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Koki Shimoji - One of the best experts on this subject based on the ideXlab platform.
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Preemptive Analgesia by intravenous low dose ketamine and epidural morphine in gastrectomy a randomized double blind study
Anesthesiology, 2000Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:Background: Morphine and ketamine may prevent central sensitization during surgery and result in Preemptive Analgesia. The reliability of Preemptive Analgesia, however, is controversial. Methods: Gastrectomy patients were given Preemptive Analgesia consisting of epidural morphine, intravenous low-dose ketamine, and combinations of these in a randomized, double-blind manner. Postsurgical pain intensity was rated by a visual analog scale, a categoric pain evaluation, and cumulative morphine consumption. Results: Preemptive Analgesia by epidural morphine and by intravenous low-dose ketamine were significantly effective but not definitive. With epidural morphine, a significant reduction in visual analog scale scores at rest was observed at 24 and 48 h, and morphine consumption was significantly lower at 6 and 12 h, compared with control values. With intravenous ketamine, visual analog scale scores at rest and morphine consumption were significantly lower at 6, 12, 24, and 48 h than those in control subjects. The combination of epidural morphine and intravenous ketamine provided definitive Preemptive Analgesia: Visual analog scale scores at rest and morphine consumption were significantly the lowest at 6, 12, 24, and 48 h, and the visual analog scale score during movement and the categoric pain score also were significantly the lowest among the groups. Conclusion: The results suggest that for definitive Preemptive Analgesia, blockade of opioid and N-methyl-D-aspartate receptors is necessary for upper abdominal surgery such as gastrectomy; singly, either treatment provided significant, but not definitive, postsurgical pain relief. Epidural morphine may affect the spinal cord segmentally, whereas intravenous ketamine may block brain stem sensitization via the vagus nerve during upper abdominal surgery.
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the effectiveness of Preemptive Analgesia varies according to the type of surgery a randomized double blind study
Anesthesia & Analgesia, 1999Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:UNLABELLED: The reliability of Preemptive Analgesia is controversial. Its effectiveness may vary among anatomical areas or surgical types. We evaluated Preemptive Analgesia by epidural morphine in six surgery types in a randomized, double-blind manner. Pain intensity was rated using a visual analog scale, a verbal report, and a measurement of postsurgical morphine consumption. Preemptive Analgesia was effective in limb surgery and mastectomy, but ineffective for gastrectomy, hysterectomy, herniorrhaphy, and appendectomy. Relief of postsurgical pain in hemiorrhaphy was more rapid than that in the other surgery types. Preemptive Analgesia was effective in limb surgery and mastectomy, but not in surgeries involving laparotomy, regardless of whether the surgery was major (gastrectomy and hysterectomy) or minor (herniorrhaphy and appendectomy). These results suggest that viscero-peritoneal nociception is involved in postsurgical pain. The abdominal viscera and peritoneum are innervated both heterosegmentally (in duplicate or triplicate by the vagus and/or phrenic nerves) and segmentally (by the spinal nerves). Therefore, supraspinal and/or cervical spinal neurons might be sensitized, despite the blockade of the segmental nerves with epidural morphine. The rapid retreat of the pain after hemiorrhaphy suggests that central sensitization remits soon after minor surgery, but that in appendicitis, it may be protracted by additional noxious stimuli, such as infection. IMPLICATIONS: Epidural Preemptive Analgesia was reliably effective in limb and breast surgeries but ineffective in abdominal surgery, suggesting involvement of the brainstem and cervical spinal cord via the vagus and phlenic nerves.
Sumihisa Aida - One of the best experts on this subject based on the ideXlab platform.
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Preemptive Analgesia by intravenous low dose ketamine and epidural morphine in gastrectomy a randomized double blind study
Anesthesiology, 2000Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:Background: Morphine and ketamine may prevent central sensitization during surgery and result in Preemptive Analgesia. The reliability of Preemptive Analgesia, however, is controversial. Methods: Gastrectomy patients were given Preemptive Analgesia consisting of epidural morphine, intravenous low-dose ketamine, and combinations of these in a randomized, double-blind manner. Postsurgical pain intensity was rated by a visual analog scale, a categoric pain evaluation, and cumulative morphine consumption. Results: Preemptive Analgesia by epidural morphine and by intravenous low-dose ketamine were significantly effective but not definitive. With epidural morphine, a significant reduction in visual analog scale scores at rest was observed at 24 and 48 h, and morphine consumption was significantly lower at 6 and 12 h, compared with control values. With intravenous ketamine, visual analog scale scores at rest and morphine consumption were significantly lower at 6, 12, 24, and 48 h than those in control subjects. The combination of epidural morphine and intravenous ketamine provided definitive Preemptive Analgesia: Visual analog scale scores at rest and morphine consumption were significantly the lowest at 6, 12, 24, and 48 h, and the visual analog scale score during movement and the categoric pain score also were significantly the lowest among the groups. Conclusion: The results suggest that for definitive Preemptive Analgesia, blockade of opioid and N-methyl-D-aspartate receptors is necessary for upper abdominal surgery such as gastrectomy; singly, either treatment provided significant, but not definitive, postsurgical pain relief. Epidural morphine may affect the spinal cord segmentally, whereas intravenous ketamine may block brain stem sensitization via the vagus nerve during upper abdominal surgery.
