Pre-emptive Analgesia Effects of Hydromorphone on Stress Reaction in Patients Undergoing Gynecological Laparoscopic Surgery / 医药导报

Objective To investigate the pre-emptive analgesia effects of hydromorphone on stress reaction in patients undergoing gynecological laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ patients [age:45-58 years,body mass index:18-24 kg· (m2)-1] undergoing gynecological laparoscopic surgery were randomly divided into 2 groups (n =20 for each group):treatment group and control group.Hydromorphone (1 mg) was intravenously injected before anesthesia in treatment group.In the two groups,after routine induction and incubation,remifentanil (0.2 μg· min-1 · kg-1) and propofol (0.1 mg· min-1· kg-1) were injected with micro perfusion pump,cisatracurium was injected intermittently.Injection of remifentanil and propofol was stopped when skin suture started.The concentrations of epinephrine(E) and norepinephrine(NE) were obtained before induction (t1),pneumoperitoneum (t2),1 h after pneumoperitoneum (t3) and extubation (t4),respectively.The heart rate,blood pressure and the time of operation to extubation of the patients were recorded.Results There were no significant changes in extubation time after operation among the groups.Heart rate and systolic blood pressure were significantly lower in the treatment group than in the control group (P ＜ 0.05).Plasma E and NE levels at t1 were significantly lower than those at t2,t3 and t4.Plasma E and NE were significantly lower in treatment group than that of control group at t2,t3 and t4 (P ＜ 0.05).Conclusion Pre-emptive analgesia of hydromorphone can significantly decrease the release of epinephrine and norepinephrine during and after laparoscopic surgery,restrain the increase of heart rate and systolic blood pressure during extubation,without influence of revival time.

Preemptive Use of Ketamine on Post Operative Pain of Appendectomy

BACKGROUND: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. METHODS: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). RESULTS: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was 23.1 +/- 6.7 minutes for the case group and 18.1 +/- 7.3 minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was 0.6 +/- 0.6 for the case group and 2.0 +/- 0.8 for the controls (P = 0.032). There were no drug side effects for the case group. CONCLUSIONS: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

The effect of pre-incision nefopam on postoperative pain after major upper abdomonal surgery

Background: Nefopam a powerful painkiller has been put into clinical use since 1976, effects preemptive analgesia. Objectives: To assess the effect of presurgical IV Nefopam on postoperative pain after major upper abdomonal surgery. Subjects and method: A double-blind randomized controlled trial. 62 patients were divided into 2 groups: Nefopam (N, n = 31) and placebo group (PG, n = 31). Presurgical IV 20 mg Nefopam was used in N.PCA was used for both groups. Postoperative non-painful time (PNPT); VAS/48 hours at rest and on cough; IV Morphine rescue with PCA was measured during postsurgical 48 hour period.Results: PNPT was longer in N 42 \xb1 8,9 vs. 22 \xb1 4,8, p<0,01. Titration dose of morphine, Morphine consumption of first 24 hours, and of another 24 hours were lower in N 5,6 \xb1 1,7; 25,2 \xb1 4,9; 10,1 \xb1 3,6 mg vs. 7,1 \xb1 1,5; 30,1 \xb1 4,5; 13,3 \xb1 2,1, p<0,05 and < 0,01, respectively. VASs under tested conditions during first 16 hours were significant lower in N. Conclusion: Presurgical Nefopam had the effect of pre-emptive analgesia as evidence by a significant VAS decrease during the first 16 hours with lower Morphine consumption of 48 hours .

