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Medicina (Kaunas, Lithuania) 2002The aim of study was to evaluate features for spinal morphine in undergoing coronary artery bypass surgery in early postoperative time and side effects of opioids. (Comparative Study)
Comparative Study
OBJECTIVE
The aim of study was to evaluate features for spinal morphine in undergoing coronary artery bypass surgery in early postoperative time and side effects of opioids.
MATERIAL AND METHODS
Two groups of patients undergoing coronary artery bypass surgery were analyzed. In first group (15 patients) spinal morphine 2 mg and general anesthesia was used, control group (22 patients) - just general anesthesia. Postoperative pain was analyzed with VAS (Visual Analogical Scale). For analgesia, after surgery, was used piritramide via i/v in both groups. Dose of piritramide, extubation time and side effects was analysed after surgery.
RESULTS
In first group dose of piritramide was 4.5+/-1.1 mg, in control group - 16.5+/-1.1 mg (p<0.05). Extubation time in both groups (354+/-36 min. and 279+/-17 min.) and side effects (nausea and vomiting) was similar.
CONCLUSION
Spinal morphine decreased pain after cardiosurgery and don't increased extubation time and side effects of opioids.
Topics: Aged; Analgesics, Opioid; Anesthesia, General; Coronary Artery Bypass; Data Interpretation, Statistical; Female; Humans; Injections, Spinal; Male; Middle Aged; Morphine; Pain Measurement; Pain, Postoperative; Pirinitramide; Postoperative Care
PubMed: 12560666
DOI: No ID Found -
Anesthesiology Nov 1988
Topics: Animals; Dogs; Drug Interactions; Isoflurane; Liver Circulation; Oxygen; Partial Pressure; Pirinitramide
PubMed: 3189910
DOI: 10.1097/00000542-198811000-00001 -
British Journal of Anaesthesia Mar 1999We have compared patients' and nurses' assessments of postoperative pain and anxiety after different analgesic treatments. Sixty orthopaedic patients were allocated... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
We have compared patients' and nurses' assessments of postoperative pain and anxiety after different analgesic treatments. Sixty orthopaedic patients were allocated randomly to receive i.v. piritramide (either nurse-controlled or patient-controlled) or subarachnoid bupivacaine (nurse-controlled or patient-controlled). Patients and nurses assessed pain and anxiety using a visual analogue scale (VAS; 1-100 mm). Pain and anxiety ratings of patients and nurses were significantly correlated (Spearman's r > or = 0.69; P < 0.001). In general, patients' pain scores were higher than nurses' scores (patients' median VAS = 34 (range 1-76) mm; nurses VAS 21 (1-59) mm) and for all groups except the patient-controlled subarachnoid bupivacaine group, where they were significantly higher (P < 0.01). Discrepancy in pain estimates between patients and nurses increased with the level of pain. The relationship between patients' and nurses' anxiety scores was less clearly defined and did not depend on the level of anxiety.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analgesia; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Anxiety; Bupivacaine; Female; Humans; Male; Middle Aged; Orthopedic Nursing; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Pirinitramide; Prospective Studies; Psychometrics
PubMed: 10434819
DOI: 10.1093/bja/82.3.374 -
Regional Anesthesia and Pain Medicine Feb 2018Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Management of postoperative pain after laparoscopic segmental colonic resections remains controversial. We compared 2 methods of analgesia within an Enhanced Recovery After Surgery (ERAS) program. The goal of the study was to investigate whether administration of intrathecal bupivacaine/morphine would lead to an enhanced recovery.
METHODS
A single-center, randomized, double-blind controlled trial was performed (NL43488.101.13). Patients scheduled for laparoscopic segmental intestinal resections were considered. Exclusion criteria were patients in whom contraindications to spinal anesthesia were present, conversion to open surgery, and gastric and rectal surgery. The intervention group received single-shot intrathecal bupivacaine/morphine (12.5 mg/300 μg), with an altered dose for older patients. The control group received a sham procedure and a bolus of piritramide (0.1 mg/kg). Both groups received standardized general anesthesia and a patient-controlled intravenous analgesia pump as postoperative analgesia. All patients were treated according to an ERAS protocol. A decrease in days to "fit for discharge" was the primary outcome.
