Oxycodone vs. fentanyl in the treatment of early post-operative pain after total knee replacement: randomized controlled trial

양수안,김건식,강희용 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4

Background: Total knee replacement is often accompanied by severe post-operative pain. Oxycodone has sufficient analgesic effects and somewhat greater, but tolerable side effects compared to fentanyl. However, most studies on the topic evaluate visceral pain relief. In this study, we determine the effectiveness of oxycodone for somatic pain and evaluate the incidence of side effects. Methods: Sixty-nine patients were involved in a randomized control trial. Analgesic agents were administered to two experimental groups at a post anesthetic care unit (PACU) 15 min after PACU admission: a 50 g fentanyl group (n = 40) and a 4 mg oxycodone group (n = 29), both with severe pain (numeric rating scale, NRS > 5). Changes in NRS at the PACU were measured. Additional analgesic agents were administered at 0–6, 6–12, 12–24, and 24–48 h after surgery. Results: Total fentanyl consumption and the number of patients who required additional opioids were significantly lower in the oxycodone group than in the fentanyl group. Incidence of side effects was not significantly different between the two groups. Conclusions: Oxycodone shows a better analgesic effect than fentanyl in somatic pain in the acute phase of post-operative pain. The side effects of oxycodone are not significantly different from those of fentanyl.

Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study

( Emad Zarief Kamel ),( Sayed Kaoud Abd-elshafy ),( Jehan Ahmed Sayed ),( Mohammed Mahmoud Mostafa ),( Mohamed Ismail Seddik ) 대한통증학회 2018 The Korean Journal of Pain Vol.31 No.2

Background: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. Methods: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 μg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. Results: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 μg in group 1 vs. 69 ± 18 μg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. Conclusions: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups. (Korean J Pain 2018; 31: 93-101)

The status of clinical trials regarding root canal sealers

Malak Ahmad AL,Masri Yasmina EL,Al Ziab Mira,Zrara Nancy,Baroud Tarek,Salameh Pascale 대한치과보존학회 2024 Restorative Dentistry & Endodontics Vol.49 No.1

Objectives This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers. Materials and Methods In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study. Results Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials. Conclusions This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control. Objectives This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers. Materials and Methods In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study. Results Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials. Conclusions This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

A survey of post-craniotomy analgesia in Korea

정성태,손주태,최승호,윤명하 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

Background: There is increasing evidence that more aggressive pain management is needed in patients undergoing craniotomy in Korea. However, no consensus or standardized analgesic regimen has been established to date. To achieve this consensus, we undertook a survey of the current state of post-craniotomy pain management in Korea. Methods: A postal questionnaire was sent to anesthesiologists,neurosurgeons and nurses of neurosurgical departments at 44university hospitals in Korea. Of the 44 centers that were sent questionnaires, 35 centers returned these from their anesthesiology department resulting in a response rate of 73%, and 25 returned the questionnaires from their neurosurgery department (response rate: 57%). Results: Fifty-three percent of neurosurgeons answered that current postoperative pain management was adequate after craniotomy,whereas only 8% of anesthesiologists agreed. However, 72% of neurosurgeons also agreed that a more aggressive pain management was needed for post-craniotomy patients. Fifty-two percent and 23% of neurosurgeons used non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as a first-line analgesic,respectively. Twenty-five percent of neurosurgeons used opioids as a first-line analgesic. Fifty percent of anesthesiologists used strong opioids alone or with NSAIDs as a first-line analgesic. About 10% of both groups used weak opioids as a first-line drug. Conclusions: Many clinicians agree that post-craniotomy pain is not adequately managed and more aggressive strategies are needed. Nevertheless, opioid analgesics are still avoided because of the concern of side effects despite no evidence to suggest increased risk when use carefully.

운동 프로그램이 요추유합술 환자의 통증과 일상생활활동장애에 미치는 효과

이미영,김복자 병원간호사회 2011 임상간호연구 Vol.17 No.3

Purpose: This study was to develop a post-operative exercise program, apply it to patients undergone lumbar spinal fusion surgery, and evaluate the effectiveness of the program on pain and disability activities of daily living. Methods: Fifty six patients who had lumbar spinal fusion were enrolled in this study. The patients were divided into two groups; 28 patients in the intervention group completed post-operative lumbar exercise program including walking for four weeks and 28 patients in the control group only did walking exercises. The degrees of pain on low back and leg were evaluated using visual analog scale (VAS) and the functional outcome was evaluated using the Korean version of Oswestry Disability Index (KODI) before surgery and 5 weeks after surgery. The data were analyzed using descriptive statistics, Chi-square test, t-test with SPSS 18.0 program. Results: Low back and leg pain of the participants in both experimental and control groups were improved after surgery compared to pre-surgery pain. However, there was no statistically significant difference between the groups. KODI score in the intervention group was significantly lower than that of the control group (p=.014). Conclusion: The developed post-operative exercise program in patients with lumbar spinal fusion surgery seems to be a useful intervention to reduce disability in activities of daily living.

Pre-Emptive Tramadol Could Reduce Pain after Ureteroscopic Lithotripsy

Nataša Denčić,Ana Mimić,Jelena Jovičić,Jelena Mirković,Otaš Durutović,Dragica Milenković-Petronić,Nebojša Lađević 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.5

Purpose: Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. Materials and Methods: This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwentureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocatedto two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analoguescale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effectsof tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperativefentanyl consumption, and postoperative analgesic requirement. Results: The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different betweenthe groups. Conclusion: Pre-emptive tramadol did reduce early postoperativepain. The patients who received pre-emptive tramadol were less likely to experiencesevere post-operative pain. Purpose: Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. Materials and Methods: This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwentureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocatedto two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analoguescale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effectsof tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperativefentanyl consumption, and postoperative analgesic requirement. Results: The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different betweenthe groups. Conclusion: Pre-emptive tramadol did reduce early postoperativepain. The patients who received pre-emptive tramadol were less likely to experiencesevere post-operative pain.

