Incisional Block With Bupivacaine for Analgesia After Celiotomy in Dogs

2008 ◽  
Vol 44 (2) ◽  
pp. 60-66 ◽  
Author(s):  
Ioannis Savvas ◽  
Lysimachos G. Papazoglou ◽  
George Kazakos ◽  
Tilemahos Anagnostou ◽  
Vassiliki Tsioli ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Clinical Trial ◽  
Skin Closure ◽  
Midline Incision ◽  
Pain Scores ◽  
Opioid Administration ◽  
Lower Pain ◽  
Numerical Rating

A blind, placebo-controlled clinical trial was performed to evaluate the postoperative analgesic effect of preoperative infiltration of the incision site with bupivacaine in dogs undergoing celiotomy. Sixty dogs were randomly allocated into four groups: preoperative bupivacaine, postoperative bupivacaine, preoperative saline, and postoperative saline. All dogs were premedicated with acepromazine and meperidine; then they were anesthetized with thiopentone and isoflurane. Each group received either bupivacaine or normal saline before midline incision or just before skin closure. After surgery, pain scores were assigned using a numerical rating scale. Preoperative bupivacaine was associated with significantly lower pain scores and a significantly lower need for opioid administration. The authors conclude that a preoperative incisional block with bupivacaine seems to be a useful adjunct for controlling pain after celiotomy in dogs.

scholarly journals Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Richard Mwase ◽  
Tonny Stone Luggya ◽  
John Mark Kasumba ◽  
Humphrey Wanzira ◽  
Andrew Kintu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Mulago Hospital ◽  
Clinical Trial Registry ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Intravenous Ketamine

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects.Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.”Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group.Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry numberPACTR201404000807178.

scholarly journals Electroanalgesia for the postoperative control pain in dogs

2012 ◽  
Vol 27 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Renata Navarro Cassu ◽  
Daniele Alves da Silva ◽  
Túlio Genari Filho ◽  
Helaine Stevanin
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Serum Cortisol ◽  
Acupuncture Points ◽  
Rescue Analgesia ◽  
Postoperative Control ◽  
Lower Pain ◽  
Numerical Rating ◽  
Control Pain ◽  
Electrical Stimuli

PURPOSE: To evaluate the analgesic and neuroendocrine effects of electroanalgesia in dogs undergoing ovariohysterectomy. METHODS: Eighteen dogs were randomly distributed to three groups of six animals each and received either electrical stimuli at acupuncture points (EA), at peri-incisional dermatomes (DER) and at both acupuncture points and peri-incisional dermatomes (EAD). Pre-anesthetic medication was acepromazine (0.05mg kg-1, IV). Anesthesia was induced with propofol (4 to 5mg kg-1, IV) and maintained with isoflurane. Postoperatively pain degree was measured using a numerical rating scale. Dogs were scored at 1, 3, 6, 12 and 24 hours postoperative. If the pain score was ≥6, supplemental morphine (0.5mg kg-1, IM) was administered. Serum cortisol concentration was measured before pre-anesthetic medication (basal), and at 1, 12 and 24 hours postoperative. RESULTS: EA and EAD- treated dogs had lower pain scores than DER treated dogs one hour postoperatively. Fewer EA and EAD-treated dogs required rescue analgesia. Serum cortisol did not differ among treatments. CONCLUSION: Preoperative application of electrical stimuli to acupuncture points isolated or in combination with peri-incisional dermatomes provides a reduced postoperative opioid requirement and promotes an effective analgesia in dogs undergoing ovariohyterectomy.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

scholarly journals The ALOHA Trial: (Intra-Articular Local Anaesthetic in Hip Arthroscopy) – A Double-Blinded, 3-Arm Randomised Controlled Clinical Trial Comparing Pre-Emptive, High- and Low-Dose Intra-Articular Local Anaesthetic in Hip Arthroscopy

