Lee, Mi Geum;Kim, Hyun Jung;Lee, Keun Hwa;Choi, Yun Suk
The Korean Journal of Pain
/
v.29
no.1
/
pp.34-39
/
2016
Background: Although opioids are the most commonly used medications to control postoperative pain in children, the analgesic effects could have a large inter-individual variability according to genotypes. The aim of this study was to investigate the association between single nucleotide polymorphisms and the analgesic effect of morphine for postoperative pain in children. Methods: A prospective study was conducted in 88 healthy children undergoing tonsillectomy, who received morphine during the operation. The postoperative pain score, frequency of rescue analgesics, and side effects of morphine were assessed in the post-anesthesia care unit. The children were genotyped for OPRM1 A118G, ABCB1 C3435T, and COMT Val158Met. Results: Children with at least one G allele for OPRM1 (AG/GG) had higher postoperative pain scores compared with those with the AA genotype at the time of discharge from the post-anesthesia care unit (P = 0.025). Other recovery profiles were not significantly different between the two groups. There was no significant relationship between genotypes and postoperative pain scores in analysis of ABCB1 and COMT polymorphisms. Conclusions: Genetic polymorphism at OPRM1 A118G, but not at ABCB1 C3435T and COMT Val158Met, influences the analgesic effect of morphine for immediate acute postoperative pain in children.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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v.27
no.6
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pp.556-559
/
2001
The aim of the present study was to evaluate the influences of epinephrine and pain on the changes of blood pressure and pulse rates in mandibular 3rd molar extraction. A total of 80 patients(aged between 10 and 30) without systemically compromised conditions were selected and divided into two groups(I, II). 2% lidocaine with 1:100,000 epinephrine was administered in group I (male 20, female 20), and 2% lidocaine without epinephrine was administered in group II (male 20, female 20). Systolic blood pressure and pulse rates were checked by a digital monitor during the pre-local anesthesia state(stage 1), 5 minute later in the post-local anesthesia state(stage 2), the extraction state(during odontectomy, stage 3), and during the post-suture state(stage 4). The measurement of pain perceived by patients was made using a three-point visual analog scale. The results suggest that local anesthetic with epinephrine is better at decreasing pain preventing the severe elevation of systolic blood pressure than local anesthetic without epinephrine. However, these results should be confirmed by additional studies on cardiac patients.
Purpose: This study compared the effect of music and noise blocking on the vital signs, postoperative pain, analgesic use, length of stay in the Post Anesthesia Care Unit (PACU) and satisfaction after a laparoscopic colectomy. Methods: This randomized controlled trial was performed in a 555-bed National Cancer Center, from February 13 through May 31, 2012. Subjects consisted of 69 patients who underwent a laparoscopic colectomy under general anesthesia, and were recruited by informed notices. The inclusion criteria were patients between the ages of 35-75, with an American Society Anesthesiologist physical classification I or II. The subjects were randomly allocated to three groups; music therapy group (MTG), noise blocking group (NBG) and control group (CG). Collected data were analyzed using Repeated measures ANOVA, one-way ANOVA and Kruskal-Wallis test through IBM SPSS (Version 19.0). Results: There were no significant differences in vital signs among the three groups. Postoperative pain in MTG (p<.05) and NBG (p<.05) was significantly decreased compared to CG. The amount of analgesics (p=.030) and length of stay at PACU (p=.021) in MTG was significantly decreased compared to NBG or CG; satisfaction in MTG and NBG was significantly higher compared to CG. Conclusion: Music seems to reduce postoperative pain, the amount of analgesics, and the length of stay at PACU. Therefore, music therapy is considered to be included in nursing intervention for postoperative patients at PACU.
Background: Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery. Methods: A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo. Results: The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences. Conclusions: Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.
Background: Pain, edema, and trismus are predictable sequelae for surgical extraction of impacted mandibular third molars (M3M). The present study aimed to compare the anti-phlogistic potential of bromelain and aceclofenac in the reduction of post-surgical sequalae in the extraction of impacted M3M. Method: A randomized controlled, triple-blinded clinical study included 72 patients scheduled for surgical removal of impacted M3M under local anesthesia. Randomization was performed and subjects were equally allocated to groups A (control) and B (study), who intended to receive aceclofenac and bromelain, respectively. The primary outcome variables were pain, edema, and trismus evaluated on postoperative days 2 and 7 and compared with baseline values. The secondary variables evaluated were the quantity of rescue analgesics required and the frequency of adverse effects in both groups for 7 postoperative (PO) days. Data were analyzed with a level of significance of P < 0.05. Results: Group B demonstrated a significant decrease in the severity of edema and trismus compared to group A on both PO days 2 and 7 (P < 0.001). Bromelain demonstrated similar analgesic efficacy with an insignificant difference compared to aceclofenac (P > 0.05). Conclusion: The present study showed that the efficacy of bromelain was comparable to that of aceclofenac in reducing inflammatory complications following surgical removal of impacted M3M. Bromelain can be considered a safe and potent alternative to routinely used aceclofenac when addressing inflammatory outcomes after surgery.
