RESUMEN
PURPOSE: To determine if preoperative pregabalin could decrease 24-h postoperative morphine consumption after spinal anesthesia with intrathecal morphine compared with placebo. METHODS: A randomized, double-blind, controlled trial was performed in the tertiary care center. Patients aged between 18 and 65 years who were American Society of Anesthesiologists class I-II and scheduled for abdominal hysterectomy with or without salpingo-oophorectomy were randomly allocated to a placebo or a pregabalin group. Patients received pregabalin 150 mg or placebo 1 h prior to anesthesia. Spinal anesthesia was achieved with 0.5% hyperbaric bupivacaine with morphine 0.2 mg. Intravenous patient-controlled analgesia morphine was provided postoperatively. Postoperative morphine consumption at 6, 12, and 24 h, time to first analgesic rescue, pain scores, adverse effects, and patient satisfaction were evaluated at 24 h after the operation. RESULTS: One hundred twenty-five patients were recruited and 119 patients (placebo N = 58, pregabalin N = 61) were included in the analysis. Forty-seven (81.0%) patients in the placebo group and 53 (86.9%) patients in the pregabalin group required morphine in the first 24 h. Median [IQR] 24-h morphine consumption was 4.0 [1.8, 10.0] mg in the placebo group and 5.0 [2.0, 11.0] mg in the prebagalin group, p = 0.60. There were no differences in cumulative morphine consumption at 6, 12, and 24 h postoperatively. The two groups also did not differ in time to first analgesic rescue, pain scores at rest and on movement, and side effects. CONCLUSION: A single preoperative dose of pregabalin 150 mg did not reduce 24-h postoperative morphine consumption or pain scores or prolong the time to first analgesic rescue in spinal anesthesia with intrathecal morphine.
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Analgésicos/administración & dosificación , Histerectomía/métodos , Dolor Postoperatorio/tratamiento farmacológico , Pregabalina/administración & dosificación , Adolescente , Adulto , Anciano , Analgesia Controlada por el Paciente/métodos , Anestesia Raquidea/métodos , Bupivacaína/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Ovariectomía/métodos , Adulto JovenRESUMEN
BACKGROUND: Acute pain service (APS) has been set up at Siriraj Hospital with the aim of providing postoperative pain management for patients receiving anesthetic pain control and other complicated cases undergoing major operations. OBJECTIVE: To identify the incidence of moderate to severe postoperative pain and its risk factors. To describe the techniques used and adverse effects in patients under APS care. MATERIAL AND METHOD: A prospective study in 340 surgical patients under APS care from January to September 2008 was performed. Data were obtained from medical records and patients' answers during 48 hours postoperatively. RESULTS: The incidences of postoperative pain scores 4-10 at 24 and 48 hours were 28.8% and 7.4%, with median pain intensity (0-10, [interquartile range]) of 2.5 [1.0-4.0] and 1.0 [0.0-2.0], respectively. The risk factors related to pain score 4-10 included analgesic intake for > 2 consecutive weeks prior to operation, type of surgery with severe degree of pain and age 65 years (odds ratios [95% CI] of 7.12 [1.92, 26.44], 6.17 [1.37, 27.77], and 1.87 [1.07, 3.29], respectively). Of the patients, 67.9% received epidural block for postoperative analgesia. The incidences of nausea/vomiting and itching that needed treatment were 12.4% and 9.4%, respectively. CONCLUSION: Risk factors that should be concerned were age ≤ 65 years, pre-operative prolonged analgesic use and surgeries with expected severe degree of pain.
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Manejo del Dolor , Dolor Postoperatorio/prevención & control , Dolor Agudo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales , Humanos , Lactante , Masculino , Persona de Mediana Edad , Clínicas de Dolor , Dolor Postoperatorio/etiología , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the postoperative analgesic effect and postoperative nausea and vomiting (PONV) after using epidural low-dose morphine-soaked microfibrillar collagen sponge (MMCS), as compared with placebo. MATERIAL AND METHOD: A prospective randomized double-blind placebo-controlled study was performed on patients under-going single-level posterior lumbar spinal decompression and instrumented fusion at the Department of Orthopedic Surgery, Siriraj Hospital, between August 2012 and December 2013. Patients were randomly allocated into two groups to receive either an epidural MMCS or an epidural normal saline-soaked microfibrillar collagen sponge (placebo). Intensity ofpain, PONV and total amount of morphine were recorded at 4, 24, 48, and 72 hours, postoperatively. RESULTS: The analgesic effect was enhanced significantly in the epidural MMCS group, as the amount ofmorphine used was statistically less than in the placebo group at 4 and 24 hours (p < 0.05). CONCLUSION: A single low-dose epidural MMCS is effectiveforpain control after posterior lumbar spinal surgery with a low incidence of PONV.
