Preoperative oral rofecoxib and postoperative pain in patients after laparoscopic cholecystectomy: a prospective, randomized, double-blinded, placebo-controlled trial

Cyclooxygenase-2 (COX-2) inhibitors are a class of drugs that may avoid some of the side effects of narcotics and nonsteroidal anti-inflammatory drugs (NSAIDs). We performed a randomized, double-blinded, placebo-controlled trial giving a single oral dose of the COX-2 inhibitor rofecoxib 25 mg or placebo preoperatively to determine the impact upon postoperative pain, complications, narcotic use, and hospital stay after laparoscopic cholecystectomy. Investigators and patients were blinded. Pain was measured on a 10-point visual analogue scale. Eighty patients were randomized: 40 to the rofecoxib group and 40 to the placebo group. The amount of pain between the two groups postoperatively was equivalent. Pain was recorded at 1 hour, 4.03 +/- 1.93 in the rofecoxib group versus 4.38 +/- 1.34 in the placebo group (P = 0.36); at 6 hours, 3.00 +/- 1.12 in the rofecoxib group versus 2.78 +/- 0.78 in the placebo group (P = 0.42); and at 24 hours, 1.64 +/- 0.67 in the rofecoxib group versus 2.68 +/- 1.90 in the placebo group (P = 0.17). The amount of pain medication received and lengths of hospital stay was not significantly different between the two groups. Our data demonstrate no significant benefit of preoperative oral rofecoxib in patients undergoing laparoscopic cholecystectomy.     

Prospective, double-blinded, randomized, placebo-controlled comparison of local anesthetic and nonsteroidal anti-inflammatory drugs for postoperative pain management after laparoscopic surgery

Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.     

Postoperative analgesia in total hip arthroplasty: a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration

Background Comfort and lack of pain are important for optimal mobilization after hip replacement. We investigated the efficacy of double wound infiltration.

Patients and methods 40 consecutive patients undergoing total hip replacement were randomized into two groups in this double-blinded study. They received wound infiltration at the end of surgery and through an intraarticular catheter 24 h postoperatively. The catheter was placed at the end of surgery. One group received solutions of ropivacaine, ketorolac, and adrenaline. Patients in the control group were injected with saline instead. The observation period was 6 weeks.

Results The patients who received the analgesic solution had less pain up to 2 weeks postoperatively. They reached an earlier and lower pain minimum during the first days postoperatively, had lower use of analgesia up to day 4 postoperatively, and were more satisfied. Use of analgesic solution resulted in less joint stiffness and better function 1 week postoperatively.

Interpretation Operative and postoperative wound infiltration with multimodal drugs reduces pain and the requirement for analgesics after hip replacement, leading to faster postoperative mobilization.     

Improved analgesia with clonidine when added to local anesthetic during combined spinal-epidural anesthesia for hip arthroplasty: a double-blind, randomized and placebo-controlled study

Background: The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty. Methods: This was a double‐blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 µg of clonidine (Group BC‐RC) or without clonidine (Groups B‐R and B‐RC). Postoperatively, epidural infusion was administered in the following way: Group B‐R – ropivacaine 4 mg h^?1; Groups B‐RC and BC‐RC: ropivacaine 4 mg h^?1 and clonidine 40 µg h^?1. Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli. Results: The maximal upper level of sensory block measured by pin‐prick (T6–T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin‐prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC‐RC compared to Groups B‐R and B‐RC (P < 0.02). Postoperatively, both VAS score on movement and PCA‐morphine consumption were higher in Group B‐R than in Groups B‐RC and BC‐RC (P < 0.01). The arterial pressure and heart rate in Groups B‐RC and BC‐RC were significantly lower than in Group B‐R at 10–24 and 15–24 h, respectively, after spinal injection. Conclusion: Low‐dose intrathecal clonidine provided a better quality of anesthesia and longer‐lasting analgesia. Epidural clonidine‐ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.     

Postoperative analgesia in total hip arthroplasty: A randomized double-blinded,placebo-controlled study on peroperative and postoperative ropivacaine,ketorolac, and adrenaline wound infiltration

Background?Comfort and lack of pain are important for optimal mobilization after hip replacement. We investigated the efficacy of double wound infiltration.

Patients and methods?40 consecutive patients undergoing total hip replacement were randomized into two groups in this double-blinded study. They received wound infiltration at the end of surgery and through an intraarticular catheter 24 h postoperatively. The catheter was placed at the end of surgery. One group received solutions of ropivacaine, ketorolac, and adrenaline. Patients in the control group were injected with saline instead. The observation period was 6 weeks.

Results?The patients who received the analgesic solution had less pain up to 2 weeks postoperatively. They reached an earlier and lower pain minimum during the first days postoperatively, had lower use of analgesia up to day 4 postoperatively, and were more satisfied. Use of analgesic solution resulted in less joint stiffness and better function 1 week postoperatively.

Interpretation?Operative and postoperative wound infiltration with multimodal drugs reduces pain and the requirement for analgesics after hip replacement, leading to faster postoperative mobilization.     

