Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients' satisfaction, and side effects were collated. The level of significance was set at <0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13).Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects

Role of butorphanol in preemptive analgesia: a comparison with pentazocine

Background: Preemptive analgesia establishes effective antinociception before surgery and continuation of this effective analgesic level well into the postoperative period. Butorphanol tartrate and pentazocine lactate are opioid analgesics with mixed agonist-antagonist properties

Aim: The aim of the present study was to compare the preemptive analgesic effect of butorphanol and pentazocine given by intramuscular [IM] route as a primary outcome. Secondary outcome was to compare hemodynamic parameters and the side effects profile

Methodology: A comparative randomized, single blind, and prospective clinical study in sixty patients ASA physical status I and II was carried out. Patients were demographically similar. Patients were randomized to receive either a butorphanol injection [Group B] 2 mg [n=30] or pentazocine injection [Group P] 60 mg [n=30] both IM 60 min before surgery. Lower abdominal surgeries under spinal anesthesia were selected. Duration of pain relief was recorded by visual analogue scale [VAS] postoperatively up to 24 h. Sedation was measured with Cook's sedation score system. Patients were observed for any change in vital signs and any other side effect for 24 h. Rescue analgesia in the form of IM diclofenac sodium 75 mg was given when VAS>3

Results: Duration of analgesia was up to 18 h in Group P while it was extended in Group B, but this was statistically not significant. Requirements of rescue analgesia were higher and occurred earlier in Group P, although not statistically significant. Sedation score was also comparable. Hemodynamic changes were not significant with the exception of an increase in mean arterial pressure in Group P. No severe side effects were observed in any patient of either group

Conclusion: Butorphanol a mixed agonist-antagonist opioid in the dose of 2 mg IM is an acceptable alternative to pentazocine as a pre-emptive analgesic due to longer duration of analgesia and greater analgesic efficacy with low incidence of side effects

Efficacy of the Thoracolumbar Interfascial Plane Block for Lumbar Laminoplasty: A Retrospective Study

STUDY DESIGN: This paper was a single center-based retrospective study with prospective data collection. PURPOSE: Compared with other surgeries, limited options are available for perioperative pain management in spinal surgery. Therefore, we aimed to identify new pain management in this study. OVERVIEW OF LITERATURE: The thoracolumbar interfascial plane (TLIP) block has been reported to provide effective regional analgesia in the lumbar region. This study investigated the efficacy of the TLIP block for pain management in lumbar laminoplasty. METHODS: We investigated patients who underwent lumbar laminoplasty for the treatment of lumbar spinal canal stenosis from April to October 2015. Patients with secondary surgery or surgery involving more than four intervertebral spaces were excluded. The primary outcome measure was the pain scale score within 48 hours after the surgery. The secondary outcomes were the number of additional analgesic drugs used and the number of patients complaining of complications, such as nausea and vomiting, within 24 hours after the surgery. RESULTS: We retrospectively assessed the data of 44 patients who underwent lumbar laminoplasty. Of these, 25 patients received only general anesthesia (G group), whereas 19 patients received the TLIP block along with general anesthesia (T group). Compared with the G group, the T group reported lower pain scores for pain at 1, 2, 4, and 24 hours postoperatively. Moreover, the number of patients who received the additional analgesic pentazocine was lower in the T group than in the G group. The two groups showed no significant differences in the incidence of complications. CONCLUSIONS: The TLIP block provides effective analgesia for 24 hours postoperatively in patients undergoing lumbar laminoplasty.

Study on the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the preemptive analgesia effects of both the parecoxib sodium and the pentazocine in patients undergoing nasal endoscopic surgery.@*METHOD@#In the randomized, double blind, controlled study, 120 patients undergoing septoplasty were divided into 3 groups (n = 40): group A received parecoxib 40 mg by muscle injection 30 min before the operation; group B received pentazocine 30 mg; group C received an equal volume of saline. The preemptive analgesia effect was evaluated with VAS scores which recorded at different time points. The proportion of participants using rescue analgesia after the operation were recorded as additional measures of preemptive analgesia.@*RESULT@#Intra-operative as well as the postoperative pain scores were less in the group A and group B than in the control group. Fewer participants required rescue medication after operation with parecoxib as well as pentazocine than placebo. However there were no difference in the preemptive effects between the group A and group B.@*CONCLUSION@#Administration of both the parecoxib and pentazocine before the nasal endoscopic surgery can provide preemptive analgesia without serious adverse side effects that deserves popularization in the clinic.

