Effect of Pre-Treatment with Ketorolac Tromethamine on Post-operative Pain Following Periodontal Surgery: A Randomized Crossover Clinical Trial

Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material & Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg & Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.

Is there an effective way to control pain perception after free gingival graft removal? A systematic review and meta-analysis

Abstract The literature describes multiple ways to stimulate wound healing to reduce the patient's perception of pain. This systematic review aimed to evaluate if methods that enhance wound healing can reduce the patient's perception of pain after free gingival graft removal from the palate region compared to natural healing. A systematic review protocol was written following the PRISMA checklist. Electronic searches of five databases were performed to identify randomized clinical trials (RCTs) that assessed the patient's perception of pain after the removal of a free gingival graft from the palate. The primary outcome was the visual analog scale (VAS) score assessing the patient's perception of pain 7 days after the free gingival graft removal from the palate region. Of the 1,622 potentially relevant articles retrieved from the electronic databases, 16 RCTs were selected for qualitative analysis, and of these, 6 RCTs were included in the meta-analysis. RCTs showed a significant VAS reduction associated with the use of methods to enhance wound healing. The pooled estimates revealed a significant overall VAS reduction of 2.20 (95% CI 2.32, 2.07) 7 days after surgery. The methods that presented the greatest reduction in the perception of pain were platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue. Methods that enhance wound healing, including platelet-rich fibrin, hyaluronic acid, and autologous fibrin glue, can reduce pain perception after free gingival graft removal in the palate region. However, only 1 RCT investigated each approach, which hinders the conclusion regarding the best procedure to reduce the perception of pain.

Resumo A literatura descreve diferentes formas de estimular a cicatrização para reduzir a percepção de dor do paciente. Esta revisão sistemática teve como objetivo avaliar se métodos que melhoram o reparo de feridas podem reduzir a percepção de dor do paciente após a remoção de enxerto gengival livre da região do palato quando comparado a cicatrização natural. Um protocolo de revisão sistemática foi escrito seguindo a lista de verificação PRISMA. Pesquisas eletrônicas em cinco bancos de dados foram realizadas para identificar ensaios clínicos aleatorizados (ECA) que avaliaram a percepção de dor do paciente após a remoção do enxerto gengival livre do palato. O desfecho primário foi o escore da escala visual analógica (VAS) avaliando a percepção de dor do paciente 7 dias após a remoção do enxerto gengival livre da região do palato. Dos 1.622 artigos potencialmente relevantes recuperados das bases de dados eletrônicas, 16 ECAs foram selecionados para análise qualitativa, e destes, seis ECAs foram incluídos na meta-análise. Os estudos analisados demonstraram uma redução significativa de VAS associada ao uso de métodos para melhorar a cicatrização de feridas. As estimativas agrupadas revelaram uma redução global significativa do VAS de 2,20 (95% CI 2,32, 2,07) 7 dias após a cirurgia. Os métodos que apresentaram maior redução na percepção de dor foram fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. Métodos que melhoram a cicatrização de feridas podem reduzir a percepção de dor após a remoção do enxerto gengival livre na região do palato, especialmente fibrina rica em plaquetas, ácido hialurônico e cola de fibrina autóloga. No entanto, apenas um ECA avaliou cada abordagem, o que impossibilita a conclusão sobre qual é o melhor procedimento para reduzir a percepção de dor.

Outcome of Longitudinal Pancreatico-Jejunostomy on Pain Control and Pancreatic Function in Chronic Pancreatitis

Background: Outcome of drainage operation for chronic pancreatitis are variable. The present study is taken to observe effect of longitudinal pancreatico-jejunostomy (LPJ) on pain control and pancreatic function in chronic pancreatitis in our setting.Material & Methods:Thirty-three patients who underwent LPJ for symptomatic chronic pancreatitis for one year period presented with abdominal pain (100%), steatorrhoea (30.3%), diabetes (66.7%) and weight loss (78.8%). Definitive diagnosis was made on the basis of ultrasonography and MRCP findings. LPJ (Partingtong-Rochelle) operation was done in all patients. Pain (using visual analoge scale), glycemic status (using FBS, 2hABF, HbA1c), body weight, serum zinc levels (as a marker of exocrine function), and serum insulin level (as a marker of endocrine function) were measured immediately after admission and 3 months after operation.Results:Three months after operation pain was completely disappeared in 23 (69.7%) patients, it persisted in different grade in 10 (30.3%) patients and the pain reduction rate was significant. Twenty two patients who had diabetes prior to surgery, their glycemic status significantly decreased and serum insulin level significantly increased (preoperative; 7.1�1 礥/L, postoperative; 14.3�礥/L) in 22 patients with DM after surgery. Serum zinc level increased (preoperative; 80.8�.5 礸/dl, postoperative; 85.3�.7 礸/dl) 3 months after surgery but the difference was not significant (p=0.571). However the body weight of all patients were significantly increased after operation.Conclusions:LPJ reduces abdominal pain and improves both exocrine and endocrine function in patient with chronic pancreatitis. Serum zinc levels can be considered as a tool of exocrine function.

