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The Effect of Intravenous Dexketoprofen on the Severity and Incidence of Rebound Pain
Evaluation of the Effect of Intravenous Dexketoprofen on the Severity and Incidence of Rebound Pain in Patients Undergoing Interscalene Brachial Plexus Block
Orthopedic shoulder surgeries are associated with severe postoperative pain, particularly within the first 24-48 hours after surgery. In postoperative pain management, single or continue interscalene brachial plexus blocks, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids administered as needed are commonly used as components of multimodal analgesia.
Rebound pain is defined as severe postoperative pain (VAS ≥ 7) occurring within the first 24 hours after resolution of the block. It is considered an adverse effect of regional anesthesia and typically develops 8-12 hours after a single-shot nerve block. Risk factors for rebound pain include pre-existing pain, female sex, younger age, bone surgery, lack of intraoperative dexamethasone administration, and inadequate analgesia.
The primary objective of this study is to evaluate the effect of intravenous dexketoprofen administered during the postoperative period on the incidence and severity of rebound pain in patients undergoing shoulder surgery with interscalene brachial plexus block
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
Sixty-six patients undergoing rotator cuff repair will receive standardized ISB and general anesthesia for the surgery.All patients will be administered 0.03 mg/kg of midazolam during the preoperative period and an interscalene brachial plexus block will be administered using 10 cc of %0.5 bupivacaine and 5 ml of normal saline.During induction under general anesthesia, the following will be administered: lidocaine 1 mg/kg, propofol 2-3 mg/kg, rocuronium 0.6 mg/kg, and remifentanyl 0.5 mcg/kg. Maintenance of anesthesia will be provided using a mixture of %2-3 sevoflurane, %50 air, and %50 oxygen, maintaining the bispectral index between 40 and 50.
Heart rate and blood pressure values will be titrated by increasing or decreasing the remifentanil infusion to ensure that the values remain within %20 of baseline or that the OAB remains above 65.
If the mean arterial pressure drops by more than %20, 5 mg of ephedrine will be administered.
At the end of the procedure, the surgical duration and the total intraoperative remifentanil dose administered will be recorded.
In the postoperative recovery room, patients who show no loss of sensation in the C5-C6 dermatome (over the deltoid muscle) on the pinprick test but report severe pain (VAS ≥ 4) will be considered to have had a failed block.
Under the postoperative analgesia protocol all patients will be equipped with an IV morphine patient-controlled analgesia (PCA) device. The solution will be prepared such that morphine is 0.5 mg / ml. PCA 1mg bolus dose will be delivered with 10 min lock-out time and all patients will be administered 1 gram of paracetamol at 8th 16th and 24th hours.
Patients will be randomly divided into 2 groups as Group K(Patients not receiving nonsteroidal anti-inflammatory drugs) and Group D(Patients receiving nonsteroidal anti-inflammatory drugs) In Group D (Patients receiving nonsteroidal anti-inflammatory drugs) cases, will be administered 25 miligram of dexketroprofen at 6th and 18th hours.
In the postoperative period, a researcher assessed the patient's visual pain scores (resting and movement), rebound pain intensity, timing, and duration, systolic blood pressure, mean arterial pressure, diastolic blood pressure, peripheral oxygen saturation, postoperative analgesic consumption, and postoperative complications will be recorded.
Patient follow-up will be concluded at the end of 24 hours.
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: Meryem Onay
- Telefoonnummer: 02222392979
- E-mail: dr.meryemonay@hotmail.com
Studie Contact Back-up
- Naam: Çağla Uzalp
- Telefoonnummer: 02222392979
- E-mail: caglauzalp@gmail.com
Studie Locaties
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Odunpazarı
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Eskişehir, Odunpazarı, Turkije (Türkiye), 26040
- Werving
- Eskisehir Osmangazi Universıty Faculty of Medicine
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Contact:
- Çağla Uzalp
- Telefoonnummer: 02222392979
- E-mail: caglauzalp@gmail.com
-
Contact:
- Meryem onay
- Telefoonnummer: 02222392979
- E-mail: drmeryemonay@hotmail.com
-
Hoofdonderzoeker:
- Çağla Uzalp
-
-
Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
Age 18-70 years ASA score of I-III Arthroscopic shoulder surgery
Exclusion Criteria:
Patients who do not wish to participate in the study Creatinine clearance <50 mL/ min Patients for whom NSAID use is contraindicated due to heart failure, Patients with psychiatric or cognitive dysfunction that would impair their ability to assess visual analog scale (VAS) pain scores Patients for whom peripheral nerve block is contraindicated
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: Gerandomiseerd
- Interventioneel model: Crossover-opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
|
Placebo-vergelijker: Group K
Under the postoperative analgesia protocol all patients will be administered 1 gr of paracetamol at 8th 16th and 24th hours and all patients will be equipped with an IV morphine patient-controlled analgesia (PCA) device.
|
ISB + paracetamol IV 3*1
|
|
Actieve vergelijker: Group D
Under the postoperative analgesia protocol all patients will be administered 1 gram of paracetamol at 8th 16th and 24th hours and all patients receiving nonsteroidal anti-inflammatory drugs (25 miligram of dexketroprofen) at 6th and 18th hours.
The patients will be equipped with an IV morphine patient-controlled analgesia (PCA) device.
|
ISB+ paracetamol IV 3*1 +deksketoprofen IV 2*1. 25 miligram of dexketroprofen
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Effect of intravenous dexketoprofen administered during the postoperative period on the severity and incidence of rebound pain
Tijdsspanne: 24 hours
|
Rebound pain score(VAS ≥ 7) and incidence
|
24 hours
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Total opioid consumption
Tijdsspanne: 24 hours
|
Total morphine patient control analgesia prepared 0.5 mg / ml.
PCA 1 mg bolus dose will be delivered with 10 min lock-out time.
Follow up morphine consumption at postoperative 24 hours
|
24 hours
|
|
Visual analog Scale
Tijdsspanne: 24 hours
|
Visual analog scale at rest and movement (0 (no pain)-10 (unbearable pain))
|
24 hours
|
Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie stoel: MERYEM ONAY, Eskisehir Osmangazi University Faculty Of Medıcıne
Publicaties en nuttige links
Algemene publicaties
- Barry GS, Bailey JG, Sardinha J, Brousseau P, Uppal V. Factors associated with rebound pain after peripheral nerve block for ambulatory surgery. Br J Anaesth. 2021 Apr;126(4):862-871. doi: 10.1016/j.bja.2020.10.035. Epub 2020 Dec 31.
- Uppal V, Barry G, Ke JXC, Kwofie MK, Trenholm A, Khan M, Shephard A, Retter S, Shanthanna H. Reducing rebound pain severity after arthroscopic shoulder surgery under general anesthesia and interscalene block: a two-centre randomized controlled trial of pre-emptive opioid treatment compared with placebo. Can J Anaesth. 2024 Jun;71(6):773-783. doi: 10.1007/s12630-023-02594-0. Epub 2023 Oct 13.
- Singh NP, Makkar JK, Chawla JK, Sondekoppam RV, Singh PM. Prophylactic dexamethasone for rebound pain after peripheral nerve block in adult surgical patients: systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Br J Anaesth. 2024 May;132(5):1112-1121. doi: 10.1016/j.bja.2023.09.022. Epub 2023 Oct 26.
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