Cushingoid features in an obese female with XY Karyotype / Journal of the ASEAN Federation of Endocrine Societies

@#Disorders of sexual development are congenital in nature. Complete androgen insensitivity syndrome (CAIS) is a rare disorder with an incidence of nearly 1 in 20,000 male births. The majority of patients present with complaints of primary amenorrhoea and are phenotypically female but genotypically male. We report a case of a 40-year-old female presenting with backache and skin ulcers who was found to have exogenous Cushing’s syndrome with long glucocorticoid administration and suspected CAIS. The ulcers were secondary to intramuscular pentazocine injections.

Application of subclinical doses of pentazocine and propofol in painless vaginal egg retrieval / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the feasibility of using subclinical doses of pentazocine in painless egg retrieval.</p><p><b>METHODS</b>Eighty-one patients undergoing painless egg retrieval were randomized into the observation group and the control group to receive 0.4 mg/kg pentazocine with 1.5 mg/kg propofol and 0.5 mg/kg pentazocine with 1.5 mg/kg propofol, respectively. The mean arterial pressure (MAP), heart rate (HR), SPO(2), respiratory rate (RR), unconsciousness time, awake time, hospital stay, complications, consciousness during the operation and adverse effects were compared between the two groups.</p><p><b>RESULTS</b>The two groups showed no significant differences in the analgesic effect, dosage of propofol, adverse effects, unconsciousness time, awake time, or hospital stay. But compared with the control group, the observation group showed greater intraoperative consciousness but with more stable respiration.</p><p><b>CONCLUSION</b>Subclinical doses of pentazocine can be used in the painless egg retrieval, but the dose of propofol should be increased to reduce the body activity during the operation.</p>

Clinical observation of pentazocine for postoperative intravenous analgesia in patients with lumbar herniation / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effects and side effects of Pentazocine for postoperative intravenous analgesia in patients with lumbar herniation, and to investigate the difference of Pentazocine with different doses.</p><p><b>METHODS</b>From January 2009 to December 2009, sixty patients undergone laminectomy and pedicle internal fixation, who using equal analgesic dosage of Pentazocine and Sulfentanil, were retrospectively analysed. The patients including 34 males and 26 females, aged 40 to 65 (average 59), weighted 60 to 80 kg (average 71 kg), ASA I-II, were divided into Sufentanil group and Pentazocine group I and Pentazocine group II, with 20 cases each. The regimens of the three groups included: Sufentanil of 2 g/kg; Pentazocine group I of 3 mg/kg; Pentazocine group II of 5 mg/kg. All were diluted with saline into 100 ml and were continuously infused at the rate of 2 ml/h. Visual analogue scale (VAS), Ramsay sedation scale and side effects were recorded at 4, 8, 12, 24, 36, and 48 h postoperatively.</p><p><b>RESULTS</b>The three groups had no significant difference in analgesic effects, VAS of all groups were below 3. The sedation scale of Pentazocine group II at 4, 8, 12 h was higher than that at 4 h, significantly different than the other two groups. The incidence of nausea, vomiting and pruritus in Sufentanil group were higher than that in the other two groups. The incidence of respiratory depression in Sufentanil group and Pentazocine group II were higher than that in Pentazocine group II. The incidence of dizziness in Pentazocine group II were higher than that in the other two groups.</p><p><b>CONCLUSION</b>Pentazocine can produce reliable postoperative analgesia for patients with lumbar herniation, as same as the effect of sulfentanil in equal dose. And Pentazocine has fewer adverse effects compared with sufentanil. 3 mg/kg of Pentazocine is an optimal dose for postoperative intravenous patient-control analgesia.</p>

Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.

Background : Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases. Aims: To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine. Settings and Design : Outpatient gynecological department and open randomized trial. Materials and Methods : One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Statistical Analysis : Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the χ2 test. Results: Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13± 1.28; group II, 5.93± 1.26; group III, 5.58± 1.51), (P< 0.001); as well as 30 minutes later (group I, 1.78± 0.89; group II, 2.53± 0.81; group III, 2.23± 0.94), (P< 0.001) and 60 minutes later (group I, 1.2± 0.46; group II, 1.98± 0.83; group III, 1.68± 0.75), (P< 0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed. Conclusions : Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.