The effect of biofeedback on pain and sleep in a patient with temporomandibular disorder. Case report / Efeito do biofeedback na dor e no sono de paciente com disfunção temporomandibular. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Literature has shown that behavioral and educational modalities are effective options in the treatment of chronic pain, including temporomandibular disorder, and techniques such as biofeedback have been used for single therapy or in combination for effective pain control in these individuals. Furthermore, the severity of symptoms is related to relevant prognostic factors, such as quality of life, emotional states and sleep quality. The aim of the present study was to evaluate the effect of the biofeedback audiovisual technique on pain control and sleep quality in a patient with temporomandibular disorder. CASE REPORT: Female patient, 34 years old, with Temporomandibular Disorder. The DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I, diagnostic was applied, and the patient was classified with more than one subtype of temporomandibular disorders: local myalgia and myofascial pain with reference, in addition to neck pain as a comorbidity. CONCLUSION: In this case, the biofeedback treatment was effective both in reducing pain intensity and improving sleep quality.

RESUMO JUSTIFICATIVA E OBJETIVOS: A literatura tem demonstrado que as modalidades comportamentais e educacionais são opções efetivas no tratamento da dor crônica, inclusive da disfunção temporomandibular, e técnicas como o biofeedback vêm sendo utilizadas como terapia isolada ou em combinação para um controle efetivo da dor nesses indivíduos. Além disso, a gravidade dos sintomas tem correlação com fatores de relevância para o prognóstico, como a qualidade de vida, estados emocionais e qualidade do sono. O objetivo deste estudo foi avaliar o efeito da técnica do biofeedback audiovisual no controle da dor e na qualidade do sono em paciente com disfunção temporomandibular muscular. RELATO DO CASO: Paciente do sexo feminino, 34 anos, com disfunção temporomandibular. O critério diagnóstico DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Eixo I foi aplicado, sendo a paciente classificada com mais de um subtipo de disfunção temporomandibular: mialgia local e dor miofascial com referência, além de cervicalgia como comorbidade. CONCLUSÃO: No caso clínico apresentado a terapia com biofeedback foi efetiva na redução da intensidade da dor e melhoria da qualidade do sono.

The Support in Opioid Introduction Period for Outpatients with Cancer by Palliative Care Staffs

Introduction: Our palliative care staff began the support activity in opioid introduction for outpatients with cancer at Komaki City Hospital in March 2018, because it was difficult to make them understand about proper use of opioid analgesics and misinterpretation about abuse at the time of opioid introduction in outpatient settings. This study aimed to evaluate the effects of the activity (patient education on pain control, telephone follow up, and assessment of the symptom). Method: Outpatients with cancer receiving strong opioids for pain relief from January 2017 to March 2019 were eligible. We retrospectively investigated the difference of the variables between baseline and after the activity as follows; the ratios of prescribing immediate-release opioids, antiemetics, and laxatives when opioids were prescribed and side effects due to opioid analgesics appeared. Results: The study included 122 patients. The prescribing ratios of immediate-release opioids antiemetics and laxatives all increased from 90.7 to 98.5%, from 63.0 to 70.6%, and from 61.1 to 70.6%, respectively. The side effect incidence due to opioids with STAS-J 2 or more decreased from 12 (22.2%) to 9 (13.2%). Discussion: The activity could contribute to the provision of drug treatments and counselling needed for opioid therapy.