Evaluation of the effect of preemptive analgesia receiving tramadol combined with local anesthesia in neck surgery / 医学研究生学报

Objective: To evaluate the preemptive analgesia of intravenous tramadol preoperatively in neck-surgery. Methods: Eighty patients, ASAⅠ-Ⅱ,were scheduled for neck-surgery under local anesthesia. Patients were randomly divided into 2 groups (40 cases/group).In group P intravenous tramadol was administered as a bolus dose of 3mg/kg 15min prior to skin incision. Group C received saline as a placebo. The patients-controlled analgesia(PCA) devices were used in all patients after operation. We observed BP, HR,VAS score, the time of first PCA activation, the valid number of press PCA and the total consumption of analgesic after operation. Results:The postoperative VAS was markedly lower in group P compared with the group C in 0-24h( P

Effect of pre-emptive analgesia with lornoxicam on pain and the expression of pselectin on platelet after modified radical mastectomy / 中国现代普通外科进展

Objective:To determine whether lornoxicam has a preemptive analgesic effect to the patients who undergo modified radical mastectomy.To study the effect of lonoxicam on platelet function and investigate the surface expression of p-selectin on platelet by a flow-cytometric assay.Methods:After obtaining a written informed consent from patients,sixty ASAⅠ-Ⅱpatients,aged 40-60 yr,weighted 40-60 Kg,who were scheduled for modified radical mastectomy were included in the study.All patients were randomly divided into two groups.Patients underwent breast surgery under general anesthesia,Group I was administered 16mgof lornoxicam iv.30 minutes prior to surgery,Group Ⅱ was administered 4 mL placebo.Two mL blood was drawn from a peripheral vein to analyze the surface expression of p-selectin on platelet,blood sample was collected at three time points:30 minutes prior to surgery,6h and 24h after surgery.Introoperative blood loss and the volume of drainage fluid 24h,48h,and 72h after surgery was documented;PONV and other side effects was recorded.The rescue analgesics was recorded.Result:Group I demonstrated reduced pain scores compared to Group Ⅱ at three specific time points;Great difference for the expression of p-selectin on platelet at certain time point in each group was noted,the postoperative express was higer than that of the preoperation;there were no difference for the expression of p-selectin on platelet between two groups.There were no difference in introoperative blood loss and the volume of drainage fluid between two groups;Great difference for the rescue analgesics was recorded,GroupⅡdemends more analgesics than GroupⅠ.The rate of PONV was similar between two groups,no other side effects were recorded.Conclusion:Lornoxicam administered preemptively appears to reduce pain scores after surgery,which can improve the quality of postoperative analgesia.Lornoxicam has no significant effect on platelet activation and aggregation with only one dose before surgery,there is no effect in the quality of blood coagulation.Lornoxicam may be safely used in perioperative period.

Analgesic Effects of Preoperative Versus Postoperative Tiaprofenic Acid in Pediatric Tonsillectomy & Adenoidectomy / 대한마취과학회지

BACKGROUND: The aim of this study was to investigate the pre-emptive effect of preoperative intravenous tiaprofenic acid in children aged 4~11 years after tonsillectomy and adenoidectomy. METHODS: We compared in 45 children the effect of preoperative with postoperative tiaprofenic acid (5 mg/kg) on pain after tonsillectomy and adenoidectomy, which was approved by Ethics Committee. Informed consents were obtained from all their parents. After induction of anesthesia, patients were allocated randomly to receive a tiaprofenic acid intravenously either before (n=15) or immediately after (n=15) surgery. The control group was received saline (n=15). Postoperative pain was rated on a faces scale for postoperative 48 hours. Tiaprofenic acid was given when patient complained pain. The cumulative pain score within 3 hours and 48 hours, time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 50 ml water were checked. RESULTS: Postoperative pain score of the preoperative group was significantly lower than the postoperative group at 9, 42, and 48 hours after operation. The cumulative pain scores during the first 3 hours were 15+/-4 (p <0.05 vs postoperative), 21+/-7 and 22+/-5 in pre, postoperative and saline groups respectively. The cumulative pain scores for 48 hours were 40+/-18 (p <0.05 vs postoperative), 61+/-17 and 63+/-18 in pre, postoperative and saline groups respectively. The times of the first swallowing were 6 (5~6)(p <0.05 vs postoperative) hours, 7 (6.7~9)hours, and 8 (4.5~8.7)hours after operation in pre, postoperative, and saline groups respectively. CONCLUSIONS: Preoperative tiaprofenic acid in the tonsillectomy and adenoidectomy was effective on the reducing the intensity of the postoperative pain. The time to the first swallowing was shorter in the preoperative than postoperative group. The results of this study support the theory of pre-emptive analgesia.

