Postoperative pain management with intravenous patient-controlled morphine: Comparison of the effect of adding magnesium or ketamine

PubMedID: 12790216Background and objective: This double-blind randomized study tested whether the addition of magnesium or ketamine to morphine for intravenous patient-controlled analgesia resulted in improved analgesic efficacy and lower pain scores compared with morphine patient-controlled analgesia alone after major abdominal surgery. Methods: Ninety patients (3 × 30) were randomly allocated to receive either morphine 0.4 mg mL-1 (Group M) by patient-controlled analgesia, morphine 0.4 mg mL-1 + MgSO4 30 mg mL-1 (Group MM) or morphine 0.4 mg mL-1 + ketamine 1 mg mL-1 (Group MK). Postoperative analgesia was started when the verbal rating scale was ?2. Patients were first given a standardized loading dose (0.05 mg kg-1) of the study solution. They were then allowed to use bolus doses of this solution (0.0125 mgkg-1 every 20 min without time limit). Discomfort, sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 24 h after the start of the patient-controlled analgesia. Results: The level of discomfort, level of sedation and verbal rating scores decreased significantly with time in all groups (P < 0.05). Both verbal rating and discomfort scores were significantly lower in Groups MM and MK at 15, 30 and 60 min compared with Group M (P < 0.001). Cumulative morphine consumption after 12 and 24 h was significantly higher in Group M alone (median 26 and 49 mg, respectively) compared with Group MM (24.2 and 45.7 mg) and Group MK (24.4 and 46.5 mg). Conclusions: In the immediate postoperative period, the addition of magnesium or ketamine to morphine for intravenous patient-controlled analgesia led to a significantly lower consumption of morphine. However, these differences are unlikely to be of any clinical relevance

Comparison of different doses of remifentanil in brief surgical procedures [Sedonanaljezide farkli dozda remifentanil uygulamasi]

This study was designed to compare the safety and analgesic effectiveness of remifentanil when administred as intermittent bolus injections or a single bolus injection followed by two different dosages of continuous infusion during brief painful procedures. Sixty adult patients undergoing breast or lymph node biopsy were premedicated with intravenous 0.15 mg kg-1 midazolam following haemodynamic and respiratory monitoring Patients were randomly assigned to one of the three modes of remifentanil administration. Group I received 1 kg-1 bolus of remifentanil at 30-60 seconds followed by intermittent 0.5 µg kg-1 bolus of remifentanil as needed. Group II received 1 µg kg-1 bolus of remifentanil followed by a continuous infusion of remifentanil at a rate 0.1 µg kg-1 min-1 Group III received 1 µg kg-1 bolus of remifentanil followed by a continuous infusion of remifentanil at a rate 0.2 µg kg-1 min-1 Discomfort, pain, sedation scores, haemodynamic variables and complications were recorded at pretreatment and 1, 5 and 15 minutes after administration. In all groups, respiratory rate was significantly lower than preoperative control values at 1 and 5 min (p<0.05), whereas heart rate was only lower at 1 min (p<0.05) There were no differences in oxygen saturation and blood pressure (systolic-diastolic) among the groups. Patient comfort and VAS were superior in the 0.2 µg kg-1 min-1 remifentanil group (p<0.05) whereas sedation scores and incidence of O2 desaturation were higher than group I and II during the procedures (p<0.05). Both bolus injections and continuous infusions of remifentanil provided effective analgesia for pain control during brief surgical procedures without using local anaesthetic but was complicated by a high incidence of O2 desaturation at higher doses of 0.2 µg kg-1 min-1

Postoperative analgesia in children: Comparison of bupivacaine with a mixture of bupivacaine and alfentanil [1]

PubMedID: 11553247[No abstract available

The comparison of remifentanil, alfentanil and fentanyl in the management of pain in burned patients [Yanikli hastalarin agri tedavisinde remifentanil, alfentanil ve fentanil karşilaştirmasi]

Objective of this study was to compare sixty adult burned patients intermittent bolus administration of remifentanil (2 µg/kg), alfentanil (40 µg/kg) and fentanyl (2 µg/kg) for pain management in burned patients undergoing dressing changes and debridement procedures. Following 0.15 mg/kg IV midazolam, IV remifentanil 2 µg/kg in group I, alfentanil 40 µg/kg in group II and fentanyl 2 µg/kg were applied at 30-60 s. The level of sedation was assessed with a score of 0 = awake, alert to 3 = asleep, unarousable. Discomfort and pain were assessed using visual analog scale (VAS). Side effects were not observed. VAS values were statistically significant lower (p=0.018), in group III than in group I at 5. minutes, whereas no statistically significant difference observed among the groups at 1. and 15. minutes. The level of sedation was statistically significant higher(p=0.002, p=0.036), in group III than in group I and II at 15. min., whereas no statistically significant difference was observed among the groups at 1. and 5. min. Apnea and respiratory depression were not seen in group III whereas 3 patients in group I and 1 patient in group II showed apnea episodes. In conclusion we observed that IV bolus administration of remifentanil (2 µg/kg), alfentanil (40 µg/kg) and fentanyl (2 µg/kg) provided effective analgesia for pain control in burn patients. As it is required frequent dose application and caused apnea, intermittent bolus doses of remifentanil is not thought to be suitable whereas alfentanil and fentanyl can used safely for long-term therapeutic procedures in burn patients

Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in boys

PubMedID: 15078378Background: In this study we compared caudal with intravenous (i.v.) tramadol given pre- or postoperatively for pain relief in boys having hypospadias repair. Methods: The study was approved by the Ethics Committee and informed written consent was obtained from the parents of each patient. Patients (n = 134), aged 1-3 years, American Society of Anesthesiologists (ASA) physical status I, scheduled for hypospadias surgery were recruited. The patients were randomly allocated to one of the four groups: group I (n = 33), received 2 mg·kg-1 (0.5 ml·kg-1) of caudal tramadol after the surgical procedure was completed, group II (n = 33) received 2 mg·kg-1 (0.5 ml·kg-1) of caudal tramadol before incision, group III (n = 34) received 2 mg·kg-1 tramadol intravenously, after surgery and group IV (n = 34) received 2 mg·kg-1 tramadol intravenously, after anaesthesia induction. When the patients were fully awake in the recovery area, heart rate, arterial pressure, peripheral oxygen saturation, respiratory rate, pain and sedation scores were recorded at 5, 10, 15, 30, 60 min, and 2, 3, 4, 6, 12 and 24 h postoperatively and side-effects were noted. Pain was assessed using an objective pain score (OPS). Results: The OPS were lower in caudal tramadol groups than in i.v. tramadol groups only at 3 h (P < 0.05). The duration of postoperative analgesia was longer in the caudal groups than in the i.v. groups (P = 0.001). However, the duration of postoperative analgesia was unaffected by the timing of administration. Conclusions: Caudal tramadol provides better and longer lasting postoperative analgesia than i.v. tramadol. These results also suggest that preoperative caudal tramadol did not provide any clinically perceptible benefits compared with postoperative caudal tramadol

Remifentanil produces vasorelaxation in isolated rat thoracic aorta strips

PubMedID: 12492799Background: Remifentanil can cause transient instability in hemodynamic variables. However this change may not be solely the result of autonomic or central nervous system inhibition or of centrally mediated vagal stimulation. In this study, the aim was to examine the direct effects of remifentanil on isolated thoracic aorta strips in vitro. Methods: Forty-five Wistar rat thoracic aorta rings were isolated, and contraction-relaxation responses were recorded. Results: In aortic rings precontracted with phenylephrine or potassium chloride, remifentanil produced concentration-dependent relaxation in both endothelium-intact and denuded rings (P<0.001). Remifentanil induced significantly greater relaxation in intact rings than in those denuded of endothelium, regardless of whether they were precontracted with phenylephrine hydrochloride or KCl (P<0.001). When the endothelium was present, remifentanil produced greater relaxation in KCl-contracted rings than in PE-contracted rings at lower concentrations (10-9 and 10-8), and similar relaxation at higher concentrations (10-7 and 10-6). However, when the endothelium was removed, relaxation was similar in both solutions, at all concentrations (10-9 to 10-6). In intact rings, pretreatment with L-NO-ARG or indomethacin reduced the degree of remifentanil-induced relaxation. In Ca+ ± free media, calcium-dependent KCl contractions were inhibited in a dose-dependent manner by remifentanil (P<0.001). Conclusion: Remifentanil vasodilates by an endothelium-dependent mechanism, involving prostacyclin and nitric oxide released from the endothelium. Its endothelium-independent vasodilation probably occurs via the suppression of voltage-sensitive Ca++ channels. © Acta Anaesthesiologica Scandinavica 47 (2003)