Pain Assessment in Post-Operative Patients in Pediatric Intensive Care Unit

Kanda Sirirat,Monta Ammarathorn 한국간호과학회 2011 한국간호과학회 학술대회 Vol.2011 No.10

Ways of Assessing Post-operative Pain

Sung Ok Chang,Hesook Suzie Kim,Bjuorn Sjostrom,Donna Swartz-Barcott 한국간호과학회 2001 Journal of Korean Academy of Nursing Vol.31 No.7

복강경 수술 후 반좌위가 수술회복성과 통증에 미치는 영향

최운정(Un Jong Choi),하태욱(Tae Uk Ha),강지숙(Ji Sook Kang) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.5

본 연구는 본 연구는 전신마취 하에 복강경 수술을 받은 환자를 대상으로 수술 후 반좌위가 수술 회복성과 통증에 미치는 영향을 규명하고 향후 복강경 수술환자 간호에 대한 근거기반 간호중재의 기초자료로 사용되도록 시도되었다. 본 연구는 전신마취하에 복강경 수술을 받은 비뇨기과 혹은 산부인과 환자를 대상 사전동의 후 진행되었으며, 실험처치로 실험군에게는 반좌위룰 대조군에게는 기존 앙와위를 수술직후부터 24시간까지 취하게 하였다. 수술후 회복성을 확인하기 위해 회복실저류시간, 장운동 회복기간, 자가배뇨 회복기간, 수술후 병동 체류기간을 측정하였고, 통증에 대한 영향을 확인하기 위해 수술일부터 수술 2일째 까지 VAS로 통증강도를 측정하였다. 수집된 자료는 SPSS Win 20.0을 이용하여 실수, 백분율, 평균, 표준편차, Chi-square test, Independent t-test 반복측정 분산분석(Repeated Measures ANOVA)로 분석하였으며 그 결과는 다음과 같다. 첫째, 대상자의 수술회복성은 수술 후 회복실 체류시간(t=-0.284, p=.506), 수술 후 최초 가스배출시간(t=-0.837, p=.407), 수술 후 최초 대변배출시간(t=0.665, p=.509), 유치도뇨관 삽입시간(t=1.635, p=.109), 유치도뇨관 제거 후 자가배뇨시간(t=1.427, p=.165), 수술 후 병동체류시간(t=0.290, p=.773)으로 실험군과 대조군의 유의한 차이가 없었다. 둘째, 대상자의 통증은 주효과인 통증에서 실험군과 대조군간의 유의한 차이를 보였으며(F=4.851, p=.032), 세 시점간의 통증의 변화도 유의한 차이를 나타내었다(F=24.200, p=<.001). 이상과 같이 본 연구에서 복강경 수술 후 반좌위는 수술회복성에 영향을 미치지 않지만 통증에는 효과가 있었다. 따라서 복강경 수술환자에게 반좌위는 통증을 완화시키고 안위를 개선하는 데 유용한 간호중재임이 확인되었다. Purpose:This study was conducted to identify the effects of theSemi-Fowler’s position on post-operative recovery and pain for patients with laparoscopic abdominal surgery Methods: This study utilized a non-equivalent control group non-synchronized design to validate the effects of theSemi-Fowler’s position. After IRB approval, 56 patients took part in this study, 29 in the experimental group and 27 in the control group. Consent was obtained from the participants. The Semi-Folwer’s position was applied to experimental group and the supine position was applied to the control group for 24 hours after surgery. All data were reviewed retrospectively from April to June 2016. Collected data, frequency, percentage, average, standard deviation, chi-squared test, independent t-test and repeated measures ANOVA were conducted using SPSS 20.0. Results: There was no significant difference between the experimental and control group with regard to recovery outcomes; however, there was a significance differencebetween groups and among check times with regard to post operational pain. Conclusion:The results of this study provide information that will be usefulto the development of strategies for improving recovery outcomes and pain for laparoscopic operation patients.

The effect of diluted ropivacaine in distending fluid on cramping pain after hysteroscopic surgeries: a randomized clinical trial study

Kobra Tahermanesh,Abolfazl Mehdizadeh Kashi,Marziyeh Ajdary,Samaneh Rokhgireh,Masood Mohseni,Shahla Chaichian,Maryam Ahmadi 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.6

ObjectiveThe effect of ropivacaine on postoperative hysteroscopy has not yet been evaluated; this study investigated the effectof diluted ropivacaine in distending media during hysteroscopy on postoperative cramping pain. MethodsThis double-blind randomized clinical trial was conducted on 60 women who underwent hysteroscopy at a tertiaryhospital. Normal saline was used as the distending fluid in both groups. The intervention group received 10 mLof 2% ropivacaine in only one bottle of 1,000 mL normal saline as a distending fluid, while the control groupreceived 10 mL of normal saline in 1,000 mL normal saline during hysteroscopy. Patients’ pain scores wereevaluated before hysteroscopy and at 2, 6, 12, 24, and 48 hours after hysteroscopy. ResultsBased on the results, the pain measured by visual analog scale (VAS) score was significant at 6 and 12 hours after theintervention was significantly lower than that in the ropivacaine group (3.03±1.57 vs. 4±1.49, P=0.02 at 6 hours and1.28±1.36 vs. 2.4±1.43, P=0.003 at 12 hours). There were no significant differences in the VAS scores at 2, 24, and 48hours after the intervention between the two groups. ConclusionRopivacaine in the distending fluid during hysteroscopy is associated with a significant reduction in pain within a fewhours after hysteroscopy with no remarkable adverse effects.