Effect of preoperative rectal indomethacin on postoperative pain reduction after open appendectomy

Jangjoo, Ali; Bahar, Mostafa Mehrabi; Soltani, Ehsan

doi:10.5055/jom.2010.0006

Cited by 5 publications

(4 citation statements)

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“…The greatest impact on postoperative morphine PCA consumption was associated with the intraoperative administration of diclofenac with statistically significant lower pain scores for the first 12 hours, however again this may be of limited clinical significance given that the difference in mean pain scores was only 0.5 out of 10 (Figure 3). Others have also reported a benefit with NSAIDs after appendicectomy (12,13,14). Our morphine PCA consumption in the first 24 hours is comparable to that of Lambert et al (15) whose patients all received regular NSAID and used an average of 480 µg•kg -1…”

Section: Author Manuscriptsupporting

confidence: 81%

An audit of patient‐controlled analgesia after appendicectomy in children

Ousley

Burgoyne

Crowley

et al. 2016

Pediatric Anesthesia

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Section: Author Manuscriptsupporting

confidence: 81%

An audit of patient‐controlled analgesia after appendicectomy in children

Ousley

Burgoyne

Crowley

et al. 2016

Pediatric Anesthesia

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“…55 Preappendectomy NSAID administration has been demonstrated safe and opiate sparing. 56 Multimodal analgesia, using acetaminophen, NSAIDs, and opiates, 54 and scheduled as opposed to as needed administration, have been shown to optimize analgesia effectiveness. 57 Therefore, a scheduled oral or parenteral NSAID, as was used in a few trials, 6,22,29 and/or acetaminophen, and as needed opiates to control pain while treating with antibiotics can be expected to optimize pain control and limit unnecessary opiate use.…”

Section: Discussionmentioning

confidence: 99%

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

Talan

Saltzman

DeUgarte

et al. 2019

J Trauma Acute Care Surg

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BACKGROUND Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist. METHODS PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Thirty-four studies involving 2,944 antibiotic-treated participants were identified. The greatest experience with conservative treatment is in persons 5 to 50 years of age. In most trials, imaging was used to confirm localized appendicitis without evidence of abscess, phlegmon, or tumor. Antibiotics regimens were generally consistent with intra-abdominal infection treatment guidelines and used for a total of 7 to 10 days. Approaches ranged from 3-day hospitalization on parenteral agents to same-day hospital or ED discharge of stable patients with outpatient oral antibiotics. Minimum time allowed before response was evaluated varied from 8 to 72 hours. Although pain was a common criterion for nonresponse and appendectomy, analgesic regimens were poorly described. Trials differed in use of other response indicators, that is, white blood cell count, C-reactive protein, and reimaging. Diet ranged from restriction for 48 hours to as tolerated. Initial response rates were generally greater than 90% and most participants improved by 24 to 48 hours, with no related severe sepsis or deaths. In most studies, appendectomy was recommended for recurrence; however, in several, patients had antibiotic retreatment with success. CONCLUSION While further investigation of conservative treatment is ongoing, patients considering this approach should be advised and managed according to study methods and related guidelines to promote informed shared decision-making and optimize their chance of similar outcomes as described in published trials. Future studies that address biases associated with enrollment and response evaluation, employ best-practice pain control and antibiotic selection, better define cancer risk, and explore longer time thresholds for response, minimized diet restriction and hospital stays, and antibiotic re-treatment will further our understanding of the potential effectiveness of conservative management. LEVEL OF EVIDENCE Systematic review, level II.

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“…Jangjoo et al 's randomised trial demonstrated significantly reduced pain scores and opioid consumption while comparing preoperative rectal indomethacin (100 mg) application versus placebo in adult patients undergoing open appendicectomies 108 . The use of adequate baseline analgesia was not described.…”

Section: Regional Analgesia Techniquesmentioning

confidence: 99%

Perioperative pain management for appendicectomy

Freys,

Bigalke,

Mertes

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).

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Effect of preoperative rectal indomethacin on postoperative pain reduction after open appendectomy

Cited by 5 publications

References 0 publications

An audit of patient‐controlled analgesia after appendicectomy in children

An audit of patient‐controlled analgesia after appendicectomy in children

Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review

Perioperative pain management for appendicectomy

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