Meltem Uyar

Analysis of the antinociceptive effect of systemic administration of tramadol and dexmedetomidine combination on rat models of acute and neuropathic pain

The aim of the present study was to investigate the possible antinociceptive effect of systemic administration of tramadol and dexmedetomidine either alone or in combination on acute and neuropathic pain models in rats. The antinociceptive effects of intraperitoneal (i.p.) tramadol (5-20 mg/kg) and dexmedetomidine (5-20 microg/kg) and three different combinations of tramadol+dexmedetomidine (5+5, 5+10 and 10+5, mg/kg+microg/kg, respectively) were measured by tail-flick and hot-plate methods in acute pain. The effects on the sciatic nerve ligation-induced neuropathic pain was tested by i.p. administration of tramadol (5 mg/kg), dexmedetomidine (5 microg/kg) and tramadol+dexmedetomidine combination (5+5) using a thermal plantar test. Sedation/motor-incoordination was assessed on rotarod. Tramadol and dexmedetomidine produced dose-related antinociception in tail-flick and hot-plate tests. In both tests, combination of these drugs produced an antinociceptive effect that is greater than that produced by tramadol or dexmedetomidine alone at several time points. In hot-plate test, tramadol+dexmedetomidine combination (5+10) exerted the strongest antinociceptive effect, while tramadol+dexmedetomidine combination (10+5) was significantly most effective in tail-flick test. In the neuropathic pain, the antinociceptive effect exerted by tramadol+dexmedetomidine combination (5+5) was also significantly greater than their applications alone. In rotarod test, tramadol (30 and 40 mg/kg), dexmedetomidine (30 and 40 microg/kg), tramadol+dexmedetomidine combination (10+10, 20+20) produced sedation/motor-incoordination, whereas tramadol (5-20 mg/kg), dexmedetomidine (5-20 microg/kg) and tramadol+dexmedetomidine combination (5+5, 5+10 and 10+5) did not produce any effect on sedation/motor-incoordination. The combination of tramadol and dexmedetomidine was more effective in increasing the pain threshold in acute and neuropathic pain when compared with the administration of either of these drugs alone.

The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for Caesarean section

Background and objective: The quality of spinal anaesthesia, often used for Caesarean section, can be improved by adding an opioid to the local anaesthetic. This study compared the quality of anaesthesia, postoperative analgesia, and adverse effects on mother and neonate when either sufentanil 5 μg or morphine 0.2 mg was added to intrathecal hyperbaric bupivacaine for Caesarean section. Methods: This prospective, randomized and double‐blind study encompassed 54 females undergoing Caesarean section. Spinal anaesthesia was obtained with 2 mL of 0.5% bupivacaine supplemented with either 0.2 mg morphine or 5 μg sufentanil. Characteristics of spinal block, intraoperative analgesia, maternal and neonatal side‐effects and the time to first request for analgesics were assessed. Results: There were no differences in the onset time of sensory block, time to sensory block to T10, time to highest sensory block, highest sensory block level, time to regression of sensory block to T10 level and time to resolution of motor blockade. Perioperative haemodynamic parameters, neonatal Apgar scores, neurological and adaptive capacity scores, umbilical blood gas values, sedation scores, nausea–vomiting and pruritus incidences were similar in both groups. The time to the first request for an analgesic was significantly longer (19.5 ± 4.7 h vs. 6.3 ± 5.2 h) in patients given morphine (P < 0.05). Conclusions: The addition of 5 μg sufentanil or 0.2 mg morphine to hyperbaric bupivacaine for Caesarean section both provided safe and effective anaesthesia. Morphine increased the duration of postoperative analgesia compared with sufentanil without increasing maternal or neonatal side‐effects.

The antinociceptive effect of tramadol on a model of neuropathic pain in rats.

The antinociceptive activity of tramadol was investigated on the vocalization threshold to paw pressure in a rat model of unilateral mononeuropathy produced by loose ligatures around the common sciatic nerve. Despite the analgesic activity of tramadol was clearly established in motor and sensory responses of the nociceptive system in rats, the effect of this atypical opioid on experimental neuropathic pain models is not investigated. The intraperitoneally injected tramadol (2.5, 5 and 10 mg/kg) produced a potent and dose-dependent antinociceptive effect on both lesioned and non-lesioned hind paws. However, the analgesic effect on the lesioned paw was significantly more potent than the non-lesioned paw. This effect was partially antagonized by intraperitoneally administered naloxone (0.1 mg/kg) suggesting an additional non-opioid mechanism. Our results suggest that tramadol may be useful for the alleviation of some symptoms in peripheral neuropathic conditions

Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study.