Avaliação da eficácia de diferentes protocolos de analgesia preemptiva em cirurgias odontológicas / Evaluation of the effectiveness of different preemptive analgesia protocols in dental surgery

A analgesia preemptiva tem como princípio a administração de fármacos antes do início dos estímulos dolorosos, a fim de reduzir ou prevenir a dor pós-operatória. Apesar da sua importância, os efeitos da analgesia preemptiva em cirurgias odontológicas reportados na literatura ainda são conflitantes. Assim, o objetivo deste estudo foi avaliar a eficácia clínica de diferentes classes de medicamentos para analgesia preemptiva, em 2 propostas de investigação 1) cirurgias para exodontia de terceiros molares impactados; 2) cirurgias periodontais a retalho. Para tal, foram realizados ensaios clínicos randomizados placebo-controlados onde os participantes recebiam, 1 hora antes da cirurgia, o medicamento teste e o placebo em cirurgias distintas, em um desenho boca-dividida. Na primeira proposta de investigação, de um total de 376 pacientes com necessidade de exodontia de terceiros molares inferiores classe IIB, foram selecionados 100 pacientes, com idade entre 18 - 30 anos (22,4±2,9), alocados em 5 grupos (n = 20 por grupo), sendo: 1) paracetamol; 2) cetoprofeno; 3) ibuprofeno; 4) nimesulida; 5) dexametasona). Através de escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h e edema foi avaliado nos tempos baseline, 24h, 48h, 72h e 7 dias pós-operatórias. As diferenças entre o medicamento de teste e o placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O ibuprofeno e a nimesulida apresentaram efeitos preemptivos gerais mais altos no controle de dor ao longo do tempo, sem diferenças entre eles (p = 0,557). O paracetamol mostrou efeitos gerais mais baixos no controle do edema ao longo do tempo, quando comparado aos outros medicamentos em teste, que mostraram efeitos semelhantes (p<0,05). Também foram observados melhores resultados na quantidade de medicamentos de resgate para o ibuprofeno e a nimesulida, sem diferenças entre eles (p = 0,999). Ibuprofeno e a nimesulida mostraram melhores efeitos preemptivos gerais nas cirurgias de terceiros molares inferiores impactados e assim devem ser considerados caso a caso como medicamentos de escolha em analgesia preemptiva. Na segunda proposta de investigação, de um total de 360 indivíduos com necessidade de cirurgias a retalho, foram selecionados 40 pacientes, com idade entre 18 a 60 anos (43,40 ± 11,91), alocados em 2 grupos (n = 20 por grupo), sendo 1) ibuprofeno; 2) nimesulida. Através da escala visual analógica, dor pós-operatória foi avaliada nos tempos 1h, 6h, 12h, 24h, 48h e 72h. As diferenças entre medicamento teste e placebo foram determinadas como a variável de resposta. Um modelo de Equação de Estimativa Generalizada separado foi ajustado para cada variável desfecho e os grupos foram comparados pelo teste de Tukey. O uso de medicação de resgate foi menor e o tempo pós-operatório foi maior nos grupos teste ibuprofeno e nimesulida em comparação ao placebo (p<0,001). E o grupo nimesulida apresentou escores de EVA mais baixos nos tempos T12, T24, T72 horas (p<0,001; p<0,001; p<0,007), mostrando-se um coadjuvante benéfico para o controle da dor pós-operatória em cirurgias periodontais a retalho.

Preemptive analgesia has as its principle the administration of drugs before the start of painful stimuli, in order to reduce or prevent postoperative pain. Despite its importance, the effects of preemptive analgesia in dental surgeries reported in the literature are still conflicting. Thus, the objective of this study was to evaluate the clinical efficacy of different classes of drugs for preemptive analgesia, in 2 different research proposals: 1) surgeries for extraction of impacted third molars; 2) periodontal flap surgeries. To this end, randomized placebo-controlled clinical trials were carried out where the participants received, 1 hour before surgery, the test drug and the placebo in different surgeries, in a mouth-divided design. In the first research proposal, from a total of 376 patients in need of extraction of lower third molars, class IIB, 100 patients were selected, aged between 18 - 30 years (22.4 ± 2.9), allocated in 5 groups ( n = 20 per group), being: 1) acetaminophen; 2) ketoprofen; 3) ibuprofen; 4) nimesulide; 5) dexamethasone). Through a visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h and edema was assessed at baseline, 24h, 48h, 72h and 7 postoperative days. Differences between test drug and placebo were determined as response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. Ibuprofen and nimesulide higher overall preemptive sinks in pain controls over time, with no differences between them (p = 0.557). Paracetamol general effects resulting from lower control of edema over time, when compared to other drugs under test, which affect other similar effects (p <0.05). Better results were also observed in the quantity of rescue drugs for ibuprofen and nimesulide, with no differences between them (p = 0.999). It was concluded that ibuprofen and nimesulide are the main general preemptive effects in impacted lower third molar surgeries. Thus, in the decision-making process for preemptive analgesia, ibuprofen and nimesulide should be considered case by case as the drugs of choice. In the second research proposal, from a total of 360 individuals in need of retail surgery, 40 patients were selected, aged between 18 and 60 years (43.40 ± 11.91) years, allocated in 2 groups (n = 20 per group), being 1) ibuprofen; 2) nimesulide. Through the visual analog scale, postoperative pain was assessed at 1h, 6h, 12h, 24h, 48h and 72h. The differences between the test drug and the placebo were determined as the response variable. A separate Generalized Estimation Equation model was separated for each outcome variable and the groups were compared using the Tukey test. The nimesulide group had lower complementary EVA scores at times T12, T24, T72 hours (p <0.001; p <0.001; p <0.007). The use of rescue medication was less secondary and the postoperative time was longer in the ibuprofen and nimesulide test groups compared to placebo (p <0.001). Thus, nimesulide can be considered a beneficial adjunct to the control of postoperative pain in periodontal flap surgeries.

