M. Ozalevli

A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery

Background: We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient‐controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol.

The effect of adding intrathecal magnesium sulphate to bupivacaine–fentanyl spinal anaesthesia

Background:  The addition of intrathecal (IT) magnesium to spinal fentanyl prolongs the duration of spinal analgesia for vaginal delivery. In this prospective, randomized, double‐blind, controlled study, we investigated the effect of adding IT magnesium sulphate to bupivacaine–fentanyl spinal anaesthesia.

Postoperative pain management with intravenous patient-controlled morphine: comparison of the effect of adding magnesium or ketamine.

Background and objective: This double‐blind randomized study tested whether the addition of magnesium or ketamine to morphine for intravenous patient‐controlled analgesia resulted in improved analgesic efficacy and lower pain scores compared with morphine patient‐controlled analgesia alone after major abdominal surgery. Methods: Ninety patients (3 × 30) were randomly allocated to receive either morphine 0.4 mg mL−1 (Group M) by patient‐controlled analgesia, morphine 0.4 mg mL−1 + MgSO4 30 mg mL−1 (Group MM) or morphine 0.4 mg mL−1 + ketamine 1 mg mL−1 (Group MK). Postoperative analgesia was started when the verbal rating scale was ≥2. Patients were first given a standardized loading dose (0.05 mg kg−1) of the study solution. They were then allowed to use bolus doses of this solution (0.0125 mg kg−1 every 20 min without time limit). Discomfort, sedation, pain scores, cumulative morphine consumption and adverse effects were recorded up to 24 h after the start of the patient‐controlled analgesia. Results: The level of discomfort, level of sedation and verbal rating scores decreased significantly with time in all groups (P < 0.05). Both verbal rating and discomfort scores were significantly lower in Groups MM and MK at 15, 30 and 60 min compared with Group M (P < 0.001). Cumulative morphine consumption after 12 and 24 h was significantly higher in Group M alone (median 26 and 49 mg, respectively) compared with Group MM (24.2 and 45.7 mg) and Group MK (24.4 and 46.5 mg). Conclusions: In the immediate postoperative period, the addition of magnesium or ketamine to morphine for intravenous patient‐controlled analgesia led to a significantly lower consumption of morphine. However, these differences are unlikely to be of any clinical relevance.

Comparison of morphine and tramadol by patient-controlled analgesia for postoperative analgesia after tonsillectomy in children

Background : Tramadol is an alternative to other opioids for postoperative pain management. This prospective, randomized, double‐blind study was designed to compare the analgesic efficacy of patient‐controlled tramadol with patient‐controlled morphine for postoperative pain after tonsillectomy in children.

A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery

PurposeWe compared the efficacy of patient-controlled analgesia (PCA), with or without a background infusion of morphine, on postoperative pain relief in patients extubated in the operating room after coronary artery bypass grafting (CABG) surgery.MethodsWith Faculty Ethics approval, 60 consenting adults undergoing elective coronary artery surgery were randomly assigned to receive either morphine PCA alone (group PCA-A,n = 30) or morphine PCA plus a background infusion (group PCA-B,n = 30) for 24 hr postoperatively Pain scores with verbal rating scale (VRS1 from 0 to 10) at rest, sedation scores, morphine consumption and delivery/demand ratios were assessed at zero, one, two, four, six, 12 and 24 hr after surgery. Hemodynamic variables and arterial blood gases were also recorded in the same periods.ResultsSedation scores in the two groups were similar. At all study periods after the first postoperative hour, VRS remained below 5 in both groups. Pain scores were significantly lower in the background infusion group, which also had greater cumulative morphine consumption (61.7 ± 10.9 mg vs 38.5 ± 16.2 mg). There were no episodes of hypoxemia or hypertension.ConclusionMorphine PCA effectively controlled postoperative pain after cardiac surgery. The addition of a background infusion of morphine enhanced analgesia and increased morphine consumption.RésuméObjectifNous avons comparé les effets de l’analgésie autocontrôlée (AAC), avec ou sans une perfusion de morphine de base, sur l’analgésie postopératoire des patients extubés au bloc opératoire à la suite d’un pontage aortocoronalre.MéthodeSoixante adultes consentants devant subir une opération de pontage aortocoronalre réglée ont été recrutés dans notre étude après l’accord du Comité d’Éthique de la Faculté. Les patients ont reçu soit de la morphine en AAC seule (Groupe AAC-A, n = 30), soit de la morphine en AAC plus une perfusion de base continue (Groupe AAC-B, n =30) pendant 24 h après l’opération. La douleur au repos selon une échelle verbale analogique (score de 0 à 10), les scores de sédation, la consommation de morphine, ainsi que les niveaux sérlques de morphine à zéro, une, deux, quatre, six, 12 et 24 h après l’opération ont été évalués. Le bilan hémodynamique et les gaz du sang ont aussi été enregistrés durant la même période.RésultatsIl n’y avait pas de différence dans les scores de sédation entre les deux groupes. Après la première heure postopératoire l’échelle verbale analogique était en dessous de 5 dans les deux groupes. Les scores de douleurs étalent slgnlfcatlvement moins élevés dans le groupe perfusion de base; ce dernier groupe avait aussi une plus grande consommation cumulative de morphine (61,7 ± 10,9 mgvs38,5 ± 16,2 mg). Il n’y a pas eu d’épisode d’hypoxle ni d’hypertension.ConclusionLAAC avec la morphine réduit efficacement la douleur postopératoire en cardiochirurgie. L’ajout d’une perfusion de base de morphine améliore l’analgésie et augmente la consommation de morphine.

Remifentanil produces vasorelaxation in isolated rat thoracic aorta strips.

Background: Remifentanil can cause transient instability in hemodynamic variables. However this change may not be solely the result of autonomic or central nervous system inhibition or of centrally mediated vagal stimulation. In this study, the aim was to examine the direct effects of remifentanil on isolated thoracic aorta strips in vitro.

Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery

Background: Intrathecal (i.t.) administration of magnesium has been reported to potentiate opioid antinociception in rats and humans. In this prospective, randomized, double‐blind, study, we investigated the sensory, motor, and analgesic block characteristics of i.t. magnesium 50 mg compared with fentanyl 25 μg and saline when added to 0.5% bupivacaine (10 mg).

Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in boys

Background : In this study we compared caudal with intravenous (i.v.) tramadol given pre‐ or postoperatively for pain relief in boys having hypospadias repair.

Comparison of caudal ketamine with lidocaine or tramadol administration for postoperative analgesia of hypospadias surgery in children.

Background:  This study was designed to investigate whether the addition of tramadol or lidocaine to ketamine would enhance the quality of intra‐ and postoperative analgesia for hypospadias surgery in children.

The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children

Background: Our aim was to compare the effect of single dose caudal ketamine, alfentanil or a mixture of both drugs in the treatment of pain after hypospadias repair surgery in children.