Objective: The purpose of this study was to compare the analgesic efficacy and pain intensity of and patient's satisfaction with non-opioid analgesics while evaluating postoperative piritramide consumption for providing pain relief after abdominal hysterectomy. Design: This was a randomized, double-blinded study. Materials and Methods: With the patient under general anesthesia, surgery was performed on 120 women using propofol, remifentanil, and muscle relaxant. Four patient groups (n = 30 each) were treated over 24 hours with normal saline (NaCl), parecoxib, metamizol, or paracetamol in addition to piritramide using the patient-controlled analgesia (PCA) pump. Postoperatively, patients were asked every 2 hours for the first 6 hours, and afterwards once every 6 hours, to quantify their pain experience at rest on different pain scales, including patient satisfaction. Cumulative piritramide consumption within 24 hours postoperatively was recorded on the display of the PCA pump. Results: The first required amounts of piritramide in the recovery room were similarly high in all groups and the incremental piritramide consumptions after 6, 12 and 24 hours showed no significant difference among the four groups. Also, with cumulative PCA-piritramide consumption no significant difference could be found. In all groups, the highest level of the visual analogue scale (VAS) score was registered upon arrival in the recovery room. However, there was a significant difference only at 6 hours after surgery between the NaCl group and the paracetamol and parecoxib groups. Conclusions: Compared with placebo, there was no significant difference in regard to opioid-sparing effect by administering additional non-opioids, whereas VAS scores were significantly lower in the paracetamol and parecoxib groups at 6 hours after surgery. Any further benefits were marginal and statistically not significant. ( J GYNECOL SURG 28:101)

In an attempt to reduce the dose of local anesthetic during intravenous (IV) regional anesthesia of the upper limb, we combined 100 mg of lidocaine with 0.05 mg of fentanyl and 0.5 mg of pancuronium. The study was designed in a randomized, double-blind fashion to determine the efficacy of this approach in providing analgesia and relaxation during surgery and to evaluate its safety after immediate deflation of the tourniquet following IV drug injection. Eighty unpremedicated patients, ASA physical status I or II, were assigned to the following groups: group A (n = 15) received 100 mg of lidocaine diluted in 40 mL of NaCl IV; groups B-D (n = 15 in each group) received 100 mg of lidocaine diluted in NaCl, with the addition of 0.05 mg of fentanyl (group B) or 0.5 mg of pancuronium (group C), or both (group D) to a total volume in all groups of 40 mL. Patients in groups A-D underwent elective operations on the forearm, wrist, and hand; for evaluation of safety, in 20 volunteers (group E) the tourniquet was immediately released after IV injection of the three drugs at the previously described doses. The analgesic effect was more profound in group D compared with groups A-C. In group D, 9 of 15 patients had excellent analgesia. In six patients, pain was experienced at the beginning of surgery, but 5 min thereafter patients remained pain free.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose. In a randomized, double-blind trial, the efficacy of nonopioid analgesics on postoperative piritramide consumption was compared for pain relief during the first 24 h in patients recovering from arthroscopic knee surgery. Methods. 120 patients were treated with normal saline and/or one of the nonopioid analgesics (parecoxib, metamizole, paracetamol) in addition to piritramide using the PCA pump. Beginning in the postanesthesia care unit (PACU), patients were asked to quantify their pain experience at rest while piritramide consumption was recorded. Results. Piritramide consumption upon arrival in the PACU was high in all groups. However, cumulative consumption in the parecoxib group was significantly lower than that in the placebo group at 6 and 12 h after surgery. At discharge from the PACU, VAS scores dropped in all groups and were significantly lower in the parecoxib group. In the PACU, satisfaction of the patients was moderate and improved with time after surgery. Conclusions. There was statistically significant opioid-saving effect by administering parecoxib with better VAS scores and satisfaction level compared to placebo. The high pain score in the PACU in all groups immediately after recovering from remifentanil-based anesthesia would be prevented if local anesthetics were administered intra-articularly as part of a multimodal analgesic approach.