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American Journal of Obstetrics &... Feb 2023Electroacupuncture is a nonpharmacologic intervention for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Electroacupuncture is a nonpharmacologic intervention for analgesia that is widely recognized as therapy for pain. However, the clinical efficacy of electroacupuncture combined with patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery remains unclear.
OBJECTIVE
This study aimed to assess the efficacy of electroacupuncture + patient-controlled intravenous analgesia for postoperative analgesia after cesarean delivery, determine the optimal frequency for the best analgesic effect, and explore the underlying mechanism of action.
STUDY DESIGN
This single-center, randomized, single-blinded, sham acupuncture controlled clinical trial was conducted at a tertiary university hospital in China. Female patients who underwent cesarean delivery and received fentanyl as patient-controlled intravenous analgesia for postoperative analgesia were enrolled. Patients were after surgery randomized to receive 2 Hz electroacupuncture treatment (n=53), 20/100 Hz electroacupuncture treatment (n=53), or sham electroacupuncture treatment (n=52) (controls). The 2 electroacupuncture groups received electroacupuncture treatment at 2 or 20/100 Hz at the ST36 and SP6 points, whereas, in the sham electroacupuncture group, sham electroacupuncture was performed at nonmeridian points with nonenergized electroacupuncture instruments. Of note, 4 electroacupuncture treatments were performed in all groups at 6, 12, 24, and 48 hours after surgery. The primary outcome was the number of analgesic pump compressions at 48 hours after surgery. The secondary outcomes included number of analgesic pump compressions at 6, 12, and 24 hours after surgery; pain scores at 6, 12, 24, and 48 hours after surgery; fentanyl consumption at 48 hours after surgery; interleukin 6 and procalcitonin levels at 12 and 48 hours after surgery; and time to first exhaust.
RESULTS
Overall, 174 primigravida women were included in the intention-to-treat analysis. The number of analgesic pump compressions and pain scores at all 4 time points and fentanyl consumption at 48 hours after surgery were significantly lower in the electroacupuncture treatment groups than in the sham electroacupuncture group (P<.001).
CONCLUSION
Electroacupuncture + patient-controlled intravenous analgesia had a significantly better analgesic effect than sham electroacupuncture + patient-controlled intravenous analgesia within 48 hours after surgery. Thus, electroacupuncture can be considered safe and effective and may improve the efficacy of patient-controlled intravenous analgesia for pain management after cesarean delivery. Electroacupuncture can be recommended as a routine complementary therapy for pain control after cesarean delivery.
Topics: Pregnancy; Humans; Female; Analgesia, Patient-Controlled; Electroacupuncture; Fentanyl; Analgesics; Pain
PubMed: 36464237
DOI: 10.1016/j.ajogmf.2022.100826 -
Agri : Agri (Algoloji) Dernegi'nin... Aug 2020The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous...
OBJECTIVES
The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous administrations of various doses (increased/decreased) within the following hours. This study aims to retrospectively evaluate the effects of a structured protocol based on standardized Visual Analogue Scale (VAS) and Patient-controlled analgesia (PCA) patient demand count on morphine consumption in painful crises.
METHODS
A total of 177 painful crises of 93 patients who were administered morphine using the PCA method according to appropriate analgesia protocol between 2004-2018 were evaluated in this study. The demographic data, hemoglobin chromatography and genotypes, painful episode follow-up time, VAS scores before and after treatment, and daily morphine consumption of the patients were recorded. Morphine consumption during the crisis according to age groups and sex were compared.
RESULTS
Of the patients, 57% were homozygous hemoglobin type SS (HbSS). Mean morphine consumption with PCA method was 56.9±35.4 mg (min-max: 10-232 mg) and mean follow-up time was 3.4±2.1 days (min.-max.: 1-11). VAS scores were significantly lower after treatment (6.8±2.3 pre-treatment; 0.8±0.6 post-treatment) (p<0.05).
CONCLUSION
To our knowledge, our study is the first structured protocol based on VAS and PCA demand data. We believe lower morphine dosage using PCA protocol according to the rapidly changing pain levels of the patients will provide effective analgesia. Prospective studies with fewer limitations will more effectively demonstrate the effectiveness of this protocol.
Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Anemia, Sickle Cell; Clinical Protocols; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Morphine; Pain, Intractable; Retrospective Studies; Visual Analog Scale; Young Adult
PubMed: 32789826
DOI: 10.14744/agri.2020.46354 -
Biomedical Papers of the Medical... Mar 2016Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an alternative. Since the first demonstration of the safety of remifentanil in obstetric analgesia in 1996, this has been repeatedly confirmed for both mother and newborn. The aim of this meta-analysis is to evaluate recently published studies (up to December 2014) on the analgesic efficacy of remifentanil during labour (as a Visual Analogue Scale (VAS) decrease in the first hour by 2 or more).
METHODS
Search of the US National Library of Medicine, National Institutes of Health (www.pubmed.gov), SCOPUS database (www.scopus.com) and Web of Science database (www.webofknowledge.com) using the key words "labour" and "remifentanil". 44 identified articles were included in the review and 15 published randomised controlled studies were incorporated into the meta-analysis. This was based on the fixed model and described by differences in the VAS between t=0 and t=1 hour after remifentanil administration using the 95% confidence interval (CI). The analysis was computed using the Comprehensive meta-analysis version 2.2.064.
RESULTS
The combined data from the meta-analysis showed a statistically significant decrease in VAS in the remifentanil group. From a comparison of the CIs of summary estimates with a cut-off decrease of VAS 2, for the fixed model, there was a statistically significantly greater decrease in VAS than the cut-off. In the systematic review, we describe possible modes of application, dosage and side-effects for mother, fetus/ newborn.
CONCLUSION
The meta-analysis presented here confirms that remifentanil for labour analgesia is effective but questions remain which can only be answered by further randomized trials.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Analgesics, Opioid; Dose-Response Relationship, Drug; Epidemiologic Methods; Female; Humans; Infusion Pumps; Labor Pain; Pain Measurement; Piperidines; Pregnancy; Remifentanil; Risk Assessment; Treatment Outcome
PubMed: 26460593
DOI: 10.5507/bp.2015.043 -
British Journal of Hospital Medicine... Sep 2022Patient-controlled analgesia with remifentanil is usually reserved for patients for whom other forms of pain relief are contraindicated. However, remifentanil...
Patient-controlled analgesia with remifentanil is usually reserved for patients for whom other forms of pain relief are contraindicated. However, remifentanil patient-controlled analgesia reduces the likelihood of needing an epidural and therefore the risk associated with it, provides good pain relief compared to other options, and the risks can be mitigated with appropriate management.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Analgesia, Patient-Controlled; Analgesics, Opioid; Female; Humans; Labor Pain; Pain Measurement; Patient Satisfaction; Pregnancy; Remifentanil
PubMed: 36193918
DOI: 10.12968/hmed.2020.0500 -
Journal of Cancer Research and... Aug 2015The objective was to evaluate the effect of patient-controlled intravenous analgesia (PCIA) in non-small cell lung cancer patients (NSLCPs) after thoracotomy.
OBJECTIVE
The objective was to evaluate the effect of patient-controlled intravenous analgesia (PCIA) in non-small cell lung cancer patients (NSLCPs) after thoracotomy.
MATERIALS AND METHODS
From January 2014 to March 2015, 40 patients of non-small cell lung cancer were recruited in this study and divided into two groups, (PCIA) group and control group with 20 patients in each group. The patients in the PCIA group were connected to intravenous self-control analgesia pump which contains 2 μg/ml of sufentanil and 8 mg of ondansetron diluting to 100 ml of 0.9% saline after surgery. Initial loading dose was 2 ml, background dose was 2 ml/h, single PCIA dose was 0.5 ml, and locking time 15 min. 10 mg of morphine was intramuscular injected, if necessary. Patients in the control group use an intramuscular injection of morphine 10 mg singly. The visual analog scale (VAS) score of the two groups were recorded in the time point of 2 h, 4 h, 8 h, 12 h, and 24 h. The morphine consumption of the two groups was also compared.
RESULTS
Patients in PCIA group after surgery, 2 h, 4 h, 8 h, 12 h, and 24 h VAS score were obviously lower than those in control group (P < 0.05). Moreover, the incidence of nausea and vomiting and respiratory depression of patients in PCIA group was obviously lower than control group (P < 0.05). Consumption of postoperative morphine in PCIA group was obviously less than control group (P < 0.05).