A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy

Background: Elective laparoscopic cholecystectomy (LC) has a low risk for infective complications, but many surgeons still use prophylactic antibiotics. The use of prophylactic antibiotics for LC is inconsistent and varies widely among surgeons. Methods: We performed a prospective double-blind randomized study of prophylactic antibiotics in elective LC. Antibiotics were was given first before the operation and then again 24 h afterward. Group A (n = 49) received 2 g of cefotaxime; group B (n = 43) received 10 ml of isotonic sodium chloride solution. A sample of bile was withdrawn by direct gallbladder puncture for anaerobic and aerobic cultures. Age, sex, weight, duration of surgery (DOS), presence of diabetes mellitus, American Society of Anesthesiologists (ASA) classification, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, episodes of colic within 30 days before surgery, length of stay (LOS), and number of septic complications were recorded for both groups. Results: There was no differences between the two groups in terms of sex, weight, DOS, ASA score, gallbladder rupture, bile and/or stone spillage, gallbladder histological findings, findings from bile cultures positive for bacteria, or LOS. One infection occurred in the antibiotic prophylaxis group (2.04%); in the patients not receiving antibiotics, there was one other infection (2.32%). There was no statistical difference between the two groups in infective complications. Conclusion: In patients undergoing elective LC, antibiotic prophylaxis is justified only in high-risk patients. In all other patients, antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications. In low-risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction; moreover, it would lower the risk of adverse reaction and reduce microbial resistance. Presented at the combined meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the 8th World Congress of Endoscopic Surgery, New York, NY, USA, 13–16 March 2002     

Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control--a randomized prospective double-blinded placebo-controlled trial

Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. All patients received preperitoneal abdominal wall infiltration with 0.25 per cent bupivacaine to control parietal (somatic) abdominal pain. The visual analogue and verbal rating pain scores at 0, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded in a prospective double-blind fashion at four points during the first 24 postoperative hours. Analgesia requirements, vital signs, blood glucose, and incidence of nausea and vomiting were also recorded. Patients in each group demonstrated a significant difference in visual analogue and verbal rating pain scores and analgesic consumption when compared with controls. Lignocaine controlled pain significantly better than saline or bupivacaine. Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.     

全麻复合局部浸润麻醉对腹腔镜下胆囊切除术患者心率变异性的影响

目的 探讨全麻复合局部浸润麻醉对腹腔镜下胆囊切除术(LC)患者术中和术后血流动力学和心率变异性(HRV)的影响.方法 择期行LC患者70例,随机分为全身麻醉组(GA组)和全身麻醉复合局部浸润麻醉组(GI组),每组35例,监测并记录患者入室后(T_0)、切皮时(T_1)、缝皮时(T_2)、术后1 h(T_3)、3 h(T_4)HRV的变化,并对血流动力学进行分析.结果 T_1、T_3、T_4时,GA组MAP、HR均较T_0增高(P<0.05),GL组变化均较GA组小.GA组低频标准化值(Lfnu)、LF/HF在T_1～T_4时均较T_0时显著升高(P相似文献   

开腹手术后切口局部持续浸润麻醉疗效的随机对照研究

目的 使用前瞻性随机对照方法研究开腹手术后使用切口镇痛泵持续切口浸润麻醉的镇痛疗效和副反应。方法 收集2011年5月至2012年5月间在我院普外科接受经右侧肋缘下切口进行开腹手术的30例患者（手术由同一组医生完成）,随机分成两组：对照组（生理盐水持续切口浸润,n=15）和切口镇痛泵组（罗哌卡因持续切口浸润麻醉,n=15）,所有患者同时使用舒芬太尼静脉麻醉自控泵,分别记录术后疼痛评分、累计舒芬太尼使用量、恶心呕吐发生、术后镇静评分、肠道功能恢复时间、住院时间、有无切口感染等。结果 使用切口镇痛泵进行术后切口局部持续浸润麻醉无明显副作用。与对照组相比,使用切口镇痛泵组具有更好的术后镇痛效果（P＜0.05）,更少的舒芬太尼使用量（P＜0.05）,更短的肠道功能恢复时间（P＜0.05）和平均住院时间（P＜0.05）。结论 使用切口镇痛泵进行切口持续浸润麻醉是一种安全有效的术后止痛方法,可以加速患者术后恢复,减少住院时间。     

High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial

Background and purpose

High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies.

Methods

In a randomized, double-blind placebo-controlled trial in 12 patients undergoing bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion.

Results

Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4 (range 2–7) days.