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Implantes Absorbibles , Analgesia Epidural/instrumentación , Analgésicos Opioides/administración & dosificación , Morfina/administración & dosificación , Dolor Postoperatorio/prevención & control , Adulto , Animales , Descompresión Quirúrgica , Método Doble Ciego , Femenino , Humanos , Laminectomía , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Fusión VertebralRESUMEN
OBJECTIVE: To compare the results of 0.2 mg and 0.3 mg of spinal morphine in patients with post-thoracotomy pain. DESIGN: A prospective, randomized, double-blind study. SETTING: A university hospital and a tertiary referral center. PARTICIPANTS: Forty patients undergoing thoracotomy for lung resection. INTERVENTIONS: Spinal morphine: 0.2 mg or 0.3 mg. METHODS AND MAIN RESULTS: Patients were randomly allocated to receive either 0.2 mg or 0.3 mg of spinal morphine for post-thoracotomy pain prior to general anesthesia. Cumulative 24- and 48-hour intravenous patient-controlled analgesia meperidine consumption and numeric rating scale score for pain were recorded. The severity score (4-point scale) of sedation, nausea, vomiting, and pruritus was assessed for interval during the postoperative period. The times to first drinking/eating/sitting/walking were recorded. There was no statistically significant difference in 24-hour postoperative meperidine usages between the 2 groups, which were 110 (interquartile range 90-180) and 95 (interquartile range 57.5-175) mg, respectively. The median pain free times, time to first drinking, eating, sitting, and walking showed no differences between the 2 groups. The numeric rating scale score for pain and incidences of side effects were not different between the 2 groups. One patient who received 0.3 mg of spinal morphine developed respiratory acidosis with a respiratory rate of 10 per minute at 44 minutes after extubation. CONCLUSIONS: In patients who underwent elective thoracotomy, 0.2 mg of spinal morphine was as effective as 0.3 mg. Increasing the dosage of spinal morphine does not decrease postoperative meperidine consumption, but may lead to respiratory depression in rare cases.
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Analgésicos Opioides/uso terapéutico , Morfina/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Toracotomía , Anciano , Analgesia Controlada por el Paciente , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Método Doble Ciego , Femenino , Humanos , Inyecciones Espinales , Estimación de Kaplan-Meier , Masculino , Meperidina/administración & dosificación , Meperidina/uso terapéutico , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Manejo del Dolor/métodos , Dimensión del Dolor , Estudios Prospectivos , Análisis de SupervivenciaRESUMEN
We performed a prospective, double-blinded study in 20 patients undergoing gynecologic surgery with lower abdominal incision, to investigate characteristics of intrathecal hyperbaric levobupivacaine compared with isobaric levobupivacaine. We randomly assigned them to receive 3 mL of either isobaric or hyperbaric 0.42% levobupivacaine intrathecally. We found that hyperbaric levobupivacaine, compared with isobaric levobupivacaine, spread faster to T10 level (2.8 ± 1.1 versus 6.6 ± 4.7 minutes, P = 0.039), reached higher sensory block levels at 5 and 15 minutes after injection (T8 versus L1, P = 0.011, and T4 versus T7, P = 0.027, resp.), and had a higher peak level (T4 versus T8, P = 0.040). Isobaric levobupivacaine caused a wider range of peak levels (L1 to C8) compared with hyperbaric form (T7 to T2). The level of T4 or higher reached 90% in the hyperbaric group compared with 20% in the isobaric group (P = 0.005). Our results suggest that hyperbaric levobupivacaine was more predictable for sensory block level and more effective for surgical procedures with lower abdominal approach. Hyperbaric levobupivacaine seems to be suitable, but the optimal dosage needs further investigation.
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Analgésicos/administración & dosificación , Oxigenoterapia Hiperbárica , Adulto , Analgesia Epidural , Bupivacaína/administración & dosificación , Bupivacaína/análogos & derivados , Bupivacaína/uso terapéutico , Método Doble Ciego , Humanos , Inyecciones Espinales , Levobupivacaína , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
This prospective, double-blind, randomized, controlled trial was performed to evaluate the antiemetic effectiveness and side effects of adding droperidol to morphine delivered via a patient-controlled analgesia (PCA) device in 94 women undergoing transabdominal hysterectomy with a standardized anesthetic regimen. They were randomly allocated to receive postoperative PCA as either bolus doses of morphine I mg or a combination of morphine 1 mg and 0.0625 mg droperidol with a lockout interval of 5 minutes and no continuous infusion. The incidence of nausea 6-18 hours postoperatively and 18-24 hours postoperatively was significantly lower in the morphine and droperidol group than in the morphine only group and its severity 2-6 hours, 6-18 hours, and 18-24 hours postoperatively was significantly lower. The number needed to treat to prevent nausea comparing the morphine only group at 6-18 and at 18-24 hours postoperatively were 4 and 4 (95% CI 2-27 and 2-11, respectively). The amount of morphine used 6-18 hours postoperatively in the droperidol group was lower than in the morphine only group. Although the incidence of vomiting and the amount of rescue antiemetics were lower in the morphine and droperidol group, the difference was not statistically significant. Postoperative pain scores were not different between the groups. No patients were oversedated. A series of extrapyramidal reactions were observed in one patient in the morphine and droperidol group. The drug and consumable item cost was not different between the groups. We conclude that droperidol added to morphine in PCA reduces nausea. The appropriate dose of droperidol should be further investigated to reduce the incidence of vomiting.