RESULTS
Fifty-six patients were enrolled. Intervention group patients were fit for discharge earlier (median of 3 vs 4 days, P = 0.044). Furthermore, there was a significant decrease in opioid use and lower pain scores on the first postoperative day in the intervention group. There were no differences in adverse events (except for more pruritus), time to mobilization, fluid administration, or patient satisfaction.
CONCLUSIONS
This randomized controlled trial shows that intrathecal morphine is a more effective method of postoperative analgesia in laparoscopic surgery than intravenous opioids within an ERAS program. Recovery is faster and less painful with intrathecal morphine. Other studies have confirmed these results, although data on faster recovery are new and require confirmation in future trials.
CLINICAL TRIAL REGISTRATION
This study was registered at ClinicalTrials.gov, identifier NCT02284282.
Topics: Administration, Intravenous; Adult; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthesia, Conduction; Anesthetics, Local; Bupivacaine; Colectomy; Double-Blind Method; Early Ambulation; Female; Humans; Injections, Spinal; Laparoscopy; Length of Stay; Male; Middle Aged; Morphine; Netherlands; Pain Measurement; Pain, Postoperative; Pirinitramide; Recovery of Function; Time Factors; Treatment Outcome
PubMed: 29219935
DOI: 10.1097/AAP.0000000000000703 -
Cardiovascular and Interventional... May 2024CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The...
PURPOSE
CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax.
MATERIALS AND METHODS
One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis.
RESULTS
The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate.
CONCLUSION
Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort.
Topics: Humans; Pneumothorax; Female; Male; Retrospective Studies; Tomography, X-Ray Computed; Middle Aged; Analgesics, Opioid; Radiography, Interventional; Aged; Image-Guided Biopsy; Risk Factors; Lung; Pirinitramide; Adult; Incidence
PubMed: 38639781
DOI: 10.1007/s00270-024-03717-w -
Anaesthesia May 2019We retrospectively compared patients receiving remifentanil with patients receiving sufentanil undergoing fast-track cardiac surgery. After 1:1 propensity score matching... (Comparative Study)
Comparative Study Observational Study
We retrospectively compared patients receiving remifentanil with patients receiving sufentanil undergoing fast-track cardiac surgery. After 1:1 propensity score matching there were 609 patients in each group. The sufentanil group had a significantly longer mean (SD) ventilation time compared with the remifentanil group; 122 (59) vs. 80 (44) min, p < 0.001 and longer mean (SD) length of stay in the recovery area; 277 (77) vs. 263 (78) min, p = 0.002. The sufentanil group had a lower mean (SD) visual analogue pain score than the remifentanil group; 1.5 (1.2) vs. 2.4 (1.5), p < 0.001 and consumed less mean (SD) piritramide (an opioid analgesic used in our hospital); 2.6 (4.7) vs. 18.9 (7.3) mg, p < 0.001. The results of our study show that although remifentanil was more effective in reducing time to tracheal extubation and length of stay in the recovery area, there was an increased requirement for postoperative analgesia when remifentanil was used.
Topics: Adjuvants, Anesthesia; Aged; Airway Extubation; Analgesics, Opioid; Anesthesia Recovery Period; Cardiac Surgical Procedures; Drug Administration Schedule; Female; Humans; Length of Stay; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Pirinitramide; Remifentanil; Sufentanil; Time Factors
PubMed: 30663045
DOI: 10.1111/anae.14572 -
Der Anaesthesist Sep 2020Standard protocols or algorithms are considered essential to ensure adequate analgesia. Germany has widely adopted postoperative protocols for pain management including...
BACKGROUND
Standard protocols or algorithms are considered essential to ensure adequate analgesia. Germany has widely adopted postoperative protocols for pain management including oral opioids for rescue medication, but the effectiveness of such protocols has only been evaluated longitudinally in a before and after setting. The aim of this cohort analysis was to compare the effectiveness of an oral opioid rescue medication algorithm for postoperative management of pain to the gold standard of patient-controlled intravenous analgesia (PCIA).
MATERIAL AND METHODS
This study compared cohorts of patients of two prospective observational studies undergoing elective total hip replacement. After surgery patients received piritramide to achieve a pain score of ≤3 on the numeric rating scale (NRS 0-10). A protocol was started consisting of oral long-acting oxycodone and ibuprofen (basic analgesia). Cohort 1 (C1, 126 patients) additionally received an oral opioid rescue medication (hydromorphone) when reporting pain >3 on the NRS. Cohort 2 (C2, 88 patients) was provided with an opioid by PCIA (piritramide) for opioid rescue medication. Primary endpoints were pain intensity at rest, during movement, and maximum pain intensity within the first 24 h postoperative. Secondary endpoints were opioid consumption, functional outcome and patient satisfaction with pain management.