ObjectiveChronic shoulder pain treatment is known to be a difficult and long process. The objective of this study is to compare the efficacy of intra-articular corticosteroid injection and pulse radiofrequency (PRF) applied to the suprascapular nerve in patients with shoulder pain. MethodsFifty patients with shoulder pain were included in the study. Patients were randomly allocated into group 1 (intra-articular injection of corticosteroid) and group 2 (PRF to the suprascapular nerve). Outcome measures included a pain scale (visual analog scale; VAS), range of motion, Shoulder Pain and Disability Index (SPADI), the Short Form-36, Beck Depression Scale questionnaires, and paracetamol consumption. ResultsIn both groups, significant improvement was observed in all weeks in VAS, range of motion (active-passive), and SPADI subscores (P<0.05). Improvement was detected in most of the Short Form-36 scores at the end of the treatment in both groups (P<0.05), whereas no significant change was observed in Beck Depression Inventory score (P>0.05). When the groups were compared, a significant difference was found between the groups in favor of group 1 in terms of VAS at night in weeks 1, 4, and 12; VAS at rest in weeks 1 and 4; and VAS during movement in week 1 (P<0.05). There was also a significant difference in favor of group 1 observed in weeks 1, 4, and 12 in SPADI pain and total subscores (P<0.05). Paracetamol consumption was observed to be lower in group 1 (P<0.05). ConclusionsIntra-articular injection of corticosteroid and PRF applied to the suprascapular nerve are effective in the treatment of painful shoulder. When 2 treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain than the PRF. Further studies are needed to confirm these results in the prospective treatment guidelines.

Intrathecal morphine : Effects on perioperative hemodynamics, postoperative analgesia, and stress response for total abdominal hysterectomy

Intrathecal opioids provide postoperative analgesia and hemodynamic stability by depressing the neuroendocrine response during the perioperative period. The effects of preoperative intrathecal morphine on perioperative hemodynamics, stress response, and postoperative analgesia were evaluated in patients undergoing abdominal hysterectomy with general anesthesia. A total of 24 patients were randomly assigned to the morphine group (n=12) or the control group (n=12). Patients in the morphine group were given intrathecal 5 μg/kg−1 morphine before surgery. In all patients, general anesthesia was induced with 1 g/kg−1 remifentanil, 2 mg/kg−1 propofol, and 0.1 mg/kg−1 vecuronium and was maintained with 1% to 2% sevoflurane—35% oxygen in N2O and remifentanil infusion. All patients received intravenous morphine patient-controlled analgesia after surgery. Postoperative pain was evaluated by means of a visual analogue scale. Blood samples were taken at 4 time points before and up to 4 hours after the start of surgery for assessment of plasma epinephrine, norepinephrine, and glucose. Mean arterial pressure (MAP), heart rate (HR), and adverse effects were recorded. Intraoperative hemodynamics was similar in both groups, but postoperative HR and MAP values at 4 h, 8 h, 12 h, and 20 h were significantly lower in the morphine group (P < .05). Postoperative VAS scores, total morphine consumption, and plasma epinephrine, norepinephrine, and glucose levels were significantly lower in the morphine group than in the control group (P < .05). Preoperative intrathecal morphine enhanced the quality of postoperative analgesia, decreased morphine consumption, and depressed the systemic stress response in patients undergoing total abdominal hysterectomy with general anesthesia.

The Effect of Pre-operative Lornoxicam and Ketoprofen Application on the Morphine Consumption of Post-operative Patient-controlled Analgesia

We compared the efficacy of preoperative intramuscular lornoxicam and ketoprofen for post-operative analgesia in patients undergoing abdominal hysterectomy. This randomized, double-blind, placebo-controlled, parallel-group study investigated 60 patients who received lornoxicam (group L, 8 mg), ketoprofen (group K, 100 mg) or saline (group C) 60 min before standard anaesthesia. All patients received patient-controlled analgesia (intravenous morphine) during the post-operative period. Visual analogue scale (VAS) scores recorded 2, 4, 6 and 12 h after surgery in groups L and K patients were significantly lower than in group C patients, and VAS scores at 2, 4 and 6 h in group L patients were significantly lower than those in group K patients. Morphine consumption in groups L and K was significantly lower than in group C. Pre-emptive administration of lornoxicam and ketoprofen effectively reduced post-operative pain and morphine consumption, and lornoxicam was more effective than ketoprofen in the early post-operative period.

