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Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: A randomized controlled study.

ABSTRACT: BACKGROUD:The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy. METHODS:In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n?=?25), EMLA group (n?=?25), and control group (n?=?25). TPI group received TPIs with 2?mL of 0.2% ropivacaine, and EMLA group received an occlusive dressing with EMLA cream 2?g on both shoulders. Overall, abdominal, and shoulder pains were evaluated at rest and in motion on postoperative day 3. RESULTS:The incidence of shoulder pain was significantly reduced in EMLA group (56%) compared to control (88%) or TPI (88%) groups (P?=?.025 in both); the severity of shoulder pain was mitigated in EMLA and TPI groups compared to control group (P?

SUBMITTER: Kim JE

PROVIDER: S-EPMC6336620 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: A randomized controlled study.

Kim Ji Eun JE Kim Ji Young JY Lee Hye Sun HS Seok Suhyun S Kil Hae Keum HK

Medicine 20190101 2

<h4>Backgroud</h4>The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy.<h4>Methods</h4>In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n = 25), EMLA group (n = 25), and control group (n = 25). TPI group received TPIs with 2 mL of 0.2% ropivacaine, and EMLA g ...[more]

PMID: 30633218

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Project description:This study directly compares total intrafascial laparoscopic (TAIL) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL hysterectomy, VH and AH groups is 5.8 +/- 2.4, 8.8 +/- 4.0 and 10.4 +/- 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL hysterectomy as for AH (O.R. 4.52, CI 3.25-6.31) or VH (O.R. 3.16, CI 2.16-4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL hysterectomy group, with an O.R. of 6.13 (CI 3.05-12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.

Project description:BackgroundExperimental models using short-duration noxious stimuli have led to the concept of preemptive analgesia. Ketorolac, a nonsteroidal anti-inflammatory drug, has been shown to have a postoperative narcotic-sparing effect when given preoperatively and alternatively to not have this effect. This study was undertaken to determine whether a single intravenous (IV) dose of ketorolac would result in decreased postoperative pain and narcotic requirements.MethodsIn a double-blind, randomized controlled trial, 48 women undergoing abdominal hysterectomy were studied. Patients in the ketorolac group received 30 mg of IV ketorolac 30 min before surgical incision, while the control group received normal saline. The postoperative analgesia was performed with a continuous infusion of tramadol at 12 mg/h with the possibility of a 10 mg bolus for every 10 min. Pain was assessed using the visual analog scale (VAS), tramadol consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 h postoperatively. We quantified times to rescue analgesic (morphine), adverse effects, and patient satisfaction.ResultsThere were neither significant differences in VAS scores between groups (P > 0.05) nor in the cumulative or incremental consumption of tramadol at any time point (P > 0.05). The time to first requested rescue analgesia was 66.25 ± 38.61 min in the ketorolac group and 65 ± 28.86 min in the control group (P = 0.765). There were no significant differences in systolic blood pressure (BP) between both groups, except at 2 h (P = 0.02) and 4 h (P = 0.045). There were no significant differences in diastolic BP between both groups, except at 4 h (P = 0.013). The respiratory rate showed no differences between groups, except at 8 h (P = 0.017), 16 h (P = 0.011), and 24 h (P = 0.049). These differences were not clinically significant. There were no statistically significant differences between groups in heart rate (P > 0.05).ConclusionsPreoperative ketorolac neither showed a preemptive analgesic effect nor was it effective as an adjuvant for decreasing opioid requirements or postoperative pain in patients receiving IV analgesia with tramadol after abdominal hysterectomy.

Dataset Information

Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: A randomized controlled study.

Publications

Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy: A randomized controlled study.

Similar Datasets

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