Combined analgesics for postoperative pain therapy

Lange, Hans; Kranke, Peter; Steffen, Peter R. P.; Steinfeldt, Thorsten; Wulf, Hinnerk; Eberhart, Leopold

doi:10.1007/s00101-007-1232-7

Cited by 25 publications

(4 citation statements)

References 44 publications

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“…Transversus abdominis plane (TAP) block has emerged as a safe, reliable and efficient technique to provide post-operative analgesia for a range of abdominal procedures and has been shown to minimise the usage of opioids in the perioperative period. [ 1 2 3 4 5 ] The application of TAP block for post-operative pain management of abdominal wall hernias has not been explored in any clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: A comparative, randomised double-blind prospective study

et al. 2018

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Introduction:Transversus abdominis plane (TAP) block is now a well-established technique in post-operative analgesia for lower abdominal surgeries. We evaluated the effect of ultrasound-guided TAP block on recovery parameters in patients undergoing endoscopic repair of abdominal wall hernia.Methods:Thirty adults were randomised to receive either ropivacaine with dexmedetomidine (TR) or saline (TP) in TAP block, before emergence from anaesthesia. The patients were assessed for pain relief, sedation, time to ambulate (TA), discharge readiness (DR), postoperative opioid requirement and any adverse events.Results:The median visual analogue scale pain score of the study group (TR) and the control group (TP) showed a significant difference at all time points. TA was 5.3 ± 0.5 (TR) versus 7.4 ± 0.8 (TP), P < 0.001 and DR was 7.5 ± 0.9 (TR) versus 8.9 ± 0.6 (TP), P < 0.001 in hours. No adverse events were observed in any group.Conclusion:This study demonstrates that TAP block is a feasible option for pain relief following endoscopic repair of abdominal wall hernias. It produces markedly improved pain scores and promotes early ambulation leading to greater patient satisfaction and earlier discharge.

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Section: Introductionmentioning

confidence: 99%

Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: A comparative, randomised double-blind prospective study

et al. 2018

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“…Attitudes to use of fixed dose combinations of analgesics differ (Mehlisch, ; Murnion, ). For postoperative pain, combinations of paracetamol with NSAIDs have not been considered effective by some (Lange et al., ), while others show excellent efficacy (Moore et al., ). For migraine one combination of sumatriptan and naproxen has received regulatory approval (Brandes et al., ; Smith et al., ), and non‐prescription combinations are available for migraine and other headaches.…”

Section: Introductionmentioning

confidence: 99%

A conservative method of testing whether combination analgesics produce additive or synergistic effects using evidence from acute pain and migraine

Moore

Derry

et al. 2012

European Journal of Pain

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Fixed-dose combination analgesics are used widely, and available both on prescription and over-the-counter. Combination drugs should provide more analgesia than with any single drug in the combination, but there is no evidence in humans about whether oral combinations have just additive effects, or are synergistic or even subadditive. We suggest that the measured result for the combination would be the summation of the absolute benefit increase (effect of active drug minus effect of placebo) of each component of a combination if effects were (merely) additive, and greater than the sum of the absolute benefits if they were synergistic. We tested measured effects of combination analgesics against the sum of the absolute benefits in acute pain and migraine using meta-analysis where individual components and combinations were tested against placebo in the same trials, and verified the result with meta-analyses where individual components and combinations were tested against placebo in different trials. Results showed that expected numbers needed to treat (NNT) for additive effects were generally within the 95% confidence interval of measured NNTs. This was true for combinations of paracetamol plus ibuprofen and paracetamol plus opioids in acute pain, and naproxen plus sumatriptan in migraine, but not where efficacy was very low or very high, nor combinations of paracetamol plus dextropropoxyphene. There was no evidence of synergy, defined as supra-additive effects.

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“…This conclusion is consistent with many previous expert reviews that recommend the use of combination analgesics. [ 6 13 14 15 16 17 18 19 20 ] In a qualitative systematic review article that was performed by Ong et al . [ 4 ] twenty-one human studies enrolling 1909 patients were analyzed.…”

Section: Discussionmentioning

confidence: 99%

Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial)

2016

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Background:Therapeutic superiority of a combination of Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) over either drug alone remains controversial. We evaluated the efficiency of a combination of Paracetamol and Piroxicam versus each drug alone and also placebo in the management of postoperative pain, in patients who had undergone elective upper limb orthopedic surgery under general anesthesia.Materials and Methods:A total of 100 patients were randomly divided into four groups to receive either intravenous (IV) infusion of Paracetamol, 15 mg/kg., intramuscular (IM) injection of Piroxicam 0.4 mg/kg., their combination or placebo. The pain scores were recorded at the first; second, fourth, sixth, twelfth, and 24 hours after Post Anesthesia Care Unit (PACU) admission. After the operation 0.1 mg/kg of morphine was administered, if the patient needed.Result:The means of the pain scores were 5.26 ± 1.53, 4.09 ± 0.88, 4.36 ± 1.48, and 4.11 ± 1.29, in groups A, B, C, and D, respectively, (Group A: received placebo; Group B: received both Paracetamol and Piroxicam; Group C received Piroxicam; Group D received Paracetamol). Except for differences between the mean pain scores in Groups B and D, the other differences were statistically significant (P value < 0.05). No adverse effect was reported in the four groups.Conclusion:IV infusion of 15 mg/kg Paracetamol used as a preventive may provide effective analgesia in comparison with IM 0.4 mg/kg Piroxicam or placebo. Addition of Piroxicam to Paracetamol has not much more benefit than Paracetamol alone, in reducing pain after upper limb orthopedic surgery.

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Combined analgesics for postoperative pain therapy

Abstract: A combination of non-opioid analgesics, in particular NSAIDs with paracetamol, cannot be recommended at present due to the lack of data showing improved effectiveness.

Cited by 25 publications

References 44 publications

Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: A comparative, randomised double-blind prospective study

Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: A comparative, randomised double-blind prospective study

A conservative method of testing whether combination analgesics produce additive or synergistic effects using evidence from acute pain and migraine

Comparison between paracetamol, piroxicam, their combination, and placebo in postoperative pain management of upper limb orthopedic surgery (a randomized double blind clinical trial)

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