The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia

PubMedID: 16223399Background: The addition of intrathecal (IT) magnesium to spinal fentanyl prolongs the duration of spinal analgesia for vaginal delivery. In this prospective, randomized, double-blind, controlled study, we investigated the effect of adding IT magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Methods: One hundred and two ASA I or II adult patients undergoing lower extremity surgery were recruited. They were randomly allocated to receive 1.0 ml of preservative-free 0.9% sodium chloride (group S) or 50 mg of magnesium sulphate 5% (1.0 ml) (group M) following 10 mg of bupivacaine 0.5% plus 25 µg of fentanyl intrathecally. We recorded the following: onset and duration of sensory block, the highest level of sensory block, the time to reach the highest dermatomal level of sensory block and to complete motor block recovery and the duration of spinal anaesthesia. Results: Magnesium caused a delay in the onset of both sensory and motor blockade. The highest level of sensory block was significantly lower in group M than in group S at 5, 10 and 15 min (P < 0.001). The median time to reach the highest dermatomal level of sensory block was 17 min in group M and 13 min in group S (P < 0.05). The mean degree of motor block was also lower in group M at 5, 10 and 15 min (P < 0.001). The median duration of spinal anaesthesia was longer in group M (P < 0.001). Conclusion: In patients undergoing lower extremity surgery, the addition of IT magnesium sulphate (50 mg) to spinal anaesthesia induced by bupivacaine and fentanyl significantly delayed the onset of both sensory and motor blockade, but also prolonged the period of anaesthesia without additional side-effects. © Acta Anaesthesiologica Scandinavica (2005)

Comparison of cisatracurium and atracurium-induced neuromuscular block during desflurane and sevoflurane anaesthesia [Desfluran ve sevofluran anestezisi sirasinda sisatrakuryum ile atrakuryumun oluşturdugu nöromüsküler blokun karşilaştirilmasi]

In this study, cisatracurium-induced and atracurium-induced neuromuscular blocks were compared during desflurane and sevoflurane anaesthesia. Following faculty ethic committee approval, 80 adult patients undergoing elective orthopaedic, laparascopic or plastic surgery were accepted to study. Anaesthesia was induced with thiopentone sodium (5 mg/kg) and maintained either with 4-6% desflurane or 1.5-2% sevoflurane in a mixture of 66% nitrous oxide and 34% oxygen in all patients. The patients were assigned randomly four groups. To group I desflurane+atracurium (0.5 mg/kg) (Group DA), to group II desflurane+cisatracarium (0.1 mg/kg) (Group DS), to group III sevoflurane+atracurium (0.5 mg/kg) (Group SA), and to group IV sevoflurane+cisatracurium (0.1 mg/kg) (Group SC) were applied. The onset time (T95), onset maximum block (Tmax), clinical duration (T25), recovery index (T75-25), spontaneous recovery time (T4/T1=% 70) and endotracheal intubation conditions were assessed. In cisatracurium groups; T95 values were found shorter (p=0.046) in group DS than in group SC whereas T25 and T4/T1 =% 70 values were found longer (p=0.06 and p=0.011). In atracurinm groups; T95 and Tmax values were found shorter (p=0.018 and p=0.019) in group DA than in group SA whereas T25 and T4/T1=% 70 values were found longer (p=0.00 and p=0.00). In conclusion; onset of action and onset of maximum block was longer in cisatracurium groups than atracurium groups during desflurane and sevoflurane anaesthesia. The onset of action of cisatracurium and atracuriam was shorter with desflurane than did sevoflurane whereas clinical duration of action was longer

Comparison of the effects of desflurane and sevoflurane on newborn in elective Cesarean section [Elektif Sezaryen girişimlerde sevofluran ve desfluranin yenidogan üzerine etkilerinin karşilaştirmasi]

The aim of the current study was to compare the effects of desflurane and sevoflurane on haemodynamic variables, APGAR, neuro adaptive capacity scores (NACS) and umblical vein blood gas values during cesarean section. Following Ethies Committee approval and informed patient consent, 60 ASA I or II mothers, scheduled for elective Cesarean section undergoing general anaesthesia, were enrolled to the study. Patients were randomly divided into two groups. Anaesthesia was induced in all patients by intravenous propofol 2 mg kg -1 and maintained with 1% sevoflurane in a mixture of 50% N 2O in oxygen in group 1 and 3% desflurane in a mixture of 50% N 2O in oxygen in group II. Systolic blood pressures, diastolic blood pressures, heart rate and peripheral oxygen saturation were recorded before anaesthesia induction and at 1, 15 and 30 minute after endotracheal intubation. After delivery, umblical blood samples were taken for determination of blood gas analysis. New-borns' performance were assessed using APGAR and NACS. Heart rate was found significantly higher in group II at first minute than in group I (p&lt;0.05). Systolic blood pressures was significantly higher in group II at 1,15 and 30 minutes than in group I, whereas diastolic blood pressures was significantly higher in group II at 1 and 15 minutes than in group I (p&lt;0.05). No significant difference was found in APGAR, NACS and umblical blood gas analysis. Although the effects of desflurane and sevoflurane on the newborn were similar, it was concluded that desflurane was not thought to be a good choice in cesarean section because of its unfavorable haemodynamic side effects (hypertension, tachycardia)

Remifentanil produces vasorelaxation in isolated rat thoracic aorta strips [7]

PubMedID: 15243971[No abstract available