The purpose of this study was to evaluate the effectiveness of ketorolac combined with local anesthetics for anorectal surgery.
From June 1998 through March 1999, 123 outpatients undergoing anorectal surgery were entered into a prospective, randomized, double-blinded study involving three treatment groups. All patients received intravenous sedation consisting of fentanyl and a propofol infusion, with a local anesthesia mixture of lidocaine, bupivacaine, and bicarbonate. Group A (41 patients) received placebo (saline) injections. Group B (41 patients) received 60 mg of intravenous ketorolac at the onset of the procedure, and Group C (41 patients) received 60 mg of ketorolac mixed with the local anesthetic. Data were analyzed using analysis of variance and chi-squared tests.
All groups had similar demographic characteristics and operative procedures. Twenty-nine of the 123 patients were human immunodeficiency virus-positive. There was no difference in operative or anesthesia time. Anesthesia and fluids given were similar in across groups. A significantly higher percentage of Group A patients had pain (34 percent) and required additional oral analgesia (20 percent) in the Day Surgery Unit. Only 5 percent of Group B and Group C patients complained of pain, with oral analgesics given to 2 percent of Group B and none in Group C. Voiding difficulties were more common in Group A patients, one patient requiring catheterization.
The addition of ketorolac (60 mg), either intravenous or injected with local anesthetics, reduces voiding problems and significantly decreases postoperative analgesic requirements in outpatients undergoing anorectal surgery.
"Groups 1 and 4 had the highest level of pain. These results are in line with studies that used general, spinal, or local anesthesia to reduce pain, including studies by Place et al. , Notaras , and Bell . "
[Show abstract][Hide abstract] ABSTRACT: Background and objective:
This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients.
In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old) with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1). Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS) at 0 (transfer to ward), 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups.
Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P < 0.001). Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P < 0.05).
Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5%) combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.
The Scientific World Journal 12/2014; 2014:1-6. DOI:10.1155/2014/424152 · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute orofacial pain is usually managed by the administration of local anesthetics, systemic analgesics, or a combination of the two methods. In an emergency, intraoral maxillary nerve blockade is helpful for controlling pain in the midface, although infiltrations may be more suitable for discomfort originating from individual teeth or portions of the alveolar process. Mandibular anesthesia can be achieved by open or closed-mouth techniques for inferioral alveolar-lingual nerve blockade. Systemic pain relief is optimized by using full analgesic doses of NSAIDs, with opioids serving to increase the degree of analgesia if required, or to be used, often with acetaminophen, in patients intolerant to NSAIDs.
Emergency Medicine Clinics of North America 09/2000; 18(3):449-70. DOI:10.1016/S0733-8627(05)70138-3 · 0.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery. OBJECTIVES: -Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.
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