CONCLUSION
Intravenous PCIA-controlled intravenous analgesia can significantly decrease the VAS score without increasing the toxicity in NSLCP after thoracotomy.
Topics: Analgesia, Patient-Controlled; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Morphine; Pain Management; Pain Measurement; Pain, Postoperative; Thoracotomy; Time Factors
PubMed: 26323912
DOI: 10.4103/0973-1482.163870 -
Annals of Palliative Medicine Nov 2020Intravenous patient-controlled analgesia (IV-PCA) is recommended for postoperative systemic analgesia by the American Pain Society. As there is no efficacy advantage and...
BACKGROUND
Intravenous patient-controlled analgesia (IV-PCA) is recommended for postoperative systemic analgesia by the American Pain Society. As there is no efficacy advantage and a higher probability of adverse events, routine basal infusion of opioids is not recommended for opioid-naïve adults. However, the opioids referred to in postoperative pain management guidelines were mainly morphine. Nowadays, sufentanil is widely used in postoperative acute pain management. In this retrospective study, we evaluated and compared the analgesic effect, PCA use, as well as adverse events among different basal infusions with sufentanil-based postoperative PCA.
METHODS
The data of 322 eligible postoperative patients who received sufentanil-based IV-PCA from January 2018 to December 2019 were collected in this study. According to the settings of background infusions, patients were allocated to 3 groups: 2, 1, or 0.5 mL/hour. The primary endpoint was PCA attempts and successful delivery. We also evaluated the occurrence of adverse events associated with sufentanil-based PCA and the intensity of postoperative pain using the Numeric Rating Scale (NRS).
RESULTS
PCA attempts, successful deliveries, total volume of PCA and patient NRS scores were significantly different between the 3 groups (P<0.05). Through pairwise comparison, there was only a statistical difference between the 2 mL/hour and the 0.5 mL/hour group in PCA attempts, successful deliveries, and total volumes of PCA. There were no statistical differences in adverse events between groups (P>0.05).
CONCLUSIONS
We found that a smaller background infusion with sufentanil required more bolus infusions and a higher total volume of PCA within 24 hours after surgery. However, NRS scores were higher in the smaller background infusion group. Our results highlight the need for further studies to optimize doses for sufentanil IV-PCA basal infusions, which will also provide useful information to enhance the quality of pain control in the future.
Topics: Adult; Analgesia, Patient-Controlled; Analgesics, Opioid; Humans; Pain, Postoperative; Retrospective Studies; Sufentanil
PubMed: 33302655
DOI: 10.21037/apm-20-1939 -
Acta Obstetricia Et Gynecologica... Sep 2015The aim of this study was to compare patient satisfaction between remifentanil patient-controlled analgesia (RPCA) and epidural analgesia (EA) for labor pain. (Clinical Trial)
Clinical Trial Comparative Study
INTRODUCTION
The aim of this study was to compare patient satisfaction between remifentanil patient-controlled analgesia (RPCA) and epidural analgesia (EA) for labor pain.
MATERIAL AND METHODS
This prospective cohort study was carried out on primiparous women requesting analgesia for labor at a Teaching Hospital, Amsterdam, the Netherlands. Women self-selected the analgesia of choice (RPCA n = 166 and EA n = 124) and were asked to complete the Woman's Views of Birth Labour Satisfaction Questionnaire (WOMBSLQ), within 24 h (T0), 3 months (T3) and 6 months (T6) after birth. The WOMBSLQ comprises 11 subscales, including pain during labor and general satisfaction. The main outcome measure was general satisfaction.
RESULTS
There was no significant difference in the subscale of general satisfaction with labor and delivery (maximum of 14 points) between both groups at all three time points [median score at T0 for RPCA was 12 vs. 13 for the EA group (p = 0.95); at T3: 12 vs. 12, respectively (p = 0.41); and at T6: 12 vs. 12, respectively (p = 0.69)]. Women in the EA group had significantly better pain relief (maximum of 21 points) at all three time points [median score at T0 for RPCA was 14 vs. 18 for the EA group (p < 0.001); at T3: 13 vs. 17, respectively (p = 0.002); and at T6: 13 vs. 17, respectively (p = 0.003)].
CONCLUSION
Both self-selected groups did not differ in general satisfaction with labor and delivery at all three time points after birth despite a significantly higher experienced pain in the RPCA group.
