جستجوی مقالات مرتبط با کلیدواژه « analgesics » در نشریات گروه « پزشکی »

 Peripheral nerve blocks (PNBs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. PNBs aim to decrease overall perioperative pain and lower systemic analgesic requirements. Short-acting anesthetic agents are commonly given as single-injection PNBs for pain relief, typically lasting less than 24 hours. Liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection PNB and may allow patients to recover postoperatively with a lower need for opioid analgesics.

 This study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus PNB for hand surgery.

 A retrospective review of patients who underwent a long-acting PNB using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between July 2020 and May 2023 in Florida, USA. Patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics.

 One hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). Patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the PNB to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. Nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used NSAIDs postoperatively.

 Liposomal bupivacaine PNBs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. Patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. Given these results, long-acting PNBs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.

This research was conducted to determine the effect of a pain management program based on the Critical Care Pain Observation Tool (CPOT) on the pain intensity and adjusting the dosage of analgesics in mechanically ventilated patients hospitalized in intensive care units.

Methods & Materials:

 This randomized controlled clinical trial was conducted during 2019-2022 on 70 mechanically ventilated patients admitted to ICUs of the Imam Reza Hospital, Mashhad, Iran. In the intervention group, patients' pain intensity was measured during endotracheal suctioning using CPOT. Then the dosage of analgesics was adjusted based on the assessed pain level. The pain level was evaluated in the control group according to the department's routine. Data were analyzed using two-way repeated measures analysis of variance (RMANOVA).

CPOT and BPS showed a strong correlation (r>0.9, Pvalue<0.001) between the two pain intensity instruments. Based on the results of RMANOVA, a significant trend of pain intensity measures was observed during all three suctions (measurement effect P<0.05), which was different between the two groups (interaction effect P<0.05). The Sidak post hoc test results showed a significant difference in pain intensity measures between the intervention and control groups during all three suctions and 5 and 15 minutes after suctions (all P-values<0.05). Also, significant intervention effects were observed regarding the amount of analgesics prescribed in terms of total fentanyl blouse, total infused Fentanyl, and total Fentanyl (all P-values<0.05).

Using CPOT is a positive step in the evaluation and control of dosage adjustment of analgesic medications for patients with mechanical ventilation.

Chemical and natural toxic compounds can harm human health through a variety of mechanisms. Nowadays, herbal therapy is widely accepted as a safe method of treating toxicity. Garcinia mangostana (mangosteen) is a tree in the Clusiaceae family, and isoprenylated xanthones, its main constituents, are a class of secondary metabolites having a variety of biological properties, such as anti-inflammatory, anti-oxidant, pro-apoptotic, anti-proliferative, antinociceptive, neuroprotective, hypoglycemic, and anti-obesity. In this review, the protective activities of mangosteen and its major components against natural and chemical toxicities in both in vivo and in vitro experiments were evaluated. The protective effects of mangosteen and its components are mediated primarily through oxidative stress inhibition, a decrease in the number of inflammatory cells such as lymphocytes, neutrophils, and eosinophils, reduction of inflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), cyclooxygenase-2 (COX-2), prostaglandin (PG) E2, inducible nitric oxide synthase, and nuclear factor-ĸB (NF-ĸB), modulation of apoptosis and mitogen-activated protein kinase (MAPK) signaling pathways, reducing p65 entrance into the nucleus, α-smooth muscle actin (α-SMA), transforming growth factor β1 (TGFβ1), improving histological conditions, and inhibition in acetylcholinesterase activity.

Postoperative pain following laparoscopic cholecystectomy is common in abdominal surgeries. Opioids and non-steroidal anti-inflammatory drugs are used in the management of postoperative pain. The current clinical study was undertaken to evaluate the efficacy of a preemptive diclofenac suppository for the alleviation of post-surgery pain and opioid consumption in laparoscopic cholecystectomy patients.

A total of eighty patients aged 18 to 65 who underwent laparoscopic cholecystectomy in Sina Hospital of Maragheh University of Medical Sciences were included in this prospective, matched case-control study and were randomly allocated to two groups of 40 each. Subjects received 100 mg diclofenac suppository or placebo within 2 h before surgery. The pain score and analgesic consumption data were recorded up to 24 h postoperatively. An Independent t-test was utilized for the analysis of results.