Pre-emptive Analgesia: The Effect of Low-Dose Ketamine on the Postoperative Pain after Circumcision with Unilateral Hydrocelectomy in Children / 대한마취과학회지

Backgrounds: Brief noxious stimuli are found to produce long-lasting neuronal sensitization. This cumulative depolarization results from the activation by glutamate of N-methyl-D-aspartic acid (NMDA) receptor. Ketamine at subanesthetic doses blocks the channel associated with the NMDA receptor. The aim of this study was to investigate the pre-emptive effect of ketamine in children after circumcision with unilateral hydrocelectomy. MATERIALS AND METHODS: We have compared the effect of preoperative ketamine (0.3 mg/kg) in a double-blind, randomized study, which was approved by the local Ethics Committee. Informed consents were obtained from their parents. After induction of anesthesia, patients were allocated randomly to receive a ketamine (n=20) or placebo (n=20) intravenously before surgery. Postoperative pain was rated on a faces scale for the first 24 hours. If pain occurred, children received tiaprofenic acid in a dose related to body weight. The cumulative pain score, the time of the first requirement of analgesics, and total requirement of analgesics for 24 hours were also checked. RESULTS: The pain scores at 4, 5, 6, 7, 8, 9, and 12 hours after operation were significantly low in ketamine group. The cumulative pain scores for the first 8 hours and the total requirements of analgesics were significantly low in ketamine group. The time of the first requirement of analgesic was significantly delayed in ketamine group. CONCLUSIONS: Preoperative ketamine in the pediatric circumcision with unilateral hydrocelectomy is effective on the reducing the intensity of the postoperative pain. The results of this study support the theory of pre-emptive analgesia of ketamine.

Comparison of Preoperative with Postoperative Tiaprofenic Acid on Pain after Adult Local Tonsillectomy / 대한마취과학회지

BACKGREOUND: The aim of this study was to compare the pre-emptive effect of preoperative with postoperative tiaprofenic acid in adult local tonsillectomy. METHODS: We compared in forty adults the effect of preoperative with postoperative tiaprofenic acid on pain after tonsillectomy in a double-blind, randomized study, which was approved by the Ethics Committee. Informed consents were obtained. Patients were allocated randomly to receive a tiaprofenic acid (200 mg) intravenously either before (n=20) or immediately after (n=20) surgery. Postoperative pain was rated by self-rating visual analog scale for the first 24 hours. Tiaprofenic acid (200 mg) was given when patient complained pain. Time to the first analgesic administration, total requirement of analgesics for 48 hours and the first time of swallowing 100 ml water were checked. RESULTS: Postoperative 1 hour pain score of the preoperative group was significantly lower than postoperative groups (p<0.05). Times to the first analgesic administration, the total requirement of analgesics for 48 hours and the times of the first swallowing of 100 ml water were not significantly different between the two groups. CONCLUSIONS: Preoperative intravenous tiaprofenic acid (200 mg) in adult local tonsillectomy was effective on the reducing the intensity of the postoperative pain only 1 hour after operation. The use of preoperative tiaprofenic acid in adult local tonsillectomy was associated with a more calm recovery. The results of this study do not support the theory of preemptive analgesia.

