Acute Pain最新文献

Background

Thrombophlebitis is a common complication of a widely used formulation of injectable diclofenac that employs propylene glycol and benzyl alcohol (PG–BA) as solvents. Initial studies of Dyloject^®, a novel injectable diclofenac solubilised with hydroxypropyl-β-cyclodextrin (HPβCD), suggested that this complication occurred less frequently and with lower severity with the newer formulation.

Methods

We conducted a safety analysis of seven single-dose clinical trials that enrolled 531 patients receiving either a rapid intravenous (IV) bolus of Dyloject^® or a 30 min IV infusion of PG–BA diclofenac.

Results

The incidence of thrombophlebitis observed as an adverse event following Dyloject^® treatment was 1.2% (5 of 423) versus 6.5% (7 of 108) following PG–BA diclofenac (p < 0.01). In a subset of clinical studies that included an observer-rated thrombophlebitis assessment, the incidence of mild irritation was similar for both products (5.4% for Dyloject^® and 4.9% for PG–BA diclofenac). Differences between the formulations were most evident in the higher incidence of moderate to severe thrombophlebitis after PG–BA diclofenac (2.4% incidence) compared to Dyloject^® (0% incidence).

Conclusion

HPβCD, the solubilising agent in Dyloject^®, may be less irritating and result in less clinical thrombophlebitis than the cosolvents propylene glycol and benzyl alcohol used in PG–BA diclofenac.

Background

Successful acute pain management after breast surgery remains challenging, and if not achieved, may increase the likelihood of subsequent chronic pain.

Aims

This article aimed to evaluate the evidence for varied techniques described for peri-operative pain management in breast surgery, and to review the literature on chronic pain after breast surgery and particularly ‘post-mastectomy pain syndrome’.

Method

A Pubmed search was performed, with the key words “mastectomy” and “pain” for articles in the English language in the adult human population (age > 19 years), looking specifically for different analgesic techniques that have been evaluated.

Results

Thirty-three peer-reviewed publications with pain outcome data were included, ranging from 15 to 289 patients per study (total n = 2104). Twenty three were randomised controlled trials and the rest were prospective or retrospective audits and case series. Inconsistent trial methodology precluded a meta-analysis. Paravertebral local anaesthetic nerve blockade resulted in lower pain scores and fewer side effects than opioid-based regimens. Three risk factors emerged predicting chronic pain post-mastectomy: higher post-operative pain scores, age <65 years and inclusion of major reconstructive surgery.

Conclusion

Paravertebral block should be considered for use in major breast surgery. Pain control should be optimised/a priority for both acute care and to potentially reduce chronic pain.

Objective

The aim of this study was to determine the analgesic effect of parecoxib when administered either before or at the end of surgery in patients undergoing colorectal laparotomy.

Methods

Sixty patients were randomised to three groups of 20. The PS group received intravenous parecoxib 40 mg before skin incision and normal saline at skin closure. The SP group received saline before skin incision and intravenous parecoxib 40 mg at skin closure. A control group (SS) received saline at both time points.

Results

In both SP and PS groups, morphine consumption was smaller. There was a 40–55% reduction in cumulative morphine consumption in both treatment groups at all time points up to 48 h after anaesthesia finished. The greatest reduction was from 12 h to 24 h which showed a 66% reduction for the SP group and a 55% reduction for the PS group compared to control (p = 0.0003 and 0.0049, respectively, with an adjusted significance value = 0.0167). For SP and PS groups, the time to first post-operative analgesic request tended to be longer and the number of patients requesting morphine in the recovery room was less.

Conclusion

Parecoxib administration at the end of surgery is as effective as at the beginning with regard to analgesic and opioid-sparing effects.

Effective pain management is essential for early recovery and rehabilitation after total hip and knee arthroplasty. Current methods include a multimodal regimen of oral analgesics combined with either continuous epidural analgesia or continuous peripheral nerve blockade both of which have risk of side effects and demand expertise. A simple and effective local infiltration technique with local anaesthetic, epinephrine and NSAID has been developed by D. Kerr and L. Kohan in Sydney, but with variable results reported from others. Since there is no detailed description of the technique we herein present the method in detail as developed by the inventors.