Visual Analogue Scale (VAS) scores in the diclofenac group were statistically lower at 2, 4, 8, and 12 hours compared to the placebo-controlled group. Opioid consumption was statistically significantly reduced in the treatment group compared to the control group (20.0 ± 3.48 vs 54.7 ± 3.63 ml, respectively. Rescue analgesia usage was significantly higher in the control group. Half of the patients in the diclofenac group did not need any opioid drug. Besides, postoperative side effects and hospital staying duration were decreased in the diclofenac group in comparison to the control group.

Current study demonstrates that preemptive diclofenac 100 mg administration could be taken into consideration to alleviate postoperative pain and is a valuable addition to the standard treatment following cholecystectomy pain management.

Pain is associated with increased prevalence of chronic diseases which adversely affects the quality of life of patients. This also leads to increased demand of drugs for chronic pain relief. Drug utilization pattern studies of pain clinic are therefore important to ascertain rational use of medicines in healthcare system.The study aims to evaluate drug utilization pattern in pain clinic of a tertiary care teaching hospital.

A cross sectional study was done by analyzing prescriptions of patients at pain clinic of MYH Hospital of Indore, MP, India, for a period of 3 months from November 2021 to January 2022. Total 260 prescriptions were analyzed on the basis of WHO core prescribing indicators, FDC (Fixed Dose Combinations) & NLEM (National List of Essential Medicines) list by using descriptive statistics.

Study results showed that analgesics were most commonly prescribed in the age grou p 41-60 years. Lower back pain (28.8%) was the most common indication for prescribing analgesics in pain clinic with a female preponderance of 57.7%. Out of total 639 drugs, Fixed Dose Combinations (FDC)(76.2%) were more than single drugs (24.8%). 59.3% of drugs were concomitant medications. 80% (220) FDCs were generic and Gabapentin+Nortryptiline (31.8%) was the commonest FDC. Pregabalin was the most commonly prescribed single drug preparation. Average number of drugs per encounter were 2.45 and generic prescribing was 85.7%. Total 46% of medicines were prescribed from NLEM.

We found that FDC, generic prescribing and concomitant medications use was higher in our study. The study guides for rational prescribing of analgesics to maximize pain relief and minimize adverse effects associated with it.

Zhumeria majdae Rech. F. & Wendelbo. traditionally has been used in several remedies, as a carminative agent especially for children, as an antiseptic agent, and it is used in treating diarrhea, stomach irritations, headaches, colds, convulsions, spasms, dysmenorrhea, and healing wounds. According to clinical studies, it is highly effective for reducing inflammation and pain, treating bacterial and fungal infections, morphine tolerance, morphine dependence, withdrawal syndrome symptoms, convulsions, and diabetes. The goal of this review is to find therapeutic opportunities by analyzing the traditional uses and pharmacological effects of the chemical constituents of Z. majdae.The information on Z. majdae in this review was gathered from scientific databases or search engines (PubMed, Wiley Online Library, Scopus, SID, Google Scholar, and Microsoft Academic). The literature cited in this review dates from 1992 to 2021. Several bioactive components including linalool, camphor, manool, and bioactive diterpenoids are presen in different parts of Z. majdae. Various properties were observed such as antioxidant, antinociceptive, anti-inflammatory, antimicrobial, antiviral, larvicidal, anticonvulsant, antidiabetic, and anticancer properties. Also, the effect of Z. majdae on morphine tolerance, morphine dependence, and withdrawal syndrome as well as its toxicology has been established. Although there are in vitro and animal studies on several pharmacological effects of Z. majdae, the lack of clinical studies is significant. Therefore, further clinical trials should be performed to confirm the in vitro and animal findings.

Considering the side effects of high doses of opioids taken postoperatively for pain control, paracetamol and magnesium sulfate may be able to aid in pain control. This study assessed the effects of paracetamol and magnesium sulfate on the level of pain and opioid intake following orthognathic surgery.   

In this double-blind randomized clinical trial, patients scheduled for bimaxillary orthognathic surgery were randomly assigned to two groups of 25. Group 1 patients received 1 g infusion of intravenous acetaminophen (paracetamol) administered within 20 minutes while group 2 patients received 50 mg/kg magnesium sulfate infusion one hour prior to completion of surgery. The patients were asked to express their level of pain prior to discharge from the recovery, and every 4 hours for 12 hours using a visual analog scale (VAS). Patients with pain score > 5 at any time received 30 mg pethidine. The total received dosage of pethidine postoperatively was recorded and those that received pethidine were not included in pain score analysis. Data were analyzed by generalized estimating equation (GEE), and Mann-Whitney U, Chi-square, and t-tests.

