Postoperative Intravenous Patient-Controlled Analgesia in Thyroid Surgery: Comparison of Fentanyl and Ondansetron Regimens With and Without the Nonsteriodal Anti-Inflammatory Drug Ketorolac

Kim, So Yeon; Kim, Eun Mi; Nam, Kee‐Hyun; Chang, Dong Jin; Nam, Sun Ho; Kim, Ki Jun

doi:10.1089/thy.2008.0007

Cited by 32 publications

(28 citation statements)

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“…For the management of postoperative pain following throidectomy, NSAIDs and/or opioid analgesics are used commonly in practice. To decrease the postoperative pain and reduce the need for analgesics following thyroidectomy surgery, preoperative oral controlled-release analgesia with opioids and alternative regional techniques such as incisional local anesthesia, intraoperative bilateral superficial and/or deep cervical plexus block, local wound infiltration with local analgesia have also been suggested recently (20,21,23,(27)(28)(29). Performing thyroidectomy under local or regional anesthesia rather than general anesthesia has also been suggested to control postoperative pain (30).…”

Section: Discussionmentioning

confidence: 99%

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

Dumlu¹,

Tokaç²,

Öcal³

et al. 2016

UCD

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Objective: We aimed to evaluate the effect of bupivacaine and to compare the routes of administration of bupivacaine in the management of postoperative incision site pain after thyroidectomy. Material and Methods:Consecutive patients who were planned for thyroidectomy surgery were randomized into three groups of 30 patients each: Group 1 (control group): standard thyroidectomy surgery without additional intervention; Group 2 (paratracheal infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was applied on the surgical area; Group 3 (subcutaneous infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was injected into the cutaneous, subcutaneous region and fascia of the surgical area. Postoperative pain was evaluated by a visual analog scale (VAS) at 1 st , 4 th , and 12 th hours after thyroidectomy. Total daily requirement for additional analgesia was recorded. Results:The mean age of 90 patients was 44.37±13.42 years, and the female:male ratio was 62:28. There was no difference between study groups in terms of age, thyroid volume, TSH and T4 levels. VAS score of patients in paratracheal infiltration with bupivacaine group was significantly lower than control group patients at 1 st , 4 th and 12 th hours following thyroidectomy (p=0.030, p=0.033, p=0.039, respectively). The need for analgesics was significantly lower in both paratracheal infiltration and subcutaneous infiltration groups than the control group (86.7%, 83.0%, and 73.3%, respectively, p=0.049). Conclusions:Intraoperative local bupivacaine application is effective in decreasing postoperative pain in patients with thyroidectomy.

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Section: Discussionmentioning

confidence: 99%

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

Dumlu¹,

Tokaç²,

Öcal³

et al. 2016

UCD

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“…In performing PCA, the side effects of opioid analgesics such as hypoventilation, drowsiness, nausea, vomiting, and pruritus act as limiting factors. Numerous studies have been conducted to obtain effective analgesic effects while reducing such side effects [8-10,12,21]. …”

Section: Discussionmentioning

confidence: 99%

“…Picard et al [11] have reported that the co-administration of morphine and ketorolac results in superior analgesic effects by up to to 2.6 times compared with those of the drugs administered alone. In addition, Kim et al [12] reported that the addition of ketorolac to fentanyl resulted in the same analgesic efficacy but less nausea, vomiting and drowsiness. Studies on the combined administration of hydromorphone and ketorolac have not previously been conducted.…”

Section: Discussionmentioning

confidence: 99%

“…Its mechanism of action is the suppression of prostaglandin synthesis unrelated to opioid agents, and thus the use of ketorolac may facilitate return of gastrointestinal function, reduce nausea, decrease respiratory depression, and improve patient satisfaction [9]. When ketorolac is used in combination with opioid agents, it exerts opioid-sparing effects and improves analgesic action, and it is also used frequently in combination with opioid analgesics in IV-PCA [10-12]. Studies on the combined administration of hydromorphone and ketorolac have not previously been conducted.…”

Section: Introductionmentioning

confidence: 99%

“…Studies on the combined administration of hydromorphone and ketorolac have not previously been conducted. Therefore, in this study, by referring to the results of the supplemental administration of ketorolac from several previous studies [9-12], hydromorphone and ketorolac were added to the basic IV-PCA.…”

