Pre‐emptive effect of epidural sufentanil in abdominal hysterectomy

Akural, E. I.; Salomäki, Timo; Tekay, Aydin; Bloigu, Aini; Alahuhta, Seppo

doi:10.1093/bja/88.6.803

Cited by 32 publications

(14 citation statements)

References 23 publications

(19 reference statements)

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“…The postoperative first VAS pain score was importantly lower in the bupivacaine group than in the tramadol group. The result supports studies which indicated the superiority of local anesthetics when compared with intra-or suprathecal opioids for preemptive analgesia [32,33,42]. All the other VAS values of the bupivacaine group were significantly lower than in the tramadol group during the study with an insignificantly different supplementary demand dose requirement.…”

Section: Discussionsupporting

confidence: 84%

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Patient-Controlled Epidural Analgesia after Major Urologic Surgeries

et al. 2003

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The efficiency and safety of patient-controlled epidural analgesia by using tramadol alone and combined with bupivacaine were investigated for postoperative pain treatment after major urological surgeries. For PCEA: in group I (n = 17) a loading dose of 20 mg tramadol with a continuous infusion of 1 mg/ml tramadol at a rate of 8 ml/h was given. In group II (n = 17), patients received an initial loading dose of 20 ml bupivacaine 0.125% and a supplemental continuous infusion of 8 ml/h. In group III (n = 17), a loading dose of 20 mg tramadol with 20 ml bupivacaine 0.125% were given and a supplemental infusion of 1 mg/ml tramadol in 20 ml bupivacaine 0.125% combination was begun with a rate of 8 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 min was also used in all patients. VAS for pain intensity, vital signs, sedation scale and side effects was monitored at 0, 15, 30 min and 1, 2, 3, 4, 8, 12, and 24 h of the postoperative period. Statistical significance was determined using Kruskal-Wallis, Fisher’s exact, analysis of variance for repeated measurements and Tukey tests. The hemodynamic values and sedation scales were insignificantly different (p > 0.05). The adequate analgesia was provided in all patients. However VAS values were significantly lower in group III than in groups I and II at every measurement (p < 0.05). The incidence of side effects in all three groups was low (p > 0.05). In conclusion, we suggested that a combination of tramadol with bupivacaine can provide the most effective and safe postoperative analgesia with minimal risk for side effects.

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Section: Discussionsupporting

confidence: 84%

“…Preemptive effect of opioids especially in small doses is still controversial [32,33]. Anti-analgesia with increased side effects in the postoperative period was previously demonstrated with preincisional administration of lowdose (20 mg) bolus epidural tramadol when compared with 100 mg and placebo administrations [34].…”

Section: Discussionmentioning

confidence: 99%

Patient-Controlled Epidural Analgesia after Major Urologic Surgeries

et al. 2003

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“…Several classes of analgesics have been utilized in the treatment of post-operative pain. At this respect, several clinical studies have demonstrated the effectiveness of NSAIDs (Liu et al, 2005;Karaman et al, 2006) and opioids (Akural et al, 2002;Yoshimoto et al, 2005) in pre-emptive analgesia. In addition, most of these drugs have side-effects, which limit their use in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Examination of the interaction between peripheral lumiracoxib and opioids on the 1% formalin test in rats

Ortiz

Castañeda‐Hernández

2008

European Journal of Pain

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It has been shown that the association of non-steroidal anti-inflammatory drugs (NSAIDs) with opioid analgesic agents can increase their antinociceptive activity, allowing the use of lower doses and thus limiting side effects. Therefore, the aim of the present study was to examine the possible pharmacological interaction between lumiracoxib and codeine or nalbuphine at the local peripheral level in the rat using the 1% formalin test and isobolographic analysis. Lumiracoxib, codeine, nalbuphine or fixed-dose ratios lumiracoxib-codeine or lumiracoxib-nalbuphine combinations were administrated locally in the formalin-injured paw and the antinociceptive effect was evaluated using the 1% formalin test. All treatments produced a dose-dependent antinociceptive effect. ED(40) values were estimated for the individual drugs and an isobologram was constructed. The derived theoretical ED(40)'s for the lumiracoxib-codeine and lumiracoxib-nalbuphine combinations were 423.4+/-31.3 microg/paw and 310.9+/-24.2 microg/paw, respectively, being significantly higher than the actually observed experimental ED(40) values, 233.2+/-30.9 microg/paw and 132.7+/-11.6 microg/paw, respectively. These results correspond to a synergistic interaction between lumiracoxib and opioids at the local peripheral level, potency being about two times higher with regard to that expected from the addition of the effects of the individual drugs. Data suggest that low doses of the lumiracoxib-opioids combination can interact synergistically at the peripheral level and therefore this drug association may represent a therapeutic advantage for the clinical treatment of inflammatory pain.

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“…Spinal morphine seems to attenuate several measures of the surgical stress response, in particular serum values of catecholamines and glucose . However, preoperative intravenous morphine fails to attenuate the stress response measured by serum cortisol, glucose and leukocytes (Kilickan, 2001); the socalled "preemptive effect" has been largely abandoned in clinical life because many studies fail to document better pain relief when opioids are administered preoperatively than postoperatively, even though studies appear from time to time arguing the case of preemptive analgesia from the viewpoint of minor effects on immune function, parameters which may be clinically redundant (Akural, 2002;Akural, 2004).…”

Section: Opioid-free Analgesiamentioning

confidence: 99%