Terapia tópica para controle da dor em ferida neoplásica maligna: revisão de escopo / Topical therapy for pain management of malignant fungating wounds: a scoping review protocol

Introdução: Pacientes com câncer, principalmente de mama e cabeça e pescoço, podem desenvolver feridas neoplásicas malignas (FNM) como uma importante complicação. As FNM são lesões friáveis, exsudativas, fétidas e dolorosas que impactam negativamente na qualidade de vida das pessoas. Estudos mostram que todos os pacientes com FNM apresentam dor nessas lesões, a maioria com intensidade moderada a grave. A literatura tem estabelecido recomendações para o cuidado de pacientes com FNM visando ao gerenciamento ou controle dos sintomas porém embasadas em escassas evidências. Objetivo: Examinar e mapear e as evidências existentes sobre as terapias tópicas utilizadas para o controle da dor em FNM. Métodos: Revisão de escopo, conduzida de acordo com a metodologia do Joanna Briggs Institute (JBI). Foram pesquisadas as publicações nos bancos de dados CINAHL, LILACS, Embase, Scopus, Web of science e PubMed, Cochrane, NICE, Scopus, JBISRIR e literatura cinzenta, em inglês, português e espanhol e sem delimitação de tempo. Esta revisão considerou estudos realizados com pacientes, a partir de 18 anos de idade, com dor em FNM. A busca foi realizada em três etapas. Após as buscas, todos os registros identificados foram agrupados e enviados para Mendeley (MendeleyLtd., Elsevier, Holanda). Os títulos e resumos foram examinados por dois revisores independentes. Os dados foram extraídos usando uma ferramenta de extração de dados desenvolvida pelos revisores. Após a extração dos dados, realizou-se uma reunião entre os revisores para a análise dos dados e organização das categorias que deles emergiram. Resultados: Incluíram-se 70 publicações compostas por 32 Revisões não Sistemáticas de Literatura - RNS, 20 Estudos de casos - EC, seis Ensaios Clínicos Randomizados - ECR, três Coortes Retrospectivas - CP, três Revisões Sistemáticas - RS, três Guidelines, dois Surveys e uma Coorte Retrospectiva - CR que evidenciaram 20 propostas de terapias tópicas para controle de dor em FNM, assim categorizadas: Terapias Tópicas Aplicadas nas FNM (Coberturas (41 / 58,6%), Drogas analgésicas (39 / 55,7%), Substâncias antimicrobianas (18 / 25,7%), Crioterapia (4 / 5,7%) e Terapia por Pressão Negativa (3 / 4,3%) e Terapias Tópicas aplicadas na Pele Peri-Ferida (Protetores de pele (11 / 15,7%)). A dor não foi avaliada em 68,5% dos estudos. Conclusão: Muitas são as terapias tópicas descritas nesta revisão de escopo (70 publicações incluídas) para o controle de dor em FNM, principalmente do tipo RNS (32/ 45,7%) e mesmo EC (20/ 28,5%). No entanto, existem poucos estudos primários de intervenção voltados especificamente para a avaliação da sua eficácia, com metodologias consideradas inadequadas para sustentar a prática clínica, evidenciando a necessidade de novos estudos com delineamentos mais robustos. Implicações para a prática clínica e pesquisa: Esta revisão de escopo contribui para a sistematização dos achados acerca do controle da dor em FNM, sintoma bastante frequente na plêiade que acompanha essa condição tão impactante sobre a qualidade de vida e final de vida dos pacientes por ela acometidos. Seus resultados certamente possibilitam a implementação mais adequada de atenção multiprofissional a esses pacientes bem como mostram as lacunas de investigação para suporte a uma prática mais segura.