Studies on the potentiation analgesic effect of phenytoin and ketorolac with pelitazocine using albino mice by eddy's hot plate method

The analgesic activity was tested by Eddy's hot plate method in albino mice using combination of Pentazocine [1 mg/kg] with Phenytoin [10.20 mg/kg] and Pentazocine [1 mg/kg] with Ketorolac [10.20 mg/kg] was given by intra-peritoneal administration, The results showed a significant increase in reaction time [analgesia] in albino mice and hence the present study indicates that combination of Phenytoin and Ketorolac with Pentazocine has significant prolonged analgesic effect as compared with analgesic effect produced by Pentazocine alone

Pentazocine-induced leg ulcers and fibrous papules.

We herein describe a case of 55-year-old farmer, who presented with chronic non-healing ulcers over both shins of 4 years duration. Intravenous drug abuse was suspected due to inability to find any venous access and all peripheral veins being found thickened and fibrosed. There were multiple atrophic scars in linear distribution in all limbs as well as in both groins. In addition there were multiple discrete fibrous papules in linear distribution on both hands, which were more obvious on the left side. The patient denied abusing intravenous drugs. However, his relatives confirmed that he abused pentazocine for almost one year before his chronic pain in abdomen was treated by appendicectomy. With subsequent counseling, it was found that he continued to abuse pentazocine at times even after surgery leading to the non-healing of ulcers.

Analgesic activity of methanol extract of Eupatorium adenophorum Spreng. leaves.

The methanol extract of the leaves of E. adenophorum (100, 200 and 300 mg/kg, po) showed significant analgesic activity, as compared to standard drugs diclofenac sodium and pentazocine, employing acetic acid-induced writhing test, tail immersion test and tail flick test models.

Possible analgesic and anti-inflammatory interactions of aspartame with opioids and NSAIDs.

The purpose of the present study was to investigate analgesic and anti-inflammatory properties of aspartame, an artificial sweetner and its combination with various opioids and NSAIDs for a possible synergistic response. The oral administration of aspartame (2-16mg/kg, po) significantly increased the pain threshold against acetic acid-induced writhes in mice. Co-administration of aspartame (2mg/kg, po) with nimesulide (2 mg/kg, po) and naproxen (5 mg/kg, po) significantly reduced acetic acid-induced writhes as compared to effects per se of individual drugs. Similarly when morphine (1 mg/kg, po) or pentazocine (1 mg/kg, po) was co-administered with aspartame it reduced the number of writhes as compared to their effects per se. Aspartame (4,8,16 mg/kg, po) significantly decreased carrageenan-induced increase in paw volume and also reversed the hyperalgesic effects in rats in combination with nimesulide (2 mg/kg, po).The study indicated that aspartame exerted analgesic and anti-inflammatory effects on its own and have a synergistic analgesic response with conventional analgesics of opioid and non-opioid type, respectively.

Inhibition of COXI and not COX2 enzyme potentiates the opioid induced analgesia in rats

Opioids are widely used in the treatment of various types of pain and hyperalgesic states. However, opioid related side effects are well known and are representing a great challenge in using these drugs for the management of pain. A combined use of opioids with nonsteroidal anti-inflammatory drugs [NSAIDs] has been advocated in clinical practice to potentiate each other analgesic effect and to reduce the dose and related side effects of both drugs. Several studies on animal and human models have shown that such combination provides greater efficacy in pain relief. Reducing the doses of opioids used, due to the presence of N'SAIDs, ultimately reduces potential for side effects. It is unclear whether NSAIDs induces its opioid analgesic potentiating effect through inhibition of COX1 or COX2 enzymes. Both isoforms contribute to the inflammatory process, but COX2 is of considerable therapeutic interest as its induction, results in an enhanced formation of prostaglandins, during acute as well as chronic inflammation. It is generally assumed t hat NSAIDs anti-inflammatory and analgesic activity is mediated via COX2 inhibition. In contrast, it has been reported that the potencies of various NSAIDs to potentiate opioid induced presynaptic inhibitory effect nearly matched their inhibitory potencies at COX1. The present study was designed to study the effect of co-administration of the non selective COX inhibitor, indomethacin or diclofenac with pentazocine on pain relief and to compare it with the effect of its coadministration with the selective COX2 inhibitors, rofecoxib and meloxicam. Tail flick and hot plate assays were used asmodels o f central nociception. Non selective COX inhibitors, indomethacin and diclofenac potentiated the antinoceceptive effect of the opioid agonist pentazocine, an effect that was abolished by naloxone. The selective COX2 inhibitors, rofecoxib and meloxicam failed to modify the analgesic effect of pentazocine. These results suggest that analgesia potentiating effect of NSAIDs is mediated through inhibition of COX1 rather COX2 enzyme. The finding support a novel therapeutic intervention by which reduced doses of opioids can be used in the presence of NSAIDs that act preferentially on COX1 to produce effective pain relief with reduced side effects

