Browsing by Subject "pain"

Now showing 1 - 3 of 3
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    Open Access
    The Effect of a Novel Multimodal Therapeutic Protocol on Patient Reported Post-Neurosurgical Pain Scores, versus the Current Postoperative Analgesic Practice Employed at a Local South African Hospital – An Investigator Initiated Randomized Controlled Trial
    (2021) Nell, Antonette; Tucker, Lawrence; Butler, James
    Background: There is a high incidence of moderate to severe postoperative pain in patients undergoing neurosurgery. Post-craniotomy headache (PCH) remains undertreated due to the cautious use of opioids in this surgical population. Various alternative analgesics such as acetaminophen and scalp blocks are widely utilized for the treatment of PCH, but this is often inadequate. Although a multimodal approach to the management of PCH may be effective in improved pain relief, only a limited number of randomized controlled trials have explored this. Aim: This study aims to investigate whether or not a multimodal analgesic regime, consisting of gabapentinoids and non-steroidal inflammatory drugs (NSAIDs) provides superior pain relief in patients undergoing elective craniotomy compared to the standard of care analgesia utilized at a local South African hospital. Methods: Twenty-seven patients, 18 years or older, scheduled for elective craniotomy for the management of their epilepsy were recruited into this clinical trial. Enrolled participants were randomized into one of two groups. The experimental group received oral 150mg pregabalin one hour before surgery, IV 40mg parecoxib at surgical closure, and oral 150mg pregabalin two hours after surgery. The control group received a matching placebo at these respective time points. Postoperatively, all patients received standard of care analgesia consisting of 24 hours IV paracetamol and additional analgesia as required (prn). Pain assessments using the numerical rating scale (NRS) and visual analogue scale (VAS) were performed at 1 hour, 8 hours, 24 hours, 48 hours and 72 hours postoperatively. Additional analgesia consumption, postoperative nausea and vomiting, as well as the incidence of any adverse events were captured. Results: Patients who received placebo showed an average trend of higher mean NRS pain scores compared to patients receiving pregabalin and parecoxib, although there was no significant difference (p = 0.218) in the maximum mean NRS pain scores between the experimental and control groups. However, patients who received pregabalin and parecoxib consumed significantly less dihydrocodeine than those who received placebo (p = 0.029). No significant differences were identified in use of other additional opioids and non-opioid analgesia during the first 24 postoperative hours. Conclusion: There is insufficient evidence to confirm that the perioperative use of pregabalin and parecoxib reduces PCH in patients undergoing elective craniotomy. The study medication did, however, result in a significant reduction in the use of postoperative dihydrocodeine, although it was also associated with higher rates of reported blurred vision and dizziness.
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    Open Access
    Use of a tourniquet in lower limb amputations: Evaluating blood loss in peripheral arterial disease patients A systematic review
    (2022) Eldurssi, Omar; Kloppers, Jacobus Christo
    Background: Tourniquets have become an inseparable part of many different types of intricate and major surgeries, including amputation. Tourniquets create a bloodless environment, which is thought to facilitate surgery and reduce time, potential errors and subsequent complications. Objectives: To investigate the effectiveness of using a pneumatic tourniquet as an adjunct in lower limbs amputation in peripheral arterial disease to reduce blood loss and requirement for blood transfusions. Stump revision rate, complication and mortality will be assessed as secondary objectives. Method: For this systematic review, a search was performed using the keywords phrases, “peripheral arterial disease”, “lower limb amputation” and “tourniquet” in PubMed, Medline, Embase and Google scholar. Results: Based on univariate analysis, to determine the relationship between risk factors and blood loss, the study demonstrated the use of tourniquet significantly reduces the amount of blood loss during lower limb amputation (LLA), F (21.01), P=0.044. An independent t -test, demonstrated that there was a statistically significant difference in mean blood loss between tourniquet and non-tourniquet studies, (T=-2.588, P=0.049). In this review the mean blood loss was 251.67±2.89 and 462.5±137.69ml for tourniquet and non-tourniquet studies respectively. Conclusion: Using a tourniquet is a technically feasible approach to LLA, and effectively reduces the amount of blood loss and requirements of blood transfusion. No change in revision rates were noted.
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    What is a Mind Week 2 - Empathising with other minds
    (2015-08-15) Solms, Mark
    In this video, Professor Mark Solms explains how absolute certaintly is not a requirement in everyday life and even in some aspects of science; rather, a systematic common sense approach is often used to test whether something has subjectivity or not. He uses the example of pain to illustrate this idea. This is video 3 in Week 2 of the What is a Mind MOOC.