Introduction: Cancer patients, especially breast and head and neck, can develop malignant fungating wounds (MFW) as an important complication. MFW are friable, exudative, fetid, and painful lesions that negatively impact people\'s quality of life. Studies show that all patients with MFW have pain in these lesions, the majority with moderate to severe intensity. The literature has established recommendations for the care of patients with MFW aiming at the management or control of symptoms but based on little evidence. Objective: Examine and map and the existing evidence on topical therapies used to control pain in NFM. Methods: Scoping review, conducted according to the Joanna Briggs Institute (JBI) methodology. Publications were searched in the CINAHL, LILACS, Embase, Scopus, Web of Science and PubMed, Cochrane, NICE, Scopus, JBISRIR, and gray literature databases in English, Portuguese and Spanish and without time limits. This review considered studies carried out with patients, from 18 years of age, with pain in NMF. The search was carried out in three stages. After the searches, all identified records were grouped and sent to Mendeley (MendeleyLtd., Elsevier, Netherlands). Titles and abstracts were examined by two independent reviewers. The data were extracted using a data extraction tool developed by the reviewers. After extracting the data, a meeting was held between the reviewers to analyze the data and organize the categories that emerged from them. Results: 70 publications comprising 32 non-systematic literature reviews - RNS, 20 case studies - EC, six randomized clinical trials - ECR, three retrospective cohorts - CP, three systematic reviews - RS, three guidelines, two Surveys, and a Retrospective Cohort - CR that showed 20 proposals for topical therapies for pain control in FNM, categorized as follows: Topical Therapies Applied in MFW (Dressing (41 / 58.6%), Analgesic Drugs (39 / 55.7%), Substances antimicrobials (18 / 25.7%), Cryotherapy (4 / 5.7%) and Negative Pressure Therapy (3 / 4.3%) and Topical Therapies applied to Peri-Wound Skin (Skin Protectors (11/15, 7%)). Pain has not been evaluated in 68.5% of the studies. Conclusion: There are many topical therapies described in this scoping review (70 publications included) for pain control in NFM, mainly of the RNS type (32 / 45.7%) and even EC (20 / 28.5%). However, there are few primary studies interventions aimed specifically at assessing their effectiveness, with methodologies considered inadequate to support clinical practice, highlighting the need for further studies with more robust designs. Implications for clinical practice and research: This scoping review contributes to the systematization of the findings of pain control in MFW, a very common symptom in the crowd that accompanies this condition that has such an impact on the quality of life and end of life of patients through it affected. Its results certainly enable the most appropriate implementation of multi-professional care for these patients, as well as showing the research gaps to support a safer practice.

Pain Relief Efficacy of Ibuprofen Releasing Foam Dressing (Biatain Ibu®) on Outpatient Patient with Partial Thickness Burn Wound

PURPOSE: Pain management in burn treatment is important in improving wound healing and quality of life. Ibuprofen is a proven pain relieving agent in patients with partial thickness burn by intraveous injection. The purpose of this study is to evaluate the efficacy of Biatain Ibu® (polyurethane foam containing ibuprofen) in pain control for outpatients with partial thickness burns. METHODS: A prospective randomized clinical trial was performed in outpatients with partial thickness burn from August 1, 2017 to July 31, 2018. Acute pain, chronic pain, complications, days for re-epithelialization and patient's satisfaction were compared between Biatain Ibu® and Biatain® groups. RESULTS: A total of 20 patients (Biatain Ibu®, n=10; Biatain®, n=10) were assessed in the trial. On Burn days 3, 5, 7, 11, 13, and 15, the acute pain levels were significantly lower in the Biatain Ibu® group than in the Biatain® group. Complications, chronic pain levels and days for re-epithelialization were not significantly different between the two groups. Patient's satisfaction was not statistically significant but was higher in the Biatain Ibu® group. CONCLUSION: Biatain Ibu® is effective in relieving pain in outpatients with partial thickness burn without decreasing patient satisfaction, wound healing ability or developing any complications.