Effect of buprenorphine, pentazocine and tramadol on respiration

The purpose of this study was to evaluate the effects of Bupernorphine, Pentazocine and Tramadol on Respiration. Study design: This is a prospective study. Place and duration of study: This study was conducted at Intensive Care Unit of Nishtar Hospital, Multan from July to December 2001. Patients and method: Sixty patients belonging to age group ranging between 18-35 years, of ASA-I and II grades undergoing elective cesarean section were selected. All the patients suffering from severe systemic disease, not falling in ASA 1 or 2 and patients allergic to Opioids were excluded from the study. Patients were divided into three groups using the non-probability convenience sampling technique. Each group comprised of 20 patients. All the patients received endotracheal general anesthesia. In postoperative period Group-A received injection Bupernorphine 0.5mg IM. Group-B received injection Pentazocine 30mg IM and Group-C received Tramadol 100mg IM for pain relief. The effects on respiratory rate, tidal volume, minute volume and arterial blood gases were evaluated 30 minute, 1 hour, 2 hour and 4 hour after giving analgesia. Dosages were repeated 8 hourly. Bupernorphine led to a fall in respiratory rate and minute volume in 30 minute, whereas Pentazocine decreased the respiratory rate after 30 minute but minute volume was decreased in 5 minute, where as Tramadol had no effect on respiratory rate and minute volume. Pa02 was decreased within 30 minute with Bupernorphine and Pentazocine where as PaC02 raised after 60 minutes with Bupernorphine but within 5 minute with Pentazocine where as with Tramadol there was no significant alteration in arterial blood gas values. Opioids have a respiratory depressant effect which manifested within 30-60 minute of IM administration, where as Tramadol which is a non opioid, does not cause respiratory depression in equiv. potent doses

Gabapentin in the management of pentazocine dependence: a potent analgesic--anticraving agent.

OBJECTIVES: To evaluate the role of Gabapentin in the management of Pentazocine dependence for suppressing muscle aching and craving during its withdrawal. MATERIAL AND METHODS: Patients of Pentazocine dependence were divided in two groups GpA and GpB (n = 10 in each) and were administered Clonidine (P.O.) in first seven days (acute detoxification phase) and later Naltrexone (P.O.) from seventh day onwards (stabilisation-maintenance phase). Gabapentin (1200 mg/day) was additionally added in group B. Muscle pain and craving were rated on 100 mm visual-analogue scale. Psychological dependence was assessed on four step categorical scale. RESULTS: Group B (Gabapentin group) scored significantly lower (p < 0.001) than group A on both the parameters. Psychological dependence was significantly low (p < 0.01) in Gabapentin group. CONCLUSION: Gabapentin is an important adjuvant to the management of opiate dependence both in acute detoxification as well as stabilisation phase.

Effects of some recent intramuscular analgesics on labour pain and maternal and fetal blood gases and pH

This study attempted to determine the analgesic properties of pentazocine hydrochloride, nalbuphine hydrochloride, butarphanol tartarate and tramadol hydrochloride given during labor and their potential effects on maternal and fetal blood gases and pH. Tramadol and butarphanol analgesics were superior to either nalbuphine or pentazocine in relieving labor pain. The studied analgesics caused maternal respiratory acidosis and fetal metabolic acidosis and these acidetic changes were marked with pentazocine, moderate with nalbuphine and minimal with butarphanol and tramadol analgesia

Anti-inflammatory and analgesic activity of Indian Hypericum perforatum L.

A standardised 50% aqueous ethanolic extract of the Indian variety of Hypericum perforatum (IHp) was examined for its putative anti-inflammatory and analgesic activity at the doses of 100 and 200 mg/kg, po. The experimental paradigms used were carrageenan induced pedal edema and cotton pellet induced granuloma for anti-inflammatory activity, whereas the tail flick, hot plate and acetic acid induced writhing methods were used to asses analgesic activity. Indomethacin (20 mg/kg, ip) was used as the standard anti-inflammatory drug. Pentazocine (10 mg/kg, ip) and aspirin (25 mg/kg, ip), both clinically used analgesics, were used as standard analgesics for comparison. IHp extract showed significant anti-inflammatory and analgesic activity at both dose levels, in all the paradigms used. Additionally, IHp potentiated the anti-inflammatory activity of indomethacin and analgesic activities of pentazocine and aspirin.