52 results on '"Narinder Rawal"'
Search Results
2. Thirty-five Years of Acute Pain Services: Where Do We Go From Here?
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Ulrike M. Stamer, Gregory A. Liguori, and Narinder Rawal
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Analgesics ,medicine.medical_specialty ,Time Factors ,business.industry ,Analgesic ,Staffing ,MEDLINE ,Chronic pain ,Perioperative ,medicine.disease ,Acute Pain ,Anesthesiology and Pain Medicine ,Patient satisfaction ,Patient Satisfaction ,Humans ,Pain Clinics ,Medicine ,business ,Intensive care medicine ,Adverse effect ,Early discharge ,Forecasting ,Pain Measurement - Abstract
Acute pain services (APS) have developed over the past 35 years. Originally implemented solely to care for patients with regional catheters or patient-controlled analgesia after surgery, APS have become providers of care throughout the perioperative period, with some institutions even taking the additional step toward providing outpatient services for patients with acute pain. Models vary considerably in terms of tasks and responsibilities, staffing, education, protocols, quality, and financing. Many challenges face today's APS, including the increasing number of patients with preexisting chronic pain, intake of analgesics and opioids before surgery, substance-dependent patients needing special care, shorter hospital stays, early discharge of patients in need of further analgesic treatment, prevention and treatment of chronic postsurgical pain, minimization of adverse events, and side effects of treatment. However, many APS lack a clear-cut definition of their structures, tasks, and quality. Development of APS in the future will require us to face urgent questions, such as, "What are meaningful outcome variables?" and, "How do we define high quality?" It is obvious that focusing exclusively on pain scores does not reflect the complexity of pain and recovery. A broader approach is needed-a common concept of surgical and anesthesiological services within a hospital (eg, procedure-specific patient pathways as indicated by the programs "enhanced recovery after surgery" or the "perioperative surgical home"), with patient-reported outcome measures as one central quality criterion. Pain-related functional impairment, treatment-induced side effects, speed of mobilization, as well as return to normal function and everyday activities are key.
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- 2020
3. PROSPECT guideline for elective caesarean section: a reply
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Girish P. Joshi, M. Van de Velde, E. Roofthooft, and Narinder Rawal
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Pregnancy ,medicine.medical_specialty ,Science & Technology ,business.industry ,Cesarean Section ,General surgery ,MEDLINE ,PAIN ,Guideline ,medicine.disease ,Dexamethasone ,Anesthesiology and Pain Medicine ,Elective Surgical Procedures ,Anesthesiology ,Medicine ,Humans ,Female ,Elective caesarean section ,business ,Elective Surgical Procedure ,Life Sciences & Biomedicine - Abstract
ispartof: ANAESTHESIA vol:76 issue:9 pages:1280-1281 ispartof: location:England status: published
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- 2021
4. Surgeon-administered regional analgesia to replace anaesthetist-administered regional analgesia: need for communication and collaboration
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Henrik Kehlet, Girish P. Joshi, and Narinder Rawal
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Surgeons ,Anesthesiology and Pain Medicine ,business.industry ,Communication ,Interprofessional Relations ,Anesthetists ,Humans ,Medicine ,Medical emergency ,Analgesia ,Cooperative Behavior ,business ,medicine.disease - Published
- 2019
5. Tailoring postoperative pain management using a procedure-specific approach
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E. Roofthooft, Girish P. Joshi, M. Van de Velde, and Narinder Rawal
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medicine.medical_specialty ,Pain, Postoperative ,Science & Technology ,business.industry ,Postoperative pain ,MEDLINE ,Anesthesiology and Pain Medicine ,Text mining ,Anesthesiology ,Physical therapy ,Medicine ,Humans ,Pain Management ,business ,Life Sciences & Biomedicine - Abstract
ispartof: ANAESTHESIA vol:76 issue:9 pages:1282-1282 ispartof: location:England status: published
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- 2021
6. PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure-specific postoperative pain management recommendations
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Katarzyna, Korwin-Kochanowska, Arnaud, Potié, Kariem, El-Boghdadly, Narinder, Rawal, Girish, Joshi, Eric, Albrecht, D, Lobo, PROSPECT/ESRA Working Group Collaboration, Joshi, G.P., Pogatzki-Zahn, E., Van de Velde, M., Schug, S., Kehlet, H., Bonnet, F., Rawal, N., Delbos, A., Lavand'homme, P., Beloeil, H., Raeder, J., Sauter, A., Albrecht, E., Lirk, P., Freys, S., and Lobo, D.
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medicine.medical_specialty ,Percutaneous ,medicine.drug_class ,Analgesic ,Review ,Fentanyl ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,ambulatory care ,Randomized controlled trial ,030202 anesthesiology ,law ,acute pain ,analgesia ,pain management ,pain, postoperative ,Humans ,Medicine ,Hallux Valgus ,Contraindication ,Bupivacaine ,Pain, Postoperative ,030222 orthopedics ,biology ,business.industry ,Local anesthetic ,Nerve Block ,General Medicine ,biology.organism_classification ,Surgery ,Valgus ,Anesthesiology and Pain Medicine ,business ,medicine.drug - Abstract
Hallux valgus repair is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and develop recommendations for optimal pain management after hallux valgus repair. A systematic review using PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomized controlled trials (RCTs) published in the English language from inception of database to December 2019 assessing postoperative pain using analgesic, anesthetic, and surgical interventions were identified from MEDLINE, EMBASE, and Cochrane Database, among others. Of the 836 RCTs identified, 55 RCTs and 1 systematic review met our inclusion criteria. Interventions that improved postoperative pain relief included paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, ankle block, and local anesthetic wound infiltration. Insufficient evidence was found for the use of gabapentinoids or wound infiltration with extended release bupivacaine or dexamethasone. Conflicting evidence was found for percutaneous chevron osteotomy. No evidence was found for homeopathic preparation, continuous local anesthetic wound infusion, clonidine and fentanyl as sciatic perineural adjuncts, bioabsorbable magnesium screws, and plaster slippers. No studies of sciatic nerve block met the inclusion criteria for PROSPECT methodology due to a wider scope of included surgical procedures or the lack of a control (no block) group. The analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a non-steroidal anti-inflammatory drug or cyclo-oxygenase-2 selective inhibitor administered preoperatively or intraoperatively and continued postoperatively, along with systemic steroids, and postoperative opioids for rescue analgesia.
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- 2020
7. Anesthesia and Analgesia Practice Pathway Options for Total Knee Arthroplasty: An Evidence-Based Review by the American and European Societies of Regional Anesthesia and Pain Medicine
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Jessica T. Wegener, Sandra L. Kopp, Asokumar Buvanendran, Narinder Rawal, Jens Børglum, Stavros G. Memtsoudis, Brian M. Ilfeld, Joseph M. Neal, Terese T. Horlocker, APH - Quality of Care, Other Research, Anesthesiology, ACS - Heart failure & arrhythmias, and ACS - Diabetes & metabolism
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medicine.medical_specialty ,Pain medicine ,Analgesic ,Replacement ,Clinical Sciences ,Total knee arthroplasty ,Pain ,Regional anaesthesia ,Conduction ,Arthroplasty ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Anesthesiology ,Medical ,medicine ,Humans ,Pain Management ,Anesthesia ,Knee ,Postoperative ,030222 orthopedics ,Evidence-Based Medicine ,business.industry ,Nerve Block ,General Medicine ,Evidence based review ,United States ,Europe ,Anesthesiology and Pain Medicine ,Regional anesthesia ,Physical therapy ,Analgesia ,business ,Societies ,Pain therapy - Abstract
In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual settings.
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- 2017
8. Procedure-Specific Pain Management (PROSPECT) - An update
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Brian Lee, Stephan A. Schug, Girish P. Joshi, Henrik Kehlet, Helene Beloeil, Francis Bonnet, Patricia Lavand’Homme, Philipp Lirk, Esther Pogatzki-Zahn, Johan Raeder, Narinder Rawal, Marc van der Velde, UCL - SSS/IONS - Institute of NeuroScience, and UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire
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procedure specific ,medicine.medical_specialty ,Evidence-based practice ,Clinical Decision-Making ,Psychological intervention ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,evidence-based ,030202 anesthesiology ,Medicine ,Humans ,Pain Management ,guidelines ,030212 general & internal medicine ,Risks and benefits ,Intensive care medicine ,Pain, Postoperative ,Evidence-Based Medicine ,business.industry ,Surgical procedures ,Pain management ,Anesthesiologists ,Anesthesiology and Pain Medicine ,treatment recommendations ,outcome ,post-operative analgesia ,business - Abstract
Post-operative pain management protocols may be optimised by examining procedure-specific evidence and outcomes. This recognition led to the formation of the PROcedure-SPECific Pain ManagemenT (PROSPECT) collaboration of anaesthesiologists and surgeons. The aim of PROSPECT is to provide practical and evidence-based recommendations to prevent and treat post-operative pain after specific surgical procedures, thereby overcoming the limitations of generic, non-specific guidelines. Updates in the methodology of PROSPECT in 2017 have placed an increased emphasis on the clinical relevance of studies, including a focus on interventions in the context of multimodal analgesia strategies and consideration of risks and benefits of interventions in specific surgical settings. Evidence-based reviews of analgesic measures, including advice on surgical techniques and adjuvants after diverse surgical procedures, have been completed by the PROSPECT collaboration and are accessible on the website (www.postoppain.org) and published in the peer-reviewed literature. These reviews continue to identify significant gaps in clinically relevant research on post-operative analgesia and are possibly leading to a closing of some of these gaps.
