The comparison of effectiveness of two variants of preventive anesthesia/analgesia in cancer surgery
Despite modern drugs and technologies in medicine, the questions of adequate analgesia in the postoperative period remain quite relevant. The effectiveness of preventive analgesia in the perioperative period remains a contentious issue.
The study included 53 oncosurgical patients. Gr.1 received dexketoprofen in combination with paracetamol for perioperative analgesia before the operation, Gr.2 the same medication was given before closing the operating wound. Anesthesia in both groups included an inhaled (Sevoran) and an extended epidural.
The study showed that the pain intensity on ANI monitoring and the total dose of fentanyl was less in Gr.1, compared to Gr.2. Cortisol plasma level and the level of glycemia in the perioperative period were less in patients in Gr.1 than in Gr.2. Pain intensity after surgery during first postoperative day was lower in Gr.1, then in Gr.2.
The administration of multimodal analgesia with paracetamol and dexketoprofen prior to the surgical interventions provides for the best quality of perioperative analgesia in oncological surgical interventions.
Ready LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med. 1999 Nov-Dec;24(6):499-505.
Pflug AE, Murphy TM, Butler SH, Tucker GT. The Effects of Postoperative Peridural Analgesia on Pulmonary Therapy and Pulmonary Complications. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1974 Jul;41(1):8–17. Available from: https://doi.org/10.1097/00000542-197407000-00003
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. The American Journal of Surgery [Internet]. Elsevier BV; 2002 Jun;183(6):630–41. Available from: https://doi.org/10.1016/s0002-9610(02)00866-8
Wall PD. The prevention of postoperative pain. Pain. 1988 Jun;33(3):289-90.
Lavand’homme P. From Preemptive to Preventive Analgesia. Regional Anesthesia and Pain Medicine [Internet]. BMJ; 2011 Jan;36(1):4–6. Available from: https://doi.org/10.1097/aap.0b013e31820305b8
Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature [Internet]. Springer Nature; 1983 Dec;306(5944):686–8. Available from: https://doi.org/10.1038/306686a0
Møiniche S, Kehlet H, Dahl JB. A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain Relief. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Mar;96(3):725–41. Available from: https://doi.org/10.1097/00000542-200203000-00032
Macintyre PE, Scott DA, Schug SA, Visser EJ, Walker SM, editors. Acute pain management: scientific evidence. Melbourne: Australian and New Zealand College of Anaesthetists; 2010 May.
Schug SA, Palmer GM, Scott DA. Acute pain management: scientific evidence. Fourth Edition, 2015.
Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. European Journal of Cardio-Thoracic Surgery [Internet]. Oxford University Press (OUP); 2009 Jul;36(1):170–80. Available from: https://doi.org/10.1016/j.ejcts.2009.02.005
Woolf CJ, Wall PD. Morphine-sensitive and morphine-insensitive actions of C-fibre input on the rat spinal cord. Neuroscience Letters [Internet]. Elsevier BV; 1986 Feb;64(2):221–5. Available from: https://doi.org/10.1016/0304-3940(86)90104-7
Ong CK-S, Lirk P, Seymour RA, Jenkins BJ. The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A Meta-Analysis. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2005 Mar;100(3):757–73. Available from: https://doi.org/10.1213/01.ane.0000144428.98767.0e
Siribumrungwong K, Cheewakidakarn J, Tangtrakulwanich B, Nimmaanrat S. Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: a prospective randomized double-blinded placebo-controlled trial. BMC Musculoskeletal Disorders [Internet]. Springer Nature; 2015 Mar 18;16(1). Available from: https://doi.org/10.1186/s12891-015-0522-5
Ng A, Temple A, Smith G, Emembolu J. Early analgesic effects of parecoxib versus ketorolac following laparoscopic sterilization: a randomized controlled trial. British Journal of Anaesthesia [Internet]. Elsevier BV; 2004 Jun;92(6):846–9. Available from: https://doi.org/10.1093/bja/aeh161
Norman PH, Daley MD, Lindsey RW. Preemptive Analgesic Effects of Ketorolac in Ankle Fracture Surgery. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2001 Apr;94(4):599–603. Available from: https://doi.org/10.1097/00000542-200104000-00012
SAI S, FUJII K, HIRANUMA K, SATO T, NEMOTO T. Preoperative Ampiroxicam Reduces Postoperative Pain after Hand Surgery. Journal of Hand Surgery [Internet]. SAGE Publications; 2001 Aug;26(4):377–9. Available from: https://doi.org/10.1054/jhsb.2000.0520
Jebaraj B, Maitra S, Baidya DK, Khanna P. Intravenous Paracetamol Reduces Postoperative Opioid Consumption after Orthopedic Surgery: A Systematic Review of Clinical Trials. Pain Research and Treatment [Internet]. Hindawi Limited; 2013;2013:1–6. Available from: https://doi.org/10.1155/2013/402510
Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Presented in part at the Annual Meeting of the Société Française d’Anesthésie-Réanimation, Paris, April 2004. British Journal of Anaesthesia [Internet]. Elsevier BV; 2005 Apr;94(4):505–13. Available from: https://doi.org/10.1093/bja/aei085
Lin J, Zhang L, Yang H. Perioperative Administration of Selective Cyclooxygenase-2 Inhibitors for Postoperative Pain Management in Patients After Total Knee Arthroplasty. The Journal of Arthroplasty [Internet]. Elsevier BV; 2013 Feb;28(2):207–213.e2. Available from: https://doi.org/10.1016/j.arth.2012.04.008
Renner B, Walter G, Strauss J, Fromm MF, Zacher J, Brune K. Preoperative administration of etoricoxib in patients undergoing hip replacement causes inhibition of inflammatory mediators and pain relief. European Journal of Pain [Internet]. Wiley; 2011 Dec 19;16(6):838–48. Available from: https://doi.org/10.1002/j.1532-2149.2011.00062.x
Munteanu AM, Cionac Florescu S, Anastase DM, Stoica CI. Is there any analgesic benefit from preoperative vs. postoperative administration of etoricoxib in total knee arthroplasty under spinal anaesthesia? European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Nov;33(11):840–5. Available from: https://doi.org/10.1097/eja.0000000000000521
Hassan HIA. Perioperative analgesic effects of intravenous paracetamol: Preemptive versus preventive analgesia in elective cesarean section. Anesthesia: Essays and Researches [Internet]. Medknow; 2014;8(3):339. Available from: https://doi.org/10.4103/0259-1162.143135
Arici S, Gurbet A, Türker G, Yavaşcaoğlu B, Sahin S. Preemptive analgesic effects of intravenous paracetamol in total abdominal hysterectomy. Agri. 2009 Apr;21(2):54-61.
Jess G, Pogatzki-Zahn EM, Zahn PK, Meyer-Frieem CH. Monitoring heart rate variability to assess experimentally induced pain using the analgesia nociception index. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Feb;33(2):118–25. Available from: https://doi.org/10.1097/eja.0000000000000304
This work is licensed under a Creative Commons Attribution 4.0 International License