Section: Introductionmentioning

confidence: 99%

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Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

Min

Kim

Jeong

et al. 2012

Korean J Anesthesiol

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BackgroundNuss surgery is preferred in pectus excavatum repair because this procedure produces excellent cosmetic results and prevents postoperative distressed pulmonary function. However, the procedure causes severe pain due to thoracic expansion. This study was designed to investigate the analgesic effect of small doses of ketamine on an intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and ketorolac for pain control after Nuss surgery.MethodsForty-four patients undergoing elective Nuss surgery were randomly assigned to receive hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron 0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 µg/kg/hr, ketorolac 0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group HK, n = 22) via an IV-PCA pump after surgery. A blind observer evaluated each patient using the Modified Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for the assessment of pain control. The total administered PCA volume, side effects and parents satisfaction with pain control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours.ResultsThere were no significant differences in Modified CHEOPS between the groups during postoperative 48 hours. The total PCA volume in group HK was significantly lower than that in group HO (P < 0.05). The side effects in both groups did not significantly differ except for pruritus. The levels of satisfaction from the parents were not significantly different between the groups.ConclusionsA small dose of ketamine on IV-PCA reduced the total administered dose of IV-PCA with hydromorphone and ketorolac and reduced the incidence of pruritus after the Nuss procedure in pediatric patients.

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Multimodal Analgesia in Outpatient Head and Neck Surgery

Oltman

Militsakh

D’Agostino

et al. 2017

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Perioperative analgesia strategies that rely solely on narcotics may contribute to adverse effects and concerns about opioid abuse or dependence. Multimodal analgesia protocols incorporating nonnarcotic agents may reduce the need for postoperative narcotic use.OBJECTIVE To evaluate the feasibility and safety of a multimodal analgesia protocol for outpatient head and neck surgical procedures and to identify the association of the multimodal analgesia protocol with postoperative pain perception scores and patient satisfaction. DESIGN, SETTING, AND PARTICIPANTSRetrospective evaluation of prospectively collected data on adults who underwent outpatient thyroid, parathyroid, and parotid surgery between July 2016 and February 2017 at the head and neck surgery service of a tertiary care hospital using a multimodal analgesia strategy with use of immediate preoperative acetaminophen and gabapentin, and intention to treat with a nonnarcotic postoperative outpatient analgesia strategy. MAIN OUTCOMES AND MEASURESOverall patient satisfaction scores, Overall Benefit of Analgesia Score (OBAS), and median resting and peak pain scores were recorded. Incidence of reliance on a narcotic-based postoperative outpatient analgesia strategy and adverse events related to altered analgesia strategy were identified.RESULTS Sixty-four patients (48 [75%] female; mean [SD] age, 54.6 [14.3] years) underwent outpatient thyroid, parathyroid, or parotid surgery with use of a multimodal analgesia protocol. On a 10-point rating scale, patients reported low resting pain perception scores (median, 2 [range, 0-8]) and peak pain scores (median, 4 [range, 0-9]). The OBAS assessment for composite effectiveness of analgesia indicated a favorable median score of 1 (range, 0-10; permissible range, 0-28, with lower scores better). Thirty-nine (61%) patients were able to avoid postoperative narcotic use on discharge. Fifty-six (88%) patients reported "high" or "very high" satisfaction with the multimodal analgesia strategy. No complications related to bleeding, hematoma, significant adverse events, or readmissions were observed. CONCLUSION AND RELEVANCEA multimodal analgesia strategy was feasible and safe in patients undergoing outpatient head and neck surgery and may reduce the need for narcotic use. It was associated with low pain perception scores, favorable OBAS, and overall satisfaction scores. The role of multimodal analgesia needs additional evaluation through comparative effectiveness assessment vs conventional pain management strategies.

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Postoperative Intravenous Patient-Controlled Analgesia in Thyroid Surgery: Comparison of Fentanyl and Ondansetron Regimens With and Without the Nonsteriodal Anti-Inflammatory Drug Ketorolac

Cited by 32 publications

References 45 publications

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

Effect of ketamine on intravenous patient-controlled analgesia using hydromorphone and ketorolac after the Nuss surgery in pediatric patients

Multimodal Analgesia in Outpatient Head and Neck Surgery

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