Articles: analgesics.
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Randomized Controlled Trial Clinical Trial
Intrathecal fentanyl for post-thoracotomy pain.
This double-blind, placebo-controlled study investigated the efficacy of intermittent doses of intrathecal fentanyl in 30 patients undergoing thoracotomy. They were allocated randomly to three groups, two of which had microspinal catheters inserted into the lumbar subarachnoid space at the end of surgery; the third group acted as a control. Intrathecal fentanyl or 0.9% saline was administered through the catheters and all patients received morphine using a patient-controlled analgesia (PCA) system. ⋯ Intrathecal fentanyl resulted in a faster onset of analgesia (mean visual analogue scale (VAS) score at 1 h = 0.9 compared with 6.3 (95% confidence intervals for the difference -6.8, -4.0) for the other groups; P < 0.001) and significantly lower pain scores at rest, on cough and on movement. PEFR values were consistently higher in the intrathecal fentanyl group. There were no cases of early or delayed respiratory depression.
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J Bone Joint Surg Am · Jul 1995
Randomized Controlled Trial Clinical TrialEffect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty.
The effect of ketorolac tromethamine, a non-steroidal anti-inflammatory drug, on postoperative blood loss and on the requirement for morphine was assessed after total knee arthroplasty, an operation in which blood loss is mainly measured rather than estimated. The purpose of this prospective, randomized, double-blind clinical trial was to determine whether administration of ketorolac in the perioperative period would increase bleeding related to the operation. Fifty-nine patients who had a total knee arthroplasty received either thirty milligrams of ketorolac or a placebo consisting of saline solution, intravenously, every six hours, in four doses. ⋯ The patients who received ketorolac used 27 per cent less morphine than those who received the placebo (40.0 +/- 23.4 milligrams compared with 55.1 +/- 23.5 milligrams [mean and standard deviation]); this difference was significant (p < 0.05). On the first day after the operation, the hematocrit decreased from 0.364 +/- 0.043 preoperatively to 0.278 +/- 0.032 in the patients who received ketorolac and from 0.363 +/- 0.046 to 0.298 +/- 0.030 in the patients who received the placebo. The 6 per cent greater decrease in the group that received ketorolac was significant (p < 0.05) but not clinically important.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison.
Tramadol hydrochloride is a synthetic mu-opioid agonist with additional monoaminergic activity. Tramadol's analgesic effect has been equated with that of pethidine, with a more favourable side-effect profile. Tramadol has been the most-selling prescription analgesic in Germany for several years, and it is now available in many other European countries, but still there is a lack of adequately controlled clinical studies of its analgesic properties. ⋯ The active drug control, paracetamol+codeine, was significantly superior to placebo for all efficacy variable (P = 0.0002-0.004), confirming good assay sensitivity. Paracetamol+codeine was also significantly superior to both 50 mg tramadol (P = 0.002-0.03) and 100 mg tramadol (P = 0.002-0.02). There was no difference between placebo and 50 and 100 mg tramadol for any of the efficacy variables.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Jul 1995
Randomized Controlled Trial Comparative Study Clinical TrialIntravenous regional anesthesia using lidocaine and ketorolac.
Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. ⋯ Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.
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Case Reports Randomized Controlled Trial Clinical Trial
Ketamine as an adjunct to morphine in the treatment of pain.
A double-blind multidose trial of the addition of ketamine (0-40 mg, i.m., 8 times per day) to intramuscular morphine therapy was undertaken in a 61-year-old man with chronic back pain related to osteoporosis who had received inadequate pain relief from anterior interbody fusion, dorsal column stimulation and morphine alone. The patient reported only mild side effects. ⋯ In addition, the amount of morphine used by the patient was significantly reduced as the ketamine dose increased. This patient experienced substantial benefit from the addition of ketamine to intramuscular morphine therapy.