Anesthetic considerations for surgical treatment of geriatric hip fracture

Hip fracture is one of the most common traumatic fractures in geriatric patients. With the increase in the geriatric population, physicians are more concerned about anesthetic management of these patients and a lot of articles have been published in relation to geriatric hip fracture. Due to age related comorbidities and physical status, perioperative management of these patients are complex and related to mortality and morbidity. Anesthesia and pain control for these patients are directly related to the postoperative outcome. This article summarizes the most recent opinions about perioperative management of geriatric hip fracture patients at the point of preoperative evaluation, anesthetic managements, and pain control.

Tratamiento multimodal del dolor agudo postoperatorio agregando paracetamol IV a protocolo ya establecido / Multimodal treatment of acute postoperative pain adding IV paracetamol to an established protocol

Introducción: El paracetamol intravenoso fue autorizado en el año 2001 para Europa, en el 2016 se autoriza en Guatemala. Esta presentación ha generado diferentes expectativas alrededor del mundo, por lo que se evaluó su administración al agregarse al tratamiento de analgesia postoperatoria multimodal. Objetivo: Evaluar el efecto analgésico en el tratamiento multimodal de dolor agudo postoperatorio con paracetamol IV en la población guatemalteca. Métodos: Estudio retrospectivo caso-control para la evaluación del dolor postoperatorio inmediato (24 horas) al agregar paracetamol IV al protocolo de analgesia estándar. En pacientes de ambos géneros, entre 18 y 70 años de edad, con peso mayor o igual a 50 Kg. con una cirugía electiva abierta o por vía laparoscópica, en una muestra de 110 pacientes dividida en dos grupos. Se comparó el número de pacientes que necesitaron dosis de rescate y el nivel de dolor según la Escala Visual Análoga (EVA) durante 4 evaluaciones en el postoperatorio agudo. Para determinar la correlación entre las variables se utilizó la prueba de independencia de Ji cuadrado. Resultados: Se demostró que agregar paracetamol IV al tratamiento estándar disminuye la cantidad de pacientes que requieren dosis de rescate y mejoran su analgesia durante el postoperatorio agudo. Conclusiones: El paracetamol IV es de beneficio al ser agregado al tratamiento de analgesia multimodal convencional de un hospital privado de Z.10. Palabras clave: Analgesia, anestesia, Escala Visual Análoga, multimodal, paracetamol, control post operativo del dolor

Background: In 2001 was authorized IV paracetamol for its use in Europe. In Guatemala it was used for the first time until 2016. This formulation has awakened different expectations around the world, for this reason its administration was evaluated when added to the multimodal postoperative analgesia treatment to demonstrate its efficiency. Objective: The aim of this study is to evaluate the analgesic effect in the multimodal treatment for acute postoperative pain with IV paracetamol in a group of Guatemalans patients. Methods: Retrospective case-control study for the evaluation of acute postoperative pain (24 hours) by adding IV paracetamol to the standard analgesic protocol. Patients of both sexes, between 18 and 70 years old, with a weight greater than or equal to 50 kg with open or laparoscopically elective surgery, in a sample of 110 patients divided into two groups. The number of patients needing rescue dose and the level of pain according to the Visual Analogue Scale (VAS) were compared during 4 evaluations in the acute postoperative period. To determine the correlation between the variables, the chi square independence test was used. Results: Adding IV paracetamol to standard treatment decreases the number of patients who require rescue doses with opioids and improves their analgesia during the acute postoperative period. Conclusions: IV paracetamol is of benefit when added to the conventional multimodal postoperative analgesia treatment of a private hospital. Keywords: Analgesia, anesthesia, Visual Analogue Scale, multimodal, paracetamol, postoperative pain control

Efficacy of ketoprofen with or without omeprazole for pain and inflammation control after third molar removal

Abstract In view of the gastrointestinal problems generated by the ketoprofen use, the ketoprofen association with omeprazole is available on the market. However, this association efficacy in acute pain control has not been established. Bilateral extraction of lower third molars in similar positions is currently the most used model for the evaluation and investigation of the efficacy and pharmacological effects of new compounds for the treatment of acute postoperative pain. The randomized and crossover study consisted in evaluating the clinical efficacy of therapy performed by ketoprofen 100 mg (twice daily-b.i.d.) versus ketoprofen 200 mg + omeprazole 20 mg (once daily-q.d.) to pain, swelling and trismus control in the bilateral extraction model of lower third molars in similar positions in two different appointments, in 50 volunteers. Volunteers reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study when they took the combination of ketoprofen 200 mg + omeprazole 20 mg (q.d.). Following administration of both study drugs, no gastrointestinal adverse reactions were reported by volunteers. Furthermore, the evaluations of the drugs in pain control by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg (q.d.). For swelling and trismus control, the treatments presented similar results. In conclusion, when volunteers took ketoprofen 200 mg + omeprazole 20 mg (q.d.), they reported significantly less postoperative pain at various post-surgical periods and consumed less rescue analgesic medication throughout the study compared with ketoprofen 100 mg (b.i.d).