Effect of Pre-emptive Analgesia by Epidural Morphine in Lower Abdominal Surgery / 대한마취과학회지

Recent evidence suggests that surgical incision and other noxious perioperative events may induce prolonged changes in central neural function that later contribute to postoperative pain, Inhibition of these changes may be of value in the reduction of postoperative pain. Several clinical studies have shown that pretreatment with local anesthetics, opioids, NASAIDs and N-methyl-D-aspartate(NMDA) antagonist are effective in relieving postoperative pain. We compared the efficacy of pre-emptive and post-incisional epidural analgesia with morphine 2 mg in 0.25% bupivacaine(8 ml) on the postoperative pain. Seventy patients (ASA physical status I, 2) scheduled for elective lower abdominal surgery were randomized to one of two groups of equal size and prospectively studied in a double-blind manner. Group I received epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) before surgical incision followed by epidural normal saline(8 ml) just before termination of the surgery. Group 2 received epidural normal saline(8ml) before surgical incision, followed by epidural morphine(2 mg, in 8 ml 0.25% bupivacaine) just before termination of the surgery. Anesthesia was induced with thiopental sodium(4~6 mg/kg) and maintained with N2O/O2 and enflurane. Paralysis was achieved with pancuronium. Percentage of maximal possible effect(MPE) was significantly higher(P<0.05) in group 1 (85.3%) than in group 2 (70.8%). Secondary analgesic requirement was less in group 1(9/35 patients, 25.7%) than in group 2 (15/35 patients, 42.9%). Visual analog scale pain and mood score and Prince-Henry pain score are not significantly different between two groups. We conclude that pre-emptive epidural analgesia with morphine and bupivacaine may be more effective in relieving postoperative pain than post-incisional analgesia in lower abdominal surgery.

Pre-emptive Infiltration of Lidocaine Reduces Formalin Pain Behavior in Rat / 대한마취과학회지

Surgical tissue damage induces dual phenomenon of peripheral and central sensitization. Postoperative pain could be partially explained by neuronal hyperexcitability. As a postoperative pain model, formalin test, subcutaneous injection of formalin in the rat hind paw, results in initial vigorous flinching(phase 1), depends on acute chemical stimulation, followed by cessation of activity, and then resumption of flinching(phase 2), which depends on central sensitization. Pre-emptive analgesia, given before the onset of a painful stimuli, reduces or ptevents postoperative pain by preventing this central sensitization. This study was performed to evaluate the effect of local infiltration of lidocaine as a pre-emptive analgesia in the formalin test. Forty experimental rats were divided four groups; CONTROL group(without any treatment), POST group(0.04 mL of 1% lidocaine injection 5 min after formalin injection), PRE group(0.04mL of 1% lidocaine 5 min before formalin injection), and SHAM group(injection of normal saline 5 min before formalin injection). All animals received inhalation anesthesia for 15 min before and 5 min after formalin injection. Under halothane inhalation anesthesia, all were injected subcutaneously 0.04 mL of 5% formalin in the distal plantar area of right hind paw. After recovery of anesthesia, the formalin-induced flinching behavior was observed during only the phase 2 period(10-60 min) after formalin injection. The time to first flinching, the mean number of flinches per min, and the mean number of total flinches during phase 2 expressed as a percent of the values of the CONTROL group were compared between the groups with an t-test or an ANOVA. The first flinching was appeared before recovery of anesthesia in CONTROL and SHAM groups. The time to first flinching after formalin injection was 21.2+/-3.4, 16.6+/-3.1 min respectively in PRE and POST groups. It was significantly longer in PRE group than in POST group(P<0.05), despite of 10 min earlier injeetion of lidocaine in PRE group. The mean number of flinches per min was significantly lower in PRE and POST groups(P<0.05) until 25 min after formalin injection, and after that time the difference between PRE group and POST group was significant(P<0.05). The means of the total number of flinches during phase 2, expressed as a percent of the values of the CONTROL poup, were 100+/-17.2%, 31.8+/-13.1%, 76.9+/-14.5% respectively in SHAM, PRE and POST groups. Those in PRE and POST groups were significantly lower than that of CONTROL group(P<0.001), and the difference between PRE group and POST group was significant(P<0.05). In summary, pre-emptive infiltration of lidocaine on formalin test prolongs the duration of analgesia and reduces the severity of formalin pain in rat. Therefore, the infiltration of lidocaine before formalin test is really provided pre-emptive analgesia.