hydrocodone and Postoperative-Nausea-and-Vomiting

To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery.. A single-center, prospective, randomized, double-blind, crossover trial was conducted. The study population consisted of 20 nonsmoking patients referred to the Department of Oral and Maxillofacial Surgery of Columbia University College of Dental Medicine for extraction of all 4 TMs. Each patient received nicotine nasal spray or placebo spray before TM surgery. At a subsequent visit the contralateral TMs were removed with prior administration of the alternate treatment. For an hour postoperatively, subjects reported information on pain and nausea, and hemodynamic variables were recorded at 15-minute intervals. Telephone follow-up was recorded for 5 days postoperatively, where patients reported information on pain, nausea, and use of hydrocodone/acetaminophen as rescue analgesia.. Nicotine treatment was associated with a highly significant decrease in pain reported during the 5 days after TM surgery. There was no difference in the amount of hydrocodone/acetaminophen used or amount of nausea reported. There was a small but significant increase in heart rate after nicotine treatment compared with placebo during the first hour after surgery. There was no difference in blood pressure between groups.. Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious.

Topics: Acetaminophen; Administration, Intranasal; Adolescent; Adult; Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Blood Pressure; Cross-Over Studies; Double-Blind Method; Female; Follow-Up Studies; Ganglionic Stimulants; Heart Rate; Humans; Hydrocodone; Male; Middle Aged; Molar, Third; Nicotine; Pain, Postoperative; Placebos; Postoperative Nausea and Vomiting; Premedication; Prospective Studies; Treatment Outcome; Young Adult

Women undergoing postoperative postpartum tubal ligation (PPTL) often experience considerable pain. We hypothesized that epidural morphine, as part of a multi-modal analgesic regimen, would decrease postoperative pain and the need for systemic analgesia after PPTL. In a double-blinded study, patients were randomized to receive epidural saline or morphine 2 mg, 3 mg, or 4 mg after epidural anesthesia for PPTL. Postoperatively, ibuprofen 600 mg was administered every 6 h and patients could request acetaminophen 325 mg/hydrocodone 10 mg. The primary outcome variable was time to first request for supplemental analgesia. Verbal rating scores for pain and the incidence and severity of side effects were recorded for 24 h. Morphine group subjects requested supplemental analgesia later and received fewer doses compared with the saline group subjects. Peak cramping and incisional verbal rating scores for pain and the area under the verbal rating scores for pain x time curve for cramping pain were less after epidural morphine compared with saline, but there were no differences among morphine groups. Nausea, vomiting, and pruritus occurred more often in all morphine groups and subjects who received morphine 4 mg required treatment for these side effects more frequently than the saline or morphine 2 mg groups. In conclusion, epidural morphine 2 mg as part of a multi-modal analgesic regimen improved analgesia and decreased the need for supplemental analgesics after PPTL. The need to treat side effects with morphine 2 mg was not increased compared to a regimen of oral acetaminophen/opioid/nonsteroidal antiinflammatory analgesics.

Topics: Acetaminophen; Administration, Oral; Adult; Analgesia, Epidural; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Humans; Hydrocodone; Ibuprofen; Morphine; Pain Measurement; Pain, Postoperative; Postoperative Nausea and Vomiting; Preanesthetic Medication; Pruritus; Respiratory Mechanics; Sterilization, Tubal

Topics: Acetaminophen; Adenoidectomy; Analgesics, Non-Narcotic; Analgesics, Opioid; Child; Humans; Hydrocodone; Pain, Postoperative; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Research Design; Selection Bias; Sleep Apnea, Obstructive; Tonsillectomy