Resumo Em vista dos problemas gastrointestinais gerados pelo uso do cetoprofeno, a associação do cetoprofeno com o omeprazol está disponível no mercado. No entanto, esta eficácia de associação no controle da dor aguda não foi estabelecida. A extração bilateral de terceiros molares inferiores em posições semelhantes é atualmente o modelo mais utilizado para a avaliação e investigação da eficácia e efeitos farmacológicos de novos compostos para o tratamento da dor aguda pós-operatória. O estudo randomizado e cruzado consistiu na avaliação da eficácia clínica da terapia com cetoprofeno 100 mg (duas vezes ao dia-b.i.d.) versus cetoprofeno 200 mg + omeprazol 20 mg (uma vez ao dia-q.d.) para o controle da dor, do edema e do trismo no modelo bilateral de terceiros molares inferiores em posições semelhantes em duas consultas diferentes, em 50 voluntários. Os voluntários relataram significativamente menos dor pós-operatória em vários períodos pós-operatórios e consumiram menos medicação analgésica de socorro (acetaminofeno 750 mg) durante todo o estudo quando tomaram a combinação de 200 mg de cetoprofeno + 20 mg de omeprazol (q.d.). Após a administração de ambas as drogas do estudo, nenhuma reação adversa gastrointestinal foi relatada pelos voluntários. Além disso, as avaliações das drogas no controle da dor pelos voluntários foram significativamente favoráveis ​​ao cetoprofeno 200 mg + omeprazol 20 mg (q.d.). Para o controle do edema e do trismo, os tratamentos apresentaram resultados semelhantes. Em conclusão, quando os voluntários tomaram 200 mg de cetoprofeno + 20 mg de omeprazol (q.d.), eles relataram significativamente menos dor pós-operatória em vários períodos pós-cirúrgicos e consumiram menos medicação analgésica de socorro durante o estudo comparado com 100 mg de cetoprofeno (b.i.d).

Pain Control : Current Understanding And Multimodal Approach In Management Of Maxillary Midline Cyst

In 1968 Mc Caffery defined pain as “Whatever the experiencing person says it is whenever he/she says it does” Pain is the most common reason individuals seek health care. Pain control in Oral And Maxillofacial Surgery is an important factor for reducing the fear Department of Oral and Maxillofacial and anxiety associated with dental procedures. In dentistry, local Bharati Vidyapeth Dental College anaesthetics form the backbone for pain control. This case report highlights the implication of splash block technique in enucleation a maxillary midline Contact no: +91-8552887325 residual cyst which would otherwise be operated under general anesthesia owing to its proximity to nasal floor.

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

STUDY DESIGN: Prospective study. OBJECTIVES: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. SUMMARY OF LITERATURE REVIEW: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. MATERIALS AND METHODS: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. RESULTS: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p < 0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p < 0.05). CONCLUSIONS: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

Implementação de um programa de controle da dor em hospital de traumatologia e ortopedia. Relato de caso / Implementation of pain control program in a traumatology and orthopedics hospital. Case report

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é uma das mais frequentes queixas clínicas na prática diária, ambulatorial e hospitalar. Independentemente da sua causa, permanece subvalorizada e, consequentemente, sem tratamento adequado, resultando em insucessos no seu controle, prejudicando uma proposta de reabilitação física e social. O objetivo deste estudo foi apresentar o programa de controle da dor e divulgar as reais vantagens de sua implementação. RELATO DO CASO: Trata-se de um estudo descritivo com relato de experiência, em um hospital cirúrgico ortopédico, de referência nacional que atende exclusivamente pacientes do sistema único de saúde. CONCLUSÃO: Essa experiência e seus resultados incentivam a manutenção da Política de Controle da Dor e contribuem para referenciar a outras instituições de saúde os benefícios da implementação de programas e políticas semelhantes.

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the most frequent clinical complaint in daily, ambulatory and hospital practice. Regardless of its cause, it remains undervalued and, as a consequence, without adequate management, resulting in poor control, thus impairing a physical and social rehabilitation proposal. This study aimed at presenting a pain control program and at spreading the real advantages of its implementation. CASE REPORT: This is a descriptive study with experience report of a national reference orthopedic surgical hospital exclusively assisting Single Health System patients. CONCLUSION: This experience and its results encourage the maintenance of the Pain Control Policy and contribute to reference to other health institutions the benefits of implementing similar programs and policies.

