Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib versus celecoxib for post-operative pain relief after arthroscopic anterior cruciate ligament reconstruction.</p> <p>Methods</p> <p>One hundred and two patients diagnosed as anterior cruciate ligament injury were randomized into 3 groups using opaque envelope. Both patients and surgeon were blinded to the allocation. All of the patients were operated by one orthopaedic surgeon under regional anesthesia. Each group was given either etoricoxib 120 mg., celecoxib 400 mg., or placebo 1 hour prior to operative incision. Post-operative pain intensity, time to first dose of analgesic requirement and numbers of analgesic used for pain control and adverse events were recorded periodically to 48 hours after surgery. We analyzed the data according to intention to treat principle.</p> <p>Results</p> <p>Among 102 patients, 35 were in etoricoxib, 35 in celecoxib and 32 in placebo group. The mean age of the patients was 30 years and most of the injury came from sports injury. There were no significant differences in all demographic characteristics among groups. The etoricoxib group had significantly less pain intensity than the other two groups at recovery room and up to 8 hours period but no significance difference in all other evaluation point, while celecoxib showed no significantly difference from placebo at any time points. The time to first dose of analgesic medication, amount of analgesic used, patient's satisfaction with pain control and incidence of adverse events were also no significantly difference among three groups.</p> <p>Conclusions</p> <p>Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction.</p> <p>Trial registration number</p> <p>NCT01017380</p

Multimodal Pain Management for Laparoscopic Adnexal Surgery: A comparative cohort study

Objectives:To determine the morphine-sparing effect of multimodal pain management for laparoscopic surgery.Materials and Methods: A retrospective cohort study was carried out in 210 patients who underwent laparoscopic adnexal surgery from August 2008 to November 2013 at the Songklanagarind Hospital. The patients were divided into three groups (n = 70 each) according to analgesic management. Group I received parecoxib 40 mg intravenously 2 hours preoperatively with postoperative paracetamol/NSAIDs around the clock, Group II received parecoxib 40 mg intravenously 15-30 minutes preoperatively with postoperative paracetamol/NSAIDs as needed, and Group III received only postoperative paracetamol/NSAIDs as needed. Morphine or fentanyl was used during operation and morphine was used as needed for severe postoperative pain in all cases. Patients in each group were matched by the operation in the same time period. The consumption of analgesic agents during surgery and 24 hours postoperation, pain scores, and adverse events were evaluated.results:Intraoperative morphine consumption was not different among the 3 groups. However, in the 24 hours postoperation, 40% of patients in Group I received morphine (mean 1.1 mg) compared to 68.6% in Group II (mean 6.1 mg) and 80% in Group III (mean 9.6 mg) (p < 0.01). Group I received more postoperative paracetamol/NSAIDs than both Group II and Group III (p < 0.01). Group I had 88.5% morphine-sparing effect compared to Group III and 82% compared to Group II. The pain scores were similar between the groups.Conclusions: Preemptive parecoxib and postoperative paracetamol/NSAIDs provide a significant morphine-sparing effect in laparoscopic adnexal surgery

Cancer Pain and its Management: A Survey on Interns’ Knowledge, Attitudes and Barriers

Objective We conducted this study to evaluate the knowledge and attitudes of interns regarding cancer pain and its management. Materials and methods This study included 116 interns recently graduated from the Faculty of Medicine, Prince of Songkla University. They provided their demographic characteristics and completed a questionnaire in regards to their knowledge and attitudes about cancer pain and its management. Results Data were obtained from 116 interns. The majority of interns did not hesitate to provide maximal doses of analgesics for patients in severe pain when the prognosis was poor. A significant number favored to prescribe pethidine more than morphine and thought that pethidine caused less harmful effects in long-term use. Most respondents agreed or strongly agreed that they would prescribe opioids carefully to avoid tolerance and addiction. They considered that barriers to effective pain management were inadequate knowledge, inadequate pain assessment and lack of time to attend patients’ requirements. Conclusion The interns demonstrated positive attitudes toward cancer pain and its management, principally on opioid usage. However, a significant number of them had misconceptions in terms of knowledge for prescribing opioids. To provide better cancer pain management, attention must be given to improving the curriculum and integrating it into clinical practice