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- 2018
9. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update
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Andrew G. Hill, Patricia Lavand'homme, M. Van de Velde, Ahmed W.H. Barazanchi, Stephan A. Schug, Narinder Rawal, Philipp Lirk, Marcel Vercauteren, Jamie-Lee Rahiri, Wiremu S. MacFater, Johan Raeder, Hélène Beloeil, Francis Bonnet, Esther M. Pogatzki-Zahn, Girish P. Joshi, Senitila Dr Tutone, and Henrik Kehlet
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medicine.medical_specialty ,medicine.medical_treatment ,Analgesic ,MEDLINE ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Pneumoperitoneum ,030202 anesthesiology ,Medicine ,Humans ,Pain Management ,Randomized Controlled Trials as Topic ,Analgesics ,Pain, Postoperative ,Evidence-Based Medicine ,business.industry ,General surgery ,Evidence-based management ,medicine.disease ,Anesthesiology and Pain Medicine ,Systematic review ,Opioid ,Cholecystectomy, Laparoscopic ,030220 oncology & carcinogenesis ,Cholecystectomy ,business ,medicine.drug - Abstract
BACKGROUND: Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy. METHODS: Randomised controlled trials published in the English language from January 2006 (date of last PROSPECT review) to December 2017, assessing analgesic, anaesthetic, or operative interventions for laparoscopic cholecystectomy in adults, and reporting pain scores, were retrieved from MEDLINE and Cochrane databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) search protocols. PROSPECT methodology was used, and recommendations were formulated after review and discussion by the PROSPECT group (an international group of leading pain specialists and surgeons). RESULTS: Of 1988 randomised controlled trials identified, 258 met the inclusion criteria and were included in this review. The studies were of mixed methodological quality, and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported. CONCLUSIONS: We recommend basic analgesic techniques: paracetamol + NSAID or cyclooxygenase-2 specific inhibitor + surgical site local anaesthetic infiltration. Paracetamol and NSAID should be started before or during operation with dexamethasone (GRADE A). Opioid should be reserved for rescue analgesia only (GRADE B). Gabapentanoids, intraperitoneal local anaesthetic, and transversus abdominis plane blocks are not recommended (GRADE D) unless basic analgesia is not possible. Surgically, we recommend low-pressure pneumoperitoneum, postprocedure saline lavage, and aspiration of pneumoperitoneum (GRADE A). Single-port incision techniques are not recommended to reduce pain (GRADE A). ispartof: Br J Anaesth vol:121 issue:4 pages:787-803 ispartof: location:England status: published
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- 2018
10. Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey
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Pether K. Jildenstål, Narinder Rawal, Jan G. Jakobsson, Lars Berggren, and Jan Hallén
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medicine.medical_specialty ,Electroencephalography ,General anaesthesia ,Article ,Emergence agitation ,Medicine ,Postoperative delirium ,Intensive care medicine ,Postoperative cognitive dysfunction ,Auditory evoked potential ,Web based survey ,Postoperative cognitive side effects ,Geriatrics ,Perioperative management ,medicine.diagnostic_test ,business.industry ,Cognition ,General Medicine ,medicine.disease ,Depth of anaesthesia monitors ,Anesthesia ,Bi-spectral index ,Surgery ,business - Abstract
Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients. The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel. Methods A web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD. Results The response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals. Conclusion Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects., Highlights • We found that routines around postoperative cognitive side effects were infrequently in place. • We found that Swedish anaesthesia personnel have a sceptic view on depth-of-anaesthesia monitors. • Depth-of-anaesthesia monitors were not commonly used even in at risk patients. • There is a need for improvement in the attitude towards postoperative cognitive side effects.
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- 2014
11. Open versus Laparoscopic Surgery: Does the Surgical Technique Influence Pain Outcome? Results from an International Registry
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E Johanzon, Renée Allvin, Narinder Rawal, and Ragnar Backström
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Laparoscopic surgery ,lcsh:R5-920 ,Pain score ,medicine.medical_specialty ,Article Subject ,business.industry ,medicine.medical_treatment ,MEDLINE ,Regional anaesthesia ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Patient satisfaction ,030202 anesthesiology ,Anesthesia ,medicine ,In patient ,Registry data ,Neurology (clinical) ,lcsh:Medicine (General) ,Prospective cohort study ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Postoperative pain management relevant for specific surgical procedures is debated. The importance of evaluating pain with consideration given to type of surgery and the patient’s perspective has been emphasized. In this prospective cohort study, we analysed outcome data from 607 patients in the international PAIN OUT registry for assessment and comparison of postoperative pain outcome within the 24 first hours after laparoscopic and open colonic surgery. Patients from the laparoscopic group scored minimum pain at a higher level than the open group (P=0.012). Apart from minimum pain, no other significant differences in patient reported outcomes were observed. Maximum pain scores >3 were reported from 77% (laparoscopic) and 68% (open) patients (mean ≥ 5 in both groups). Pain interference with mobilization was reported by 87–93% of patients. Both groups scored high levels of patient satisfaction. In the open group, a higher frequency of patients received a combination of general and regional anaesthesia, which had an impact of the minimum pain score. Our results from registry data indicate that surgical technique does not influence the quality of postoperative pain management during the first postoperative day if adequate analgesia is given.
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- 2016
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12. The Postoperative Recovery Profile (PRP) - a multidimensional questionnaire for evaluation of recovery profiles
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Narinder Rawal, Elisabeth Svensson, Margareta Ehnfors, Renée Allvin, Ewa Idvall, and Anna-Maria Kling
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medicine.medical_specialty ,business.industry ,Health Policy ,Abdomen surgery ,Public Health, Environmental and Occupational Health ,MEDLINE ,Medicine ,Postoperative recovery ,Young adult ,business ,Orthopedic Procedures ,Surgery - Abstract
Background. The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evalu ...
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- 2010
13. Postoperative Pain After Abdominal Hysterectomy: A Double-Blind Comparison Between Placebo and Local Anesthetic Infused Intraperitoneally
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Anil Gupta, Sven E. Thörn, Narinder Rawal, Kristina Crafoord, Andrea Perniola, and Kjell Axelsson
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Visual analogue scale ,medicine.medical_treatment ,Analgesic ,Hysterectomy ,chemistry.chemical_compound ,Double-Blind Method ,medicine ,Ketobemidone ,Humans ,Anesthetics, Local ,Pain Measurement ,Bupivacaine ,Pain, Postoperative ,business.industry ,Local anesthetic ,Middle Aged ,Surgery ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Levobupivacaine ,chemistry ,Anesthesia ,Postoperative Nausea and Vomiting ,Female ,medicine.symptom ,business ,Injections, Intraperitoneal ,Postoperative nausea and vomiting ,medicine.drug - Abstract
Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained
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- 2004
14. Patient-controlled Regional Analgesia (PCRA) at Home
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Gustav Ekbäck, Jan Hallén, Kjell Axelsson, Anders Amilon, Narinder Rawal, Torbjörn Ohlsson, and Renée Allvin
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Bupivacaine ,medicine.medical_specialty ,business.industry ,Ropivacaine ,Local anesthetic ,medicine.drug_class ,Analgesic ,Hand surgery ,law.invention ,Surgery ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Anesthesia ,Ambulatory ,Medicine ,business ,Brachial plexus ,medicine.drug - Abstract
Background The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. Methods Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery. Results Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection. Conclusions This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.
