Acetaminophen reduces acute and persistent incisional pain after hysterectomy.

OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.

Acetaminophen Reduces acute and persistent incisional pain after hysterectomy.

OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [Q1, Q3]: 0 [0, 0]) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain. KEY WORDS: Anesthesia, acetaminophen, Persistent surgical pain, Postoperative acute pain.

The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial.

OBJECTIVES: To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. DESIGN: Randomized, double-blinded study. PATIENTS: 120 patients ASA I-II who underwent abdominal hysterectomy. INTERVENTIONS: All the patients were given 1g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCl (8mg, 2ml IV) (Group I, N=60) and saline (2ml IV) (Group II, N=60) at the skin closure. MEASUREMENT: Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. MAIN RESULTS: Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1h [by 1.3 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [Q1, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P=0.95. CONCLUSIONS: Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived.

Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial.

STUDY OBJECTIVE: To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine. DESIGN: Prospective, randomized, double-blinded study. SETTING: University-affiliated hospital. PATIENTS: One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery. INTERVENTIONS: Patients were randomly assigned to neostigmine (70 µg/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade. MEASUREMENTS: We recorded PONV, recovery parameters, antiemetic consumption, and side effects. MAIN RESULTS: Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P < .05), but thereafter low and comparable. Postoperative antiemetic and analgesic consumption were similar in each group. Extubation (median [interquartile range], 3 [1-3.25] vs 4 [1-3.25]; P < .001) first eye opening (4 [3-7.25] vs 7 [5-11]; P < .001), and head lift (4 [2-7.25] vs 8 [11-25]; P < .001) in minutes were shorter in patients given sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine. CONCLUSIONS: Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine.

Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy.

OBJECTIVE: To compare unilateral spinal anaesthesia (USA) and ultrasound-guided combined sciatic-femoral nerve block (USFB) in ambulatory arthroscopic knee surgeries in terms of haemodynamic stability, nerve block quality, bladder function, adverse events and time-to-readiness for discharge (TRD). METHODS: Patients undergoing ambulatory arthroscopic knee surgery were randomly assigned to one of two groups. The USA group received 2 ml (10 mg) of 0.5% levobupivacaine and the USFB group received a 25 ml mixture consisting of 10 ml of 2.0% lidocaine, 10 ml of 0.5% levobupivacaine and 5 ml of saline (15 ml for the femoral and 10 ml for the sciatic nerve block). Preparation time (PT), surgical anaesthesia time (SAT), operation time, total anaesthesia time, time-to-first spontaneous urination, time-to-first analgesia, TRD, adverse events and patient satisfaction were recorded. RESULTS: A total of 40 patients were enrolled in the study (n = 20 per group). PT, SAT, total anaesthesia time and time-to-first analgesia were significantly shorter in the USA group than the USFB group; time-to-first spontaneous urination and TRD were significantly longer in the USA group than the USFB group. CONCLUSIONS: USFB provided sufficient duration of sensory blockade and it reduced the TRD and the rate of adverse events.

The effect of anesthetic agents on perioperative bleeding during tonsillectomy: propofol-based versus desflurane-based anesthesia.

OBJECTIVE: Hemorrhage during tonsillectomy is related to the surgical technique, management of bleeding, and choice of anesthetic agent. This study evaluated the effects of anesthetic agents on hemorrhage during tonsillectomy with standardized surgical techniques and management of bleeding. STUDY DESIGN: Double-blind, randomized controlled trial. SUBJECTS AND METHODS: Sixty patients, aged 3 to 12 years, who were scheduled for elective tonsillectomy were enrolled in the study. Propofol-based anesthesia was administered to the first group; desflurane-based anesthesia, to the second. The amount of blood loss due to hemorrhage was measured. RESULTS: Propofol-based anesthesia significantly decreased bleeding during tonsillectomy. CONCLUSION: Propofol-based anesthesia is a reliable method for use in children who undergo tonsillectomy.

The analgesic efficacy of preoperative versus postoperative lornoxicam in varicocele repair.

STUDY OBJECTIVE: To determine whether intravenous injection of lornoxicam 30 minutes before skin incision provides better pain relief after varicocelectomy than postoperative administration of lornoxicam. DESIGN: Prospective, double-blind, randomized clinical investigation. SETTING: Operating room and postoperative recovery area. PATIENTS: 44 ASA physical status I and II adult male patients undergoing varicocelectomy. INTERVENTIONS: Patients were randomized either to receive 8 mg lornoxicam infusion 30 minutes before skin incision, followed by saline infusion immediately after skin closure (group 1), or to receive the identical injections but in reverse order (group 2). All patients received local anesthesia with bupivacaine. MEASUREMENTS: Postoperative pain scores were evaluated hourly for the first 8 hours after surgery, then at 12, 16, 20, and 24 hours after surgery, using a 10-cm visual analog scale. Time to first analgesic request and patients' global assessments also were recorded. MAIN RESULTS: Patients in group 1 reported significantly lower pain scores (P < 0.05) at all time intervals except at 24 hours and better global assessment (P = 0.001) than did group 2. There were significantly fewer patients in the preemptive group than group 2 who required rescue analgesic within the first 24 hours (0% vs 22.7%; P = 0.024). Mean time to first analgesic request was also significantly longer in the preemptive group (P = 0.001). CONCLUSION: Intravenous lornoxicam administered before surgery has a better analgesic effect for varicocelectomy than when administered postoperatively.