Subrectal and Subcutaneous Wound Infiltration with Bupivacaine versus Pethidine for Post Cesarean Section Pain Relief: Randomized Controlled Trial

Background: Cesarean section (CS), one of the most common major operative procedures, performed all over the world. Incisional infiltration with local anesthetics is a simple, cheap and effective mean of providing good analgesia for surgical operations without any major side effects & allowing early patients’ mobilization & postoperative recovery, so the purpose of study is to compare between the effect of wound infiltration with bupivacaine versus pethidine for post cesarean section pain relief. Patients and Methods: A randomized controlled trial (RCT) was conducted in Ain Shams University Maternity hospital in the period from August 2016 and January 2017. 100 full term pregnant females randomized into two groups: Group A (50 patients) Bupivacaine group: Subcutaneous and subrectal infiltration with 10 ml 0.25% Bupivacaine (2.5 mg/ml) diluted in 10 ml normal saline before closure of the wound was done;Group B (50 patients) Pethidine group: Subcutaneous and subrectal infiltration with 1 ml pethidine (50 mg/ml) diluted in 19 ml normal saline before closure of the wound was done. All patients had cesarean section under spinal anesthesia. Study outcome measures post-operative pain scores using visual analogue scale, post-operative analgesia requirement time to first rescue analgesia, onset of mobilization, side effect of local anesthetic, wound infection (after one week). It was registered on clinical trials.gov with ID: NCT03652116. Results: Visual analogue scale values differ significantly between pethidine group and that of bupivacaine at rest and on coughing at 4, 8, 12, 24 hours & analgesic consumption (P value st time request analgesia per minute comparing group A to group B (P value 0.001). There is no significant difference between bupivacaine and pethidine regarding time of ambulation, side effects or complications. Conclusion: Infiltration of the wound of cesarean section with pethidine gives effective analgesia for several hours as compared to Bupivacaine.

Mechanism of palliative effect of pethidine on tracheal hot air inhalation injury in rats

The increases of tracheal vascular permeability and malondialdehyde(MDA) content 1,2 and 3 h after introduction of hot air into the rat tracheaswere markedly inhibited by pethidine.The decreases of tracheal superoxidedismutase (SOD) activity 2 and 3h after hot air injury were elevated bypethidine.However,the inhibitory effect of pethidine on tracheal vascularpermeability was not antagonized by naloxone.This implies that opiate receptorsensitive to naloxone is not involved in the inhibitory effect of pethidine ontracheal vascular permeability.Pethidine could decrease MDA content and in-crease SOD activity.These antioxidative effects are beneficial to decreasingvascular permeability.

Effects of melatonin on pethidine-induced physical dependence and its antioxidative action

Objective To study the effects of melatonin on pethidine-induced physical dependence and its antioxidative action.Methods A trauma-pain model was established in Wistar rats by combining right limb amputation with 50 ℃ tail-flick test.The contents of MDA and the activity of the total superoxide dismutase(SOD)in the brain tissue of trauma-pain rats were detected by thiobarbituric acid method and the xanthine oxidase method.A physical dependence model in mice was reproduced by subcutaneous injection of pethidine and the withdrawal syndromes were induced by intraperitoneal injection of naloxone.Results The contents of MDA enhanced,but the activity of SOD decreased greatly in brain tissues postinjury in rats.Melatonin(30,60,120 mg·kg-1)i.p.reduced the contents of MDA and enhanced the activity of SOD dose-dependently.Melatonin alone showed no withdrawal syndrome when it was given until the dosage of 840 mg·kg-1.Moreover,Melatonin(5,15,20 mg·kg-1)obviously inhibited the withdrawal jumpings of mice in pethidine-treated groups dose-dependently(P<0.01),the jumping rates of mice were decreased 61.4%,72.8%,84.8%,respectively.Conclusions The present results indicated that melatonin has good antioxidative effects on the trauma rats.In addiction,melatonin might inhibit withdrawal syndromes in pethidine-dependent mice.