2019 ◽  
Author(s):  
Chong Oon Tan ◽  
Phong Tran ◽  
YewMing Chong ◽  
William Howard ◽  
Laurence Weinberg
Keyword(s):  
Local Anaesthetic ◽  
Hip Arthroscopy ◽  
Low Dose ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Multimodal Analgesia ◽  
Optimum Dose ◽  
Controlled Clinical Trial ◽  
High Dose ◽  
Pain Scores

Abstract Background Pain after hip arthroscopy is variable but can be severe [11-point Numerical Rating Scale (NRS-11) pain scores of 10] despite multimodal analgesia. Although postoperative rescue regional analgesia is useful in these cases its efficacy may be limited by the maximum safe dose of local anaesthetic (LA) permissible when high-dose intra-articular local anaesthetic (IALA) has already been used. IALA may reduce acute postoperative pain after hip arthroscopy, however neither its optimum dose nor timing of administration have been systematically evaluated. Methods In 132 randomly assigned adult patients scheduled for therapeutic hip arthroscopy we compared the effects of two different doses of IALA given at procedure end (Group L [low-dose]: 100mg ropivacaine; Group H [high-dose]: 200mg ropivacaine). We also investigated the effect of an additional pre-emptive dose at the beginning of the procedure (Group P [pre-emptive]: 100mg ropivacaine at procedure start and end). Results There were no statistically significant differences between groups for NRS-11 pain scores in recovery (mean[SD]: Group L – 2.2[1.9]; Group H – 2.3[2.1]; Group P – 2.7[2.5]; lowest p = 0.6), or post recovery Visual Analogue Scale (VAS) pain scores [largest mean difference VAS 1.5 hours: 5mm (p = 0.32); VAS 2 hours: 5mm (p = 0.35); VAS 4 hours: 2mm (p = 0.7); VAS 6 hours: 3mm (p = 0.7)]. There were also no significant differences in antiemetic usage and requirement for rescue fascia iliaca block (FIB) between groups. Conclusions Compared to a single 100 mg dose of ropivacaine at the end of the procedure, we were unable to demonstrate any advantage of either a higher dose IALA or a pre-emptive dose IALA when multimodal analgesia is used. Lower-dose IALA could reduce total systemic LA absorption if a given rescue regional analgesic LA dose is used postoperatively.

Acute Cervical Radiculopathy Outcomes: Soft Disc Herniations vs Osteophytes

Pain Medicine ◽  
2020 ◽  
Author(s):  
William Jeremy Beckworth ◽  
Benjamin A Abramoff ◽  
Iain M Bailey ◽  
Sook Yoon ◽  
Monica Umpierrez ◽  
...  
Keyword(s):  
Pain Score ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Pain Scores ◽  
Plain Films ◽  
Numerical Rating ◽  
Disc Herniations

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P > 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P > 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P > 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P > 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P > 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.

Low dose ketamine versus morphine for acute severe vaso occlusive pain in children: a randomized controlled trial

2018 ◽  
Vol 18 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Felix Anthony Lubega ◽  
Mithrika S. DeSilva ◽  
Deogratias Munube ◽  
Rita Nkwine ◽  
Janat Tumukunde ◽  
...  
Keyword(s):  
Side Effects ◽  
Sickle Cell ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Duration Of Action ◽  
Pain Scores ◽  
Sickle Cell Crisis ◽  
Numerical Rating ◽  
Life Threatening ◽  
Intravenous Ketamine

