Evaluation of the contribution to postoperative analgesia by local cooling of the wound (original) (raw)
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Cooling for the reduction of postoperative pain: prospective randomized study
Hernia, 2006
Hernia surgery has been associated with severe pain within the first 24 h postoperatively. The application of cold or cryotherapy has been in use since at least the time of Hippocrates. The physiological and biological effects from the reduction of temperature in various tissues include local analgesia, inhibited oedema formation and reduced blood circulation. Our hypothesis was that cold therapy, applied by means of ice packs, following inguinal hernia surgery, controlled pain postoperatively. Forty patients scheduled for inguinal hernia repair were enrolled in a double-blind, randomized study. Postoperatively, chipped ice in a plastic bag (cold group), and a plastic bag containing only room temperature water (control) were placed over the incision for 20 min. Postoperative pain data were collected at 2, 6 and 24 h after operation according to the well validated visual analogue scale (VAS). The highest pain levels were recorded 2 h postoperatively for both groups. Pain levels then gradually decreased for both the trial groups during the first 24 h postoperatively. There were significant differences in the VAS scores between the groups at 2, 6 and 24 h. We conclude that local cooling is a safe and effective technique for providing analgesia following inguinal hernia repair.
Organisation and methods in postoperative pain therapy
Anaesthesia, 2010
Thus, it may be useful sometimes to depress postoperative shivering, which is a physiological compensatory mechaniun. The intravenous adrmnistration of K agonists, such as pethidine, as well as fkt warming by active warming systems, can be used to decrease both duration and intensity of muscular mass contractions during the early postoperative period ~7 1 .
The Effect of Warm Intravenous Fluid on Postoperative Pain: A Double-Blind Clinical Trial
Preventive Care In Nursing and Midwifery Journal, 2019
Background: Hypothermia is likely to cause enormous dangers for patients undergoing cesarean section. Objectives: This study aims to comparison between the effect of using two different temperatures of IV fluids (37.5°C versus 21-22°C) in body temperature drop and the post-operative pain. Methods: This experimental study was double-blind clinical trial, conducted in 2017 (April, 2017 to January, 2018). The method of sampling was simple random sampling. The randomly selected mothers, undergoing cesarean section, were assigned into two groups of equal number (the hexagonal blocks of A and B) in this clinical trial. The experimental and control group participants received IV fluid at the operation room temperature (25°C) and the IV fluid of 37.5°C, respectively. The core intraoperative body temperature was measured by Microlife Infrared Tympanic-IR100 thermometer. Severity of the experimental and control group patients' post-operative pain was also measured and compared for 24 hours (since when the patients were discharged from the recovery ward) by the VAS (0-10). Results: A total of 80 patients underwent this study. The demographic information of the two group members showed no difference of significance (p>0.05). The average intraoperative body temperature of the experimental group participants was higher in the level (p=0.001) of significance than that of the control group members. There was no difference of significance (p=0.41) between the mean severity of pain of both groups' participants in the first 24 hours. Conclusion: The intraoperative IV fluid warming seems not to have any tranquilizing effect in the postsurgery pain.
Indian journal of anaesthesia, 2017
Very few studies have compared continuous wound infiltration (CWI), continuous epidural infusion (CEI) and intravenous Patient Controlled Analgesia (PCA) with morphine in spine surgery. This study compared these modalities in patients undergoing microdissectomy. This prospective, randomized control trial was conducted on 75 patients of American Society of Anesthesiologists' physical status I or II undergoing microdiscectomy. Patients in all the three groups received morphine 1 mg IV, with a lockout period of 10 min after each bolus, and the maximum allowed dose was 15 mg/5 h postoperatively. Patients in Group A received CWI with 0.25% levobupivacaine 20 mL as bolus after extubation followed by infusion at 5 mL/h. Group B received CEI with 0.25% levobupivacaine at 5 mL/h. Patients in Group C received intravenous (IV) morphine by PCA pump only. The primary end points were static and dynamic visual analogue scores (VAS) and postoperative pain scores. Secondary observations were pos...
Spine Journal, 2004
Administration of analgesic medication, before the actual onset of painful stimulus, is more effective than that after the onset of painful stimulus. This is the principle of preemptive analgesia. Although it is often considered superior to other forms of analgesia, its role in postoperative pain relief after lumbosacral spinal surgery has not been fully investigated.To analyze the efficacy of preemptive analgesia with a single caudal epidural injection for patients undergoing surgeries on the lumbosacral spine by the posterior approach.Randomized, double-blinded and controlled clinical trial.Eighty-two patients who underwent discectomy in the lumbosacral spine by the posterior approach, with or without instrumentation, were randomized to the control group (n=40) and to the study group (n=42).Patients in control group received a single caudal epidural injection of 20 ml of normal saline. Patients in study group received a single caudal epidural injection of 20 ml containing bupivacaine and tramadol as the active agents. The time interval between this injection and the surgical incision was never less than 20 minutes in either of the groups. This facilitated enough time for the drug to get fixed to the nerve roots, leading to effective preemptive analgesia.Patients were monitored for postoperative pain immediately after surgery when they had completely recovered and regained consciousness from general anesthesia, and subsequently 4, 8, 12 and 24 hours thereafter. Pain was quantified using the visual analog scale (VAS) and the verbal rating scale (VRS). The time at which supplemental analgesic medication was first demanded in the postoperative period by the patient was also noted.The two groups were comparable for age, sex, body weight and the type of surgery they underwent. Because the data did not have a normal Gaussian distribution, the one-tailed Mann-Whitney test, being a nonparametric test, was adopted for statistical analysis. Accordingly, VAS and VRS values at all time intervals were significantly lower (p<.0001) in the study group as compared with the control group. This indicated significantly better pain relief in the study group. There was also a significant delay (p=.0041) in the first demand for supplemental analgesic medication in the postoperative period in the study group. No complication specific to the procedure was noted except for the development of postoperative urinary retention, which was transient and appropriately managed with urinary catheterization.Preemptive analgesia with a single caudal epidural injection of bupivacaine and tramadol is a safe, simple and effective method for postoperative pain relief.
