ESP block is a favourable technique that results in very good analgesic effect preoperatively and also lessens the use of intravenous opioids and other analgesics. KEYWORDS ESP Block, PCNL Surgery, Tramadol, Kidney Stones

scholarly journals Analgesic and Antihyperalgesic Properties of Propofol in a Human Pain Model

2010 ◽  
Vol 113 (2) ◽  
pp. 421-428 ◽  
Author(s):  
Oliver Bandschapp ◽  
Joerg Filitz ◽  
Harald Ihmsen ◽  
Andreas Berset ◽  
Albert Urwyler ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Scale Score ◽  
Pain Perception ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pharmacodynamic Modeling ◽  
Maximum Effect ◽  
Significant Group ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Background Propofol (Disoprivan, AstraZeneca AG, Zug, Switzerland) has long been considered to be nonanalgesic. However, accumulating evidence shows that propofol possesses modulatory action on pain processing and perception. In this study, the authors investigated the modulatory effects of propofol and a formulation similar to the solvent of propofol (10% Intralipid; Fresenius Kabi, Stans, Switzerland) on pain perception and central sensitization in healthy volunteers. Methods Fourteen healthy volunteers were included in this randomized, double-blind, placebo-controlled, crossover study. Intracutaneous electrical stimulation (48.8 +/- 25.8 mA) induced spontaneous acute pain (Numeric Rating Scale, 6 of 10) and stable areas of hyperalgesia and allodynia. Pain intensities and areas of hyperalgesia were assessed regularly before, during, and after a 45-min target-controlled infusion (2 microg/ml) of propofol, the solvent 10% Intralipid, and saline. Results During administration, propofol significantly decreased pain scores and areas of hyperalgesia and allodynia compared with both 10% Intralipid and saline (placebo-corrected mean Numerical Rating Scale score reduction by propofol: 38 +/- 28%). This difference disappeared shortly after cessation of the infusion. Thereafter, no significant group differences were observed in the Numerical Rating Scale score and the areas of hyperalgesia or allodynia. However, there was a trend to reduced hyperalgesia and allodynia after propofol treatment. Pharmacodynamic modeling regarding the analgesic effect of propofol showed an EC50 (half-maximum effect site concentration) of 3.19 +/- 0.37 microg/ml. Ten percent Intralipid was free of pain-modulatory effects in the authors' experiments. Conclusions Propofol showed short-lasting analgesic properties during its administration, whereas the solvent-like formulation 10% Intralipid had no effect on pain perception.

scholarly journals Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

2020 ◽  
Vol 37 (3) ◽  
pp. 187-192
Author(s):  
Ga Hyeon Jung ◽  
Hyun Lee ◽  
Hwa Yeon Ryu ◽  
Jae Hui Kang
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Insufficiency Fracture ◽  
Sacral Insufficiency Fracture ◽  
Korean Medicine ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
History Of ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

Opioid titration with sustained-release oxycodone and immediate-release morphine for moderate/severe cancer pain: A pilot assessment of the CoDem protocol

2014 ◽  
Vol 10 (1) ◽  
pp. 29 ◽  
Author(s):  
Boaz Gedaliahu Samolsky Dekel, MD, PhD, MA ◽  
Marco Tomasi, MD ◽  
Alessio Vasarri, MD ◽  
Alberto Gori, MD ◽  
Marco Adversi, MD ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Sustained Release ◽  
Cancer Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Numerical Rating Scale ◽  
Immediate Release ◽  
Rescue Dose ◽  
Numerical Rating ◽  
Strong Opioids

Objectives: Opioid titration is the first challenging stage for rapid control of moderate/severe cancer pain. Evidence shows that sustained-release formulations may be used for opioid titration. We set a pilot assessment of the efficacy and tolerability of our in-house protocol (continuous and on demand opioids [CoDem]) of the association of sustained-release oxycodone and immediate-release morphine as rescue dose for opioid titration/rotation in opioid-naïve (NAOP, n = 13), tolerant to weak (WOP, n = 20), or strong opioids (STOP, n = 44) in-patients with moderate/severe cancer pain.Methods: Observational and retrospective analysis of cancer in-patients treated for ≥7 days with the CoDem protocol.Outcome measures: Pain intensity (patients self-reported pain with numerical rating scale [NRS] under static [NRSs] and dynamic [NRSd] conditions), amount of drug consumption, opioid adverse effects, and patient satisfaction.Efficacy endpoints: In more than 50 percent of the patients and in <72 hours, steady NRSs and NRSd score reduction of at least two points, NRSs ≤ 3 and NRSd ≤4; and mean daily morphine consumption < mean of one rescue dose and t1:t6 ratio of mean oxycodone daily dose < 1:2.Results: Endpoints were reached within 24 hours both within the sample and subgroups. Only NAOP patients reached NRSd ≤ 4 endpoint within 48 hours. Against moderate and transient adverse effects, most patients (84.4 percent) found pain treatment to be good or excellent.Conclusions: The CoDem protocol was shown to be effective and reasonably tolerated for titration for moderate/severe cancer pain relief in both opioid-naïve or opioid-tolerant cancer in-patients. This pilot assessment warrants prospective and comparative studies with larger samples for more generalized results.