The pain score was not significantly different between the two groups at the time of recovery and 4 and 8 hours (P>0.05). The magnesium sulfate group had significantly lower pain score at 12 hours (P=0.009). The difference in pethidine dosage was not significant (P>0.05).

Both magnesium sulfate and paracetamol decreased postoperative pain and the need for opioid consumption, but magnesium sulfate was slightly more effective.

Pain management during root canal therapy and after that is of great importance in endodontics. This study aimed to compare the effect of two non-steroidal anti-inflammatory drugs (NSAIDs); ibuprofen and ibuprofen lysine with two methods of prescription on pain after single-visit root canal treatment of first and second mandibular molar teeth with irreversible pulpitis. 

 This randomized study recruited subjects experiencing moderate to severe pain from a tooth diagnosed with symptomatic irreversible pulpitis (n = 120). Subjects were randomized to receive 400 mg ibuprofen acid or 400 mg ibuprofen lysine regularly or on demand. The primary objective was to measure changes in pain scores at post-operative time frames of 6, 12, 18, 24, 48 and 72 hours after the root canal treatment on a 0-10 numerical rating scale (NRS).  Independent T-test, Non-parametric Kruskal-Wallis Test and Friedman Test were used to analyze the data. 

  Kruskal-Wallis analysis showed a significant difference in NRS score between on-demand ibuprofen group and regular ibuprofen group and also between regular ibuprofen lysine group and regular ibuprofen group at 6 hours after the treatment (P<0.05). But no remarkable difference was observed in the recorded mean pain intensity of four study groups in the other time frames (P>0.05). 

 Based on this randomized clinical trial, there was no significant difference in the pain intensity of patients using ibuprofen and ibuprofen lysine. Additionally, there was no significant difference in the degree of pain between the on-demand and regular groups, despite the fact that patients in the on-demand group used less medications. Due to the multiple negative effects of NSAIDs, it would be wise to prescribe ibuprofen on demand.

The use of opioids is considered a risk factor for laryngeal cancer. A retrospective study was performed to explore the relationship between recreational drug exposure and laryngeal cancer.

Patients diagnosed between the 1st of January 2013 and the 31st of December 2017 using ICD-10 CD-32 coding were identified from the Head and Neck Multidisciplinary Team database. We divided the study population into two cohorts (RD and non-RD) and compared the demographics, morbidity, and outcomes of these two populations. In addition, we performed case-matched analysis to control for potential confounding factors including gender, alcohol use and cigarette smoking.

329 patients in Glasgow, Scotland were included with a mean age of 64.96 ± 10.94 and a follow-up of 24 ± 13.91 months. Of these, 39 reported recreational drug use (RD). RD was associated with younger age (53.0 vs. 66.6, p<0.001) at diagnosis with laryngeal cancer. A greater proportion of tumours occurred in the supraglottic subsite (p=0.041). Furthermore, these patients were more likely to undergo tracheostomy (RR=2.50, 95% CI: 1.41-4.44, p=0.008) and laryngectomy (RR=2.25, 95% CI: 1.57-3.21, p<0.001). Recreational drug users were more likely to require enteral feeding support (RR= 1.44, 95% CI: 1.13-1.84, p=0.02) during oncological treatment. No survival differences were noted at 1, 2, or 3-years (plog-rank=0.83). Case matched analysis correcting for smoking, alcohol and gender confirmed that recreational drug users were younger at diagnosis with a predilection for the supraglottic subsite.

Recreational drug use is associated with an increased burden of disease and morbidity in laryngeal cancer. We suggest that clinicians view recreational drug exposure as a red flag in those with suspected laryngeal cancer regardless of patient age.

Rosemary (Rosmarinus officinalis L.) has been used for its therapeutic effects since a long time ago. Most of the healing properties of rosemary might be attributed to its antinociceptive, antioxidant, and anti-inflammatory effects. The present review covers the certified patents and discoveries on medicinal, pharmaceutical, and therapeutic properties of rosemary to disclose its brilliant value on athletes’ health. An extended literature review was carried out in Google Patent, US Patent, and Patentscope in the field of sports injuries, inflammation, and pain. Numerous patents uncovered the importance of rosemary to apply in various healing, pharmaceutical, and medicinal fields. These discoveries might also be used as complementary methods in sports medicine for sore muscle, muscle and ligament sprain, strain, bruise, spasm, tendinitis, tendon rupture, cartilage, and joint injuries. Due to a lack of clinical trials, the use of rosemary in the clinic has been limited to a few medicinal products. Considering the human trend to use phytocompounds rather than medications based on chemical compounds, precise attention must be devoted to linking the value of rosemary from basic science to clinical usage.

