Comparison between preoperative rectal diclofenac plus paracetamol and diclofenac alone for postoperative pain of hysterectomy

To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy. Ninety female patients [American Society of Anesthesiologists [ASA] physical status I-II], scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8,16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A10 cm visual analog scale [VAS] was used to assess pain intensity at rest. In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower [13.9 +/- 2.7 mg] compared to diclofenac group [16.8 +/- 2.8 mg] and placebo group [20.1 +/- 3.6 mg] [p<0.05]. VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours [p<0.05]. There had been a significant difference between combination group and the two other groups in terms of the first request of morphine [p<0.05]. According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone

blinded study using celecoxib for prevention of morphine induced pruritus in patients undergoing cesarean section

We aimed to evaluate the efficacy of celecoxib in reducing Intrathecal morphine-induced pruritus in parturient undergoing cesarean section delivery under spinal anesthesia. In a randomized double-blind placebo controlled study 126 women undergoing elective cesarean section under spinal anesthesia [0.5% bupivacaine 12mg plus 0.2 mg preservative free morphine]were randomly allocated to receive celecoxib 400 mg or placebo, 2 hours prior to surgery. Severity of pruritus and pain score and frequency of opioid's side effects were recorded. Patients receiving celecoxib had significantly lower pruritus incidence and severity at 30 min,2,4 and 8 hours [40% versus 82%], but not at 12 and 24 hours postoperatively. Also there was a reduction in pain score but it was not significant [1.5 +/- 0.5 versus 1.9 +/- 0.65].Analgesic requirement was similar between two groups. Oral administration of celecoxib significantly reduced Intrathecal morphine-induced pruritus in parturient undergoing cesarean section under spinal anesthesia. There was no significant difference in pain scores and analgesic requirement

Prevention of postoperative nausea and vomiting by administration of sub hypnotic doses of propofol and midazolam during spinal anesthesia for cesarean section

To evaluate, the efficacy of sub hypnotic doses of midazolam and propofol, in prophylactic control of postoperative nausea and vomiting, in parturients undergoing elective cesarean section under spinal anesthesia. In a double-blind, placebo-controlled, randomized trial, 114 ASA physical status I-II parturient undergoing elective cesarean section under spinal anesthesia [using 0.5% bupivacaine 12 mg] were allocated randomly to receive propofol [20 mg bolus and 1.0 mg/kg/hr infusion, n=38] or midazolam [1 mg bolus and 2.0 mg/hr infusion, n=38] or saline [2 cc IV, n=38] immediately after clamping of umbilical cord. The occurrence of nausea and/or vomiting and respiratory depression was recorded during operation until 12 hr after that. The incidence of nausea and vomiting was significantly lower in midazolam and propofol groups compared with saline group in all 12 hr, [nausea: 19%, 15.8% versus 57.9%], vomiting [7.9%, 5% versus 34.2%]. There was not manifestation of respiratory depression at the time of surgery and after it. Sub hypnotic dose of midazolam was as effective as the sub hypnotic dose of propofol for preventing of nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia. We undertook this study in regard to examine a simple, safe and non-expensive antiemetic method