The efficacy of Sublingual Buprenorphine in controlling pain After cesarean Surgery under Spinal Anesthesia

 Aims and background: One of the major challenges in women’s surgery, including cesarean section, is postoperative pain control. Postoperative pain as one of the most common problems in the postoperative phase and can lead to a significant reduction in the quality of surgical operations, along with other problems such as nausea and vomiting, hypotension and shivering. Therefore, the present study we aimed to study the efficacy of sublingual Buprenorphine in postoperative pain control following cesarean surgery and its effects among patients. Materials and Methods: The present study is a randomized, double-blind clinical trial. Patients aged 1845years old and all candidates underwent cesarean section at Alavi Hospital in Ardabil in 2017. After obtaining consent from patients for inclusion in the study, 80 patients were selected using simple sampling method and divided into two groups of 40. In the first group,) control group) 40 patients received fentanyl and placebo tablets, and the pump was used to inject intravenous fentanyl and the drug lasted for up to 24 hours. the second group )40 patients) received normal saline pump and buprenorphine pills. In the second group (sublingual buprenorphine + placebo pump), it was repeated 6 and 12 hours after the first dose. Then, VRS pain scores, vomiting  nausea, sedation )from Ramsay sedation scale), and the amount of analgesic demand for pain control at 2, 6, 12, and 24 hours, and postoperative analgesia (time to first need analgesia) were recorded. Finally, all patient information entered into a pre-designed checklist and all the data entered into the SPSS v20 statistical analysis program and we analyzed the data. Findings: In this study, 80 patients were evaluated in two groups The results of VRS pain score in patients showed that, except within 24 hours after surgery, in other hours of study, the pain score in the two groups did not show any significant difference. In the control group, the demand for analgesics was higher than the buprenorphine group. In the early hours after surgery (hours 2 and 6), the incidence of nausea and vomiting was significantly lower in the buprenorphine group than in the control group, but the rest of  it, no difference was observed. The sedation score was also evaluated, but no significant difference was observed in the two groups. Also, the incidence of other side effects in the two groups did not differ significantly. Conclusion: The results of this study showed that buprenorphine is an effective drug in reducing postoperative pain in postoperative patients and, due to its very low side effects, can be routinely used in patients

The Effect of Nicotine Patch on Reducing Nausea, Vomiting, and Pain Following Laparoscopic Cholecystectomy: A Randomized Clinical Trial

Background: The effect of nicotine on nausea, vomiting, and postoperative pain has been investigated in studies on animals and humans. This study aimed to evaluate the effect of nicotine patch on decreasing nausea, vomiting, and pain in laparoscopic cholecystectomy. Methods: The study sample consisted of 100 non-smoking patients undergoing laparoscopic cholecystectomy under general anesthesia in a triple-blind clinical trial. One hour after the start of surgery, patients were randomly assigned to receive 17.5-mg nicotine or placebo patches. The patches located on the right arm were left for 24 hours. The visual analogue scale (VAS) for pain and N/V score for the severity of nausea and vomiting were measured at intervals of 0, 6, 12, and 24 hours. Findings: The results showed there was no statistically significant difference between the groups in terms of pain intensity as well as nausea and vomiting at different time periods after surgery (P>0.05). A total of 36 patients in the nicotine group and 24 patients in the placebo group received meperidine. There was also no statistically significant difference between the two groups in terms of analgesics (P=0.096) and antiemetics (P=0.1). Moreover, the frequency of severe nausea and vomiting during the study in the nicotine group was higher than in the placebo group (4 vs. 1) but this difference was not statistically significant (P>0.05).  Conclusion: Receiving a 17.5-mg nicotine patch had a similar effect to receiving placebo in controlling postoperative pain, nausea, and vomiting in non-smokers. Nicotine use had no effect on reducing analgesia

Evaluation the effects of adding ketamine to morphine in intravenous patient-controlled analgesia after orthopedic surgery

