1.
Impact of Intraoperative Infusion and Postoperative PCIA of Dexmedetomidine on Early Breastfeeding After Elective Cesarean Section: A Randomized Double-Blind Controlled Trial.
Wang, Y, Fang, X, Liu, C, Ma, X, Song, Y, Yan, M
Drug design, development and therapy. 2020;:1083-1093
Abstract
OBJECTIVE Few studies have investigated the effects of dexmedetomidine (DEX) on breastfeeding after cesarean delivery. A randomized double-blind controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient-controlled intravenous analgesia (PCIA), can be beneficial for breastfeeding. PATIENTS AND METHODS One hundred sixty parturients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to the DEX group (a loading dose of DEX was pumped at 0.5 μg/kg within 10 min, followed by a further infusion of DEX at 0.5 μg/kg/h until the end of the surgery and PCIA for 2 days with DEX plus sufentanil) or the standard care group (infusion saline intraoperatively, and PCIA for 2 days with sufentanil). The number of days required to switch to exclusive breastfeeding within six weeks of delivery, the time to first lactation and breast milk volume on day 1 and day 2 after delivery were recorded. Recovery quality, comfort, anxiety, depression, postoperative analgesia, and adverse reactions of parturients were also assessed. RESULTS Compared with the standard care group, parturients in the DEX group could be converted to exclusive breastfeeding earlier (11 [14] vs 8 [10] days, log-rank P=0.025), the first lactation time was sooner (28.38 [13.82] vs 33.79 [14.85] hrs, P=0.024), and the amount of breast milk on the second day after delivery increased (P=0.012). There was no difference between the two groups in postpartum uterine contraction pain, but postpartum rest and movement VAS scores and recovery quality score in the DEX group were better than those in the standard care group (all P<0.05). Moreover, the hospital anxiety and depression scale and anxiety subscale score on the second day after delivery and the comfort score on the third day after delivery in the DEX group were significantly better than those in the standard care group (5 [5] vs 6 [8], 2 [2] vs 3 [3], 83.58 [6.75] vs 80.48 [6.58]; P=0.013, P=0.005, P=0.006, respectively). The incidence of adverse events, such as bradycardia, vomiting, hypersomnia, hypertension and hypotension, was not significantly different between the DEX and standard care groups (6.9% vs 2.7%, 5.6% vs 13.7%, 4.2% vs 0%, 5.6% vs 2.7%, 11.1% vs 8.2%; P=0.275, P=0.158, P=0.366, P=0.681, P=0.556, respectively), except more parturients experienced nausea in the standard care group than in the DEX group (28.8% vs 11.1%, P=0.012). Furthermore, there was no difference in Neonatal Behavioral Neurological Assessment scores on the first and second days after delivery between the DEX and standard care groups (38 [3] vs 37 [2], 38.5 [2] vs 38 [2]; P=0.173, P=0.312, respectively). CONCLUSION The application of DEX in the perioperative period of cesarean section was not only conducive to the early conversion of infant feeding to exclusive breastfeeding but could also improve the recovery quality and comfort of the parturient, optimize analgesia, shorten the time to first lactation, and increase lactation. CLINICAL TRIALS REGISTRATION NCT03805945.
2.
The effect of adjuvant oral application of honey in the management of postoperative pain after tonsillectomy in adults: A pilot study.
Geißler, K, Schulze, M, Inhestern, J, Meißner, W, Guntinas-Lichius, O
PloS one. 2020;(2):e0228481
Abstract
OBJECTIVE To analyze the effect of adjuvant oral application of honey for treating postoperative pain after tonsillectomy. DESIGN Single centre prospective cohort study. SETTING Two cohorts of patients after tonsillectomy. PARTICIPANTS 56 patients treated with honey 8 times per day (honey group), 18 patients treated without honey (control group); baseline analgesia were non-steroidal anti-inflammatory drugs (NSAID) or coxibs; opioids were used as pro re nata (PRN) medication; mean age 34.4 ± 13.4 years; 36% women. MAIN OUTCOME MEASURES On first to fifth postoperative day, patients rated their pain using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0-10) for determination of patient's pain. QUIPS allows standardized assessment of patients' characteristics andpain-associated patient-reported outcomes (PROs). The influence of preoperative and postoperative parameters on patients' postoperative pain were estimated by univariate and multivariate statistical analysis. RESULTS Average pain in activity in the control group was greater than 4 (NRS 4.4 ± 2.4) during the first five postoperative days, with a renewed increase in pain intensity on the fifth day (4.3 ± 2.5). In the honey group, the pain in activity decreased without any further pain increase and was only higher than 4 on the first three postoperative days (4.3 ± 2.1, all p>0.05). However; neither minimal nor maximal pain were significantly different between both groups on the first postoperative day (p = 0.217, p = 0.980). Over the five postoperative days, the minimal and maximal pain in the honey group decreased continuously and faster than in the control group. With regard to pain-related impairments on the first day, the honey group reported less pain-related sleep disturbance (p = 0.026), as well as significantly fewer episodes of postoperative oral bleeding (p = 0.028) than the control group. Patients without honey consumption had on the first and fifth postoperative day a higher risk of increased minimal pain (OR = -2.424, CI = -4.075 --0.385). Gender was an independent factor for compliance of honey consumption on the second postoperative day (p = 0.037). Men had a lower probability for compliance of honey consumption (OR = -0.288, CI = -2.863 --0.090). CONCLUSION There was a trend of reduced postoperative pain after oral honey application. Honey also seems to reduce pain-related impairments. The need for additional opioids on the first day could be reduced. A larger controlled trial is now needed to varify the effect of honey on pain after tonsillectomy. CLINICAL TRIAL REGISTRATION NUMBER German Clinical Trials Register DRKS00006153. The authors confirm that all ongoing and related trials for this drug/intervention are registered.