Intravenous lidocaine for the treatment of acute pain in the emergency department

OBJECTIVE: To evaluate intravenous lidocaine’s safety and efficacy as an analgesic agent in the treatment of a variety of painful conditions presenting to the emergency department. METHODS: This case series identified seventeen patients who received lidocaine over a six month period and recorded demographic data, amount of lidocaine administered, the amount of opioid medication administered before and after lidocaine, pre- and post-lidocaine pain scores, and any qualitative descriptors of the patient’s pain recorded in the record. Side effects and adverse events were also recorded. RESULTS: Of the seven patients who had a pre- and post-lidocaine pain score recorded, the mean reduction was 3 points on a 10 point scale. Patients who received lidocaine used less opioid medication. One patient received an improperly high dose of lidocaine and suffered a brief seizure and cardiac arrest, but was quickly resuscitated. CONCLUSION: This series suggests that lidocaine may be a useful adjunct in the treatment of acutely painful conditions in the emergency department.

Application of Continuous Adductor Canal Block in Pain Control After Total Knee Arthroplasty / 中国微创外科杂志

It is very frequent that patients undergoing total knee arthroplasty ( TKA) suffer a severe pain from the bone cutting and soft tissue balance procedures postoperatively .In addition , pain control is the key point of the rehabilitation after surgery . Therefore, establishing an effective method to decrease the pain should be considered as a priority .Femoral nerve block (FNB), as a common and effective peripheral nerve block after TKA , affects the strength of quadriceps femoris and the postoperative recovery . Adductor canal block (ACB), targeting at the saphenous nerve , is proved to be as effective as FNB in pain control , and has less influence on the quadriceps strength .However , considering about the short time following up , the expansion of local anesthesia drug and few reports in China , the application of ACB in TKA needs further study .

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control

We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 µg/kg) over 1 minute followed by a 0.4 µg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 µg/kg) over 1 minute followed by a 0.08 µg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 µg/kg) over 10 minutes followed by a 0.5 µg/kg/hr infusion (DK group, n = 30) initiating at the end of main procedures of the operation to the time in the PACU. A single dose of intravenous ketorolac (30 mg) was given to all patients at the end of surgery. We respectively evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs and the perioperative side effects to compare the efficacy of fentanyl, remifentanil and dexmedetomidine. Compared with other groups, the modified OAA/S scores were significantly lower in DK group at 0, 5 and 10 minutes after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different from other groups. The blood pressure and heart rate in the DK group were significantly lower than those of other groups at the PACU (P < 0.05). DK group, at sedative doses, had the better postoperative hemodynamic stability than RK group or FK group and demonstrated a similar effect of pain control as RK group and FK group with patient awareness during sedation in the PACU. (World Health Organization registry, KCT0001524).

Efficacy and Safety of Combined Subacromial and Intravenous Patient-controlled Analgesia after Arthroscopic Rotator Cuff Repair

BACKGROUND: This study investigated the efficacy and safety of combined subacromial and intravenous patient-controlled analgesia for control of postoperative pain after arthroscopic rotator cuff repair. METHODS: Between May 2012 and August 2014, 60 patients who underwent arthroscopic rotator cuff repair with acromioplasty and received patient-controlled analgesia were studied prospectively. Cases were divided into 2 groups: combined subacromial and intravenous infusion group (group A, 30 cases) and solitary intravenous infusion group (group B, 30 cases). The visual analogue scale was used to record the patient's level of pain every 12 hours during postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analogue scale score was 7.8 in group A and 7.6 in group B, and the immediate postoperative visual analogue scale score was 7.9 and 8.1 for each group. At postoperative time (From 12 hours to 72 hours after operation), the scores of combined subacromial and intravenous infusion were significantly lower than those of solitary intravenous infusion. Significant difference in the frequency of supplemental analgesic injections was observed between group A and group B (p=0.008). However, no significant difference in complication rate was observed between the two groups (p=0.562). CONCLUSIONS: Combined subacromial and intravenous patient-controlled analgesia after arthroscopic rotator cuff repair is more effective than solitary intravenous infusion without significantly increasing complications. Therefore, combined subacromial and intravenous patient-controlled analgesia could be a effective pain control method.

Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines / 대한고관절학회지

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.