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- 2002
15. Incisional self-administration of bupivacaine or ropivacaine provides effective analgesia after inguinal hernia repair
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Narinder Rawal, Gorazd Pozlep, Slavko Rakovec, Neli Vintar, and Marija Godec
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Hernia, Inguinal ,Self Administration ,Catheterization ,Double-Blind Method ,medicine ,Humans ,Surgical Wound Infection ,Ropivacaine ,Local anesthesia ,Hernia ,Anesthetics, Local ,Digestive System Surgical Procedures ,Aged ,Pain Measurement ,Bupivacaine ,Pain, Postoperative ,Local anesthetic ,business.industry ,Surgical wound ,General Medicine ,Middle Aged ,medicine.disease ,Amides ,Surgery ,Inguinal hernia ,Catheter ,Anesthesiology and Pain Medicine ,Patient Satisfaction ,Anesthesia ,Female ,business ,medicine.drug - Abstract
To evaluate the safety and applicability of two local anesthetic (LA) solutions self-administered for pain treatment after inguinal hernia repair (IHR) by balloon-pumps via catheters placed in the surgical wound. Effectiveness of analgesia was also compared.Two groups of patients for IHR were included in the randomized, double-blind study. An epidural catheter was placed in the surgical wound, tunneled subcutaneously and connected to a balloon-pump containing either 0.25% bupivacaine (B) or 0.25% ropivacaine (R). Postoperatively, the patient self-administered the LA into the wound. Administration could be repeated after 20 min. If moderate to severe pain still persisted, rescue medication (piritramid) was given intravenously. The variables recorded in both groups were: visual analogue scale (VAS), pain scores at rest and with movement, number of applications, wound healing, patients' satisfaction.During the first 24 hr, median number of LA applications in 26 B patients was 4 (range 1-6) and in 25 R patients 3 (range 1-5). Both groups showed low VAS pain scores: less than 2 at rest, less than 4 with movement. Eighty percent of patients of each group would choose this type of analgesia again. Two patients from B Group and three from R Group needed rescue medication. No wound infection was observed. There were no statistically significant differences between the groups.Self-administration of the LA solution via a catheter in the surgical wound is an effective method of pain relief after IHR with little side-effects.
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- 2002
16. Routines for reducing the occurrence of emergence agitation during awakening in children, a national survey
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Jan G. Jakobsson, Pether K. Jildenstål, Lars Berggren, Jan Hallén, and Narinder Rawal
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Multidisciplinary ,business.industry ,Research ,Premedication ,Postoperative recovery and volatile anesthetics ,Generalanesthesia ,Sevoflurane ,Clonidine ,Emergence agitation ,Postoperative pain ,Distress ,Desflurane ,Anesthesia ,Anesthetic ,medicine ,Midazolam ,business ,Propofol ,medicine.drug ,Volatile anesthetics - Abstract
Emergence agitation following anesthesia in children is not uncommon. It is, although generally self-limiting, associated with both patient and parents distress. We conducted a national survey around the management of behavioral and neurocognitive disturbances after surgery/anesthesia including a case scenario about a child at risk for emergence reaction. Premedication with clonidine or midazolam would have been used 58 and 37% of responders respectively. A propofol based anesthesia was the most common anesthetic technique, however sevoflurane or desflurane was an option for 45 and 8% of responders. Before awakening 65% would have administered an opioid, 48% a low-dose of propofol and 25% clonidine. Sign or symptoms of behavioral disturbance was not assessed by standardize assessment tools. A majority of Swedish anesthesia personnel would undertake some preventive action when handling a child at risk for an emergence reaction, the preventive measure differed and it seems as there is an obvious room for further improvements.
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- 2014
17. Adequate depth of anaesthesia during general anaesthesia for Caesarean section, a national survey
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Jan G. Jakobsson, Lars Berggren, Jan Hallén, Pether K. Jildenstål, and Narinder Rawal
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Depth of anaesthesia ,Anesthesiology and Pain Medicine ,business.industry ,medicine.medical_treatment ,Anesthesia ,medicine ,General anaesthesia ,Caesarean section ,business - Published
- 2014
18. Postoperative Analgesia at Home After Ambulatory Hand Surgery: A Controlled Comparison of Tramadol, Metamizol, and Paracetamol
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Narinder Rawal, Renée Allvin, Anders Amilon, Jan Hallén, and Torbjörn Ohlsson
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Adult ,Male ,Visual analogue scale ,Nausea ,Analgesic ,Propoxyphene ,Dipyrone ,Double-Blind Method ,medicine ,Humans ,Prospective Studies ,Adverse effect ,Tramadol ,Acetaminophen ,Aged ,Analgesics ,Pain, Postoperative ,business.industry ,Middle Aged ,Hand ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Anesthesia ,Ambulatory ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
We compared in a prospective, randomized, double-blinded study the analgesic efficacy of three drugs in 120 ASA I and II patients scheduled to undergo ambulatory hand surgery with IV regional anesthesia. At discharge, oral analgesic tablets were prescribed as follows: tramadol 100 mg every 6 h, metamizol 1 g every 6 h, and paracetamol (acetaminophen) 1 g every 6 h. Rescue medication consisted of oral dextropropoxyphene 100 mg on demand. Analgesic efficacy was evaluated by self-assessment of pain intensity by visual analog score at six different time intervals during the 48-h study period. Patients also recorded global pain relief on a 5-grade scale, total number of study and rescue analgesic tablets, frequency and severity of adverse effects, sleep pattern, and overall satisfaction. None of the study drugs alone provided effective analgesia in all patients. The percentage of patients who required supplementary analgesics was 23% with tramadol, 31% with metamizol, and 42% with acetaminophen. Tramadol was the most effective analgesic, as evidenced by low pain scores, least rescue medication, and fewest number of patients with sleep disturbance. However, the incidence of side effects was also increased with tramadol. Seven patients (17.5%) withdrew from the study because of the severity of nausea and dizziness associated with the use of tramadol. Metamizol and acetaminophen provided good analgesia in about 70% and 60% of patients, respectively, with a decreased incidence of side effects. Despite receiving oral analgesic medication, up to 40% of patients undergoing hand surgery experienced inadequate analgesia in this controlled trial. Although tramadol was more effective, its use was associated with the highest frequency and intensity of adverse effects and the most patient dissatisfaction. Metamizol and acetaminophen provided good analgesia with a small incidence of side effects. For patients undergoing ambulatory hand surgery, postoperative pain can last longer than 2-3 days, and there is a need for both better education before the procedure and oral analgesic therapy at home.
- Published
- 2001
19. The Analgesic Efficacy of Patient-Controlled Ropivacaine Instillation After Cesarean Delivery
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Brian Fredman, Arie Shapiro, Narinder Rawal, Ella Feldman, Robert Jedeikin, Edna Zohar, and Shy Shorer
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Adult ,medicine.medical_specialty ,medicine.drug_class ,Analgesic ,Double-Blind Method ,Pregnancy ,medicine ,Humans ,Ropivacaine ,Prospective Studies ,Anesthetics, Local ,Pain, Postoperative ,Cesarean Section ,Local anesthetic ,business.industry ,Analgesia, Patient-Controlled ,Surgical wound ,Amides ,Surgery ,Catheter ,Continuous wound infiltration ,Anesthesiology and Pain Medicine ,Anesthesia ,Morphine ,Female ,business ,Perfusion ,medicine.drug - Abstract
To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B. Braun, Melsungen, Germany) was placed above the fascia such that the tip was sited at the point that demarcated 50% of the length of the surgical wound. Thereafter, the catheter was connected to the elastometric pump. According to a computer-generated randomization schedule, the pump was filled with either ropivacaine 0.2% (Ropivacaine Group) or an equal volume of sterile water (Control Group). Postoperatively, patient-controlled analgesia was administered via the elastometric pump. During the first 6 postoperative hours, a coinvestigator administered "rescue" morphine (2 mg, IV). Thereafter, "rescue" dipyrone (1 g) was administered on patient request. In a subset of 10 patients, blood ropivacaine levels were assessed. Compared with the Control Group, significantly fewer patients in the Ropivacaine Group received "rescue" morphine (92% vs. 48%, respectively) (P