A New Potentiometric Sensor for Determination of Pethidine hydrochloride in Ampoules and Urine

A simple, precise, rapid and low-cost potentiometric method for pethidine determination in pharmaceuticals and urine is proposed. A chemically modified carbon paste electrode (CMCPE) for pethidine hydrochloride (PDCl) based on pethidine-phosphotungstate (PD-PT) as ion-pair complex was prepared and fully character-ized in terms of composition, usable pH range, response time and temperature. The pethidine electrode showed Nernstain responses in the concentration range 2.1 × 10–6-1.0 × 10–2 M with a detection limit of 7.3 × 10-7 and usable within the pH range 3.5-6.6. This sensor exhibited a fast response time (about 5-8 s), good stability. The value (dE/dt) of the electrode was found to be 0.00071 V/?C, which indicates fairly high ther-mal stability. Selectivity coefficients determined by matched potential method (MPM) and separate solution method (SSM) showed high selectivity for PDCl with respect to a large number of inorganic cations, organic cations, sugars and some common drug excipients. The sensor could be used successfully in the estimation of PDCl in ampoules and in spiked urine samples.

誘導前靜注Pethidine對Propofol靜脈全麻過程維持量的影響

50名需行吸刮宮術病人進行Propofol全身性靜脈麻醉。病人隨機分組。第一組病人單獨使用Propofol,第二組病人除使用Propofol外,附加靜脈注射Pethidine。Propofol之劑量:誘導量均為2mg/kg,維持量為4~10mg/kg/h.在手術中根據血壓與肢體活動調整劑量以此維持穩定之麻醉狀態。結果顯示,Propofol誘導起效快速,術後短時間恢復良好之自我控制能力,麻醉誘導時閒和清醒時閒未因Pethidine之使用與Propofol劑量變化而出現明顯差別。Propofol之維持量(麻醉首10分鐘),在附加使用Pethidine組顯著減少(P<0.05),且術中病人出現肢體活動情況亦明顯比第一組少(P<0.01),麻醉過程,兩組病例均同樣顯示呼吸與循環系統抑制情況,此情況經調整Propofol劑量後迅速恢復。

Effects of Pre-Operative Single Dose Gabapentin on Postoperative Pain Following Total Abdominal Hysterectomy: A Dose Finding Study

Background & Aims: The multimodal analgesia provides superior pain relief and reduces opioid consumption and its side effects. Gabapentin has been used successfully in multi-modal analgesia in different doses. We designed a double-blind randomized control trial to find the minimal effective dose of gabapentin in multimodal analgesia for postoperative pain following total abdominal hysterectomy. Material & Methods: After informed consent, total of 87 patients were randomly assigned to A, B & C groups to receive gabapentin orally 300 mg, 600 mg, and 900 mg respectively one to two hours before surgery. Postoperatively pain was managed by patient-controlled analgesia (PCA) using pethidine. Pain score, opioid consumption, and side effects of gabapentin were monitored. Rescue analgesia was given and monitored. Results: There was no statistically significant difference among the groups with respect to age, weight, height, pethidine consumption, and rescue analgesia. Mean pain scores were statistically insignificant at baseline, 8, 12, and 24 hours postoperatively. Only at 4 hours, the highest pain score (mean) was found in group A, which is statistically significant. The side effects of gabapentin like nausea, vomiting, somnolence, and dizziness were also statistically insignificant. Conclusion: A single preoperative oral gabapentin 300 mg was found to be minimal effective dose in multimodal analgesic regimen for reducing post-operative pain and analgesic requirement following total abdominal hysterectomy.

CLINICAL STUDY OF ACUPUNCTURE-DRUG COMBINED ANESTHESIA FOR ANTERIOR APPROACH CERVICAL DISCECTOMY

The study compared the anesthetic effects between acupuncture-drug combined anes-thesia and local anesthetic-drug combined anesthesia for anterior approach cervical discectomy. Theresults demostrated that the analgesic effects have no difference between these two groups. Theacupuncture-drug combined anesthesia group had less postoperative complication, sooner recovery andbetter social and economic benefits. The method is worth using widely in clinical practice.

Subtype of Opioid Receptor in Airway SmoothMuscle and the Role of the Receptor in Asthmatic Attacks

In order to elucidate the behavior of opioid receptor in the airway smooth muscle (ASM) and potential role of the receptor in asthmatic attacks electrical field stimulation (EFS) was used to evaluate the effects of different narcotics and naloxine (Nal) on isolated rabbit ASM and biochemical methods were used to assay the influences of morphine (Mor) and pethidine(Pet) on the activities of adenylcyclase (AAC) and phosphodiesterase(APDE) in homogenate derived from rabbit ASM.Nal was used to treat the bronchospasm during anesthesia. It shows that Mor increased the rabbit ASM contraction and Nal reversed this effect, while Nal itself did not affect ASM. Fentanyl(Fen) decreased the contraction and Pet not only decreased the contraction but relaxed the ASM. Mor decreased the AAC in the rabbit ASM but didn't affect the APDE in the rabbit ASM. Pet had no influence on both the AAC and the APDE. Nal effectively relieved the bronchospasm which failed to the traditional treatment during anesthsia. These indicate that the opioid receptor in the ASM is a new subtype one.Mor exhibits satuable binding the subtype receptor and exerts strong agonistic activity to induce bronchospasm, while Nal antagonizes this effect. Yet Fen and Pet don's bind this subtype receptor. Endogenous opioid-like peptides may also bind this subtype receptor. In patients with airway hyperreactivity (PAHR) Mor is contraindicated, Fen and Pet may be used. and the latter may be the best choice.Asthma or bronchospasm may be treated with Nal.

Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study

BACKGROUND It is important to reduce patient discomfort in esophagogastroduodenoscopy.Remedial measures can be taken to alleviate discomfort if the causative factors are determined;however,all the factors have not been elucidated yet.AIM To clearly determine the factors influencing discomfort in transoral esophagogastroduodenoscopy using a large-size cross-sectional study with readily available data.METHODS Consecutive patients who underwent screening transoral esophagogastroduodenoscopy consecutively between August 2017 and October 2017 at a health check-up center were included.Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire.Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy.Univariate analysis was performed in both the unsedated and sedated study groups.Age,sex,height,body mass index,smoking status,alcohol intake,hiatal hernia,history of gastrectomy,biopsy during examination,Lugol’s solution usage,administration of butylscopolamine with/without a sedative(pethidine,midazolam,or both),endoscope model,history of endoscopy,and endoscopists were considered as possible factors of discomfort.RESULTS Finally,1715 patients were enrolled in this study.Overall,the median discomfort score was 2 and the interquartile range was 2-4.High discomfort(score≥6)was recorded in 18%of the participants.According to univariate analysis,in the unsedated group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P<0.001)were factors associated with increased discomfort.Significant differences were also noted for height(P=0.007),smoking status(P=0.003),and endoscopists(P<0.001).In the sedation group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P=0.004)were associated with increased discomfort;additionally,significant differences were found in smoking status(P<0.001),type of sedation(P<0.001),and endoscopists(P=0.027).There was also a marginal difference due to alcohol intake(P=0.055).Based on multiple regression analysis,young age,female sex,less height,current smoking status,and presence of hiatal hernia[regression coefficients of 0.08,P<0.001(for-1 years);0.45,P=0.013;0.02,P=0.024(for-1 cm);0.35,P=0.036;and 0.34,P=0.003,respectively]were factors that significantly increased discomfort in esophagogastroduodenoscopy.Alternatively,sedation significantly reduced discomfort and pethidine(regression coefficient:-1.47,P<0.001)and midazolam(regression coefficient:-1.63,P=0.001)significantly reduced the discomfort both individually and in combination(regression coefficient:-2.92,P<0.001).A difference in the endoscopist performing the procedure was also associated with discomfort.CONCLUSION Young age,female sex,and smoking are associated with esophagogastroduodenoscopy discomfort.Additionally,heavy alcohol consumption diminished the effects of sedation.These factors are easily obtained and are thus useful.

Postoperative Nausea &Vomiting in Malawi

Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.

提高剖宮產術後病人自控鎮痛效果

目的通過術後鎭痛藥物配方的改變,使剖宮產術後病人自控鎭痛(Petient controlled analegsia以下縮寫爲PCA)效果提高,減少病人自訴中度和重度的傷口痛和宮縮痛。方法ASA評級Ⅰ-Ⅱ級剖宮產手術病人180例,随機分爲A、B、C三組。A組60例:配方Pethidine 10mg/kg,Droperidol 5mg,加生理鹽水至100ml;B組60例:配方與A組不同之處是在A組配方基礎上用Morphine 10mg代替Pethidine 100mg,然後加Droperidol 5mg,加生理鹽水至100ml;C組60例:配方與A組不同之處是在A組配方基礎上用Morphine 20mg代替Pethidine200mg,然後加Droperidol 5mg,加生理鹽水至100ml。結果統計各組安靜時傷口輕度痛,宮縮輕度痛。安靜時傷口中重度痛,宮縮中重度痛。並計算中重度痛發生率:A組63%,B組62%,C組43%,中重度痛發生率組間比較:C組與A組比較,經統計學處理,P<0.05,差異有顯著性。結論用Pethidine 10mg/kg作剖宮產術後靜脈PCA,以Morphine 20mg代替Pethidine 200mg病例組比較單純用Pethidine 10mg/kg作剖宮產術後鎭痛病例組,中重度痛發生率明顯減少。