A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy

Kamali, Alireza; Ashrafi, Taha Hojati; Rakei, Siamak; Noori, Gholamreza; Norouzi, Afsaneh

doi:10.1097/md.0000000000013330

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…Despite all the progresses made in clinical pharmacology, proper control of pain in this case is still under discussion. 19,20 Therefore, the aim of this study was to compare the effect of sublingual buprenorphine with injectable morphine on the reduction of pain associated with bone metastasis in cancer patients. The findings of this study showed the efficacy of sublingual buprenorphine in increasing the duration of analgesia and reducing the amount of pain more than intravenous morphine, as well as reduction of the drug side effects and its deprivation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

Sotodeh

Mohaghegh

2019

Eur J Transl Myol

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Bone metastases is one of the most common causes of pain in cancer patients and have a significant effect on their quality of life. The most common symptom of bone metastases is pain that gradually develops. Morphine is used to relieve pain in these patients, poorly accepted by patients due to its adverse events. Therefore, the current study was aimed to compare the effect of sublingual buprenorphine, with certainly lower complications with morphine. Fourth patients were divided into 2 groups. In group A, metastatic cancer patients received 2.5 mg of intravenous (IV) morphine. Furthermore, in group B, sublingual tablet of buprenorphine (one-fourth of a 500 μg tablet) was administered sublingually. Pain was measured 15, 30, and 45 minutes after the onset of pain using visual analog scale (VAS) Ruler. Based on the obtained data, two groups A and B were compared using SPSS 23 software. There was a significant difference between the patient's pain intensity after 15 and 30 minutes from the onset of pain in both groups. Due to the fact that the duration of the effect of morphine is 3-4 hours and the duration of the effect of sublingual buprenorphine is 6-8 hours, therefore, morphine showed fast acting forms of opioids (P= 0.001). The required dose level on the first day was similar in both groups and there was no statistically significant difference between the two groups. While on the second and third days, the median dose in group A (morphine) was greater than group B (buprenorphine), indicating prolonged duration of action for buprenorphine compared with morphine, thus requiring a lower subsequent doses. The results of this study suggested that sublingual buprenorphine is a higher effective drug compared to intravenous morphine during after operation. With regard to easy and painless administration, it seems that its use can be useful in controlling pain due to bone metastases in cancer patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

Sotodeh

Mohaghegh

2019

Eur J Transl Myol

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“…Fourteen aspects of twelve trials enrolling 967 patients were subjected to analysis ( Figure 1 ) [ 11 – 22 ]. Eight trials used placebo as a control [ 11 – 13 , 15 – 18 , 20 ], whereas three used paracetamol [ 14 , 21 , 22 ], one used dexamethasone [ 19 ], and one used clonidine or tramadol [ 16 ]. DEX infusion commenced at a rate of 0.05 to 0.6 µg/kg/h in 9 studies [ 11 , 12 , 14 , 15 , 17 , 18 , 20 – 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…For outcomes, opioid consumption in the first 24 h after the operation was reported in eight trials [ 11 – 15 , 19 – 21 ], the time of first request of analgesia was reported in seven aspects of five trials [ 12 – 14 , 16 , 19 ], VAS scores 24 h after the operation was reported in six trial [ 12 , 13 , 17 , 18 , 21 , 22 ], and the incidence of patients’ need for rescue analgesics was reported in six aspects of four trials [ 15 , 16 , 18 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

Effect of dexmedetomidine on opioid consumption and pain control after laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials.