- Published
- 2000
20. AAI-guided anaesthesia is associated with lower incidence of 24-h MMSE25 and may impact the IL-6 response
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Narinder Rawal, Jan G. Jakobsson, Pether K. Jildenstål, Lars Berggren, and Jan Hallén
- Subjects
Adult ,Male ,Adolescent ,Cognitive decline ,Ophthalmologic Surgical Procedures ,Minor surgery ,Anesthesia, General ,General anaesthesia ,Young Adult ,Postoperative Complications ,Risk Factors ,Medicine ,Humans ,Prospective Studies ,Evoked potential ,Interleukin 6 ,Aged ,Aged, 80 and over ,IL-6 ,biology ,business.industry ,Interleukin-6 ,General Medicine ,Middle Aged ,Lower incidence ,Anesthesia ,biology.protein ,Evoked Potentials, Auditory ,Surgery ,Female ,Auditory evoked potential (AEP) monitoring ,business - Abstract
IntroductionTrauma stress and neuro-inflammation caused by surgery/anaesthesia releases cytokines. This study analysed impact of Auditory Evoked Potential Index (AAI) depth-of-anaesthesia titration on the early plasma IL-6 release after eye surgery under general anaesthesia.MethodThis is a subgroup analysis of a prospective randomized study on the effect of auditory evoked potential guided anaesthesia for eye surgery. Plasma IL-6 levels taken before, 5 and 24 h after end of surgery from 450 patients undergoing elective ophthalmic surgery under desflurane anaesthesia were analysed. Minimal mental state examination (MMSE) was also tested at 24-h.ResultsIL- 6 increased significantly at both 5 and further at 24 h after surgery (3.2, 4.5 and 5.1 base-line, 5 and 24-h respectively), the IL-6 increase showed different patterns between the 2 groups; IL-6 was significantly increased in the control group of patients between preoperative baseline and 24 h after surgery (p = 0.008) also between 5 h and 24 h, (p = 0.006) after surgery while the AAI-group had only minor non-significant changes. The 18 patients that showed a 24-h MMSE score less than 25 had a significant higher 24-h IL-6 compared to the 390 patients with a MMSE score > 24 (p = 0.002).ConclusionThe IL-6 increase after surgery was less pronounced in patients where anaesthesia was titrated by AAI compared to anaesthesia adjusted on clinical signs only. IL-6 were also found to be higher in patients with a MMSE
- Published
- 2013
21. Patients' perception of postoperative pain management: validation of the International Pain Outcomes (IPO) questionnaire
- Author
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Andreas Kopf, Matthias Schwenkglenks, Winfried Meissner, Peter Funk, Maryam Yahiaoui-Doktor, Narinder Rawal, Ruth Zaslansky, Ingo Buchholz, Renée Allvin, Margarita M. Puig, Kristin Ullrich, H J Gerbershagen, Yigal Leykin, Silviu Brill, Judith Rothaug, Thomas Volk, Debra B. Gordon, Dominique Fletcher, Ragnar Backström, Esther M. Pogatzki-Zahn, Marcus Komann, Lucian Fodor, Rod S Taylor, Christoph Konrad, Christoph Engel, University of Zurich, and Rothaug, Judith
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neurology ,Quality management ,Adolescent ,Psychometrics ,Postoperative pain ,610 Medicine & health ,Surveys and Questionnaires ,Medicine ,Humans ,Pain Management ,Aged ,Aged, 80 and over ,Pain, Postoperative ,business.industry ,food and beverages ,Reproducibility of Results ,10060 Epidemiology, Biostatistics and Prevention Institute (EBPI) ,Middle Aged ,Anesthesiology and Pain Medicine ,Patient perceptions ,2728 Neurology (clinical) ,Patient Satisfaction ,2808 Neurology ,Physical therapy ,Female ,Perception ,Neurology (clinical) ,2703 Anesthesiology and Pain Medicine ,business ,human activities ,Initial public offering - Abstract
PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory.The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries.
- Published
- 2013
22. Risk of Catheter Migration During Combined Spinal Epidural Block
- Author
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Per-Anders Nydahl, Kjell Axelsson, Narinder Rawal, and Björn Holmström
- Subjects
Adult ,Anesthesia, Epidural ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Percutaneous ,Dura mater ,Tuohy needle ,Wounds, Penetrating ,Anesthesia, Spinal ,Catheterization ,Lumbar ,Risk Factors ,Cadaver ,Humans ,Medicine ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Endoscopy ,Middle Aged ,Epidural space ,Surgery ,Catheter ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Female ,Dura Mater ,business - Abstract
Combined spinal epidural (CSE) block with the needle-through-needle technique has become increasingly popular during recent years. However, the risk of epidural catheter penetrating dura mater through the hole made by the spinal needle (migration) is a major concern. In 15 fresh cadavers a percutaneous epiduroscopy technique with a rigid epiduroscope and video recording was used to assess the risk of catheter migration when a CSE block is performed. The experimental sequence included (a) one dural hole made by the spinal needle, (b) multiple (five) dural holes made by the spinal needle, and (c) a dural hole made by Tuohy needle. Twenty-four experimental sequences were performed in the lumbar region. Four sequences were failures due to technical problems. In the remaining 20 cases, the anatomic structures in the epidural space were recognized easily. The epidural space appears to be only a potential space, kept open either by epiduroscope or by repeated injections of air or saline. The dural holes made by Tuohy and spinal needles, and the ease of difficulty of catheter penetration through these holes, were clearly visible. Extensive tenting of the dura was seen in all subjects. It was impossible to force an 18-gauge epidural catheter through the dural hole after a single dural puncture made by a 25-gauge spinal needle. After multiple (five) dural punctures with the spinal needle, the epidural catheter penetrated the perforated dura in 1 of 20 cases. The epidural catheter penetrated the dural hole made by the Tuohy needle in 9 of 20 cases. The distribution of fat, rather than any dorso median connective tissue band, influences the course of epidural catheter in epidural space.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1995
23. Evaluation of etoricoxib in patients undergoing total knee replacement surgery in a double-blind, randomized controlled trial
- Author
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D. Chitkara, Harold S. Minkowitz, Dimitris Papanicolaou, Eugene R. Viscusi, Sean P. Curtis, Paul M. Peloso, Narinder Rawal, Liang Chen, Anish Mehta, and Sandhya Shah
- Subjects
Male ,Narcotics ,medicine.medical_specialty ,Pain upon movement ,Sports medicine ,Pyridines ,medicine.medical_treatment ,education ,Ibuprofen ,law.invention ,Double blind ,Etoricoxib ,Pain at rest ,Rheumatology ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Sulfones ,Arthroplasty, Replacement, Knee ,Aged ,Pain, Postoperative ,Rehabilitation ,Cyclooxygenase 2 Inhibitors ,Morphine ,business.industry ,Middle Aged ,Morphine consumption ,Arthroplasty ,Surgery ,Total knee replacement ,Anesthesia ,Orthopedic surgery ,Female ,business ,medicine.drug ,Research Article - Abstract
Background Optimal postoperative pain management is important to ensure patient comfort and early mobilization. Methods In this double-blind, placebo- and active-controlled, randomized clinical trial, we evaluated postoperative pain following knee replacement in patients receiving placebo, etoricoxib (90 or 120 mg), or ibuprofen 1800 mg daily for 7 days. Patients ≥18 years of age who had pain at rest ≥5 (0–10 Numerical Rating Scale [NRS]) after unilateral total knee replacement were randomly assigned to placebo (N = 98), etoricoxib 90 mg (N = 224), etoricoxib 120 mg (N = 230), or ibuprofen 1800 mg (N = 224) postoperatively. Co-primary endpoints included Average Pain Intensity Difference at Rest over Days 1–3 (0- to 10-point NRS) and Average Total Daily Dose of Morphine over Days 1–3. Pain upon movement was evaluated using Average Pain Intensity Difference upon Knee Flexion (0- to 10-point NRS). The primary objective was to demonstrate analgesic superiority for the etoricoxib doses vs. placebo; the secondary objective was to demonstrate that the analgesic effect of the etoricoxib doses was non-inferior to ibuprofen. Adverse experiences (AEs) including opioid-related AEs were evaluated. Results The least squares (LS) mean (95% CI) differences from placebo for Pain Intensity Difference at Rest over Days 1–3 were -0.54 (-0.95, -0.14); -0.49 (-0.89, -0.08); and -0.45 (-0.85, -0.04) for etoricoxib 90 mg, etoricoxib 120 mg, and ibuprofen, respectively (p
- Published
- 2012
24. Does Depth of Anesthesia Influence Postoperative Cognitive Dysfunction or Inflammatory Response Following Major ENT Surgery?
