ANESTHESIA & ANALGESIA - IARS

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ABSTRACTS ANESTH ANALG
2004; 98; S-1–S-282
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COX-2 INHIBITOR MELOXICAM PREMEDICATION
REDUCED POSTOPERATIVE ANALGESIC
COMSUMPTION IN PATIENTS AFTER DENTAL SURGERY
AUTHORS: T. Aoki 1 , H. Yamaguchi 2 , H. Naito 3 , K. Shiiki 3 , Y.
Ota 1 , A. Kaneko 1 ;
AFFILIATION: 1 Tokai University Hospital, Isehara, Japan,
2 3
Ryugasaki Saiseikai Hospital, Ryugasaki, Japan, Iwaki Kyoritsu
General Hospital, Iwaki, Japan.
INTRODUCTION: COX-2 activation is reported to be involved in the
generation of the centrally-mediated inflammatory pain hypersensitivity
process (1). And a preoperative COX-2 inhibitor may have a preferable
effect in terms of preventing post-traumatic pain accompanying surgery
(2), and which effect is called pre-emptive analgesia. Meloxicam is one
of COX-2 inhibitors available in practice. It has not been reported if
meloxicam premedication has a pre-emptive analgesic effect when used
in a dental surgery under local anesthesia. In this study, we tested if
meloxicam premedication might produce pre-emptive analgesic effect
in patients undergoing unilateral mandibular third molar extraction
under inferior alveolar nerve block using a local anesthetic.
METHODS: The study protocol was approved by the local ethical
committees of the institutions. Ninety-two consecutive ASA physical
status I or II patients undergoing unilateral mandibular third molar
extraction surgery were enrolled in this study, and were allocated into
one of the 3 groups using randomizing method. Group A (n=32), B
(n=30), and C (n=30) patients were given meloxicam, 10 mg,
ampiroxicam, 27 mg, and placebo orally 90 min. prior to surgery,
respectively. In all patients the surgery was completed within 30 min
under inferior alveolar nerve block using 1.0% lidocaaine containing
0.001% epinephrine. Postoperatively the patients were allowed to take
oral loxoprofen, 60 mg, each when they needed for the postoperative
wound pain relief. Postoperative pain was evaluated at the clinic on the
first, 7th, and 14th day after surgery, respectively, using visual analog
scale (VAS) and verbal rating scale (VRS), and the number of
loxoprofen per a day they took. These parameters were compared
among the 3 groups using Kruskal-Wallis rank test with statistical
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COMPARISON OF SUBCUTANEOUS VERSUS
INTRAVENOUS MORPHINE IN RENAL
TRANSPLANTATION BY PCA
AUTHORS: C. Chandralekha, S. Krishnan, L. Kashyap, V. Mohan;
AFFILIATION: All India Institute of Medical Sciences, New
Delhi, India.
Postoperative pain is not adequately treated for fear of sedation in end
stage renal disease. PCA allows patients to self-administer analgesic
medications to control postoperative pain.
This study was undertaken to compare the i.v. SOS, i.v. PCA and s.c.
PCA requirement of morphine for postoperative analgesia in post renal
transplant patients.
MATERIALS AND METHODS: Sixty five patients of age 20-50
years with end stage renal disease scheduled for live or cadaveric renal
transplantation were studied. They were randomized into three groups
on the basis of route of administration of postoperative analgesia:
Group1 : intermittent intravenous (i.v.) 3 mg morphine SOS.
Group2: intravenous PCA morphine with 0.5 mg boluses and a lockout
interval of 15 minutes, 1mg/ml morphine in normal saline.
Group3: subcutaneous PCA morphine with 0.5 mg boluses and a
lockout interval of 15 minutes using 1mg/ml morphine in normal saline.
Patients were anesthetised with general anesthesia on controlled
respiration. A subcutaneous cannula was placed in the pectoral region
before reversal of neuromuscular blockade in patients of group 3.
All patients received bolus of 3 mg i.v. morphine in the ICU.
Subsequently, postoperative analgesia was according to the group
randomly selected earlier. Parameters were recorded at 1,2,6,12,18 and
24 hours after extubation:
1.Pain score at rest, cough and at movement, assessed by the standard
10 cm VAS.
2.Total Morphine requirement in the first 24 hour postoperatively
3.Monitoring of vital parameters, SpO2 , and any side effects.
Sedation scores were noted at the same intervals and graded as: 0=no
sedation, 1=sedated but awake, 2=asleep but waking up easily,
3=drowsy (needs shaking), 4=responds only to pain, 5=comatose.
significance of p