Interpretation

Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib, and acetaminophen.Continuous epidural analgesia (Choi et al. 2003) or continuous or single-shot peripheral nerve blocks (Boezaart 2006, Ilfeld et al. 2008) may provide sufficient analgesia after total hip arthroplasty (THA), but both techniques are associated with potential motor blockade, thereby hindering early rehabilitation (Choi et al 2003, Boezaart 2006, Ilfeld et al. 2008).Local infiltration analgesia (LIA) (Röstlund and Kehlet 2007, Kerr and Kohan 2008, Otte et al. 2008) with intraoperative infiltration of local anesthetic in the surgical wound and subsequent supplementary postoperative intraarticular or wound injections has been reported to be effective in knee arthroplasty (Andersen et al. 2008). However, for THA only limited and inconclusive data are available from placebo-controlled and randomized trials (Bianconi et al. 2003, Andersen et al. 2007 a, b, Busch et al. 2010) and from non-randomized cohort studies (Kerr and Kohan 2008, Otte et al. 2008). We therefore decided to evaluate the analgesic efficacy of LIA in a placebo-controlled, randomized and double-blind trial in fast-track bilateral hip arthroplasty with administration of either ropivacaine or saline to the wound, thereby limiting the large inter-individual pain response to THA. This design has proven valid in assessing the analgesic value of LIA in TKA (Andersen et al. 2008). The primary endpoint was pain on flexion of the hip joint 8 hours postoperatively.     

A randomized, placebo-controlled study of pregabalin for postoperative pain intensity after laparoscopic cholecystectomy

Study ObjectiveTo determine the efficacy of two different doses (150 mg and 300 mg) of preoperative pregabalin on pain relief and total opioid consumption after laparoscopic cholecystectomy.DesignProspective, randomized, placebo-controlled, double-blinded study.SettingTraining and research hospital.Patients90 adult, ASA physical status 1 and 2 patients.InterventionsPatients were randomly assigned to three groups to receive orally one hour before surgery, a placebo (Group 1), pregabalin 150 mg (Group 2), or pregabalin 300 mg (Group 3). Patients were observed for pregabalin side effects, somnolence via Ramsay Sedation Scale, dizziness, confusion, and ataxia.MeasurementsIn the operating room, heart rate and noninvasive systolic and diastolic blood pressures were measured. Visual analog scale (VAS), Ramsay Sedation Scale, and Aldrete scores were also recorded on arrival at the Postanesthesia Care Unit (time 0), 15, 30, 60, 120 minutes and 3, 4, 6, 8, 10, 12 and 24 hours after surgery. Additional doses of drugs (fentanyl and/or metoclopramide) were also recorded.Main ResultsPreemptive pregabalin decreased pain scores and postoperative fentanyl consumption in patients after laparoscopic cholecystectomy in a dose-dependent manner. There were no differences between the groups in side effects.ConclusionPreoperative pregabalin may be a useful analgesic for patients after laparoscopic cholecystectomy, as it lowers pain intensity and opiod consumption, and does not increase the frequency of side effects.     

Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: A systematic review and meta-analysis with trial sequential analysis

BackgroundBoth transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. We undertook this systematic review and meta-analysis with trial sequential analysis to determine the best analgesic technique.MethodsWe systematically searched the literature for trials comparing TAP block with wound infiltration after laparoscopic cholecystectomy. The primary outcome was pain score during rest (analogue scale, 0–10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, pain scores during movement and intravenous morphine consumption at 2, 12 and 24 h, and postoperative nausea and vomiting. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, hematoma, visceral injury and local anesthetic systemic toxicity.ResultsTen trials including 668 patients were identified. There was a significant difference in pain score during rest at 2 postoperative hours in favour of TAP block when compared with wound infiltration (mean difference [95%CI]: −0.7 [−1.2, −0.2]; I2 = 71%; p = 0.008). Pain scores during rest at 12 and 24 h and pain scores during movement at 24 h were also significantly lower with TAP block than wound infiltration. Postoperative morphine consumption and the incidence of postoperative nausea and vomiting were significantly lower in patients who received a TAP block. Data were insufficient to compare block-related complications. The overall quality of evidence was moderate-to-high.ConclusionsThere is moderate-to-high level evidence that the TAP block provides superior analgesia when compared with wound infiltration in patients undergoing laparoscopic cholecystectomy.Trial registry number: PROSPERO CRD42020208057.     

Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study

The analgesic effect of intraperitoneal infusion of local anesthesia after laparoscopic cholecystectomy is controversial, and the reported results range from considerable pain reduction to no significant pain reduction. In this randomized, placebo-controlled and double-blind study, we examined the efficacy of intraperitoneal administration of bupivacaine at the end of surgery in 65 patients undergoing elective laparoscopic cholecystectomy. Pain score was assessed using a visual analog scale 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after surgery. The peak expiratory flow was evaluated preoperatively and 2 hours, 4 hours, 8 hours, and 24 hours after surgery. The daily analgesic consumption was recorded. The authors only detected an analgesic effect in the heavier (body weight >77 kg) subgroup of patients at 2 hours, but detected no significant improvement of the peak expiratory flow, no decrease in the analgesic medication requirement, and no influence on the duration of hospital stay.     

Effects of preemptive analgesia in laparoscopic cholecystectomy: a double-blind randomized controlled trial

Background  

This study aimed to investigate the effect of preemptive etoricoxib compared with placebo in laparoscopic cholecystectomy.