Potentilla species have traditionally been used as anti-inflammatory and analgesic agents in Iran and other countries. 

This study aimed to investigate the antinociceptive effect of Potentilla reptans L., which has a wide distribution in the north of Iran.

The biological activities of the hydroalcoholic extract of P. reptans aerial parts have been investigated using the acetic acid-induced writhing, hot plate, and rotarod tests in the male mice. In addition, the phytochemical profile of the extract has been evaluated.

The phytochemical investigation detected secondary metabolites such as flavonoids, saponins, triterpenoids, and tannins in the extract. Moreover, the Mean±SD total phenolic and tannin contents of the extract were 251±2.08 and 111.5±1.3 mg gallic acid equivalents per gram of dried extract, respectively. Also, the Mean±SD total flavonoid content was 29.42±3.31 mg quercetin equivalents per gram of dried extract. Oral administration of the extract (100, 300, and 500 mg/kg) dose-dependently reduced the number of writhing responses induced by acetic acid and increased the reaction time in the hot-plate test. The antinociceptive effect of the extract, similar to morphine, was significantly antagonized by naloxone (4 mg/kg; IP) in the writhing test. In the rotarod test, none of the extract doses used in the experiment caused a loss of locomotor activity. 

In this study, the hydroalcoholic extract of P. reptans showed a practical antinociceptive effect in hot plate and writhing tests. It seems that opioid receptors mediate the observed effect.

This study aimed to determine the self-declarative performance of general dentists in prescription of analgesics and antibiotics for patients requiring root canal treatment (RCT).

In this cross-sectional study, 400 general dentists participating in the 55th International Annual Scientific Congress of the Iranian Dental Association (2015) were randomly selected, and requested to complete a questionnaire about their performance regarding prescribing analgesics and antibiotics for patients requiring RCT. The frequency and percentage of answers to each question were calculated and reported.

The most commonly prescribed analgesics included ibuprofen (100.0%), Gelofen (100.0%), Novafen (68.5%) and acetaminophen (24.8%). After RCT, dentists prescribed ibuprofen (100.0%), Gelofen (98.3%), dexamethasone (35.3%), Novafen (27.3%) and acetaminophen/codeine (15.8%) in decreasing order of frequency. Antibiotic prescription was minimum (48.5%) for cases with painful (moderate or severe) irreversible pulpitis (vital tooth) before the treatment and maximum for cases of pulp necrosis with acute apical periodontitis, edema, and preoperative symptoms (moderate or severe) (97.3%). For non-allergic patients, the most frequently prescribed antibiotics were amoxicillin 500 mg (93.3%), cefixime 400 mg (81.3%), amoxicillin/metronidazole 250 mg (71.8%), co-amoxiclav 265 mg (36.3%) and injectable penicillin (0.5%). For allergic patients, dentists prescribed clindamycin 300 mg (84.0%), cephalexin 500 mg (15.8%), azithromycin 500 mg (13.5%), and erythromycin 500 mg (10.8%). Sex and graduation date had no significant effect on the results (P>0.05).

Antibiotic prescription is excessive by general dentists, and their performance regarding the proper and logical prescription of antibiotics in RCT should be improved.

The fruits of Apiaceae family have been widely used in traditional medicine for the treatment of pain and inflammation. In this study, we evaluated the analgesic and anti‑inflammatory effects of wild celery (Smyrniopsis aucheri) seeds, as a member of the Apiaceae family.

Hydroalcoholic and hexane extracts of seeds were prepared and for the evaluation of analgesic activity, acetic acid, formalin, and hotplate tests in male mice (20–30 g) and for anti‑inflammatory assessment carrageenan‑induced paw edema in rats and croton oil‑induced ear edema in mice were used.

Hydroalcoholic and hexane extracts (100–400 mg/kg) significantly reduced abdominal spasms in the acetic acid test. In the formalin test, the hydroalcoholic extract at doses of 200 and 400 mg/kg reduced the pain of the chronic phase while hexane extract was effective in both acute and chronic phases. In the hot plate test, both extracts were ineffective. In the carrageenan and croton tests, both extracts at a dose of 400 mg/kg significantly reduced edema.

The results revealed the analgesic and anti‑inflammatory effects of plant seed extracts. Due to the lack of response of the extracts in the hot plate test, it seems that the plant mainly has a peripheral analgesic effect.