3.
Manual acupuncture for relieving pain associated with panretinal photocoagulation.
Chiu, HH, Wu, PC
Journal of alternative and complementary medicine (New York, N.Y.). 2011;(10):915-21
Abstract
OBJECTIVE The feasibility of manual acupuncture for reducing pain associated with panretinal photocoagulation (PRP) was investigated. METHODS This was a prospective, comparative nonrandomized study on patients with proliferative diabetic retinopathy who were receiving PRP treatment. The protocol of PRP included three sequential sessions of treatment at 2-week intervals. Both the acupuncture (acuPRP) and control groups had no acupuncture in the first session. In the second session, acupuncture was given to the acuPRP group only. The third session of PRP completed the laser treatment course. Acupuncture performed only at GB 37 (Guāngmíng) just before PRP, and the needle was removed after the treatment. An 11-point Likert-type verbal pain score test was given to all patients after each PRP treatment. RESULTS Of 34 patients with proliferative diabetic retinopathy, 18 patients were allocated to the acuPRP group and 16 patients were allocated to the control group. After the first PRP treatment, there was no statistical difference in mean pain scores between the acuPRP and control groups (6.8±1.2 versus 6.3±2.1, respectively, p=0.383). After the second PRP treatment, the mean pain score in the acuPRP group was significantly lower, compared with the control group (3.9±1.8 versus 7.4±1.9, respectively, p<0.0001). Within the group, the mean pain scores were significantly higher during the second PRP treatment, compared with the first PRP treatment, in the control group (p=0.0003). In contrast, the mean pain scores were significantly lower during the second PRP treatment, compared with the first PRP treatment in the acuPRP group (p<0.0001). No adverse reactions or complications were noted. CONCLUSIONS Acupuncture might help reduce pain during PRP treatment. However, further randomized studies are necessary to verify these preliminary results.
4.
[Profenid or veral for the postoperative analgesia in gynaecology].
Tablov, V, Popov, I, Tablov, B
Akusherstvo i ginekologiia. 2004;(4):26-8
Abstract
We present our results for study and assessment of efficacy in accordance with postoperative analgesia with single dose Profenid (ketoprofen) or Veral (diclofenac) administrated per rectum. We studied 60 patients divided in two groups--group 1 (analgesia with Profenid) and group 2 (analgesia with Veral). All patients received standard endotracheal anesthesia for elective gynaecologic operations. We have assessed quality of the postoperative analgesia by: Ta--time of analgesia (time for first want of analgesics by patient), VRS (verbal rating score), VAS (visual analogue score), PONV (postoperative nausea and vomiting) and sedation rate.
5.
[Does intravenous administration of magnesium have an effect on postoperative analgesia?].
Machowska, B, Duda, K
Folia medica Cracoviensia. 2001;(4):255-62
Abstract
The study involved 67 patients operated for malignant tumours of stomach and of the colon. The patients have been divided into 3 groups: the NORMO group--20 patients in whom the serum magnesium level remained normal during the whole period studied; the HYPO group--22 patients who developed hypomagnesaemia in the postoperative course; the MAG i.v. group--25 patients who on the day of surgery and on 4 days following surgery, received intravenously daily doses of 2.5 ml of 20% MgSO4 per each 500 ml of transfused fluids. In all patients, the basic analgesic used was morphine, administered intramusculary or extraduraly. In the intervals between the doses of morphine, patients received intravenous doses of noramidopirine. In all three groups, the daily amounts of morphine and noramidopirine received by patients was the same. The intravenous administration of daily doses of 8 to 14 mmol magnesium in the postoperative period does not affect the amount of analgesics given to patients.