Ondansetron pretreatment reduces pain on injection of Propofol

To assess the effectiveness of ondansetron pretreatment in alleviating propofol injection pain, 135 patients were randomly assigned to one of following three groups. Group 1 who received up to 2 mL pretreatment 50 mg tramadol in the saline, group 2 cases who received up to 2 mL pretreatment 4 mg ondansetron in saline, and group 3 who received up to 2 mL solution saline. A 20 gauge cannula was placed into the largest vein on the dorsum of the hand. Tourniquet was closed to the arm above the cannula and inflates to 70 mmHg, and then drug was injected. After 20 seconds, the tourniquet deflated, and propofol 2mg/kg injected over 10 seconds and pain assessment was made. Tramadol and ondansetron significantly reduced the incidence and severity of propofol injection pain more than placebo [P=0.001]. The efficacy of ondansetron in alleviating the pain on injection of propofol was no different from tramadol [P=0.330]. Ondansetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting

Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price

Cancer pain

An accurate assessment and where possible a precise diagnosis of the underlying mechanism is necessary for the effective management of pain in cancer. The majority of patients respond to oral analgesics, and the range of drugs required is not vast. Adjuvant analgesic drugs will be needed for the treatment of bone pain, visceral pain and neuropathic pain. For the remaining patients who present with difficult and occasionally intractable pain, a multi-disciplinary approach using drug and non-drug measures will usually allow significant relief of sumptoms

Metoclopramide and its effect on postoperative pain

This study was a trial to evaluate the effect of metoclopramide on postoperative pain, in the early postoperative period, in patients undergoing elective surgical operations. In this study, induction of anesthesia was with propofol to give rapid recovery. In a randomized doudle-blined study, patients received either placebo [n=23] or metoclopramide [n=23], 0.4 mg/kg i.v., at the end of surgery. Postoperative pain score was assessed on a visual analogue scale [VAS]. The VAS-pain scores showed a highly significant difference between the two groups with smaller pain scores in the metoclopramide group as compared with the control group [P < 0.01] for up to 2 hours following surgery. In conclusion, the results of this study revealed a significant analgesic effect of metoclopramide postoperatively for a period of 2 hours