- Author
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Lars Berggren, Jan Hallén, Narinder Rawal, and Pether K. Jildenstål
- Subjects
medicine.medical_specialty ,CFQ ,business.industry ,Perioperative ,medicine.disease ,Fentanyl ,Surgery ,Desflurane ,Anesthesiology and Pain Medicine ,Anesthesia ,Anesthetic ,medicine ,Cognitive decline ,Evoked potential ,business ,Postoperative cognitive dysfunction ,medicine.drug - Abstract
The aim of this study was to evaluate the role of depth of anesthesia on POCD after major ENT surgery and to assess changes in postoperative inflammatory markers in patients undergoing major ENT surgery. Thirty two patients aged 40 to 94 yrs, scheduled for surgery under general anesthesia were randomly assigned to one of two groups. In group A (AEP group) depth of anesthesia (DOA) was measured with auditory evoked potential (AEP). In the control group (group C) DOA was monitored according to clinical signs. Cognitive function was evaluated using Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM) and Cognitive Failure Questionnaire (CFQ). Inflammatory markers were measured before and after anesthesia. Perioperative requirements for desflurane and fentanyl were significantly lower in group A. On the first postoperative day MMSE changes indicating POCD were noted in 1 patient in group A and 7 patients in group C (P
- Published
- 2012
25. Intrathecal and Epidural Somatostatin for Patients with Cancer
- Author
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Peter Mollenholt, Yngve Olsson, Torsten Gordh, and Narinder Rawal
- Subjects
Chemotherapy ,Nerve root ,business.industry ,medicine.medical_treatment ,Analgesic ,Spinal cord ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nociception ,Concomitant ,Anesthesia ,Medicine ,Epidural administration ,business ,Cancer pain - Abstract
BACKGROUND The antinociceptive effects of somatostatin (SST) after intrathecal administration in rats and dogs and analgesic effects after intrathecal or epidural administration in humans were described previously. In this study, we seek to determine the efficacy of SST in cancer pain management and its potential neurotoxicity. METHODS Eight patients with intractable cancer pain were studied. Pain intensity was assessed by patients on a four-grade scale (severe, moderate, mild, none). Additional analgesic drug requirements before and concomitant with SST treatment were used to evaluate the pain relief and assessed on a four-grade scale (poor, fair, good, or excellent). Spinal cords of five patients were autopsied. RESULTS The mean duration of SST treatment was 11.3 days. The mean daily dose was 1,252 micrograms (range 250-3,000 micrograms). In six patients the pain relief was rated "excellent" or "good" and in two patients it was assessed "poor" or "fair". None of the patients demonstrated any evidence of neurologic deficit related to the SST treatment. At autopsy, two patients exhibited a moderate demyelination of some spinal dorsal roots and one patient also had a slight demyelination of the dorsal columns. CONCLUSIONS SST administered intrathecally and epidurally was an effective analgesic in patients with terminal cancer. Because the described neuropathologic changes could also be cancer-related or result from chemotherapy or radiation therapy we suggest that further judicious use of SST is justified in this category of patients, if their pain remains unrelieved despite large doses of opioid analgesics.
- Published
- 1994
26. Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial
- Author
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Marco Berti, Markus Wietlisbach, Narinder Rawal, Elena Catalá, Rui Costa, and Valery Macquaire
- Subjects
tramadol ,medicine.medical_specialty ,Nausea ,paracetamol ,Analgesic ,combination therapy ,Multicenter trial ,medicine ,Journal of Pain Research ,Adverse effect ,Original Research ,lcsh:R5-920 ,business.industry ,Hand surgery ,analgesia ,Surgery ,Anesthesiology and Pain Medicine ,Anesthesia ,Ambulatory ,Vomiting ,ambulatory hand surgery ,Tramadol ,medicine.symptom ,lcsh:Medicine (General) ,business ,postoperative pain ,medicine.drug - Abstract
Narinder Rawal1, Valery Macquaire2, Elena Catalá3, Marco Berti4, Rui Costa5, Markus Wietlisbach61Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; 2Clinique du Parc Leopold, Brussels, Belgium; 3Pain Clinic, Department Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 4Department of Anesthesiology and Reanimation, Parma Hospital, Parma, Italy; 5Garcia de Orta Hospital, Almada, Portugal; 6Department of Anesthesiology, Sursee Hospital, Sursee, SwitzerlandAbstract: This randomized, double-blind, double-dummy, multicenter trial compared efficacy and safety of tramadol HCL 37.5 mg/paracetamol 325 mg combination tablet with tramadol HCL 50 mg capsule in the treatment of postoperative pain following ambulatory hand surgery with iv regional anesthesia. Patients received trial medication at admission, immediately after surgery, and every 6 hours after discharge until midnight of the first postoperative day. Analgesic efficacy was assessed by patients (n = 128 in each group, full analysis set) and recorded in a diary on the evening of surgery day and of the first postoperative day. They also documented the occurrence of adverse events. By the end of the first postoperative day, the proportion of treatment responders based on treatment satisfaction (primary efficacy variable) was comparable between the groups (78.1% combination, 71.9% tramadol; P = 0.24) and mean pain intensity (rated on a numerical scale from 0 = no pain to 10 = worst imaginable pain) had been reduced to 1.7 ± 2.0 for both groups. Under both treatments, twice as many patients experienced no pain (score = 0) on the first postoperative day compared to the day of surgery (35.9% vs 16.4% for tramadol/paracetamol and 36.7% vs 18% for tramadol treatment). Rescue medication leading to withdrawal (diclofenac 50 mg) was required by 17.2% patients with tramadol/paracetamol and 13.3% with tramadol. Adverse events (mainly nausea, dizziness, somnolence, vomiting, and increased sweating) occurred less frequently in patients under combination treatment (P = 0.004). Tramadol/paracetamol combination tablets provided comparable analgesic efficacy with a better safety profile to tramadol capsules in patients experiencing postoperative pain following ambulatory hand surgery.Keywords: ambulatory hand surgery, analgesia, combination therapy, paracetamol, postoperative pain, tramadol
- Published
- 2011
27. Intra-Articular Patient-Controlled Analgesia Improves Early Rehabilitation after Knee Surgery
- Author
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Neli, Vintar, Narinder, Rawal, Maja, Pohar, and Matjai, Veselko
- Subjects
Adult ,Male ,Pain, Postoperative ,Knee Joint ,Morphine ,Analgesia, Patient-Controlled ,Amides ,Anesthesia, Spinal ,Injections, Intra-Articular ,Double-Blind Method ,Humans ,Female ,Ropivacaine ,knee surgery ,outcome ,postoperative analgesia ,intraarticular ,Ljubljana ,Slovenia ,Prospective Studies ,Anterior Cruciate Ligament ,Ketorolac - Abstract
The influence of patient-controlled intra-articular analgesia with ropivacaine, morphine and ketorolac (RMK) on postoperative pain relief and early rehabilitation after anterior cruciate ligament reconstruction was studied. Twenty six patients, randomized into two groups, were enrolled in a placebo-controlled, double-blind study. At the end of surgery a catheter was placed intra-articularly and connected to a patient-controlled pump, programmed to deliver 10 mL bolus and 60 min lockout interval. RMK group received 0.25% ropivacaine, morphine 0.2 mg/mL and ketorolac 1 mg/mL; P group saline. Pain was measured with 10 cm visual analog scale. At pain scores >3 cm, all patients were instructed to self-administer morphine intravenously using a patient-controlled pump. Daily rescue morphine consumption was noted and 48h rehabilitation programme was evaluated. Daily morphine consumption was significantly lower in the RMK group (p0.05). The results show that patient-controlled intra-articular analgesia with RMK combination provides effective pain relief following anterior cruciate ligament reconstruction and improves early physical rehabilitation.
- Published
- 2010
28. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability
- Author
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Elisabeth Svensson, Ewa Idvall, Renée Allvin, Narinder Rawal, and Margareta Ehnfors
- Subjects
Adult ,Male ,Medicin och hälsovetenskap ,medicine.medical_specialty ,Validation study ,Adolescent ,Postoperative recovery ,Medical and Health Sciences ,Young Adult ,Surveys and Questionnaires ,Content validity ,medicine ,Humans ,Patient participation ,Reliability (statistics) ,Aged ,Postoperative Care ,Measure (data warehouse) ,business.industry ,Kirurgi ,Health Policy ,Public Health, Environmental and Occupational Health ,Middle Aged ,Physical therapy ,Surgery ,Female ,Patient Participation ,business - Abstract
Aims and objectives. In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery. Method. The study involved four steps. 1) A conceptualisation and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons. 2) Content validity of items was tested through expert judgements. 3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement. 4) The stability of the questionnaire was evaluated through intra-patient reliability assessment. Results. As a result of the operationalisation process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability. Conclusion. Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability., Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-7731
- Published
- 2009
29. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty
- Author
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Girish P. Joshi, Edmund Neugebauer, Francis Bonnet, Narinder Rawal, Stephan A. Schug, Christopher Sharp, Christian Simanski, Henrik Kehlet, Frederic Camu, and H. B. J. Fischer
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Analgesic ,MEDLINE ,Total knee arthroplasty ,law.invention ,Randomized controlled trial ,law ,Anesthesia, Conduction ,medicine ,Humans ,General anaesthesia ,Arthroplasty, Replacement, Knee ,Physical Therapy Modalities ,Randomized Controlled Trials as Topic ,Postoperative Care ,Analgesics ,Pain, Postoperative ,business.industry ,Arthroplasty ,Femoral nerve block ,Anesthesiology and Pain Medicine ,Systematic review ,Anesthesia ,Physical therapy ,Analgesia ,business - Abstract
The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are then developed from these systematic reviews, incorporating clinical practice observations, and transferable evidence from other relevant procedures. We present the results of a systematic review of pain and other outcomes following analgesic, anaesthetic and surgical interventions for total knee arthroplasty (TKA). The evidence from this review supports the use of general anaesthesia combined with a femoral nerve block for surgery and postoperative analgesia, or alternatively spinal anaesthesia with local anaesthetic plus spinal morphine. The primary technique, together with cooling and compression techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain).