Measuring pain intensity in older patients: a comparison of five scales

Abstract Background and aims Pain is common in older individuals. In order to understand and treat pain in this group, reliable and valid measures are needed. This study aimed to evaluate: (1) the validity, utility, incorrect response rates and preference rates of 5 pain rating scales in older individuals; and (2) the associations between age, education level, and cognitive function and both (a) incorrect response and (b) preference rates. Methods Two hundred and one orthopedic clinic outpatients ≥ 65 years old were asked to rate their current pain, and least, average, and worst pain intensity in the past week using 5 scales: Verbal Numerical Rating Scale (VNRS), Faces Pain Scale - Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS). Participants were also asked to indicate scale preference. We computed the associations between each measure and a factor score representing the shared variance among the scales, the incorrect response and scale preference rates, and the associations between incorrect response and preference rates and age, education level, and cognitive function. The incorrect responses included being unable to respond, providing more than one response, responses outside a range, providing range answers rather than fixed answers, and responses indicating ‘least > average,’ ‘least > worst,’ and ‘average > worst’. Results The findings support validity of all 5 scales in older individuals who are able to use all measures. The VNRS had the lowest (2%) and the VAS had the highest (6%) incorrect response rates. The NRS was the most (35%) and the VAS was the least (5%) preferred. Age was associated with the incorrect response rates of the VRS and VAS, such that older individuals were less likely to use these scales correctly. Education level was associated with the incorrect response rates of the FPS-R, NRS and VAS, such that those with less education were less likely to use these measures correctly. Cognitive function was not significantly associated with incorrect response rates. Age, education level and cognitive function were not significantly associated with scale preference. Conclusions Although all five scales are valid, the VNRS evidences the best overall utility in this sample of older individuals with pain. The NRS or FPS-R would be fine alternatives if it is not practical or feasible to use the VNRS

Nimmaanrat, S., Geater, A., Plunsangkate, P., Saewong, L., Karnjanawanichkul, O., Chanchayanon, T., Pattaravit, N.

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Current understanding of the mixed pain concept: a brief narrative review

Despite having been referenced in the literature for over a decade, the term “mixed pain” has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of “nociplastic pain” in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term “mixed pain” is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group’s discussions, a Medline search for the Medical Subject Heading “mixed pain” was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group’s consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain. © 2019, © 2019 Informa UK Limited, trading as Taylor and Francis Group

Current understanding of the mixed pain concept: a brief narrative review

Despite having been referenced in the literature for over a decade, the term “mixed pain” has never been formally defined. The strict binary classification of pain as being either purely neuropathic or nociceptive once left a good proportion of patients unclassified; even the recent adoption of “nociplastic pain” in the IASP Terminology leaves out patients who present clinically with a substantial overlap of nociceptive and neuropathic symptoms. For these patients, the term “mixed pain” is increasingly recognized and accepted by clinicians. Thus, an independent group of international multidisciplinary clinicians convened a series of informal discussions to consolidate knowledge and articulate all that is known (or, more accurately, thought to be known) and all that is not known about mixed pain. To inform the group’s discussions, a Medline search for the Medical Subject Heading “mixed pain” was performed via PubMed. The search strategy encompassed clinical trial articles and reviews from January 1990 to the present. Clinically relevant articles were selected and reviewed. This paper summarizes the group’s consensus on several key aspects of the mixed pain concept, to serve as a foundation for future attempts at generating a mechanistic and/or clinical definition of mixed pain. A definition would have important implications for the development of recommendations or guidelines for diagnosis and treatment of mixed pain. © 2019, © 2019 Informa UK Limited, trading as Taylor and Francis Group