Evaluation of pain scoring and free cortisol levels of postoperative analgesic methods in cardiac surgery: A new perspective

Özmen, Özgür; Özçeli̇k, Fatih; Kayğın, Mehmet Ali; Yılmaz, Habip; Karakaya, Muhammet Ahmet

doi:10.5606/tgkdc.dergisi.2019.15143

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…The current study reveals increased serum cortisol at one week in the participants with better pain control. This finding aligns with a study conducted by Özmen et al, who reported lower free serum cortisol levels in patients who achieved better pain control after cardiac surgery [ 29 ]. In contrast to stress hormones, the level of D-dimer was found to be comparable in both groups.…”

Section: Discussionsupporting

confidence: 92%

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial

Jain,

Pandey,

Sonakar

et al. 2024

Cureus

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Background: Lower limb trauma in emergency settings often leads to pain management challenges. Traditional methods, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, have limitations. This study explores the efficacy of epidural analgesia in emergency for lower limb trauma patients (ELETRA) as an alternative for managing pain in lower limb trauma patients upon arrival in emergency care. Objectives: This study primarily focuses on determining ELETRA's effectiveness in reducing pain for patients with lower limb trauma upon arrival. It also aims to evaluate ELETRA's influence on decreasing stress and shortening hospital stays compared to traditional pain management approaches. Methods: This study was executed as a prospective, parallel-design, randomized controlled trial in the emergency department of a tertiary care teaching hospital. The interventions were performed in a dedicated induction room adjacent to the emergency operating theater. The trial was registered in the Clinical Trial Registry of India with registration number CTRI/2022/08/044699 dated 16/08/2022. Participants were 18- to 50-year-old patients with lower limb injuries, classified under American Society of Anesthesiologists (ASA) class 1 or 2. Participants were randomized into two groups: one receiving ELETRA and the other standard pain control treatment. The effectiveness of pain relief was measured through a visual analog scale (VAS), and hemodynamic parameters, adverse effects, levels of acute phase reactants, and stress hormones were also measured along with patient satisfaction. Results: The study enrolled 356 participants with lower limb injuries. After excluding participants lost following the intervention, data from 157 individuals in Group A and 160 in Group B were analyzed. Group A's success rate for analgesia (VAS < 2) was 92.35% (n = 145), significantly higher than Group B's 75.62% (n = 121) (p < 0.001). The commonest side effect was hypotension (5.73%) in Group A and nausea in Group B (7.5%). C-reactive protein (CRP) levels rose to 104.71 ± 8.99 mg/dL in Group A and 192.58 ± 9.23 mg/dL in Group B; the difference was statistically significant. Serum cortisol levels were also higher in Group B (67.18 ± 9.21) compared to Group A (44.72 ± 6.14) at one week. Group B had a longer hospital stay, averaging 12.24 ± 4.81 days, against Group A's 10.19 ± 4.91 days. Conclusion: ELETRA is a safe and effective alternative for pain management in lower limb trauma patients in emergency settings. It reduces pain, improves patient satisfaction, and has a favorable impact on stress responses.

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Section: Discussionsupporting

confidence: 92%

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial

Jain,

Pandey,

Sonakar

et al. 2024

Cureus

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“…Moreover, the study of Özmen et al (21) showed that there were no statistically significant differences between the groups in terms of the length of hospital stay with a (p-value of >0.05).…”

Section: Discussionmentioning

confidence: 92%

Major in Hospital Complications and Duration of Hospital Stay in a Comparative Study between a Multimodal Analgesia Regimen Versus IV Morphine Analgesia after Open-Cardiac Surgeries

Elwafa

Rahman

Abdelfattah

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Pain after surgery decreases the quality of life and has also been reported as being the main source of concern for cardiac surgery patients. It was stated that patients with higher anxiety and depression levels after operation have higher requirements of analgesics for postoperative pain. Reduction of pain and anxiety after cardiac surgery is valuable for the healing process and improvement of the overall experience. Objective: To determine if the multimodal regimen of dexamethasone, gabapentin, ibuprofen, ketorolac, and paracetamol was with less complications following open-cardiac surgeries compared to IV morphine. Patients and Methods: Sixty patients were scheduled for sternotomy elective open-heart surgeries. The patients were randomized to one of two groups (ratio 1:1) utilizing sealed envelopes by the study coordinator.30 patients in each group. This prospective, randomized, and a controlled clinical trial was performed at Sohag University Hospital. Results: Patients in the multimodal group suffered fewer major in-hospital complications than in the morphine group. Acute coronary syndrome had occurred in (one versus zero) patients with a percentage of (3.3%) in the morphine group. Cardiac tamponade had occurred in (two versus one) patients with a percentage of (6.7%) in the morphine group and was with a percentage of (3.3%) in the multimodal group with (p-value) of (0.554). The duration of hospital stays was with M± SD of (7±1.72) days among the multimodal group versus (11±1.6) days in the morphine group, with (a p-value) of (<0.001). Conclusions: Patients in the multimodal group suffered less major in-hospital complications than in the morphine group after cardiac surgeries.

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“…In the afternoon, the elevated cortisol levels returned earlier to the initial values. In another study, Özmen et al (25) compared the cortisol levels in postoperative analgesia using the local anesthetics (Bupivacaine) and the central opiate administration (Fentanyl). Results were more favourable for the local anesthetics, the patients had lower cortisol levels and reported less postoperative pain than with the centrally administered opiates.…”

Section: U N C O R R E C T E Dmentioning

confidence: 99%

Postoperative pain management in geriatric patients after cholecystectomy and studies of glycemia and cortisol levels

KNEPPOVA¹,

KRALIKOVA²,

CAMBAL³

et al. 2022

BLL

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OBJECTIVE: The purpose of the study was to follow up the cortisol levels in relation to the postoperative pain intensity, its levels after treatment with opiate and non-opiate analgesics, and to monitor the relationship between the blood glucose and cortisol levels. Another goal was to optimize the postoperative analgesia of geriatric patients with the known combinations of analgesics. METHODS: The cohort comprised 28 geriatric patients undergoing laparoscopic cholecystectomy. The patients were divided according to the intensity of postoperative pain into the groups with opiate and nonopiate analgesia. Furthermore, they were divided according to their physical condition (ASA classifi cation) into two groups, ASA 2 and ASA 3. We evaluated three values of blood glucose levels, on the day before surgery, on the operative and the fi rst postoperative days and those of cortisol on the day of surgery. RESULTS: The patients had the blood glucose levels without signifi cant deviation during the three days of measurements. The cortisol levels increased with the intensity of postoperative pain. High levels of cortisol were observed not only in the patients, who experienced acute pain after non-optimal postoperative analgesia, but also in those treated with strong opiates in the immediate postoperative period. The patients with mild pain intensity, treated with a combination of non-opiate analgesics, had the lowest values. The role of the patient's gender in both blood glucose and cortisol levels was not observed. CONCLUSION: The cortisol levels have not corresponded so much with the assessment of acute postoperative pain as with the stress that was evoked in the patient due to hospitalization and fear of surgery. It is crucial to eliminate as much as possible all the stressors that can affect the cortisol levels and thus the blood glucose levels (Fig. 6, Ref. 25).

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Evaluation of pain scoring and free cortisol levels of postoperative analgesic methods in cardiac surgery: A new perspective

Cited by 7 publications

References 24 publications

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial

Major in Hospital Complications and Duration of Hospital Stay in a Comparative Study between a Multimodal Analgesia Regimen Versus IV Morphine Analgesia after Open-Cardiac Surgeries

Postoperative pain management in geriatric patients after cholecystectomy and studies of glycemia and cortisol levels

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