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epidural morphine consumption

Caitlyn Rose Moss, Julia Christine Caldwell, Babatunde Afilaka, Khaled Iskandarani, Vernon Michael Chinchilli, Patrick McQuillan, Amanda Beth Cooper, Niraj Gusani, Dmitri Bezinover
BACKGROUND AND AIMS: Postoperative pain can significantly affect surgical outcomes. As opioid metabolism is liver-dependent, any reduction in hepatic volume can lead to increased opioid concentrations in the blood. The hypothesis of this retrospective study was that patients undergoing open hepatic resection would require less opioid for pain management than those undergoing open pancreaticoduodenectomy. MATERIAL AND METHODS: Data from 79 adult patients who underwent open liver resection and eighty patients who underwent open pancreaticoduodenectomy at our medical center between January 01, 2010 and June 30, 2013 were analyzed...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
Sylvia H Wilson, Bethany J Wolf, Abdalrahman A Algendy, Clark Sealy, Harry A Demos, Julie R McSwain
BACKGROUND: Total hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks have been described for postoperative pain control, but it is unclear if one technique is more beneficial. METHODS: Using electronic medical records, a randomly selected, cohort of 58 patients with lumbar epidurals were compared with 58 patients with lumbar plexus nerve blocks following primary THA. The primary end point was 48-hour postoperative opiate consumption...
August 10, 2016: Journal of Arthroplasty
Varut Lohsiriwat
AIM: To evaluate the opioid-sparing effect of selective cyclooxygenase-2 (COX-2) inhibitors on short-term surgical outcomes after open colorectal surgery. METHODS: Patients undergoing open colorectal resection within an enhanced recovery after surgery protocol from 2011 to 2015 were reviewed. Patients with combined general anesthesia and epidural anesthesia, and those with acute colonic obstruction or perforation were excluded. Patients receiving selective COX-2 inhibitor were compared with well-matched individuals without such a drug...
July 15, 2016: World Journal of Gastrointestinal Oncology
J J Fedriani de Matos, F J Atienza Carrasco, J Díaz Crespo, A Moreno Martín, P Tatsidis Tatsidis, L M Torres Morera
OBJECTIVES: Total knee arthroplasty is associated with severe postoperative pain. The aim of this study was to compare continuous ultrasound-guided femoral nerve block with continuous epidural analgesia, both with low concentrations of local anaesthetic after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomised, unblinded study of 60 patients undergoing total knee replacement, randomised into two groups. A total of 30 patients received continuous epidural block, while the other 30 received continuous ultrasound-guided femoral nerve block, as well as using 0...
July 8, 2016: Revista Española de Anestesiología y Reanimación
Jacques T YaDeau, Chad M Brummett, David J Mayman, Yi Lin, Enrique A Goytizolo, Douglas E Padgett, Michael M Alexiades, Richard L Kahn, Kethy M Jules-Elysee, Kara G Fields, Amanda K Goon, Yuliya Gadulov, Geoffrey Westrich
BACKGROUND: Duloxetine is effective for chronic musculoskeletal and neuropathic pain, but there are insufficient data to recommend the use of antidepressants for postoperative pain. The authors hypothesized that administration of duloxetine for 15 days would reduce pain with ambulation at 2 weeks after total knee arthroplasty. METHODS: In this triple-blinded, randomized, placebo-controlled trial, patients received either duloxetine or placebo for 15 days, starting from the day of surgery...
September 2016: Anesthesiology
B Jebaraj, P Khanna, D K Baidya, S Maitra
BACKGROUND: Dexamethasone is a potent anti-inflammatory, analgesic, and antiemetic drug. Individual randomized controlled trials found a possible benefit of epidural dexamethasone. The purpose of this meta-analysis is to estimate the benefit of epidural dexamethasone on postoperative pain and opioid consumption and to formulate a recommendation for evidence-based practice. MATERIALS AND METHODS: Prospective, randomized controlled trials comparing the analgesic efficacy of epidural local anesthetic and dexamethasone combination, with local anesthetic alone for postoperative pain management after abdominal surgery, were planned to be included in this meta-analysis...
