ent-dextilidine and Pain--Postoperative

The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management.. In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day.. Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia.. All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.

Topics: Acute Disease; Aged; Aged, 80 and over; Amides; Analgesics, Opioid; Anesthetics, Local; Catheterization; Female; Femoral Neck Fractures; Femoral Nerve; Humans; Male; Methimazole; Middle Aged; Models, Organizational; Naloxone; Narcotic Antagonists; Nerve Block; Pain; Pain Measurement; Pain, Postoperative; Prilocaine; Prospective Studies; Ropivacaine; Tilidine

The purpose of this study was to evaluate whether or not the combination of tilidin and tilidin retard as oral patient-controlled analgesia provide a suitable pain management in patients after uncomplicated myocardial revascularization.. We conducted a randomised phase IV study to evaluate the effectiveness of postoperative analgesia with tilidin and tilidin retard. Patients with a baseline tilidin retard and tilidin liquid demand medication (group B, 42 patients) were compared with a base line paracetamol and tramadol-HCl liquid demand medication (group A, 44 patients). All patients received the first dose of study medication at the second postoperative day after evaluation of the individual pain score using NRS (numeric rating scale).. Pain relief in group B was significantly better only at the second postoperative day (NRS 1,8 compared to 3,3 in group A), associated with tolerable side effects and comfortable handling.. The combination of sustained release with immediate release drugs as a patient controlled analgesia provides suitable and comfortable analgesia after myocardial bypass surgery.

Topics: Administration, Oral; Analgesics, Opioid; Delayed-Action Preparations; Humans; Myocardial Revascularization; Pain, Postoperative; Postoperative Period; Tilidine

A double-blind study involving 101 patients was done to assess the efficacy of parenteral nefopam (0.66 mg/kg) for postoperative pain suppression, in comparison to tilidine (1.67 mg/kg) or placebo. The difference in painfree duration for both active drugs compared to placebo is significant, but no significant difference was present between them; although tilidine was a little longer acting. At no moment a significant difference was present in the pain score of the patients receiving one of both active drugs. Only minor changes of blood pressure, heart rate and respiratory frequency were seen and marked side effects were not present in any of the patients.

Topics: Adolescent; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Heart Rate; Humans; Male; Middle Aged; Nefopam; Oxazocines; Pain, Postoperative; Respiration; Tilidine

Topics: Adult; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Double-Blind Method; Female; Humans; Middle Aged; Nefopam; Oxazocines; Pain, Postoperative; Placebos; Tilidine; Time Factors

A controlled, double-blind study involving 250 women was carried out ot assess the efficacy of oral tilidine 25, 50 and 100 mg in treating postepisiotomy pain, and to offer a comparison with oral pentazocine 50 mg. All the analgesics produced significant pain relief. At peak effect tilidine 50 mg produced very similar results to pentazocine 50 mg with tilidine 25 mg producing less, and tilidine 100 mg more pain relief. These results were not, however, statistically significant. In these postdelivery ambulant patients pentazocine 50 mg and tilidine 100 mg produced at 25% incidence of side-effects, mainly dizziness and drowsiness, but tilidine 25 mg produced significant analgesia with virtually no side-effects.

Topics: Administration, Oral; Adolescent; Adult; Ambulatory Care; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Drug Evaluation; Female; Humans; Middle Aged; Pain, Postoperative; Pentazocine; Tilidine; Vulva

Intramuscular injections of 10 mg morphine or 100 mg tilidine hydrochloride were administered in a double-blind fashion and in random order to 40 patients after minor surgical operations. The therapeutic effect of each analgesic was assessed by comparing the severity of pain immediately postoperatively with that 1, 2, 3 and 4 hours after injection of the relevant analgesic. Tilidine and morphine relieved pain to a similar degree. Within the limits of the protocol followed, morphine appeared superior to tilidine in some tests. No major side-effects occurred.

Topics: Adult; Aged; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Female; Humans; Male; Middle Aged; Morphine; Pain, Postoperative; Tilidine; Time Factors

Topics: Adult; Aged; Analgesics; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Female; Humans; Male; Meperidine; Middle Aged; Pain, Postoperative; Tilidine; Time Factors

Topics: Adult; Aged; Clinical Trials as Topic; Cyclohexanecarboxylic Acids; Female; Humans; Male; Meperidine; Middle Aged; Pain Measurement; Pain, Postoperative; Random Allocation; Tilidine

Topics: Analgesics, Opioid; Dose-Response Relationship, Drug; Drug Administration Routes; Drug Administration Schedule; Drug Combinations; Humans; Naloxone; Narcotics; Pain Measurement; Pain, Postoperative; Tilidine; Tramadol; Wounds and Injuries

Topics: Adult; Analgesics; Cyclohexanecarboxylic Acids; Female; Humans; Male; Menisci, Tibial; Pain, Postoperative; Pyrroles; Tilidine; Tolmetin

Topics: Adolescent; Analgesics; Child; Child, Preschool; Cyclohexanecarboxylic Acids; Drug Combinations; Female; Humans; Male; Naloxone; Pain; Pain, Postoperative; Tilidine; Wounds and Injuries

Topics: Adult; Cyclohexanecarboxylic Acids; Double-Blind Method; Hemodynamics; Hemorrhage; Humans; Indomethacin; Meperidine; Pain, Postoperative; Prostaglandins E; Prostaglandins F; Respiration; Sputum; Tilidine; Tonsillectomy

Topics: Adolescent; Adult; Aged; Cyclohexanecarboxylic Acids; Drug Combinations; Extremities; Female; Humans; Male; Middle Aged; Naloxone; Pain, Postoperative; Pentazocine; Tilidine

The mode of interaction between the new, non-narcotic analgesic tilidine and pethidine was studied in the treatment of postoperative pain. The potency ratio 3:1 (pethidine:tilidine) found previously was used in the comparison. Thus 0.25 mg/kg of pethidine with 0.75 mg/kg of tilidine and 0.5 mg/kg of pethidine with 1.5 mg/kg of tilidine were compared with 0.5 mg/kg and with 1.0 mg/kg of pethidine. These drug combinations proved to be equipotent with the pethidine dosages used. Consequently the mode of interaction seemed to be additive synergism. The onset of action was slightly faster with pethidine, but the duration of action was longer with pethidine-tilidine combinations. Respiratory depression and sedation were less evident after pethidine-tilidine combinations than after equianalgesic doses of pethidine. Circulatory effects were similar in all groups. No statistical difference in other side effects could be demonstrated between the groups.

Topics: Adolescent; Adult; Aged; Blood Pressure; Carbon Dioxide; Cyclohexanecarboxylic Acids; Drug Synergism; Female; Humans; Male; Meperidine; Middle Aged; Pain, Postoperative; Pulse; Tilidine; Time Factors