Parecoxib versus tramadol for post-appendectomy pain.

UNLABELLED: Open uncomplicated appendectomy is known for low to medium degree of postoperative pain and a short hospital stay. Based on multimodal pain therapy, non-opioid analgesics have widely been a part in pain control. Parecoxib and tramadol have advantages over traditional opioids that are causing less nausea or vomiting, respiratory depression and sedation. As a result, the authors aimed to compare parecoxib and tramadol regarding quality of pain control after open appendectomy. Fifty patients, underwent open appendectomy with spinal anesthesia, were randomized to receive either parecoxib or tramadol (n = 25 each). Parecoxib 40 mg and tramadol 50 mg IV were administered twice, when closing the peritoneum and at 12 h later Doses of rescued meperidine for 24 h were recorded. Pain score, sedation, nausea or vomiting and satisfaction scores were assessed at 6, 12 and 24 h after operation. The mean rescued doses of meperidine were 4.6 +/- 10.9 and 18.6 +/- 21.0 mg in parecoxib and tramadol groups respectively (p = 0.005). There was a significantly higher pain score at 24 h (p = 0.01) and sedation score at 6 h (p = 0.003) in the tramadol group. Parecoxib provided a lower pain and sedation scores and lesser meperidine consumption than tramadol for post-appendectomy pain. IMPLICATION: Parecoxib, as a primary analgesic, is better in analgesia and has less sedation than tramadolfor post-appendectomy pain.

Intrathecal fentanyl in spinal anesthesia for appendectomy.

OBJECTIVE: The authors assessed the effectiveness of the administration of fentanyl in spinal anesthesia for appendectomy. MATERIAL AND METHOD: Forty patients randomized double-blind, were recruited to receive either 4 ml of 0.5% hyperbaric bupivacaine + 20 mg of fentanyl (Group F) or 4 ml of 0.5% hyperbaric bupivacaine 0.5% + 0.4 ml normal saline (Group S). RESULTS: There were no significant differences in the highest analgesic level between the groups. The number of segments regressed at 60 min in Group F was statistically less than in Group S (0 vs. 2; P 0.002). Group F showed significantly lower median VNS pain scores than Group S (0 vs. 3; P 0.004). Time to first required postoperative analgesics in Group F was significantly higher than in Group S (13.6 vs. 6.3 h, P < 0.001). The incidence of shivering in Group F was significantly lower than Group S (35% vs. 70%; P 0.023). There were no significant differences in the incidence of nausea, vomiting, hypotension and urinary retention. No patient developed respiratory depression or PDPH. The patients' satisfaction of spinal anesthesia was 100% in Group F and 80% in Group S. CONCLUSION: Intrathecal 20 microg fentanyl significantly improved the quality of analgesia, it prolonged the duration of bupivacaine in spinal anesthesia and delayed the analgesics requirement in the early postoperative period. Shivering was less frequently found in the fentanyl group.

A randomized controlled study of three targets of propofol plasma concentration in patients undergoing uterine dilation and curettage.

AIM: To compare the efficacy and the complications of three target levels of propofol plasma concentration in patients undergoing uterine dilation and curettage. METHODS: Sixty-nine patients were randomly allocated to receive propofol target controlled infusion at different target concentrations of 4 (group I), 5 (group II) and 6 (group III) mcg/mL combined with 1 microg/kg of fentanyl and 66% of nitrous oxide. Patients' movement during the procedure, hemodynamic variables, oxygen saturation, end tidal carbon dioxide, time to sleep and awake, and bispectral index score were recorded. RESULTS: Seven patients in group I, one in group II, and none in group III (P < 0.05) moved grossly during the procedure. More patients in group III developed hypotension (5 vs 0 and 2 in group I and II, P < 0.05), but no difference was found regarding respiratory complication. No difference was found in time to sleep, but time to wake was longer in group III. CONCLUSION: Propofol infusion at the target concentration of 5 microg/mL was recommended for uterine dilation and curettage when it was administered with fentanyl 1 microg/kg and nitrous oxide 66% under close monitoring and appropriate respiratory management.