scholarly journals A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

2019 ◽  
pp. 280-283 ◽  
Author(s):  
JOHAN ◽  
INSTIATY ◽  
NAFRIALDI ◽  
YUDITIYA PURWOSUNU
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Management Index ◽  
Post Surgery ◽  
Emergency Cesarean ◽  
Experienced Pain ◽  
Chi Squared ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

scholarly journals Treatment of Neuropathic Pain with 5% Lidocaine-Medicated Plaster: Five Years of Clinical Experience

2011 ◽  
Vol 16 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Claire Delorme ◽  
Marie L Navez ◽  
Valérie Legout ◽  
Rodrigue Deleens ◽  
Dominique Moyse
Keyword(s):  
Neuropathic Pain ◽  
General Population ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Initial Assessment ◽  
Experienced Pain ◽  
Numerical Rating ◽  
Numerical Rating Scale Score ◽  
Excellent Safety Profile ◽  
One Year

BACKGROUND: Neuropathic pain is often severe and adversely affects patients’ quality of life.OBJECTIVE: To perform a retrospective, observational study investigating the efficacy and safety of treating refractory chronic neuropathic pain with 5% lidocaine-medicated plaster, in patients attending pain centres.METHODS: Medical records from 467 patients treated with 5% lidocaine-medicated plaster were evaluated for efficacy (maximum and minimum pain intensities and coanalgesic consumption) and adverse events. Data from an initial assessment and at least one follow-up visit had to be available, and separate analyses were conducted for the general population and the subpopulation older than 70 years of age.RESULTS: Of the patients enrolled, 25.0% were older than 70 years of age. While 20.6% had postherpetic neuralgia, 76.3% had other types of peripheral pain. Approximately 78.1% of cases of peripheral neuropathic pain followed surgery, and 23% were post-traumatic pain. The time from onset to referral was more than one year in two-thirds of cases. All patients experienced pain of at least moderate severity (mean [± SD] 11-point numerical rating scale score 5.2±2.4 to 8.2±1.6). Treatment with 5% lidocaine-medicated plaster reduced pain intensity by more than 50% in 45.5% of patients, and by at least 30% in 82.2%. Of note, the consumption of analgesics and coanalgesics was significantly reduced. Results were similar in both the general population and the subpopulation older than 70 years of age, at high risk and often receiving multiple medications.CONCLUSIONS: Treatment of refractory neuropathic pain with 5% lidocaine-medicated plaster clearly demonstrated efficacy and an excellent safety profile in patients with refractory neuropathic pain.

Methadone rotation for cancer pain: an observational study

2020 ◽  
pp. bmjspcare-2019-002175
Author(s):  
Christina Tan ◽  
Jade Fui Wong ◽  
Choon Meng Yee ◽  
Allyn Hum
Keyword(s):  
Neuropathic Pain ◽  
Cancer Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Asian Population ◽  
Cross Tolerance ◽  
High Interindividual Variability ◽  
Numerical Rating ◽  
Calculated Dose ◽  
Rotation Methods

ContextMethadone is a useful option in the treatment of cancer pain. Despite its advantages, methadone use is complicated due to high interindividual variability in pharmacokinetics. Various rotation methods from other opioids have been proposed in mostly Caucasian populations.ObjectivesThis study aims to describe our experience with opioid rotation to methadone for management of cancer pain in a predominantly Asian population.MethodsA retrospective review of 52 inpatients initiated on methadone for cancer pain from June 2015 to June 2018 was conducted. Our institution protocol for methadone rotation involves either one of two methods (‘Stop-and-go’ or the Edmonton 3-day rotation) based on the morphine-equivalent daily dose (MEDD), using an equianalgesic ratio of 10:1 for MEDD <1000 mg. To account for incomplete cross-tolerance, we further reduce the calculated dose by 30%.ResultsThe majority of patients had mixed nociceptive-neuropathic pain (83%) and the predominant reason for methadone rotation was ineffective analgesia with other opioids (75%). The median MEDD before rotation was 104 mg. Effective analgesia (defined as a decrease in numerical rating scale (NRS) of ≥1 or attainment of NRS ≤3) was achieved within 3 days after rotation in 89% of patients. Patients with an MEDD ≤100 mg/day required a greater degree of uptitration of methadone dose after rotation compared with those with an MEDD >100 mg/day.ConclusionRotation to methadone according to our protocol is effective in achieving adequate analgesia in most patients experiencing nociceptive-neuropathic pain. Our results also suggest that a fixed equianalgesic ratio of 10:1 may be adequate for patients at low-to-moderate MEDD <400 mg/day.

Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

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