- Published
- 2008
30. Experiences of the postoperative recovery process : an interview study
- Author
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Renée Allvin, Margareta Ehnfors, Ewa Idvall, and Narinder Rawal
- Subjects
Medicin och hälsovetenskap ,content analysis ,business.industry ,medicine.medical_treatment ,Kirurgi ,Qualitative descriptive ,interview ,Primary care ,Postoperative recovery ,Medical and Health Sciences ,Article ,recovery ,experience ,Nursing ,Content analysis ,medicine ,Interview study ,postoperative ,Surgery ,Qualitative content analysis ,business ,Everyday life ,General Nursing ,Gynecological surgery - Abstract
Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.
- Published
- 2008
31. Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study
- Author
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Ulf Nordensson, Anil Gupta, Elisabeth Berg, E Johanzon, K. Axelsson, Peter Enström, Gustav Ekbäck, and Narinder Rawal
- Subjects
Adult ,Male ,medicine.medical_specialty ,Shoulder ,Time Factors ,Shoulder surgery ,medicine.drug_class ,medicine.medical_treatment ,Analgesic ,Injections, Intra-Articular ,Double-Blind Method ,Surveys and Questionnaires ,medicine ,Humans ,Cyclooxygenase Inhibitors ,Infusions, Parenteral ,Ropivacaine ,Anesthetics, Local ,Saline ,Pain Measurement ,Pain, Postoperative ,Morphine ,business.industry ,Local anesthetic ,Analgesia, Patient-Controlled ,Middle Aged ,Amides ,Surgery ,Ketorolac ,Analgesics, Opioid ,Catheter ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Patient Satisfaction ,Research Design ,Anesthesia ,Injections, Intravenous ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
BACKGROUND: In this study we assessed the efficacy of intraarticular regional analgesia on postoperative pain and analgesic requirements. METHODS: Fifty-one patients undergoing shoulder surgery (Bankart) were recruited into this double-blind study. At the end of the operation, patients were randomized to three groups to receive intraarticularly via a catheter: Group 1: ropivacaine 90 mg (9 mL), morphine 4 mg (10 mL), and ketorolac 30 mg (1 mL) (total volume 20 mL); Groups 2 and 3: saline (20 mL). In addition, Groups 1 and 3 received 1 mL saline IV while Group 2 received ketorolac 30 mg (1 mL) IV. Postoperatively, Group 1 received pain relief using 10 mL 0.5% ropivacaine on demand via the intraarticular catheter while Groups 2 and 3 received 10 mL of saline intraarticularly. Group 3 was the Control group. RESULTS: Postoperative pain at rest and on movement were lower in Group 1 than in Groups 2 and 3 during the first 30 and 120 min, respectively. The time to first request for local anesthetic infusion was longer in Group 1 than in Groups 2 and 3 (P < 0.001). The median morphine consumption during the first 24 postoperative hours was less in Groups 1 and 2 than in Group 3 (P < 0.001). There was no significant difference in analgesic consumption between Group 1 and Group 2. The median satisfaction score was higher in Group 1 compared with Groups 2 (P < 0.05) and 3 (P < 0.001). CONCLUSIONS: A combination of intraarticular ropivacaine, morphine, and ketorolac followed by intermittent injections of ropivacaine as needed provided better pain relief, less morphine consumption, and improved patient satisfaction compared with the control group. The group that received IV ketorolac consumed less morphine and was more satisfied with treatment than patients in the control group.
- Published
- 2008
32. [Words can hurt. Well-meaning standardized phrases can increase both pain and anxiety]
- Author
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Narinder, Rawal and Lars, Berggren
- Subjects
Patient Education as Topic ,Communication ,Humans ,Pain ,Professional-Patient Relations ,Anxiety ,Empathy ,Placebo Effect - Published
- 2006
33. [Postoperative pain care must be improved. Formal pain scale will clearly show if a patient is in pain]
- Author
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Narinder, Rawal and Renée, Allvin
- Subjects
Pain, Postoperative ,Anesthesiology ,Humans ,Education, Medical, Continuing ,Pain Measurement - Published
- 2004
34. A comparison of intra-operative or postoperative exposure to music--a controlled trial of the effects on postoperative pain
- Author
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Narinder Rawal, Ulrica Nilsson, and Mitra Unosson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Music therapy ,Nausea ,Analgesic ,Hernia, Inguinal ,behavioral disciplines and activities ,Drug Administration Schedule ,law.invention ,Varicose Veins ,Randomized controlled trial ,law ,Varicose veins ,medicine ,Humans ,General anaesthesia ,Hernia ,Music Therapy ,Pain Measurement ,Postoperative Care ,Pain, Postoperative ,Intraoperative Care ,Morphine ,business.industry ,Middle Aged ,medicine.disease ,humanities ,Surgery ,Analgesics, Opioid ,Inguinal hernia ,Anesthesiology and Pain Medicine ,Ambulatory Surgical Procedures ,Anesthesia ,Female ,medicine.symptom ,business - Abstract
The effect of intra-operative compared to postoperative music on postoperative pain was evaluated in a controlled trial. In all, 151 patients undergoing day case surgery for inguinal hernia repair or varicose vein surgery under general anaesthesia were randomly allocated to three groups: group 1 listened to music intra-operatively, group 2 listened to music postoperatively and group 3, the control group, listened to 'white noise'. The anaesthetic and postoperative analgesic techniques were standardised. Pain was assessed using a numeric rating scale (0-10) and patients requirements for postoperative morphine, paracetamol and ibuprofen was recorded. The effect of music on nausea, fatigue and anxiety was also investigated. The results showed that patients exposed to music intra-operatively or postoperatively reported significantly lower pain intensity at 1 and 2 h postoperatively and patients in the postoperative music group required less morphine at 1 h compared to the control group. No differences were noted in the other variables. This study demonstrates that there is a short-term pain-reducing effect of music therapy however, the beneficial effects do not differ if the patient is exposed to music intra-operatively or postoperatively.
- Published
- 2003
35. Patient-controlled regional analgesia (PCRA) at home: controlled comparison between bupivacaine and ropivacaine brachial plexus analgesia
- Author
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Narinder, Rawal, Renée, Allvin, Kjell, Axelsson, Jan, Hallén, Gustav, Ekbäck, Torbjörn, Ohlsson, and Anders, Amilon
- Subjects
Adult ,Male ,Analgesia, Patient-Controlled ,Nerve Block ,Middle Aged ,Hand ,Amides ,Bupivacaine ,Catheters, Indwelling ,Double-Blind Method ,Patient Satisfaction ,Humans ,Brachial Plexus ,Female ,Ropivacaine ,Anesthetics, Local ,Aged - Abstract
The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital.Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery.Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection.This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.
- Published
- 2002
36. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy
- Author
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Kjell Axelsson, Sven E. Thörn, Björn Holmström, Göran Agren, Narinder Rawal, Anil Gupta, and Lars G Larsson
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Visual analogue scale ,medicine.drug_class ,medicine.medical_treatment ,Placebo ,Catheterization ,chemistry.chemical_compound ,Double-Blind Method ,Surveys and Questionnaires ,medicine ,Ketobemidone ,Humans ,Ropivacaine ,Anesthetics, Local ,Aged ,Pain Measurement ,Pain, Postoperative ,Local anesthetic ,business.industry ,Middle Aged ,Amides ,Surgery ,Anesthesiology and Pain Medicine ,chemistry ,Cholecystectomy, Laparoscopic ,Anesthesia ,Ambulatory ,Postoperative Nausea and Vomiting ,Cholecystectomy ,Female ,Propofol ,business ,medicine.drug ,Follow-Up Studies - Abstract
Postoperative pain has been an important limiting factor for ambulatory laparoscopic cholecystectomy. We anesthetized 40 ASA physical status I-II patients using propofol for the induction and sevoflurane in oxygen and air for the maintenance of anesthesia. At the end of the anesthesia, the patients were randomized into one of two groups: Group P (Placebo) and Group R (0.5% Ropivacaine). Twenty milliliters of normal saline or ropivacaine, respectively, were injected intraperitoneally at the end of surgery via a catheter placed in the bed of the gall bladder. Postoperatively, intermittent injections (10 mL) of the study solution were given when required for pain. Ketobemidone 1-2 mg was given IV as rescue medication. Pain was assessed using a visual analog scale at 1, 2, 3, 4, 8, 12, 16, and 20 h after surgery and once each day for 1 wk at rest (deep pain), shoulder and incision sites, and pain during coughing. Recovery was assessed by the time to transfer from Phase 1 to 2, the ability to walk, drink, and eat, and the ability to void. Plasma concentrations of ropivacaine were measured in eight patients. Time to ability to walk, defecation, driving a car, and return to normal activities were also recorded through a questionnaire sent home with the patient. During the first 4 postoperative h, patients in Group R had lower scores for deep pain and during coughing compared with Group P (P0.05). No differences were found in the postoperative consumption of ketobemidone. Median times to recovery at home were similar between the groups. By the seventh day, 93% of the patients had returned to normal activities of daily living. We conclude that the early postoperative pain after ambulatory laparoscopic cholecystectomy could be relieved using intermittent injections of ropivacaine 0.5% into the bed of the gall bladder.Early postoperative pain can be relieved by intermittent injections of ropivacaine 0.5% through a catheter placed in the bed of the gall bladder after ambulatory laparoscopic cholecystectomy.