RESULTS
Pain during movement and maximum pain intensity were higher in C1 compared to C2: pain on movement median 1st-3rd quartile: 6 (3.75-8) vs. 5 (3-7), p = 0.023; maximum pain intensity: 7 (5-9) vs. 5 (3-8), p = 0.008. There were no differences in pain intensity at rest or between women and men in either group. The mean opioid consumption in all patients (combined PACU, baseline, and rescue medication; mean ± SD mg ME) was 126.6 ± 51.8 mg oral ME (median 120 (87.47-154.25) mg ME). Total opioid consumption was lower in C1 than C2 (117 ± 46 mg vs 140 ± 56 mg, p = 0.002) due to differences in rescue opioids (C1: 57 ± 37 mg ME, C2: 73 ± 43 mg ME, p = 0.006, Z = -2.730). Basic analgesia opioid use was comparable (C1: 54 ± 31 mg ME, C2: 60 ± 36 mg ME, p = 0.288, Z = -1.063). There were no differences in respect to the addition of non-opioids and reported quality of mobilization, sleep, frequency of nausea and vomiting, or general satisfaction with pain management.
CONCLUSION
In this study PCIA provided a better reduction of pain intensity, when compared to a standardized protocol with oral opioid rescue medication. This effect was associated with increased opioid consumption. There were no differences in frequencies of opioid side effects. This study was a retrospective analysis of two cohorts of a major project. As with all retrospective studies, our analysis has several limitations to consider. Data can only represent the observation of clinical practice. It cannot reflect the quality of a statement of a randomized controlled trial. Observational studies do not permit conclusions on causal relationships.
Topics: Adult; Aged; Algorithms; Analgesia, Patient-Controlled; Analgesics, Opioid; Cohort Studies; Elective Surgical Procedures; Female; Germany; Humans; Male; Middle Aged; Oxycodone; Pain Measurement; Pain, Postoperative; Pirinitramide; Prospective Studies; Retrospective Studies
PubMed: 32617631
DOI: 10.1007/s00101-020-00806-6 -
British Journal of Anaesthesia Jun 2010We assessed the analgesic efficacy of parecoxib, acetaminophen, and the combination of both compared with placebo in patients undergoing elective thyroid or parathyroid... (Randomized Controlled Trial)
Randomized Controlled Trial
Postoperative analgesia with parecoxib, acetaminophen, and the combination of both: a randomized, double-blind, placebo-controlled trial in patients undergoing thyroid surgery.
BACKGROUND
We assessed the analgesic efficacy of parecoxib, acetaminophen, and the combination of both compared with placebo in patients undergoing elective thyroid or parathyroid surgery.
METHODS
We randomized 140 patients to receive one of the following i.v. treatments using a double-blinded double-dummy technique: placebo, 80 mg 24 h(-1) parecoxib, 5 g 24 h(-1) acetaminophen, or 80 mg parecoxib plus 5 g acetaminophen. We provided rescue analgesia with piritramide delivered by a patient-controlled analgesia device. We measured opioid consumption and pain intensity over 24 h after operation.
RESULTS
Patient characteristic data, anaesthetic, and surgical characteristics of the patients in the four groups were similar. Parecoxib, acetaminophen, and the combination significantly reduced opioid requirements during 24 h after surgery [mean (sd) 12.5 (10.9) mg for parecoxib, 14.2 (12.3) mg for acetaminophen, and 11.9 (10.7) mg for combination] compared with placebo [23.5 (15.3) mg, P<0.05]. However, the combination of parecoxib and acetaminophen did not have any advantage over individual drugs in terms of opioid consumption in our trial (P>0.05).
CONCLUSIONS
Parecoxib and acetaminophen effectively reduce postoperative opioid requirements after thyroid or parathyroid surgery. The combination of these drugs is not associated with a further reduction in opioid consumption.
