The influence of preemptive spinal anesthesia on postoperative pain.
ABSTRACT To examine the influence of spinal anesthesia on postoperative pain and postoperative opioid requirements.
Prospective randomized study.
Bnai-Zion Medical Center, Haifa, Israel-a government hospital.
30 ASA physical status I and II unpremedicated women undergoing elective total abdominal hysterectomy were randomly allocated into two groups of 15 patients each using a sealed envelope technique. Patients in Group 1 were given a subarachnoid injection of 12 mg hyperbaric bupivacaine and after 10 minutes general anesthesia was induced. Patients in Group 2 received only general anesthesia. Anesthesia was induced with midazolam and maintained with oxygen, N2O, isoflurane, and pancuronium. No opioids were given intraoperatively. Postoperatively patient-controlled analgesia (PCA) with morphine was initiated in both groups (1 mg x mL(-1), bolus dose 1 mg, lockout interval 10 minutes, and background infusion 1 mg x mL(-1)) at patient first request for analgesic. Pain was assessed over 24 hours by cumulative morphine dose and visual analog score (VAS). Postoperative PCA morphine consumption at 2, 6, and 24 hours following patient first request for analgesic for Groups 1 and 2 were: 3.1 +/- 1 mg versus 7.2 +/- 3 mg (p = 0.04), 13.4 +/- 2 mg versus 17.2 +/- 4 mg (p = 0.03) and 35.9 +/- 8 mg versus 47.7 +/- 8 mg in Group 2 (p = 0.04). VAS scores at 4, 6, 12, and 24 hours postoperatively were not significantly different between the two groups.
Preoperative neural blockade may reduce postoperative analgesic requirements.
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ABSTRACT: Fragestellung. Lornoxicam ist ein Nichtopioidanalgetikum und gehört zu der Gruppe der Oxicame.Das Ziel der Studie war es festzustellen, ob Lornoxicam einen analgetischen präemptiven Effekt aufweist. Methodik. Die Untersuchung erfolgte doppelblind randomisiert bei 66 Patienten mit gynäkologischen Operationen in 3 Gruppen. Gruppe I erhielt 8mg Lornoxicam präoperativ i.v. und dann alle 8 h Bolus von Lornoxicam 8mg,Gesamtdosis 24 mg in den ersten 24 h.Gruppe II erhielt vor Operationsende 8 mg Lornoxicam als Bolus und dann 8mg Lornoxicam alle 8 h,Gesamtdosis 24 mg Lornoxicam in den ersten 24 h.Gruppe III erhielt Placebo vor und nach der Operation und über 24 h. Die Wirksamkeit wurde postoperativ anhand einer visuellen Analogskala (Ruhe,Belastung), anhand des gesamten Analgetikaverbrauches Morphinhydrochlorid innerhalb der ersten 24 h postoperativ gemessen.Vitalparameter und Nebenwirkungen wurden dokumentiert. Ergebnisse. Gruppe I und Gruppe II zeigen zu gewissen Zeitpunkten signifikant geringere Schmerzscores als Gruppe III.Gruppe I zeigt auch einen schwach signifikant geringeren postoperativen Analgetikaverbrauch von Morphinhydrochlorid verglichen mit den Gruppen II und III. Schlussfolgerung. Lornoxicam präemptiv verabreicht scheint zu einer verbesserten Analgesiequalität postoperativ und zu einer Verringerung des postoperativen Analgetikaverbrauches zu führen. Aim. Lornoxicam is a non opioid analgesic belonging to the oxicam group.The aim of this study was to determine whether lornoxicam has a preemptive analgesic effect. Methods. This study was carried out in a randomized, double-blind fashion with 66 patients divided into three groups undergoing gynecological operations.Group I was administered 8 mg of lornoxicam i.v.preoperatively followed by an 8-mg bolus every 8 h for a total dose of 24 mg in the first 24 h. Group II was administered 8 mg of lornoxicam i.v. bolus before the end of the operation followed by 8 mg every 8 h for a total dose of 24 mg in the first 24 h.Group III was administered placebo before and after the operation and for the first 24 h.The effectivity was assessed postoperatively using the visual analogue scale (at rest, on exertion) and by calculating the total analgesic consumption of morphine hydrochloride in the first 24 h following operation.Vital signs and side effects were documented. Results. Groups I and II demonstrated significantly reduced pain scores compared to group III at various points in time.Group I also demonstrated a weakly significant reduction in analgesic consumption of morphine hydrochloride postoperatively compared to groups II and III. Conclusion. Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and lead to reduced consumption of opioid analgesics postoperatively in patients undergoing gynecological operations.Der Schmerz 12/2002; 17(1):4-10. · 1.02 Impact Factor
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ABSTRACT: Nearly every surgery can elicit a rather therapy-resistant chronic postoperative pain. Preventive medicine is therefore anticipated with hopeful eyes, but requires a better understanding of the neurobiological mechanisms underlying the transition from acute to chronic pain. Spinal mechanisms of pain amplification are regarded as fundamental to pain chronification, but these mechanisms on their own are not at all likely to be sufficient. Indeed, not every surgical patient develops chronic postoperative pain. Progress in our neurobiological understanding of postoperative pain includes scientific discoveries of 'vulnerability factors', which substantially impact on the spinal cord, augmenting pain amplification mechanisms, perhaps to levels of no-return. In this review we elaborate on spinal pain amplification mechanisms in relation to pain chronification and the impact of vulnerability factors hereon. Moreover, these insights are incorporated within a clinical frame of treatment approaches currently used in surgical settings. As such, this review provides an integrated overview of mechanism-based treatment approaches in prevention of chronic postoperative pain.Progress in Neurobiology 02/2013; · 9.04 Impact Factor
Article: Update on preemptive analgesia[Show abstract] [Hide abstract]
ABSTRACT: Perioperative pain remains prevalent and poorly treated. Apart from its impact on the rate and unpleasantness of recovery from surgery, pain often remains as a residual aftereffect of surgery even though tissue healing appears complete. A growing appreciation for the underlying neurobiology of pain has identified mechanisms that can enhance the intensity of perioperative pain and even lead to more prolonged painful conditions. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, preemptive analgesia, though firmly grounded in the neurobiology of pain, has yet to realize its anticipated clinical potential. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae.Techniques in Regional Anesthesia [amp ] Pain Management 01/2003; 7(3):116-121.