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Analgesia Controlada por el Paciente/métodos , Analgésicos Opioides/efectos adversos , Antieméticos/uso terapéutico , Droperidol/uso terapéutico , Histerectomía , Morfina/efectos adversos , Náusea y Vómito Posoperatorios/prevención & control , Adulto , Analgesia Controlada por el Paciente/efectos adversos , Distribución de Chi-Cuadrado , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
The administration of morphine intravenously in the Postanesthesia Care Unit (PACU) was practiced in many parts of the world, but not routinely done in Thailand. This prospective randomized controlled trial was performed to reassure Thai personnel that this practice was safe, to find the optimum dose of morphine for administration in the PACU, and to find the pain level at which patients needed no more analgesics. Eighty gynecological patients, ASA class I or II, were randomly allocated into two groups. Group A received morphine intramuscularly on demand for pain every 6 hours as is conventional. Group B received morphine intravenously by titration (with pain) in the PACU. On the ward, they received intramuscular morphine for pain as required. No patients had respiratory depression or oversedation. The amount of morphine needed in the PACU was related to and could be calculated from the pain score at which they first needed analgesics. Time to the first requirement of intramuscular morphine on the ward in group B was significantly longer than in group A. The amount of morphine and the number of analgesic requests on the ward in group B were significantly less than in group A. We concluded that giving morphine intravenously in the PACU was safe, effective and reduced postoperative analgesic requirement. The dose of morphine in the PACU could be calculated from the pain score at patients' first request for analgesics. Most patients declined additional analgesics when their pain was acceptable and tolerable.
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Analgésicos Opioides/administración & dosificación , Morfina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Distribución de Chi-Cuadrado , Femenino , Enfermedades de los Genitales Femeninos/cirugía , Humanos , Infusiones Intravenosas , Inyecciones , Dimensión del Dolor , Cuidados Posoperatorios , Estudios Prospectivos , Estadísticas no Paramétricas , Tailandia , Resultado del TratamientoRESUMEN
Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique in experienced hands. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients by non-experienced hands. One hundred and fifty, paralysed, anesthetized, adult patients (ASA I-II, no known or potential problems with intubation) were studied. Failure to intubate was defined as lack of successful intubation after three attempts. The duration of each attempt was recorded as the time from insertion of the device into the oropharynx to the time of its removal. The total time to intubation (TTI) was defined as the sum of the durations of all (as many as three) intubation attempts. Complications, such as mucosal bleeding, lacerations, dental injury and sore throat were recorded. The mean TTI was 42.0 +/- 34.3 seconds. The overall intubation success rate was 92 per cent. Of all the successful intubations, 87.68 per cent were successful after one attempt. There were significantly fewer traumatic events (5.33%). Most of the trauma consisted of minor mucosal bleeding or mucosal laceration. We conclude that lightwand intubation is an effective and safe technique in non-experienced hands.
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Intubación Intratraqueal/instrumentación , Transiluminación/métodos , Adulto , Competencia Clínica , Hemodinámica , Humanos , Internado y ResidenciaRESUMEN
UNLABELLED: To investigate the effectiveness of intravenous lornoxicam and morphine with the preemptive effects of ropivacaine local skin infiltration and peritoneal instillation in reducing postoperative pain after transabdominal hysterectomy, a randomized, double blinded, placebo-controlled study was done in 88 patients undergoing transabdominal hysterectomy under general anesthesia. The patients were allocated into 4 groups to receive: (group A) only intravenous morphine 10 mg; (group B) intravenous morphine 10 mg and lornoxicam 16 mg; (group C) intravenous morphine 10 mg, lornoxicam 16 mg with 0.5 per cent ropivacaine local skin infiltration before skin incision and 1 per cent ropivacaine instillation before peritoneal incision; (group D) intravenous morphine 10 mg, lornoxicam 16 mg with 1 per cent ropivacaine instillation after peritoneal closure and 0.5 per cent ropivacaine local skin infiltration before skin closure. Pain was assessed by patients using visual analog scales (VAS) at 2, 6, 12, 18, 24, 48 hours after surgery. Time to first analgesic requirement and morphine requirement during the first 6 h were significantly lower in the groups using lornoxicam (group B, C, D) as compared with the group using only morphine (group A). However there was no significant difference between group B and group C or group D which means that the additional analgesic effects of using local anesthetic infiltration and instillation either before (pre-emptive) or after the incision could not be seen in this study. IMPLICATION: Intravenous 16 mg of lornoxicam with 10 mg of morphine significantly reduced postoperative pain during the first 6 h after abdominal hysterectomy. Additional effects of using local anesthetic wound infiltration to the use of lornoxicam could not be demonstrated.