Highlights in postoperative pain treatment
Expert Review of Neurotherapeutics, 2007
Acute pain is a symptom that originates from actual ongoing or impending tissue damage. Pain is an individual subjective experience and varies markedly among individuals. For this reason, patient involvement is essential, with the most reliable indicator of severity being patient self-report. The main objective of postoperative pain management is the achievement of fast rehabilitation, recovery of all normal functions and reduction of postoperative morbidity. Sufficient evidence supports the hypothesis that effective analgesia modifies many of the adverse sequelae that accompany acute pain and assists in recovery. Nevertheless, despite the availability of drugs and techniques for its effective management, postoperative pain remains undertreated. It is now accepted that the solution to the problem of inadequate pain relief lies not only in the development of new analgesic drugs or technologies but also in the development of an appropriate organization to utilize existing expertise. Methods used to control postoperative pain are numerous; this review focuses on pharmacological and anesthetic methods.
Neurospine
Objective: Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. Methods: DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients' pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. Results: In the postanesthesia care unit, the mean VAS back pain score was 5.87 ± 0.9 in the DC group and 6.95±1.0 (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were 3.8±1.1 vs. 5.4±0.7 (p < 0.001) at 6 hours postoperatively, and 2.7±0.7 vs. 6.25±0.9 (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was 3,733.3±562.7 mg vs. 4,633.3±693.5 mg (p<0.005), 53.3±19.5 mg vs. 85.3±33.4 mg (p<0.005), and 63.3±83.4 mg vs. 393.3±79.9 mg (p<0.0001), respectively. Conclusion: The results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.
Post-operative pain management
Pulse, 2014
John J. Bonica once said, "Acute pain afflicts millions of patients world-wide. Its effective control remains one of the most important issues in post-operative care today". Modern anesthesia has advanced to a point at which all patients can be guaranteed a pain-free intra-operative period. Unfortunately, we often fall short when it comes to providing post-operative pain relief. It is not surprising; therefore, that what patients often fear most about a surgical procedure is the pain they will experience afterward. Most people suffer from post-operative pain of varying intensity who under go operation. Inadequate treatment of pain causes needless suffering and may develop complications. John J. Bonica again said that, "Inadequate or improper application of knowledge and therapies currently available is certainly one of the most important factors resulting in inadequate relief of pain." The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects as cheaply as possible. Postoperative pain relief must reflect the needs of each patient and this can be achieved only if many factors are taken into account. These may be summarized as clinical factors, patient-related factors and local factors. In the final analysis the ultimate determinant of the adequacy of pain relief will be the patient's own perception of pain.
Acta Anaesthesiologica Taiwanica, 2010
To evaluate the association between daily morphine requirement and the intravenous patient-controlled analgesia (IVPCA) setting in patients undergoing spinal surgery. Methods: We conducted a retrospective analysis of 179 patients of American Society of Anesthesiologists physical status class I−III who underwent elective posterior lumbar spinal surgery and consented to IVPCA for postoperative pain control. The regimental solution contained morphine 1 mg/mL. The IVPCA program was set to deliver a priming dose of 1.5−4 mL, a basal infusion rate of 0−1.2 mL/hr, and a 0.5−1.5 mL bolus on demand with a 5-minute lockout interval. Demographic data, surgical procedures, analgesia program setting variables, 4-hour cumulative morphine dose and 11-point numeric rating scale for pain on postoperative days 1 and 2 were collected for comparison. Results: The IVPCA requirement decreased gradually over time (p < 0.001). The number of vertebrae involved significantly influenced the daily morphine requirements (p = 0.01). None of the IVPCA settings, including continuous infusion, affected daily morphine requirements. On average, the analgesic requirement on postoperative day 2 was 18% less than that on postoperative day 1. Conclusion: The number of vertebrae involved was significantly associated with the daily IVPCA requirement. The IVPCA settings, including priming dose, basal infusion rate and bolus dose, did not affect the daily morphine requirements.
A wound infiltration as a method of postoperative analgesia
2009
A wound infiltration is a method of postoperative analgesia efficient in the various surgical subdisciplines. This technique resulted from the observation that patients whose surgical procedures were performed under regional anaesthesia techniques have reduced postoperative analgesic consumption. Owing to the advances in the drug discovery and to the introduction of local anaesthetics with prolonged effects, this technique has less adverse reactions and considerable analgesic effects. New local anaesthetics with long duration of action and low toxicity like levobupivacaine and ropivacaine are currently available at the market. Such drugs with lower potential for systemic toxicity provided additional safety dimension to local infiltration techniques. A variety of methods were developed to achieve painless recovery period, better patient comfort and to improve patient outcome. Probably the most common technique is a field block at the end of the surgery that can be performed both during regional anaesthesia techniques and in the general anaesthesia. The use of wound infiltration techniques was facilitated by important technical improvements in the multilumen catheters and by construction of special drug delivery devices. Numerous disposable elastomeric devices and patient controlled pumps are suitable for prolonged periods of analgesia in the clinical and outpatient setting. Although it can be used alone for less painful procedures, infiltration analgesia is now important part of multimodal pain treatment. This complex approach to the postoperative pain treatment is characterized by the use of different analgesic drugs and techniques, like wound infiltration and intravenous opioid or nonsteroidal anti-inflammatory drugs. M ultimodal postoperative pain treatment is acceptable after painful procedures i.e. hip and knee replacement, where it improves pain control and patient outcome.