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the effectiveness of Preemptive Analgesia varies according to the type of surgery a randomized double blind study
Anesthesia & Analgesia, 1999Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:UNLABELLED: The reliability of Preemptive Analgesia is controversial. Its effectiveness may vary among anatomical areas or surgical types. We evaluated Preemptive Analgesia by epidural morphine in six surgery types in a randomized, double-blind manner. Pain intensity was rated using a visual analog scale, a verbal report, and a measurement of postsurgical morphine consumption. Preemptive Analgesia was effective in limb surgery and mastectomy, but ineffective for gastrectomy, hysterectomy, herniorrhaphy, and appendectomy. Relief of postsurgical pain in hemiorrhaphy was more rapid than that in the other surgery types. Preemptive Analgesia was effective in limb surgery and mastectomy, but not in surgeries involving laparotomy, regardless of whether the surgery was major (gastrectomy and hysterectomy) or minor (herniorrhaphy and appendectomy). These results suggest that viscero-peritoneal nociception is involved in postsurgical pain. The abdominal viscera and peritoneum are innervated both heterosegmentally (in duplicate or triplicate by the vagus and/or phrenic nerves) and segmentally (by the spinal nerves). Therefore, supraspinal and/or cervical spinal neurons might be sensitized, despite the blockade of the segmental nerves with epidural morphine. The rapid retreat of the pain after hemiorrhaphy suggests that central sensitization remits soon after minor surgery, but that in appendicitis, it may be protracted by additional noxious stimuli, such as infection. IMPLICATIONS: Epidural Preemptive Analgesia was reliably effective in limb and breast surgeries but ineffective in abdominal surgery, suggesting involvement of the brainstem and cervical spinal cord via the vagus and phlenic nerves.
Aida Rosita Tantri - One of the best experts on this subject based on the ideXlab platform.
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Preemptive Analgesia in total knee arthroplasty comparing the effects of single dose combining celecoxib with pregabalin and repetition dose combining celecoxib with pregabalin double blind controlled clinical trial
Pain Research and Treatment, 2018Co-Authors: Andri Maruli Tua Lubis, Rangga Valentino Rawung, Aida Rosita TantriAbstract:Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive Analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with Preemptive Analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given Preemptive Analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive Analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as Preemptive Analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 ( ClinicalTrials.gov).
A Pasqualucci - One of the best experts on this subject based on the ideXlab platform.
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a new method of Preemptive Analgesia in laparoscopic cholecystectomy
Surgical Endoscopy and Other Interventional Techniques, 2002Co-Authors: Umberto Maestroni, Davide Sortini, C Devito, Pour Morad Kohan F Brunaldi, Gabriele Anania, L Pavanelli, A Pasqualucci, Annibale DoniniAbstract:Background Although laparoscopic cholecystectomy (LC) results in less pain then open cholecystectomy, it is not a pain-free procedure. The aim of this study was to test a new method of Preemptive Analgesia.
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experimental and clinical studies about the Preemptive Analgesia with local anesthetics possible reasons of the failure
Minerva Anestesiologica, 1998Co-Authors: A PasqualucciAbstract:: Though we fully agree with the truthfulness of the physiopathological sequences proving the phenomena of the hyperalgesia onset and therefore a prolongation of the postoperative pain, we do not believe, as stated by some authors that the studies carried out up to now, both experimental and clinical, are sufficient, the first ones to confirm the Preemptive Analgesia, while the second ones to be defined as contrasting and totally inadequate to confirm the Preemptive Analgesia effect. The lack of positive clinical data is why some authors have suggested a "revision" and a "reduction" of the word Preemptive Analgesia. On the contrary, we believe that differences which seem to originate from the clinical works can also be found in the experimental ones if we examine them with the same methodological principle. In order to classify better such an important treatment like the Preemptive Analgesia, the aim of this note is to focus the attention on the experimental and clinical data. Our criterion to select the works has based on a backwards research taking into consideration the last reviews and studies about the Preemptive Analgesia. Since the results obtained with local anesthetics or with opioids seem to counterbalance each other, we have reexamined the experimental and clinical works limiting our attention to the local anesthetics. On a total of 19 assessments carried out in 16 experimental studies, only three of the eight ones comparing pre-vs post-administration prove a real Preemptive Analgesia effect of the local anesthetic (block of the first and second phase of hyperexcitability) whereas four of the eleven clinical studies examined seem to confirm the validity of the Preemptive Analgesia effect. These data show how the results of the experimental studies are equal to the results of the clinical ones. However, an important characteristic that seems to come out from these works is connected to two elements strictly linked each other: the intensity and the duration of the nociceptive impulse produced and the level and the type of the induced block. In our opinion, the failure of many of these works can be attributed to the inadequacy of the analgesic levels (intensity of the block) reached and maintained in the pre-and intraoperative period. Therefore we believe that before thinking of a "review" and "reduction" of the word Preemptive Analgesia is necessary to take a step backward and to face again the methodological problems of the Preemptive Analgesia.
