Effective Analgesia After Bilateral Tubal Ligation

Wittels, Bernard; Faure, Eveline A. M.; Chavez, Ronald; Moawad, Atef H.; Ismail, Mahmoud; Hibbard, Judith U.; Principe, David; Karl, Leah; Toledano, Alicia Y.

doi:10.1097/00000539-199809000-00024

Cited by 9 publications

(13 citation statements)

References 7 publications

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“…The localization of pain to the shoulder is due to the excitation of the diaphragm and phrenic nerve. The amount of gas used is directly proportional to the postoperative pain reported (Wittels et al, 1998). Aspiration of gas at the end of the case has been shown to decrease this pain.…”

Section: Laparoscopic Tubal Ligation Painmentioning

confidence: 99%

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The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

Pitcher¹

2001

PsycEXTRA Dataset

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Public reportino burden for tNs collection of information is estimated to average 1 hour per response, including the time for reviewing inslnictions, searching existing data sources, gathering and maintaining the date needed, and completing and reviewing the collection of information. Send comments regarding tNs burden estimate or any other aspect of tNs collection of information, including suggestions for reducing tNs burden, TITLE AND SUBTITLEThe effect of pre-emptive administration of dextromethorphan on postoperative pain in patients undergoing interval laparoscopic tubal sterilization AUTHOR(S)CPT Brian M. Pitcher PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)University Each year an estimated one million women elect to have surgical sterilization. This is performed by a laparoscopic procedure which can be severe enough to warrant an unplanned admission. With an increased understanding of the physiological basis of pain, classes of drugs not normally associated with pam reduction are now being investigated based on their ability to mteract with receptors in the pain pathway. Experimental studies have shown that the N-methyl-D-aspartate (NMDA) receptor plays a significant role in neuronal "wind-up", a state of hyperalgesia that can last from hours to days following injury or trauma.. Interfering with the NMDA receptor prior to surgical stimuli, wmd-up is prevented resuUing in decreased pain and analgesic requirements followmg surgery. Dextromethorphan, a readily available nonopioid antimssive in clinical use for more than 40 years, is one such NMDA receptor Anticosti. This prospective, randomized, double blind pilot study compared the effects over time when patients received dextromethorphan versus placebo-emptively. The sample was comprised of 14 subjects undergomg laparoscopic tubal ligation under general endotracheal anesthesia at regional military medical center for the Pacific Basin. Patients were ASA physical category I or II and at least 18 years of age and assigned to one of two groups. Group I received 60 mg of dextromethorphan orally, and Group II received an oral placebo. Postoperative pain was assessed using an 11 point Numeric Rating Scale (NRS) at eight time intervals. Additionally, a follow-up questionnaire and 48-hour postoperative telephone call were used to collect data on the patients' satisfaction of being in the study. The Student's t-test was used to determine homogeneity between the two groups. Following analysis, a statistically significant difference was found in two areas. Patients who received dextromethorphan 60 mg orally before surgery had a significant decrease m postoperative pain (p<0.04). The amount of Roxicet required postoperative was statistically less in the dextromethorphan group (p<0.02). The preoperative use of dextromethorphan may significantly decreased the amount of postoperative pain experienced with a resultant decrease in need for narcotic analgesics. This prospective, randomized, double blind pilot study compared the effects over time when patients received de...

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Section: Laparoscopic Tubal Ligation Painmentioning

confidence: 99%

“…A patient undergoing a diagnostic laparoscopic procedure has much less reported pain than those with a laparoscopic tubal ligation or cholecystectomy (Davis & Miller, 1988). No one drug has been found effective in controlling all forms of pain associated with laparoscopic procedures (Wittels et al, 1998).…”

Section: Laparoscopic Tubal Ligation Painmentioning

confidence: 99%

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

Pitcher¹

2001

PsycEXTRA Dataset

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“…Combining NSAIDs with a variety of other analgesia therapies such as local anesthetics, and opioids, as well as employing psychological support is referred to as balanced, or multimodal analgesia (Chung et al, 1997). A review of the Uterature revealed that taking a multimodal approach may be the most efficacious method in treating postoperative pain following laparoscopic tubal steriUzation (Alexander, 1997;Chung et al, 1997;Goldstein et al, 2000;Kelly et al, 1995;Wittels et al, 1998). Nonetheless, controversy exists in the literature concerning the optimal timing, route of administration, and combination of drugs, so further research is needed.…”

Section: Review Of Related Literaturementioning

confidence: 99%

“…Drug modalities for this type of pain vary in regard to the use of opioids, NSAIDs, antispasmodics, and local anesthetics. As previously stated, many anesthesia researchers recommend employing a multimodal analgesia approach in attenuating postoperative laparoscopic sterilization pain (Alexander, 1997;Chung et al, 1997;Goldstein, 2000;Kelly et al, 1995;Wittels et al, 1998).…”

Section: Pain From Tubal Sterilizationmentioning

confidence: 99%

“…Based on the current body of knowledge in the literature that includes the studies by Guard & Wiltshire (1996), Kelley et al (1994), and Van EE et al (1996), it is apparent there is presently no one single drug/modality that can appreciably preempt postoperative pain. A balanced or multimodal preemptive analgesia regimen appears to be the most pragmatic contemporary approach (Alexander, 1997;Chung et al, 1997;Kelly et al, 1995;& Wittels et al, 1998).…”

Section: Theoretical Framework Used To Guide Researchmentioning

confidence: 99%

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A Comparison of Postoperative Pain With Preemptive Administration of Intravenous Ketorolac Versus Oral Ibuprofen in Patients Undergoing Interval Laparoscopic Bilateral Tubal Sterilization