- Published
- 2002
37. Intra-Articular Patient-Controlled Analgesia Improves Early Rehabilitation after Knee Surgery
- Author
-
Neli Vintar, Narinder Rawal, Maja Pohar, Matjaž Veselko, Neli Vintar, Narinder Rawal, Maja Pohar, and Matjaž Veselko
- Abstract
The influence of patient-controlled intra-articular analgesia with ropivacaine, morphine and ketorolac (RMK) on postoperative pain relief and early rehabilitation after anterior cruciate ligament reconstruction was studied. Twenty six patients, randomized into two groups, were enrolled in a placebo-controlled, double-blind study. At the end of surgery a catheter was placed intra-articularly and connected to a patient-controlled pump, programmed to deliver 10 mL bolus and 60 min lockout interval. RMK group received 0.25% ropivacaine, morphine 0.2 mg/mL and ketorolac 1 mg/mL; P group saline. Pain was measured with 10 cm visual analog scale. At pain scores >3 cm, all patients were instructed to self-administer morphine intravenously using a patient-controlled pump. Daily rescue morphine consumption was noted and 48h rehabilitation programme was evaluated. Daily morphine consumption was significantly lower in the RMK group (p<0.001). At 24h after surgery, the patients in the RMK group experienced significantly less pain (p<0.05). The patients in the RMK group achieved higher maximum degree of knee flexion in supine (p<0.001) and in prone position (p<0.05) compared to placebo group and better pain free flexion with assistance on day 1 (p<0.05) and 2 (p>0.05). The results show that patient-controlled intra-articular analgesia with RMK combination provides effective pain relief following anterior cruciate ligament reconstruction and improves early physical rehabilitation.
- Published
- 2010
38. Postoperative patient-controlled local anesthetic administration at home
- Author
-
Narinder Rawal, Jan Hallén, Kjell Axelsson, Jan Hylander, Renée Allvin, Gunnar Lidegran, and Anders Amilon
- Subjects
medicine.medical_specialty ,Pain, Postoperative ,business.industry ,Local anesthetic ,medicine.drug_class ,Analgesia, Patient-Controlled ,medicine.disease ,Surgery ,Postoperative management ,Anesthesiology and Pain Medicine ,Anesthesia ,medicine ,Humans ,Local anesthesia ,Anesthetics, Local ,business ,Administration (government) ,Infiltration (medical) - Published
- 1998
39. Spinal antinociception: clinical aspects
- Author
-
Narinder Rawal
- Subjects
Drug ,media_common.quotation_subject ,Analgesic ,Pain ,Pharmacology ,Octreotide ,Clonidine ,medicine ,Humans ,Ketamine ,Neurons, Afferent ,media_common ,Analgesics ,Clinical Trials as Topic ,business.industry ,Neurotoxicity ,Nociceptors ,General Medicine ,Spinal cord ,medicine.disease ,Analgesia, Epidural ,Nociception ,medicine.anatomical_structure ,Spinal Cord ,Anesthesia ,Nociceptor ,Drug Therapy, Combination ,business ,Somatostatin ,Adrenergic alpha-Agonists ,medicine.drug - Abstract
Recent research has demonstrated the increasing importance of the spinal cord in processing and modulating nociceptive input. Different groups of drugs, each acting by a unique mechanism, have been shown to block nociceptive afferent transmission. None of the currently available spinally administered local anesthetics, opioids or non-opioids produce analgesia without side effects. Non-opioids such as alpha-2-adrenergic agonists may be more suited as adjuvants rather than sole analgesic agents and their main role lies in reducing the dose requirements of other analgesics. Spinal somatostatin and ketamine may have neurotoxic potential. The role of these drugs and of midazolam in pain management appears to be limited. Preliminary results suggest that the neuropeptide octreotide has potent analgesic effects. 'Balanced spinal analgesia' using a combination of low doses of drugs, with separate but synergistic mechanisms of analgesia, may produce the best results. The optimal drug combinations and dosages remain to be determined. It is essential that animal neurotoxicity studies followed by controlled clinical trials are performed before widespread spinal administration of new drugs.
- Published
- 1995
40. Combined spinal epidural block versus spinal and epidural block for orthopaedic surgery
- Author
-
Björn Holmström, Kjellfrid Laugaland, Sune Hallberg, and Narinder Rawal
- Subjects
Anesthesia, Epidural ,medicine.medical_specialty ,Time Factors ,Meperidine ,medicine.medical_treatment ,Midazolam ,Anesthesia, Spinal ,Fentanyl ,Anesthesiology ,Medicine ,Humans ,Injections, Spinal ,Aged ,Bupivacaine ,Aged, 80 and over ,Pain, Postoperative ,Morphine ,business.industry ,Nerve Block ,General Medicine ,Perioperative ,Middle Aged ,Surgery ,Analgesia, Epidural ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Muscle relaxation ,Anesthesia ,Nerve block ,Hip Prosthesis ,Neuromuscular Blocking Agents ,business ,Knee Prosthesis ,medicine.drug - Abstract
In a controlled study a single segment combined spinal epidural (CSE) block was compared with spinal or epidural block for major orthopaedic surgery. Seventy-five patients, age 52-86 yr, were randomly assigned to receive one of the three blocks. Bupivacaine 0.5% was used for surgical analgesia. The postoperative pain relief after 4.0 mg epidural morphine was compared with the analgesic effect of 0.2 or 0.4 mg morphine administered intrathecally. With the spinal technique good or excellent surgical analgesia and muscle relaxation were achieved rapidly (11.8 +/- 1.1 min). The time taken to provide an equally effective and reliable block with the CSE technique was no longer (14.9 +/- 2.2 min). For epidural block with the catheter technique more time was required (35.9 +/- 3.9 min) to provide acceptable surgical conditions (P < 0.05). Perioperative sedatives and concomitant analgesics were required more frequently and in larger doses by the patients undergoing surgery with epidural block (P < 0.05) than with CSE or spinal block. Our study demonstrated that the analgesia after surgery provided by 0.2 and 0.4 mg morphine administered intrathecally was comparable to that provided by 4.0 mg of epidural morphine. It is concluded that the analgesia and surgical conditions provided by the spinal and CSE blocks were similar and were superior to those provided by an epidural block.