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Preemptive Analgesia intraperitoneal local anesthetic in laparoscopic cholecystectomy a randomized double blind placebo controlled study
Anesthesiology, 1996Co-Authors: A Pasqualucci, Annibale Donini, Verena De Angelis, Riccardo Contardo, F Colo, Giovanni Terrosu, Alberto Pasetto, F BresadolaAbstract:BackgroundA controversy exists over the effectiveness and clinical value of Preemptive Analgesia. Additional studies are needed to define the optimum intensity, duration, and timing of Analgesia relative to incision and surgery.MethodsOne hundred twenty patients undergoing laparoscopic cholecystecto
Hiroshi Baba - One of the best experts on this subject based on the ideXlab platform.
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Preemptive Analgesia by intravenous low dose ketamine and epidural morphine in gastrectomy a randomized double blind study
Anesthesiology, 2000Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:Background: Morphine and ketamine may prevent central sensitization during surgery and result in Preemptive Analgesia. The reliability of Preemptive Analgesia, however, is controversial. Methods: Gastrectomy patients were given Preemptive Analgesia consisting of epidural morphine, intravenous low-dose ketamine, and combinations of these in a randomized, double-blind manner. Postsurgical pain intensity was rated by a visual analog scale, a categoric pain evaluation, and cumulative morphine consumption. Results: Preemptive Analgesia by epidural morphine and by intravenous low-dose ketamine were significantly effective but not definitive. With epidural morphine, a significant reduction in visual analog scale scores at rest was observed at 24 and 48 h, and morphine consumption was significantly lower at 6 and 12 h, compared with control values. With intravenous ketamine, visual analog scale scores at rest and morphine consumption were significantly lower at 6, 12, 24, and 48 h than those in control subjects. The combination of epidural morphine and intravenous ketamine provided definitive Preemptive Analgesia: Visual analog scale scores at rest and morphine consumption were significantly the lowest at 6, 12, 24, and 48 h, and the visual analog scale score during movement and the categoric pain score also were significantly the lowest among the groups. Conclusion: The results suggest that for definitive Preemptive Analgesia, blockade of opioid and N-methyl-D-aspartate receptors is necessary for upper abdominal surgery such as gastrectomy; singly, either treatment provided significant, but not definitive, postsurgical pain relief. Epidural morphine may affect the spinal cord segmentally, whereas intravenous ketamine may block brain stem sensitization via the vagus nerve during upper abdominal surgery.
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the effectiveness of Preemptive Analgesia varies according to the type of surgery a randomized double blind study
Anesthesia & Analgesia, 1999Co-Authors: Sumihisa Aida, Tomohiro Yamakura, Hiroshi Baba, Kiichiro Taga, Satoru Fukuda, Koki ShimojiAbstract:UNLABELLED: The reliability of Preemptive Analgesia is controversial. Its effectiveness may vary among anatomical areas or surgical types. We evaluated Preemptive Analgesia by epidural morphine in six surgery types in a randomized, double-blind manner. Pain intensity was rated using a visual analog scale, a verbal report, and a measurement of postsurgical morphine consumption. Preemptive Analgesia was effective in limb surgery and mastectomy, but ineffective for gastrectomy, hysterectomy, herniorrhaphy, and appendectomy. Relief of postsurgical pain in hemiorrhaphy was more rapid than that in the other surgery types. Preemptive Analgesia was effective in limb surgery and mastectomy, but not in surgeries involving laparotomy, regardless of whether the surgery was major (gastrectomy and hysterectomy) or minor (herniorrhaphy and appendectomy). These results suggest that viscero-peritoneal nociception is involved in postsurgical pain. The abdominal viscera and peritoneum are innervated both heterosegmentally (in duplicate or triplicate by the vagus and/or phrenic nerves) and segmentally (by the spinal nerves). Therefore, supraspinal and/or cervical spinal neurons might be sensitized, despite the blockade of the segmental nerves with epidural morphine. The rapid retreat of the pain after hemiorrhaphy suggests that central sensitization remits soon after minor surgery, but that in appendicitis, it may be protracted by additional noxious stimuli, such as infection. IMPLICATIONS: Epidural Preemptive Analgesia was reliably effective in limb and breast surgeries but ineffective in abdominal surgery, suggesting involvement of the brainstem and cervical spinal cord via the vagus and phlenic nerves.