Liu¹,

Zhao²,

Zang³

et al. 2021

Videosurgery and Other Miniinvasive Techniques

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Introduction The clinical evidence on dexmedetomidine (DEX) for postoperative pain scores and opioid consumption remains unclear in laparoscopic cholecystectomy (LC). Aim To evaluate whether DEX could reduce opioid consumption and pain control after LC. Material and methods A meta-analysis search of EMBASE, PubMed and Cochrane CENTRAL databases was performed and randomized controlled trials (RCTs) comparing DEX with control for adult patients undergoing LC were searched. The primary outcome was opioid consumption in the first 24 h after the operation. The secondary outcomes were the time of first request of analgesia, visual analogue scale (VAS) scores 24 h after the operation, the incidence of patients’ need for rescue analgesics, opioid-related adverse effects, DEX-related adverse effects and other complications. Results There were fourteen aspects of twelve trials and 967 patients included in the analysis. DEX use significantly reduced the opioid consumption in the first 24 h after the operation (weighted mean difference (WMD), –19.17; 95% confidence interval (CI), –30.29 to –8.04; p = 0.0007), lengthened the time of first request of analgesia (WMD = 38.90; 95% CI: 0.88–76.93; p = 0.04) and lowered post-operative nausea or vomiting (PONV) (odds ratio (OR) = 0.49; 95% CI: 0.27–0.89; p = 0.02). Conclusions Intravenous DEX infusion significantly improved the duration of the analgesic effect and reduced postoperative opioid consumption. Moreover, lower incidence of post-operative nausea or vomiting was found in the DEX group.

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“…Paracetamol exerts its analgesic effects via different pathways, including the inhibition of COX-2-dependent prostaglandin E2 synthesis, indirectly activating CB1 and TRPV1 receptors in the brain through its metabolites AM404 [ 11 , 12 ]. Multiple studies have shown the positive effect of paracetamol on postoperative pain management in various procedures, including orthopedic surgery, radical mastectomy, cholecystectomy, cesarean section and abdominal hysterectomy [ 13 , 14 ]. However, a previous study involving women receiving hysterectomy revealed that intravenous acetaminophen did not decrease narcotic use or postoperative pain compared with the group that received the placebo [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial

Zhou,

Yuan,

Xing

et al. 2024

BMC Anesthesiol

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Background Although video-assisted thoracoscopic surgery (VATS) has advantages of reduced injury and faster healing, patients still endure moderate and severe postoperative pain. Paracetamol and mannitol injection, the first acetaminophen injection in China, has the advantages of convenient administration, rapid onset of action, and no first-pass effect. This aim of this study was to investigate the efficacy of postoperative analgesia with paracetamol and mannitol injection, combined with thoracic paravertebral nerve block (TPVB) in post VATS pain. Methods This study was a single-center, prospective, randomized, double-blind controlled clinical trial. Patients scheduled for VATS were randomly divided into three groups, general anesthesia group (Group C), TPVB group (Group T) and TPVB + paracetamol and mannitol injection group (Group TP). In this study, the primary outcome was determined as visual analog scale (VAS) scores at rest and coughing, the secondary observation outcomes were the first time to use analgesic pump, the total consumption of oxycodone in the analgesic pump, number of effective and total analgesic pump compressions at first 48 h postoperatively, the perioperative consumption of sufentanil, time to extubation, hospital length of stay, urine volume, and the incidence of adverse events. Results In a state of rest and cough, patients in the Group TP showed significantly lower VAS pain scores at 1, 12, 24, and 48 postoperative-hour compared with Group C and Group T. Intraoperative sufentanil and postoperative oxycodone consumption, the first time to press analgesic pump, the times of effective and total compressions of patient- controlled analgesia (PCA) were lower than those of the Group C and Group T. Interestingly, urine output was higher in Group TP. There were no differences between the three groups in terms of extubation time, length of hospital stay and adverse effects, indicating that intravenous paracetamol and mannitol injection is an effective and safe perioperative analgesia method. Conclusions Paracetamol and mannitol injection, combined with TPVB may provide important beneficial effects on acute pain control and reduce the consumption of opioid in patients undergoing VATS. Trial registration The trial was registered on Jun 19, 2023 in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=199315), registration number ChiCTR2300072623 (19/06/2023).

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A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy

Cited by 7 publications

References 25 publications

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

Comparison of sublingual buprenorphine and intravenous morphine in reducing bone metastases associated pain in cancer patients

Effect of dexmedetomidine on opioid consumption and pain control after laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials.

Efficacy of postoperative analgesia with intravenous paracetamol and mannitol injection, combined with thoracic paravertebral nerve block in post video-assisted thoracoscopic surgery pain: a prospective, randomized, double-blind controlled trial

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