Hopelessness in Turkish cancer inpatients: the relation of hopelessness with psychological and disease-related outcomes.

The purpose of this study was to investigate the hopelessness level and the relationship of depression, anxiety and disease-related factors to the presence of hopelessness among Turkish patients with cancer. Ninety-five patients hospitalized for cancer treatments were recruited for current study. Data were collected by using a demographic questionnaire, the Pain Numeric Rating Scale, the Beck Hopelessness Scale, and the Hospital Anxiety Depression Scale. The mean hopelessness score was 5.20+/-4.39. There were significant differences in terms of hopelessness between the patients who had metastasis and pain as compared with those without metastasis and pain (p<0.05). There were also found that significant correlation between hopelessness and depression and between hopelessness and anxiety (r=0.721; r=0.645, respectively, p<0.001). Foreword stepwise multiple regression analysis revealed that the independent predictors of hopelessness were depression score and thr presence of metastasis (F=55.133; p<0.001). The findings suggest that levels of hopelessness among cancer patients with pain and metastasis are higher than among those without pain and metastasis, and that the severity of pain, anxiety, and depression is positively correlated with hopelessness level. The assessment of hopelessness, pain, anxiety and depression levels of the patients with cancer should be an essential part of health care practice. Therefore, when arranging care assessment, to evaluate hopelessness could help professionals to appropriately refer patients to further psychological care resources.

The effect of music therapy on pain and anxiety in intensive care patients

In recent years, intensive care units have been using advanced technology that provides significantly improved results in clinical treatment and care practices. However, this results in intensive care patients experiencing pain and anxiety. This pain and anxiety is generally brought under control with various pharmacological preparations. When a pharmacological approach is not used or is ineffective, doctors and nurses also use non-pharmacological approaches such as music to control pain and anxiety. Research has found music therapy to be an effective method of reducing pain intensity and anxiety levels in intensive care patients. Therefore, the use of music therapy is important for intensive care patients. This article will deal with the effects of music therapy on pain and anxiety management in intensive care patients.

The Efficacy of Intrathecal Morphine in Post-thoracotomy Pain Management

This study compared the analgesic efficacy of intrathecal (IT) morphine plus IV patient-controlled analgesia (PCA) morphine with IV PCA morphine alone in 33 patients undergoing thoracotomy randomized to two groups: the IT morphine group (n = 17) received 10 μg/kg morphine 1 h before the end of surgery, while the control group (n = 16) did not. All patients had access to an IV PCA pump post-operatively that delivered 2 mg morphine boluses. Post-operative pain and sedation scores, respiratory and haemodynamic parameters, and morphine demand and delivery were assessed up to 48 h. Post-operative pain scores and morphine consumption were significantly reduced, while peak expiratory flow rates were significantly increased in the IT morphine group compared with controls. We concluded that IT morphine in addition to IV PCA established superior analgesia and maintained better respiratory function compared with IV PCA alone in post-thoracotomy patients.

Effects of ropivacaine on pain after laparoscopic cholecystectomy: A prospective, randomized study

Postoperative pain after laparoscopic cholecystectomy is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. In this prospective, singleblinded, randomized study, 45 patients with ASA (American Society of Anesthesiologists) scores I and II who were about to undergo laparoscopic cholecystectomy were divided into 3 groups. After cholecystectomy, a total of 40 mL of 3.75% ropivacaine was administered preincisionally and intraperitoneally to patients in group 1 (n=14); preincisionally and intraperitoneally to patients in group 2 (n=17); and intraperitoneally and locally at incision sites to patients in group 3 (n=14). Blood levels of epinephrine and norepinephrine were examined preoperatively, 15 min after insufflation, and at the end of the operation. Visual analog pain scale scores and analgesic requirements were used for 24-h postoperative follow-up of pain levels reported by patients. No statistically significant difference was found among the 3 groups with respect to visual analog pain scale scores, total analgesic requirements, and accompanying pain, nausea, and vomiting. The earliest analgesic requirements were seen in group 2 (P < .005), and less shoulder pain was noted in group 3 (P < .005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.