July 2016: Saudi Journal of Anaesthesia
Etrusca Brogi, Roy Kazan, Shantale Cyr, Francesco Giunta, Thomas M Hemmerling
PURPOSE: The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. SOURCE: We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Bin Hu, Tiao Lin, Shi-Gui Yan, Song-Lin Tong, Jian-Hao Yu, Jian-Jie Xu, Yi-Ming Ying
BACKGROUND: Total knee arthroplasty (TKA) is one of the most commonly performed procedures while postoperative analgesia still remains challenging. The efficacy and safety of local infiltration analgesia (LIA) versus regional blockade (RB; epidural analgesia and/or peripheral nerve block) for pain management after TKA are controversial. OBJECTIVES: The purpose of this meta-analysis was to determine whether LIA compared with RB would provide better postoperative pain control, consume less morphine, facilitate early functional recovery, entail a differential risk of side effects and complications, and allow a shorter length of stay...
May 2016: Pain Physician
Zui Zou, Mao Mao An, Qun Xie, Xiao Y Chen, Hao Zhang, Guan J Liu, Xue Y Shi
BACKGROUND: Knee arthroscopy is a common procedure and is associated with postoperative pain. Intra-articular (IA) injection of morphine for pain control has been widely studied, but its analgesic effect after knee arthroscopy is uncertain. OBJECTIVES: To evaluate the relative effects on pain relief and adverse events of IA morphine given for pain control after knee arthroscopy compared with placebo, other analgesics (local anaesthetics, non-steroidal anti-inflammatory drugs (NSAIDs), other opioids) and other routes of morphine administration...
2016: Cochrane Database of Systematic Reviews
Sabry Ayad, Rovnat Babazade, Hesham Elsharkawy, Vinayak Nadar, Chetan Lokhande, Natalya Makarova, Rashi Khanna, Daniel I Sessler, Alparslan Turan
Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery...
2016: PloS One
Xing Zheng, Xu Feng, Xiu-Jun Cai
AIM: To prospectively evaluate the effectiveness and safety of continuous wound infiltration (CWI) for pain management after open gastrectomy. METHODS: Seventy-five adult patients with American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine (group CWI). Group 2 patients received 0.5 mg/mL morphine intravenously by a patient-controlled analgesia pump (PCIA) (group PCIA)...
February 7, 2016: World Journal of Gastroenterology: WJG
José H Jiménez-Almonte, Cody C Wyles, Saranya P Wyles, German A Norambuena-Morales, Pedro J Báez, Mohammad H Murad, Rafael J Sierra
BACKGROUND: Local infiltration analgesia and peripheral nerve blocks are common methods for pain management in patients after THA but direct head-to-head, randomized controlled trials (RCTs) have not been performed. A network meta-analysis allows indirect comparison of individual treatments relative to a common comparator; in this case placebo (or no intervention), epidural analgesia, and intrathecal morphine, yielding an estimate of comparative efficacy. QUESTIONS/PURPOSES: We asked, when compared with a placebo, (1) does use of local infiltration analgesia reduce patient pain scores and opioid consumption, (2) does use of peripheral nerve blocks reduce patient pain scores and opioid consumption, and (3) is local infiltration analgesia favored over peripheral nerve blocks for postoperative pain management after THA? METHODS: We searched six databases, from inception through June 30, 2014, to identify RCTs comparing local infiltration analgesia or peripheral nerve block use in patients after THA...
February 2016: Clinical Orthopaedics and related Research
Giorgio Veneziano, Peter Iliev, Jennifer Tripi, David Martin, Jennifer Aldrink, Tarun Bhalla, Joseph Tobias
BACKGROUND: Neonates and infants have decreased metabolic capacity for amide local anesthetics and increased risk of local anesthetic toxicity compared to the general population. Chloroprocaine is an ester local anesthetic that has an extremely short plasma half-life in infants as well as adults. Existing reports support the safety and efficacy of continuous chloroprocaine epidural infusions in neonates and young infants during the intraoperative period. Despite this, continuous chloroprocaine epidural infusion may be an under-utilized method of postoperative analgesia for this patient population...
January 2016: Paediatric Anaesthesia
Wallis T Muhly, Harshad G Gurnaney, Francis W Kraemer, Arjunan Ganesh, Lynne G Maxwell
INTRODUCTION: Continuous thoracic epidural analgesia is useful in the management of infants following thoracotomy. Concerns about drug accumulation and toxicity limit the amount of amide local anesthetics that can be delivered. Continuous epidural infusions of the ester local anesthetic chloroprocaine result in little drug accumulation allowing for higher infusion rates. We retrospectively compared patients managed with 1.5% 2- chloroprocaine or 0.1% ropivacaine epidural infusions to determine if the increased infusion rate resulted in similar or improved analgesia...
