COMPARISON OF THE EFFECTS OF INTRAPLEURAL BUPIVACAINE AND MORPHINE ON POST-THORACOTOMY PAIN.

BACKGROUND: Post-thoracotomy pain is the most severe types of postoperative pain. This study compares the effects of intrapleural bupivacaine and morphine on post-thoracotomy pain. METHODS: In a double blind clinical trial study, 30 patients candidate for unilateral thoracotomy were randomly divided into bupivacaine and morphine groups. Patients in the morphine group received 0.2 mg/kg morphine and those in the bupivacaine group received 1 mg/kg bupivacaine by an intrapleural catheter placed at the end of surgery by direct vision. Intrarpleural morphine and bupivacaine continued every 4 hours for the next 24 hours. If required, systemic analgesia with morphine (patient-controlled analgesia, PCA) also used as a postoperative analgesic. The amount of morphine consumption and level of postoperative pain at 2, 6, 12 and 24 hours after surgery were recorded. RESULTS: Patients did not differ significantly in terms of age, gender and duration of surgery. There were no significant differences between the two groups with regard to their mean score of pain at 2 and 6 hours of the surgery; however, the level of pain was significantly lower in the bupivacaine group compared to the morphine group at 12 and 24 hours of the surgery. In the bupivacaine group, the mean level of intravenous opioid used over the 24 hours following surgery was significantly lower than in the morphine group. DISCUSSION: Intrapleural injection of bupivacaine can be more effective in reducing post-thoracotomy pain compared to intrapleural morphine.

Comparison of analgesic effect between gabapentin and diclofenac on post-operative pain in patients undergoing tonsillectomy.

BACKGROUND: Tonsillectomy is a common procedure causing considerable postoperative pain. Postoperative pain intensity of 60 - 70 in the scale of visual analog scale (VAS) has been reported up to 3 - 4 days which could continue until 11 days after the surgery. OBJECTIVES: The current study aimed to compare the analgesic effect of gabapentin and diclofenac on pain after tonsillectomy with the control group. PATIENTS AND METHODS: In this double-blind, placebo-controlled clinical trial, 90 patients aged 10-25 years, ASA classes I and II were randomly selected to receive 20 mg/kg oral gabapentin (n = 30), 1.0 mg / kg rectal diclofenac (n = 30) or placebo (n = 30) preoperatively. Pain was evaluated postoperatively on a visual analogue scale at 2, 6, 12 and 24 h. Opioid consumption in the first 24 h after surgery and the side effects were also recorded. RESULTS: There was no significant difference in terms of age, sex, and time of surgery in the three groups. Patients in the gabapentin and diclofenac groups had significantly lower pain scores at all-time intervals than those in the placebo group. The total meperidine consumed in the gabapentin (14.16 ± 6.97 P = 0.001) and diclofenac (16.66 ± 8.95, P = 0.004) groups was significantly less than that of the placebo (33.4 ± 13.97) group. The frequency of side effects such as vomiting, dizziness, and headache was not significantly different among the groups. CONCLUSIONS: It can be concluded that gabapentin and diclofenac reduced postoperative pain and opioid consumption without obvious side effects.