To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0.1 mg/kg ketamine and the other group received 0.05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes. Totally, 73 patients with the mean age of 32.9±10.4 were enrolled of whom 59 (80.8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was -6.2 (95% CI: -5.72 to -6.69) points in the group receiving ketamine compared to -5.8 (95%CI: -5.15 to – 6.48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p <0.05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0.002). The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED’s. Thus, it can be considered as a safe and effective alternative approach.

Self-medication practice, unfortunately, is a current issue in different countries. Patterns of self-medication vary among different populations and are influenced by different characteristics. So, this study was aimed at the prevalence of self-medication practice in Tehran. This descriptive-analytic study was performed from Oct 2019 to March 2020 by a researcher-designed questionnaire among people. The main determinants of the questionnaire included personal information, diet pattern, physical activity, smoking, alcohol consumption, and self-medication habits. Chi-square and Tukey's post hoc tests were used for statistical analysis of data. Eight hundred people participated in this study. The rate of self-medication was 78% among men and 88% among women. 35.75% of the participants had a chronic illness, and 90% of them had a history of self-medication. A significant correlation between gender and self-medication (p=0.45, r=0.55), also significant correlation between exercise and self-medication (p=0.206, r=0.75), alcohol consumption and self-medication (p=0.37, r=0.19) were not seen. Education and income levels, chronic diseases, history of drug allergies, smoking, and fast-food consumption seem to create self-medication behavior. Having an old doctor's prescription, saving time, as well as advising family members, were the most important reasons for self-medication. The most commonly used medications were analgesics, common cold medicines, and gastrointestinal drugs. Self-medication was mostly used to treat headaches, migraines, and common cold symptoms such as cough and muscle pain.

CONTEXT:

Inappropriate self-medication can increase chances of adverse drug reactions, disease aggravation, or drug interactions. Analgesics are most commonly used as self-medication.

The aim of this study was to evaluate and compare analgesic self-medication practices among medical and paramedical undergraduate students of a tertiary care teaching institute in Central India.

A cross-sectional, observational study was conducted in 216 undergraduate medical (MBBS and BDS) and paramedical (occupational therapy/physiotherapy and BSc nursing) students. A predesigned, self-developed, semi-structured questionnaire was used.
STATISTICAL ANALYSIS: The Chi-square test was used for testing statistical significance.

The overall prevalence of self-medication with analgesics was 83.33%. Self-medication was significantly high among medical students as compared to paramedical students (P = 0.003). Significantly more medical students were aware about adverse drug reactions of analgesics as compared to paramedical students (P = 0.019). The most common source of information about drugs was previous prescription (58.33%), followed by media including the Internet (53.70%). The most dominant symptom compelling self-medication was found to be muscular pain (42.12%), followed by headache (36.57%). 54.16% of the students revealed that self-medication provides quick relief from pain. The most commonly used analgesic was paracetamol (82.40%), followed by diclofenac (22.68%). A significant number of paramedical students do not know exactly what precautions should be taken while taking analgesics (P = 0.002).

Medical students are more indulged in self-medication practices with analgesics. Paramedical students need to be educated regarding safe use of analgesics.

Proper sedation is the main part of patient management in post-cardiac surgery care units. The bispectral index (BIS) monitor is a noninvasive device that can show the sedation level of patients through electroencephalography processing. We aimed to study the role of BIS monitoring to assess sedation levels in patients after cardiac surgery in the post-cardiac surgery care unit.  

This observational prospective cohort study enrolled 110 patients (37 female, mean age: 60 ± 13 y) candidated for open-heart surgery in Rajaie Cardiovascular Medical and Research Center. In the post-cardiac surgery care unit, sedation levels in 55 patients were monitored via BIS monitoring, while in the control group (n = 55), sedation levels were assessed via the Glasgow Coma Scale, the visual analog scale, and hemodynamic parameters. Both groups had the same sedation protocol. The primary endpoint of the study was the frequency of the prescription of analgesics, and the secondary endpoint was the duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Data were collected and analyzed using SPSS software, version 22.  

The results showed a decrease in the consumption of dexmedetomidine, midazolam, and morphine in the BIS group (p < 0.001), but no significant difference was observed in terms of the use of ketorolac and paracetamol (Apotel) (p > 0.05). Also, in the BIS group, the duration of mechanical ventilation (p < 0.001), ICU stay (P < 0.001), and hospital stay (P < 0.001) decreased significantly compared with that in the BIS group.  

BIS monitoring decreased the dose of sedative/analgesic drugs in the participants; it can, therefore, be a reliable method to assess sedation levels. (Iranian Heart Journal 2021; 22(1): 49-56)