Harm¹,

Gibbons²

2000

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Public fepprting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing date sources, gathering Bird maintaining the data needed, and comp'eting end reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of iniormfltion, including suggestions for reducing this burden, to WasNngton Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arfington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. AGENCY USE ONLY (Leave blank)2. REPORT DATE October 2000 REPORT TYPE AND DATES COVEREDOctober 1999 -September 2000 TITLE AND SUBTITLEA comparison of postoperative pain with reemptive administration of intravenous ketorolac versus oral ibuprofen in patients undergoing interval lapatoscopic bilateral tubal sterilization AUTHDRIS)CPT Patricia S. Harm CPT Michael T. Gibbons FUNDING NUMBERS PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)University A major goal of anesthesia practitioners is to provide a comfortable and expedient recovery from the effects of surgery and anesthesia. This includes the challenge fostered by managed-care of facilitating earlier discharges while also managing postoperative pain. Moreover, consumer knowledge and techological advances are pressing the health care community to seek higher levels of patient satisfaction and cost containment. Elective surgery patients are acquirmg greater expectations regarding the perioperative care they receive, which includes absence of recall, minmial pain or discomfort, and absence of nausea following surgery. Each year over 10 million women m the United States alone elect to have surgical sterilization. This is usuall accomplished laparoscopically despite the problems of post-laparoscopic pain, which ca|Ebe servre enough to warrant an unplanned admission. Ketorolac and ibuprofen have both been studied in this patient popAion when given preemptively with mixed results; presently there is no conclusive evidence as to which drug is mor^fpfective. This prospective, randomized, double-blind clinic trial compared the effects over time when these patie|i received ketorolac or ibuprofen preemptively. The sam was comprised of 44 subjects undergoing laparoscopic tubal ligaibn under general endotracheal anesthesia at a regional military medical center for the Pacific Rim. The patients were either ASA category I or II and at least 18 years of age assigned to one of two treatment groups. Group I received 800 mg ibuprofen orally and a 1 ml saline placebo intravenously; conversely. Group II received an oral placebo and ketorolac 30 mg intravenously. Postoperative pain was assessed using an 11 point Numeric Rating Scale (NRS) at seven time intervals. A major goal of anesthesia practitioners is to provide a comfortable and expedient recovery from the effects of surgery and anesthesia....

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Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

et al. 2004

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Living liver donors for adult liver transplant recipients undergo extensive liver resection. Partial donor hepatectomies may alter postoperative drug metabolism and hemostasis; thus, the risks and the benefits of pain management for this unique patient population may need to be reassessed. The safety and efficacy of combined epidural analgesia and field infiltration in our initial living liver donor group are presented. A thoracic epidural catheter was placed before general anesthesia in 2 female and 6 male donors (44.2 ؎ 11.3 years old, mean ؎ standard deviation [SD], range 26 -56). At the end of surgery, incisions were infiltrated (bupivacaine 0.25%), and an epidural infusion was used (bupivacaine 0.1% ؉ hydromorphone hydrochloride 0.02%). Clinical outcomes were followed for 5 days. The time sequence of pain intensity on a 0 -10 visual analog scale clustered into 3 phases, the intensity of which differed significantly from each other (2.2 ؎ 0.6, 0.69 ؎ 0.2, and 2.37 ؎ 0.3 respectively, P ‫؍‬ 0.028). Right shoulder pain was observed in 75% of the donors. Sedation, pruritus, and nausea were minimal. Consistently maximal international normalized ratio elevation occurred at 17.6 ؎ 7 hours postoperatively, then slowly declined. Platelet counts were lowest on day 3. No neurologic injury or local anesthetic toxicity was observed. This 2-site approach provided effective, safe, postoperative analgesia for our donors. Universally, coagulopathy ensued, indicating a potentially increased risk for epidural hemorrhage at epidural catheter removal and mandating close postoperative neurologic and laboratory monitoring. Research is needed to advance the understanding of postoperative coagulopathy and hepatic dysfunction in these donors to further optimize their perioperative management, including that of analgesia. (Liver Transpl 2004;10:363-368.) M inimization of perioperative pain enhances many surgical outcomes, 1 and safe, effective postoperative pain management is a clinical goal, an ethical mandate, and a standard of the Joint Commission on Accreditation of Healthcare Organizations. 2 Large liver resections may result in transient metabolic impairment [3][4][5][6] and temporary disturbances in hemostasis. 3,4,[7][8][9][10][11] Hence, development of an optimal perioperative pain management strategy for donors is a complex clinical challenge. Although epidural pain management has been recommended, 12 and used successfully in living liver donor surgery, 8,9,12 a systematic assessment of its efficacy and safety in living donors for adult liver transplantation, who typically donate approximately 60% of their liver, 13,14 is not available.Reports in operations other than liver donation suggest that epidural pain management, in combination with local anesthetic field infiltration, offers effective, opioid-sparing analgesia [15][16][17] as an alternative to systemic opioids with their potential hepatotoxicity 18,19 and risk of sedation. In the current case series, we evaluated the efficacy and safety of this 2-site approach and ...

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Effective Analgesia After Bilateral Tubal Ligation

Cited by 9 publications

References 7 publications

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

A Comparison of Postoperative Pain With Preemptive Administration of Intravenous Ketorolac Versus Oral Ibuprofen in Patients Undergoing Interval Laparoscopic Bilateral Tubal Sterilization

Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

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