AbstractBackground and aims:Acute pain episodes associated with sickle cell disease (SCD) are very difficult to manage effectively. Opioid tolerance and side effects have been major roadblocks in our ability to provide these patients with adequate pain relief. Ketamine is cheap, widely safe, readily available drug, with analgesic effects at sub-anesthetic doses and has been used in wide range of surgeries, pediatric burns dressing change and cancer related pain however, literature concerning its use in sickle cell crises is still limited in our setting. This study aimed to establish if 1 mg/kg of intravenous ketamine is non inferior to intravenous morphine 0.1 mg/kg in severe SCD-associated pain.Methods:We performed an institutional review board-approved randomized, prospective, double-blinded, active-control, non-inferiority trial at the national referral sickle cell center. Children between 7 and 18 years of age with severe painful sickle cell crisis, defined by numerical rating scale score of greater or equal to 7 were enrolled. Patients were consented and randomized to receive, either IV ketamine (LDK) 1 mg/kg or IV morphine (MOR) 0.1 mg/kg as an infusion over 10 min. The primary endpoint is maximal change in Numerical Rating Scale (NRS) pain score. Secondary outcomes were, incidence of adverse effects, optimal time to and duration of action of ketamine and incidence of treatment failures by treatment group. A clinically meaningful difference in validated pain scores was defined as 1.3 units. Assuming both treatments are on average equal, a sample size of 240 patients (120 per group) provided 95% power to demonstrate that IV LDK is non-inferior to IV morphine with a 0.05 level of significance and a 10% non-inferiority margin. All analyses were based on a modified intention to treat. This trial was registered with clinicaltrials.gov NCT02434939.Results:Two hundred and forty patients were enrolled (LDK120, MOR120). Demographic variables and baseline NRS scores (8.9 vs. 9.2) were similar. LDK was comparable to MOR in the maximum change in NRS scores, 66.4% vs. 61.3% (MD 5.5; 95% CI −2.2 to −13.2). Time to achieve maximum reduction in NRS pain scores was at 19.8 min for LDK and 34.1 min for MOR. The average duration of action for LDK was 60 min. MOR had more patients still at maximum effect at 120 min (45.8% vs. 37.5%; RR 1.2; 95% CI 0.9–1.7). LDK patients were 11.3 times more likely to develop side effects, though were transient, anticipated and non-life threatening (37.5% vs. 3.3%). MOR had significantly more treatment failures 40% vs. 28.3% (RR 0.7; 95% CI 0.5–1.03,p=0.07) Vital signs and sedation scores were similar in both groups.Conclusions:Intravenous LDK at 1 mg/kg provides comparable analgesic effectiveness as IV MOR in the acute treatment of severe painful sickle cell crisis in children in the day care sickle cell center. However, it is associated with a high incidence of several transient, non-life threatening mild side effects.Implications:Intravenous ketamine at 1 mg/kg can be a reliable alternative to morphine in the management of severe painful sickle cell crisis especially in a resource limited area where morphine is not readily available.

scholarly journals THE EFFECTS OF INJECTING INTRA ARTICULAR PLATELET-RICH PLASMA ON PAIN SCORES IN KNEE JOINT OSTEOARTHRITIS

2021 ◽  
Vol 71 (4) ◽  
pp. 1278-81
Author(s):  
Khaleel Ahmad ◽  
Liaquat Ali ◽  
Muhammad Aasam Masoom Maan
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Platelet Rich Plasma ◽  
Functional Limitation ◽  
Military Hospital ◽  
Dramatic Improvement ◽  
Pain Scores ◽  
Numerical Rating

Objective: To determine the effects of intra articular platelet rich plasma (PRP) injection on level of pain of knee joint in patients with knee osteoarthritis. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Aug 2018 to Jan 2019. Methodology: Forty patients with pain due to knee osteoarthritis for intra-articular injection were included in this observational clinical trial after informed consent and fulfilling inclusion criteria. After measuring pain by numerical rating scale, patients received intra articular platelet rich plasma (10ml) therapy in affected knee under fluoroscopy. Using the Numerical rating scale level of pain was evaluated and recorded for each patient at different intervals. Results: There was dramatic improvement in pain score after first and second injection of platelet rich plasma. There was 33.33% improvement at 3rd week, 54.32% at 6th week and 71.60% at 6th month. Conclusion: Platelet rich plasma is safe, cost effective and minimally invasive in reducing pain scores and functional limitation in knee osteoarthritis.