Background: Intravenous patient-controlled analgesia (PCA) with morphine is commonly used for post-operative pain after major surgery. Ketamine has analgesic property at lower doses, and in combination with opioids it could have synergistic effect. The aim of this study is to determine effects of the addition of ketamine to morphine for PCA after orthopedic surgery. Materials and Methods: In this double-blind randomized clinical trial, 60 patients were randomly allocated to receive PCA consisting: Group 1 (morphine 0.2 mg/ml), Group 2 (morphine 0.2 mg/ml + ketamine 1 mg/ml), and Group 3 (morphine 0.1 mg/ml + ketamine 2 mg/ml). In this, anesthesiologists managed study, patients had orthopedic surgery. Assessments were made at 24 h and 48 h post-operatively. Visual analog scale (VAS) was used for recording pain score. PCA morphine use was recorded at 24 h and 48 h. VAS scores over 48 h were analyzed with analysis of variance for repeated measures. Significance level was taken as 0.05. Results: There is no significant difference between demographic information of the three groups ( P > 0.05). Control of pain in Group 2 and Group 3 was better than in Group 1 (only morphine) ( P = 0.001) but there was no significant difference between Group 2 and Group 3 ( P > 0.05). Rate of narcotic consumption in groups 2 and 3 was significantly lower than Group 1 ( P < 0.05). Conclusion: After orthopedic surgery, the addition of ketamine to morphine for intravenous PCA was superior to Intravenous PCA opioid alone. The combination induces a significant reduction in pain score and cumulative morphine consumption

The effects of oral pregabalin on post-operative pain of lower limb orthopedic surgery: A double-blind, placebo-controlled trial

Background: Post-operative pain is one of the problems, wherein lack of control on it has many side-effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation, and poor wound healing. Aims: In this study, we evaluated the pre-operative administration of pregabalin sufficiency and security in relieving post-operative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side-effects. Materials and Methods: This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery by spinal anesthesia. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 h before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12, and 24 h after surgery, the patients were evaluated and the pain score, the score of sedation, incidence of nausea and vomiting was recorded in the checklists. Then, the data were analyzed by SPSS v16. Results: Visual analog pain scores at all hours in pregabalin group significantly reduced compared to the placebo group ( P < 0.0001). Also, in the pregabalin group nausea and vomiting scores at all hours, sedation levels at 2 h and 6 h post-operatively, and pethidine consumption in all hours have significantly been reduced. Conclusion: A single pre-operative oral dose of pregabalin 150 mg is an effective method for reducing post-operative pain and pethidine consumption in patients undergoing orthopedic surgery

The Comparative Study of Ondansetron and Metoclopramide Effects in Reducing Nausea and Vomiting After Laparoscopic Cholecystectomy

Postoperative nausea and vomiting (PONV) are one of the most common complications of anesthesia and without prophylactic intervention occurs by about one-third of patients under general anesthesia. The aim of this study was to compare the efficacy of ondansetron and metoclopramide in reducing PONV after laparoscopic cholecystectomy. In this study, 60 patients undergoing laparoscopic cholecystectomy were randomly allocated into two equal groups (n=30), and in the first group 10 mg metoclopramide and in the second group 4 mg ondansetron preoperatively were injected. Nausea and vomiting and the need for rescue antiemetic treatment in recovery and 6 hr. and 6-24 hrs. After surgery were evaluated. Data were analyzed by SPSS software with chi-square test and analysis of variance (ANOVA). The incidence of nausea in metoclopramide was 43.3 % and in ondansetron was 33.3 %. The difference between two groups was not significant (P=0.6). The incidence of vomiting in metoclopramide was 20% and in ondansetron was 26.7%, and there was not any significant difference between intervention groups (P=0.12). For prevention of PONV after laparoscopic cholecystectomy, both metoclopramide and ondansetron are effective, and in preventing of nausea, ondansetron is more effective than metoclopramide, whereas there was not any significant difference between two drugs in preventing of vomiting

The Effect of Ketamine on Posttonsillectomy Pain in Children: A Clinical Trial

Introduction: Tonsillectomy is one of the most common surgical operations and has such complications as pain, hemorrhage and laryngospasm. Pain management is of vital importance in order to reduce the suffering and restlessness in children having undergone tonsillectomy. Different studies differ in their findings as to the use of ketamine for postoperative analgesia. The aim of this study was to investigate the effect of peritonsillar injection of ketamine preoperatively on postoperative pain relief.  Materials and Methods: This was a randomized controlled trial (RCT) on sixty 3-12-year-old children. Children were randomly assigned to the intervention and control groups. Peritonsillar injection consisted of 1 mg/kg ketamine in the intervention group and of normal saline in the control group. An injection of 1 cc was administered on each side five minutes prior to tonsillectomy. Pain assessment was performed using the self-report Oucher Scale and CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and sedative state assessment was performed using the Wilson Sedation Scale. Pain, medication and complications were studied for 24 hours. Data analysis was performed using chi-squared test and t-test. Results: The ketamine group had a lower pain score compared with the control group (1.40±1.003 compared with 1.53±1.074). The average pain was less in the control group two hours after the surgery. The difference was statistically significant. There was no difference between the two groups in terms of nausea and vomiting incidence.  Conclusion: The peritonsillar injection of ketamine five minutes prior to the surgery reduces the post-tonsillectomy pain without causing any complications