Multimodal Analgesia Prolongs Duration of Postoperative Analgesia and Decreases Postoperative Pain Intensity in Short Surgical Procedures: a Randomized Controlled Trial

ABSTRACT Background: We examined the effect of preoperative combination of different analgesics and the role of each individual analgesic compared to control regarding postoperative pain, Methods: patients were randomly allocated into either control; multiple treatment, perfalgan, opioid and voltaren group. The time for first request for analgesia and visual analogue score were compared by analysis of variance and tuckey Kramer test. Results:There was a main effect of treatment p>0.0001 in favor of multi-analgesia and opioid groups. Multi-analgesia group was better than opioid group p=0.016. There was a little improvement with paracetamol (perfalgan) but no effect of voltaren on duration of analgesia nevertheless;both have reduced VAS relative to control. Conclusion: Combination ofnon-opioid analgesicsDiclofenac Na (voltaren), Paracetamol (perfalgan) with low dose morphine and dexamethasone have greatly prolonged duration of analgesia and reduced pain intensity without displaying notable side effects

Inverse association between circulating APRIL levels and serological and clinical disease activity in patients with systemic lupus erythematosus

Objective: To assess longitudinal expression of a proliferation-inducing ligand (APRIL) in patients with systemic lupus erythematosus (SLE) and its correlation with B lymphocyte stimulator (BLyS) expression, serum anti-dsDNA titres, and clinical disease activity. Methods: Sixty eight patients with SLE were longitudinally followed up for a median of 369 days. At each visit the physician assessed disease activity by SLEDAI, and blood was collected for determination of serum APRIL and BLyS levels and of blood APRIL and BLyS mRNA levels. Fifteen normal control subjects underwent similar laboratory evaluation. Results: Dysregulation of APRIL was not as great as that of BLyS. Changes in serum levels of APRIL and BLyS over time were usually discordant, whereas blood levels of APRIL and BLyS mRNA strongly paralleled each other. Serum APRIL levels modestly, but significantly, inversely correlated with serum anti-dsDNA titres in anti-dsDNA positive patients analysed in aggregate. Moreover, serum APRIL levels modestly, but significantly, inversely correlated with clinical disease activity in all patients analysed in aggregate. Conclusion: Serum levels of APRIL and BLyS are differentially regulated. APRIL may serve as a down modulator of serological and/or clinical autoimmunity in patients with SLE. This may have important ramifications for BLyS targeted treatment, and it remains to be determined whether agents which neutralise only BLyS will be preferable to agents which neutralise both BLyS and APRIL