November 2015: Paediatric Anaesthesia
Joachim Krylborn, Marie E Anell-Olofsson, Catarina Bitkover, Stefan Lundeberg, Marco Bartocci, Carl-Olav Stiller, Bjorn A Larsson
BACKGROUND: Epidurals may be challenging in neonatal patients due to technical difficulties relating to insertion and the risk of local anaesthesia toxicity. The use of wound catheters with an infusion of local anaesthetic has been shown to be well tolerated in adults and older children. There are few data concerning wound catheter techniques in neonatal patients. OBJECTIVES: The primary aim of this study was to analyse plasma levels of levobupivacaine associated with continuous wound infiltration via a catheter following neonatal surgical procedures...
December 2015: European Journal of Anaesthesiology
Lutz Kaufner, Silke Heimann, Desiree Zander, Katharina Weizsäcker, Ingrid Correns, Michael Sander, Claudia Spies, Martin Schuster, Aarne Feldheiser, Anne Henkelmann, Klaus D Wernecke, Christian VON Heymann
BACKGROUND: Cesarean section (CS) is associated with a moderate-high intensity of postoperative pain. We investigate whether continuous local anesthetic/opioid administration using patient controlled epidural anesthesia (PCEA) is superior in controlling pain after CS than epidural (ED) or intrathecal (IT) opioid bolus administration. METHODS: One hundred ninety-nine women undergoing elective CS were randomized into 3 groups: PCEA: Combined spinal-epidural anesthesia (CSE) with a PCEA of ropivacaine 0...
May 2016: Minerva Anestesiologica
Alfonso Fiorelli, Antonio Mazzella, Beatrice Passavanti, Pasquale Sansone, Paolo Chiodini, Mario Iannotti, Caterina Aurilio, Mario Santini, Maria Caterina Pace
OBJECTIVES: To evaluate if the pre-emptive administration of ketamine would potentiate the effect of intravenous morphine analgesia in the management of post-thoracotomy pain. METHODS: This was a unicentre, double-blind, placebo-controlled, parallel-group, prospective study. Patients were randomly assigned to receive 1 mg/kg ketamine (ketamine group) or an equivalent dose of normal saline (placebo group) before thoracotomy in 1:1 ratio. All patients received postoperatively intravenous morphine administration as additional analgesic regimen...
September 2015: Interactive Cardiovascular and Thoracic Surgery
M S Aydogan, M Bıçakcıoğlu, H Sayan, M Durmus, S Yılmaz
The aim of this study was the compare the donor patients who received intravenous (IV) morphine with patient-controlled analgesia (PCA) or epidural morphine during the early postoperative period who underwent liver transplantation. Forty patients were included in the study and randomly divided into 2 groups in a double-blinded manner. They were given IV morphine 5 mg (Group C), or epidural anesthesia adding morphine (2 mg; Group E) by epidural anesthesia technique starting 15 minutes before the estimated time of completion of surgery...
May 2015: Transplantation Proceedings
Waylan Wong, Dermot P Maher, Daniel Iyayi, Raul Lopez, Bahman Shamloo, Howard Rosner, Roya Yumul
BACKGROUND: Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patient's self-reported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties. OBJECTIVES: To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI...
May 2015: Pain Physician
Kethy M Jules-Elysee, Amanda K Goon, Geoffrey H Westrich, Douglas E Padgett, David J Mayman, Amar S Ranawat, Chitranjan S Ranawat, Yi Lin, Richard L Kahn, Devan D Bhagat, Enrique A Goytizolo, Yan Ma, Shane C Reid, Jodie Curren, Jacques T YaDeau
BACKGROUND: The optimal postoperative analgesia after primary total hip arthroplasty remains in question. This randomized, double-blind, placebo-controlled study compared the use of patient-controlled epidural analgesia (PCEA) with use of a multimodal pain regimen including periarticular injection (PAI). We hypothesized that PAI would lead to earlier readiness for discharge, decreased opioid consumption, and lower pain scores. METHODS: Forty-one patients received PAI, and forty-three patients received PCEA...
May 20, 2015: Journal of Bone and Joint Surgery. American Volume
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