- Published
- 1993
41. Improvement in i.v. regional anaesthesia by re-exsanguination before surgery
- Author
-
P. Hellstrand, A. Amilon, Narinder Rawal, and Jan Hallén
- Subjects
Adult ,Male ,medicine.medical_specialty ,Lidocaine ,Adolescent ,Mepivacaine ,Blood Loss, Surgical ,Regional anaesthesia ,Prilocaine ,Motor block ,Double-Blind Method ,Anesthesia, Conduction ,medicine ,Humans ,Aged ,Aged, 80 and over ,Tourniquet ,business.industry ,Hemostatic Techniques ,Hand surgery ,Middle Aged ,Tourniquets ,Hand ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Anesthesia, Intravenous ,Arm ,Upper limb ,Female ,business ,medicine.drug - Abstract
A modification of an i.v. regional anaesthesia (IVRA) technique is described in which the arm is re-exsanguinated before surgery (re-IVRA). IVRA and re-IVRA were compared for quality of operative field, sensory and motor block, quality of analgesia and blood concentrations of prilocaine, lignocaine and mepivacaine in a double-blind study in 120 patients undergoing hand surgery. Re-IVRA provided a significantly better surgical field without affecting sensory or motor block. Re-exsanguination improved tolerance of the tourniquet. Plasma concentrations in the re-IVRA group showed some increases, but these were not in the toxic range. (Br. J. Anaesth. 1993; 70: 280–285)
- Published
- 1993
42. Headaches after diagnostic dural punctures
- Author
-
Narinder Rawal and Michael Serpell
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Dura mater ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Spinal Puncture ,Hematoma ,Cerebrospinal fluid ,Anesthesia ,medicine ,Spinal canal ,Subarachnoid space ,Headaches ,medicine.symptom ,business ,Myelography - Abstract
Paper p 986 In a dural puncture a needle is passed through the dura mater into the cerebrospinal fluid within the spinal canal. It is commonly performed and is indicated for diagnostic lumbar puncture, spinal anaesthesia, myelography, and intrathecal chemotherapy. The most common adverse event after the procedure is a headache. This occurs in about a third of patients after diagnostic lumbar puncture in an ambulatory setting with a 20 or 22 gauge standard Quincke bevel spinal needle.1 The aetiology of the headache from the dural puncture is most likely related to the hole left in the dura after the needle has been withdrawn. This allows the cerebrospinal fluid to leak out of the subarachnoid space, which depletes the “cushion” of fluid supporting the brain and its sensitive meningovascular covering, resulting in gravitational traction and the classic headache, which is made worse when the patient is upright and relieved on lying down.2 The headache, the onset of which is often delayed for 24 to 48 hours, usually lasts for one or …
- Published
- 2000
43. A.308 Paediatric premedication and postoperative pain management in Europe: a 17-nation survey
- Author
-
Narinder Rawal and Renée Allvin
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Postoperative pain ,General surgery ,Medicine ,Premedication ,business - Published
- 1996
44. A.319 Management of obstetric pain in Europe — a 17-nation survey
- Author
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Narinder Rawal and Renée Allvin
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Family medicine ,medicine ,Obstetric pain ,business - Published
- 1996
45. Exclusion of Postoperative Epidural Morphine Analgesia in Sweden
- Author
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Titti Thoren, Narinder Rawal, and Björn Holmström
- Subjects
Epidural morphine ,Anesthesiology and Pain Medicine ,business.industry ,Anesthesia ,Medicine ,business - Published
- 1995
46. Sequential Combined Spinal Epidural Block Versus Spinal Block for Cesarean Section
- Author
-
Gunnar Skeppner, Narinder Rawal, Björn Holmström, Jens Schollin, Solveig Lindeberg, and Titti Thoren
- Subjects
Adult ,medicine.medical_specialty ,Tuohy needle ,Block (permutation group theory) ,Anesthesia, Spinal ,Pregnancy ,Humans ,Medicine ,Ephedrine ,Bupivacaine ,Cesarean Section ,business.industry ,Infant, Newborn ,Surgery ,Analgesia, Epidural ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Blood pressure ,Elective Surgical Procedures ,Maternal Hypotension ,Anesthesia ,Analgesia, Obstetrical ,Female ,Hypotension ,Subarachnoid space ,business ,Elective Surgical Procedure ,medicine.drug - Abstract
Sequential combined spinal-epidural (CSE) block was compared with spinal block for elective cesarean section. The quality of surgical analgesia and the effect on maternal blood pressure and neonatal neurobehavioral function were evaluated. Forty-two healthy parturients were randomly divided into a spinal (n = 21) and a sequential CSE (n = 21) group. A T4 sensory block was targeted. In the spinal group, 0.5% hyperbaric bupivacaine, 2.5 mL, was injected into the subarachnoid space through a 26-gauge Quincke needle. In the sequential CSE group, 1.5 mL of 0.5% hyperbaric bupivacaine was injected into the subarachnoid space through a long 26-gauge Quincke needle, which was introduced through an 18-gauge Tuohy needle. An epidural catheter was then inserted. If the block in the sequential CSE group did not reach the T4 level in 15 min, it was extended by fractionated doses of 0.5% bupivacaine administered through the epidural catheter. Ephedrine, 10 mg intravenously (i.v.), was given to treat hypotension (20% decrease from baseline value and/or systolic blood pressure below 100 mmHg). The time intervals from induction of block to start of surgery and to delivery were shorter in the spinal group (P < 0.01). Cephalad spread of block (pinprick) 15 min after induction was T4 [T2-T7] (median [range]) in the spinal group and T7 [T2-L1] in the sequential CSE group (P < 0.05). All patients in the sequential CSE group needed epidural bupivacaine, 53.8 +/- 6.5 mg (mean +/- SEM). The surgical analgesia was good or excellent in both groups before delivery.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1994
47. Spinal Toxicity after Repeated Intrathecal Sufentanil Administrations in Sheep
- Author
-
NARINDER RAWAL, LAURI NUTINEN, and PRITHVI RAJ
- Subjects
Anesthesiology and Pain Medicine - Published
- 1992
48. Single segment combined subarachnoid and epidural block for Caesarean section
- Author
-
Narinder Rawal
- Subjects
Anesthesia, Epidural ,medicine.medical_specialty ,Cesarean Section ,business.industry ,Pain medicine ,medicine.medical_treatment ,General Medicine ,Subarachnoid Space ,Single segment ,Anesthesiology and Pain Medicine ,Anesthesia, Conduction ,Pregnancy ,Anesthesia ,Anesthesiology ,Epidural block ,Anesthesia, Obstetrical ,Humans ,Medicine ,Female ,Caesarean section ,business - Published
- 1986
49. An Experimental Study of Urodynamic Effects of Epidural Morphine and of Naloxone Reversal
- Author
-
Kaj Möllefors, Kjell Axelsson, Narinder Rawal, Bertil Widman, and Gunnar Lingårdh
- Subjects
Adult ,Epidural Space ,Male ,Urinary Bladder ,(+)-Naloxone ,Injections, Intramuscular ,Injections ,Epidural morphine ,Urine flow rate ,medicine ,Humans ,Infusions, Parenteral ,Urinary bladder ,Morphine ,Naloxone ,Urinary retention ,business.industry ,Epidural space ,Urodynamics ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Injections, Intravenous ,medicine.symptom ,Complication ,business ,medicine.drug - Abstract
Urinary retention after epidural morphine is a distressing and troublesome complication. This study was undertaken to determine the effects of morphine (epidural, intramuscular, and intravenous) on urinary bladder function and possible reversal by naloxone. Thirty male volunteers (aged 20-28 years) were studied; the doses studied were 2, 4, and 10 mg of epidural morphine, 10 mg intramuscular morphine, and 10 mg intravenous morphine. The urodynamic study consisted of measurements of urine flow rate, strength of detrusor contraction, bladder capacity, and urethral pressure. Irrespective of dose, all subjects receiving epidural morphine showed marked relaxation of the detrusor shortly after injection. There was a corresponding increase in the maximal bladder capacity leading to urinary retention. These effects lasted an average of 14-16 h. Urethral pressures remained unchanged. Urodynamic changes after intramuscular and intravenous morphine were minimal. Treatment using a single intravenous injection of 0.8 mg naloxone promptly reversed the effects of epidural morphine on the bladder. Prevention of urinary retention was achieved with an intravenous infusion of naloxone started before administration of epidural morphine. The possible mechanisms of urinary retention following epidural opiates are discussed.
- Published
- 1983
50. Respiratory Depression after Epidural Morphine???An Experimental and Clinical Study
- Author
-
Narinder Rawal and Magnus Wattwil
- Subjects
Adult ,Anesthesia, Epidural ,Male ,pCO2 ,Naloxone ,Respiration ,medicine ,Humans ,Respiratory system ,Tidal volume ,Aged ,Pain, Postoperative ,Morphine ,business.industry ,Middle Aged ,Anesthesiology and Pain Medicine ,Depression, Chemical ,Anesthesia ,Breathing ,Female ,business ,Respiratory minute volume ,medicine.drug - Abstract
This study was comprised of an experimental part (20 volunteers) and a clinical part (10 surgical patients). In the experimental part, the effects of either 2-, 4-, or 10-mg doses of epidural morphine on ventilatory responses to a standardized CO2 challenge were studied in healthy volunteers. In the clinical part, ventilatory responses to CO2 were evaluated in patients receiving 4 mg of epidural morphine for pain relief after gall bladder surgery. Naloxone infusion was given to five volunteers to determine whether ventilatory changes due to epidural morphine could be prevented. Using a nonrebreathing method, end-tidal PCO2 (PETCO2) and minute ventilation (tidal volume X frequency) were measured before and 1, 5, 8, 13, and 22 hr after epidural morphine injection. Ventilation was stimulated by 4% CO2 in 21% O2 and 75% N2. In the experimental study, a dose-related depression of ventilatory drive was seen after epidural morphine. After 2- and 4-mg doses, increases in PETCO2 were present up to 5 hr after injection with a corresponding reduction in minute ventilation. Ten mg of epidural morphine was followed by a significant reduction in minute ventilation and an increase in PETCO2 that started 1 hr after injection, peaked at 5 hr, and then remained almost unchanged for the next 17 hr. PETCO2 was higher and remained elevated longer in surgical patients than in volunteers given the same amount of epidural morphine (4 mg).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1984
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