Topics: Acetaminophen; Adolescent; Adult; Aged; Aged, 80 and over; Analgesia, Patient-Controlled; Analgesics, Non-Narcotic; Analgesics, Opioid; Cyclooxygenase 2 Inhibitors; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Humans; Isoxazoles; Middle Aged; Pain, Postoperative; Parathyroid Glands; Pirinitramide; Postoperative Care; Thyroid Gland; Young Adult
PubMed: 20427369
DOI: 10.1093/bja/aeq096 -
Anesthesiology Jul 2004Major spinal surgery is associated with high postoperative pain scores and opioid requirement. The aim of the current prospective, randomized, placebo-controlled,... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Major spinal surgery is associated with high postoperative pain scores and opioid requirement. The aim of the current prospective, randomized, placebo-controlled, double-blind study was to assess the reduction of opioid requirement and pain scores using an intraoperatively placed epidural catheter with infusion of 0.1% ropivacaine during the postoperative period.
METHODS
Thirty patients undergoing major lumbar spinal surgery from a dorsal approach were included in this study. Before wound closure, the orthopedic surgeon inserted an epidural catheter. Postoperatively, patients were randomly assigned to receive an infusion of 12 ml/h ropivacaine, 0.1% (group R), or 12 ml/h saline (group N) after an initial bolus of 10 ml of the respective study solution. Additional pain relief was provided using an intravenous patient-controlled analgesia pump with the opioid piritramide. Patients were assessed with respect to pain scores (visual analog scale of 0-100), cumulative opioid requirement, side effects, and satisfaction with pain management.
RESULTS
: Demographic data, duration of surgery, and type of surgery were comparable between groups. Pain scores were assessed as follows (group R vs. group N: 6 h: 24 +/-20 vs. 51 +/- 20, P = 0.002; 24 h: 33 +/- 19 vs. 53 +/- 27, P = 0.04; 48 h: 21 +/-17 vs. 40 +/- 26, P = 0.04; 72 h: 14 +/- 13 vs. 38 +/- 25, P = 0.02). The cumulative piritramide requirement after 72 h was 97 +/- 23 mg in group R and 157 +/-72 mg in group N (P = 0.03). The incidence of side effects was comparable between groups, and patient satisfaction was always higher in group R (P < 0.05).
CONCLUSION
Continuous epidural infusion of 0.1% ropivacaine results in lower pain scores and opioid consumption and higher patient satisfaction when compared with placebo. Application of ropivacaine using an epidural catheter seems to be a highly effective treatment for postoperative pain after major lumbar spinal surgery.
Topics: Adult; Amides; Analgesia, Epidural; Analgesics, Opioid; Anesthetics, Local; Double-Blind Method; Humans; Middle Aged; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Pirinitramide; Ropivacaine; Spine
PubMed: 15220788
DOI: 10.1097/00000542-200407000-00027 -
Acta Orthopaedica Apr 2007For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and... (Comparative Study)
Comparative Study
INTRODUCTION
For endoprosthetic knee surgery, intensive postoperative pain therapy is necessary. We therefore evaluated whether the combination of continuous psoas compartment and sciatic analgesia (PSC) is as effective as epidural analgesia (EPI) and whether it provides better analgesia than patient-controlled intravenous analgesia with piritramide (PCA).
METHODS
We studied 63 patients who underwent total knee arthroplasty (TKA). The PSC group received a combination of continuous psoas and sciatic nerve block, the EPI group an epidural analgesia, and the PCA group an intravenous patient-controlled piritramide pump. Pain scores, satisfaction, flexion and side effects were recorded.
RESULTS
Pain scores (0-10) were higher in the PCA group (on movement, day 1/day 2: 7.0/6.5) than in the EPI group (5.0/5.0) and the PSC group (4.0/3.5). Postoperative opioid consumption over 48 h was higher in the PCA group (51 mg) than in the EPI group (0 mg) and the PSC group (0 mg). There were no differences in functional recovery. Pruritus occurred more frequently in the PCA and EPI groups than in the PSC group. Patients receiving a PSC and EPI were more satisfied than those treated with PCA.
INTERPRETATION
Analgesia with PSC catheters or EPI catheter is superior to PCA regarding pain levels, analgesic requirements, and patient satisfaction. There was no difference in functional outcome between the 3 groups.
Topics: Aged; Amides; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Female; Humans; Interviews as Topic; Male; Middle Aged; Nerve Block; Pain, Postoperative; Patient Satisfaction; Pirinitramide; Prospective Studies; Psoas Muscles; Recovery of Function; Ropivacaine; Sciatic Nerve; Treatment Outcome
PubMed: 17464606
DOI: 10.1080/17453670710013672