Articles: analgesics.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison between ketorolac and diclofenac in laparoscopic sterilization.
We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. ⋯ Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.
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Randomized Controlled Trial Clinical Trial
Effects of intravenous ketamine, alfentanil, or placebo on pain, pinprick hyperalgesia, and allodynia produced by intradermal capsaicin in human subjects.
The importance of N-methyl-D-aspartate (NMDA) receptor-mediated sensitization of central nervous system (CNS) neurons is well established in animal models of acute and chronic pain. A human model of central sensitization would be useful in screening new NMDA antagonists and establishing dose regimens for clinical trials in patients with pain related to sensitization of CNS neurons. We used this model to examine the effects of intravenous infusions of two centrally acting analgesics, the NMDA receptor antagonist ketamine and the morphine-like opioid agonist alfentanil. ⋯ Because the drugs were given systemically and produced side effects in all subjects, we cannot specify the site or sites of action nor conclusively rule out a non-specific 'active placebo' response as the cause for reduction of symptoms. Arguing against an 'active placebo' response, however, was the lack of analgesic effect of intravenous midazolam (mean dose; 3.4 mg, titrated to produce side effects of similar magnitude to ketamine and alfentanil) given at 145 min after capsaicin in 9 subjects who had received saline from 25 to 60 min. The results of this study suggest that neural systems sensitive to NMDA receptor antagonists and opioids participate in capsaicin-evoked pain phenomena, and support the feasibility of pharmacological studies using the intradermal capsaicin model.
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Randomized Controlled Trial Clinical Trial
Pre-emptive versus post-surgical administration of ketorolac for hysterectomy.
Seventy-seven women who underwent routine vaginal or abdominal hysterectomy were randomly allocated to receive intravenous ketorolac 30 mg either 30 min before surgical incision (pre-emptive group, n = 37), or at the end of the surgical procedure (post-surgical group, n = 40). The patients received routine post-operative care, which included morphine by patient-controlled analgesia, 1 mg per demand with a lockout of 6 min and a background infusion of 1 mg h-1. In addition, pain was assessed at 12 and 24 h using a 100 mm visual analogue scale (VAS), both at rest and on coughing. ⋯ There were no significant differences on univariate testing. Subsidiary stepwise multiple regression modelling identified age, weight, type of hysterectomy, and the timing of ketorolac administration as significant explanators of post-operative morphine consumption. A statistically significant pre-emptive analgesic effect was therefore identifiable, but the clinical significance is uncertain in relation to the other influences on post-operative analgesic requirements.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of continuous brachial plexus infusion of butorphanol, mepivacaine and mepivacaine-butorphanol mixtures for postoperative analgesia.
We have reported recently that continuous administration of butorphanol into the brachial plexus sheath provided analgesia of a quality superior to that of continuous i.v. administration. In the present study, we have compared postoperative pain relief produced by continuous infusion of one of three types of solution into the axillary sheath: opioid alone, local anaesthetic alone or a mixture of local anaesthetic and opioid. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, we injected one of the three solutions into the axillary neurovascular sheath: butorphanol 2 mg (group B), 0.5% mepivacaine alone (group M) and 0.5% mepivacaine-butorphanol (group MB); the volume of each solution was 50 ml, administered at a rate of 50 ml per 24 h. At 3 h after operation, visual analogue scale (VAS) scores were significantly higher in group M than in group MB (P < 0.01), and higher in group B than in group MB (P < 0.05).
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Randomized Controlled Trial Clinical Trial
Cost-effectiveness analysis of patient-controlled analgesia, intramuscular q.i.d. injection and p.r.n. injection for postoperative pain relief.
We conclude that the intravenous PCA method is a cost-effective technique. Although the PCA device is expensive, the cost-effectiveness analysis should give explicit figures for physicians and the hospital administrators to decide whether they should use the PCA instead of the conventional method.