Topics: Adult; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Cohort Studies; Female; Humans; Labor Pain; Netherlands; Pain Measurement; Patient Satisfaction; Piperidines; Pregnancy; Remifentanil; Surveys and Questionnaires; Treatment Outcome
PubMed: 26073456
DOI: 10.1111/aogs.12694 -
The Journal of Pain Dec 2019Placebo analgesia is a robust phenomenon readily observed in both experimental and clinical settings. While researchers have begun to unpack its psychobiological... (Randomized Controlled Trial)
Randomized Controlled Trial
Placebo analgesia is a robust phenomenon readily observed in both experimental and clinical settings. While researchers have begun to unpack its psychobiological mechanisms, important questions remain regarding how we can capitalize on the placebo effect to improve clinical pain outcomes. The current study tested whether providing individuals with instrumental control-that is, control over if and when they administer a treatment-is capable of enhancing placebo analgesia. Using an established electrocutaneous pain design, 87 healthy volunteers either received placebo conditioning with instrumental control over treatment administration, standard passive placebo conditioning without any control over treatment administration, or were allocated to natural history control group with no conditioning and were later tested at equivalent shock intensity with and without placebo applied. Both placebo groups demonstrated initial placebo analgesia. Importantly, however, those provided with instrumental control demonstrated significantly larger and longer lasting placebo analgesia as well as reduced anticipatory autonomic arousal than those receiving standard passive placebo conditioning. This suggests that providing instrumental control over treatment administration can facilitate placebo analgesia by enhancing its magnitude and durability. As such, providing instrumental control over treatment administration may be a cheap and ethical method of using the placebo effect to improve clinical pain outcomes. PERSPECTIVE: Placebo research typically involves passive designs where individuals have no control over treatment administration. We present novel data demonstrating that providing control over treatment administration substantially enhances both the magnitude and duration of placebo analgesia. As such, where possible, providing control may improve clinical pain outcomes via the placebo effect.
Topics: Adult; Analgesia, Patient-Controlled; Female; Humans; Male; Motivation; Placebo Effect; Transcutaneous Electric Nerve Stimulation; Young Adult
PubMed: 31150780
DOI: 10.1016/j.jpain.2019.05.013 -
European Geriatric Medicine Dec 2023Patients undergoing elective laparoscopic radical resection of colorectal cancer from July 2019 to May 2021 were selected. The patients were assigned to Ai-PCIA group...
METHODS
Patients undergoing elective laparoscopic radical resection of colorectal cancer from July 2019 to May 2021 were selected. The patients were assigned to Ai-PCIA group and control group. Ai-PCIA group received postoperative analgesia management and effect evaluation through intelligent wireless analgesia system + postoperative follow-up twice a day, while control group received analgesia management and effect evaluation through ward physician feedback + postoperative follow-up twice a day. The pain numerical score (NRS), Richards-Campbell Sleep Scale (RCSQ), and adverse outcomes were collected and compared.
RESULTS
A total of 60 patients (20 females and 40 males with average (78.26 ± 6.42) years old) were included. The NRS scores at rest and during activity of the Ai-PCA group at 8, 12, and 24 h after the operation were significantly lower than that of the control group (all P < 0.05). The RCSQ score of Ai-PCA group was significantly higher than that of control group on the 1st and 2nd days after operation (all P < 0.05). There were no significant differences in the incidence of dizziness and nausea, vomiting, and myocardial ischemia (all P > 0.05).
CONCLUSIONS
Ai-PCIA can improve the analgesic effect and sleep quality of older patients after laparoscopic radical resection, which may be promoted in clinical analgesia practice.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Analgesia, Patient-Controlled; Colorectal Neoplasms; Laparoscopy; Pain Management; Pain, Postoperative; Artificial Intelligence
PubMed: 37847474
DOI: 10.1007/s41999-023-00873-z -
BMC Anesthesiology Nov 2021The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia...
Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: a retrospective cohort study.
BACKGROUND
The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery.
METHODS
In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients.
RESULTS
The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240).
CONCLUSIONS
Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.
Topics: Analgesia, Patient-Controlled; Analgesics, Opioid; Cohort Studies; Female; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Patient Education as Topic; Postoperative Complications; Retrospective Studies; Solitary Pulmonary Nodule; Thoracoscopy
PubMed: 34773972
DOI: 10.1186/s12871-021-01505-4