Effect of non-invasive intranasal neurostimulation on tear volume, dryness and ocular pain

2019 ◽  
pp. bjophthalmol-2019-315065 ◽  
Author(s):  
Monika Farhangi ◽  
Anny Mansim Cheng ◽  
Brandon Baksh ◽  
Constantine D Sarantopoulos ◽  
Elizabeth R Felix ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Case Series ◽  
Phenol Red ◽  
Ocular Pain ◽  
Symptom Report ◽  
Subjective Change ◽  
Pain Scores ◽  
Lower Baseline ◽  
Numerical Rating

PurposeTo evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.MethodsRetrospective interventional case series of patients seen in a dry eye clinic. Seventy-five individuals underwent an ocular surface examination and one session of neurostimulation. Outcome measures included objective change in tear volume measured via phenol red test, and subjective change in sensations of dryness and ocular pain measured on a 0–10 Numerical Rating Scale.ResultsThe mean age of the 75 individuals was 59±13 years, and the majority were male (73%). Intranasal neurostimulation increased tear volume (mean 13.40±8.00 mm, p<0.0005) and reduced intensities of dryness (mean −2.85±2.79, p<0.0005) and ocular pain (mean −1.48±2.41, p<0.0005 for both). However, these effects were independent of one another as change in symptom report did not correlate with change in tear volume (r=−0.13, p=0.25 for dryness; r=0.07, p=0.56 for pain). In a multivariable model, the strongest predictors for increased tear volume were lower baseline tear volume (standardised beta (β)=−0.50, p<0.0005) and absence of an autoimmune disease (β=−0.36, p=0.001) (R2=0.30). The strongest predictors for reduced dryness and pain scores were lower baseline dryness and ocular pain scores. No complications related to neurostimulation were noted.ConclusionIntranasal neurostimulation increased tear volume and reduced intensities of dryness and ocular pain, independently of one another.

Conversion of Schedule II Opioids to Buprenorphine Buccal Film: A Retrospective Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Amanda Zimmerman ◽  
Rami Bikdash ◽  
Richard Rauck
Keyword(s):  
Chronic Pain ◽  
North Carolina ◽  
Chart Review ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
Numerical Rating ◽  
Long Acting

Abstract Objective To provide clinical data for the conversion of Schedule II opioids to buprenorphine buccal film and to demonstrate sustained analgesia and a reduction in morphine milligram equivalents after conversion. Design Retrospective review of electronic medical records. Setting Group clinical practice providing outpatient chronic pain management care in Winston-Salem, North Carolina. Subjects Patients who received opioids for chronic pain between January 1, 2016, and June 30, 2019, were selected for chart review if they were converted to buprenorphine buccal film from a Schedule II opioid. Methods Patients who met inclusion criteria were stratified into subgroups on the basis of preconversion morphine milligram equivalents, whether they remained on opioids for breakthrough pain postconversion, and pre- and postconversion numerical rating scale pain scores. Outcomes of interest included the differences between pre- and postconversion numerical rating scale pain scores and daily morphine milligram equivalents for each subgroup. Results Of 157 patients reviewed, 87.9% were successfully converted to buprenorphine buccal film. Overall, numerical rating scale pain scores were stable after conversion. Statistically significant reductions were demonstrated in the &lt;90 daily morphine milligram equivalent subgroup. Postconversion daily morphine milligram equivalents decreased by 85.4% from baseline. Change in daily morphine milligram equivalents is representative of patients who remained on breakthrough pain medication. Conclusions Results demonstrate continued analgesia after conversion to buprenorphine buccal film despite reductions in daily morphine milligram equivalents. Most patients were able to convert directly from their long-acting opioid to buprenorphine buccal film and stabilized without the use of concomitant opioids for breakthrough pain. Aggressive titration strategies were associated with greater success.

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