Kim, Cheol-U;Lee, Chul-Hyung;Yoon, Ja-Yeong;Rhee, Seung-Koo
Journal of the Korean Orthopaedic Association
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v.53
no.6
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pp.513-521
/
2018
Purpose: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. Materials and Methods: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. Results: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5-13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5-40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141-540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. Conclusion: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.
This systematic review aimed to assess the effect of premedication on postoperative pain after root canal treatment in vital teeth. Five electronic databases were searched for randomized clinical trials, and two independent reviewers selected eligible studies, extracted data, and assessed the quality of studies using the Cochrane Risk of Bias tool. Meta-analysis was conducted using the random-effects model, and the pooled effect estimate of the standardized mean difference (SMD) between premedication and placebo was calculated. Subgroup analysis was conducted based on the class and route of the drug. Studies with a high risk of bias were excluded from the sensitivity analysis. Ten trials satisfied the inclusion criteria, of which eight were included in the meta-analysis. Premedication was more effective in reducing postoperative pain than placebo at 6 hours (SMD = -1.00; 95% confidence interval [CI] = -1.33 to -0.66), 12 hours (SMD = -0.80; 95% CI = -1.05 to -0.56), and 24 hours (SMD = -0.72; 95% CI = -1.02 to -0.43). The results of the sensitivity analysis confirmed the findings of the primary analysis. Based on these results, it can be concluded that premedication is effective in reducing postoperative pain in teeth with irreversible pulpitis. However, additional quality studies are required for further validation.
Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.
Background: Trigeminal neuralgia (TN) is a severe form of pain that affects the daily activities of a patient. Transcutaneous electrical nerve stimulation (TENS) therapy is an emerging option for the treatment of acute and chronic pain. The aim of this study was to evaluate the effect of TENS therapy as an adjunct to drug therapy for the treatment of TN. Methods: A total of 52 patients diagnosed with TN according to the International Classification of Headache Disorders (version 3) were included. Each patient was randomized to either the TENS or placebo TENS groups. Intervention was given in continuous mode and 100-Hz frequency for 20 mins biweekly for 6 weeks. Parameters were measured at baseline, TENS completion and 3 months, 6 months, and 1 year of follow up. The parameters observed were mean carbamazepine dose, mean visual analog scale (VAS) score, mean present pain intensity (PPI) score, and functional outcome. Non-parametric analyses, one-way ANOVA and the Kruskal-Wallis test were applied for intragroup comparisons, while the Mann-Whitney U test and independent t-test were used for intergroup comparisons of variables. The chi-square test was applied to analyze categorical data. Results: Compared to the placebo TENS group, the mean dose of carbamazepine in the TENS group was significantly reduced at TENS completion, as well as at 6 months and 1 year follow up. Changes in mean VAS score, mean PPI score, and functional outcome did not show significant differences between the groups (P>0.05). Conclusion: TENS therapy does not lead to any changes in pain levels but it may reduce the mean dose of carbamazepine when used as an adjunct treatment in patients with TN.
Purpose: This study was to identify the effects of Nei-Guan accupressure using a wrist band on postoperative nausea and vomiting after middle ear surgery. Methods: The study design was a nonequivalent control group non-synchronized posttest design. Forty patients were assigned into two groups of 20 patients, the wrist band group and the control group. In the wristband group, acupressure was applied with a wrist band on the P6 point at both wrists from 30 min before to 24 hr after anesthesia. Results: The 1st hypothesis 'Applied wrist band groups will have a greater reduction in the nausea & vomiting grades by INVR than the control group' was accepted (t=2.303, p=.028). The 2nd hypothesis 'The Applied wrist band groups will have a greater reduction in the occurrence of nausea & vomiting than the control group' was partly accepted. The 3rd hypothesis 'The applied wrist band group will have a greater reduction in injection of antiemetics for 24 hr. post anesthesia than the control group' was rejected. Conclusion: Acupressure on the P6 point using a wrist band is effective to alleviate nausea for middle ear surgery patients.
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