piperidines and Spinal-Diseases

Pain management following major spine surgery requires high doses of opioids and is associated with a risk of opioid-induced constipation. Peripheral mu-receptor antagonists decrease the gastrointestinal complications of perioperative systemic opioid administration without antagonizing the analgesic benefits of these drugs.. To investigate the impact of alvimopan in opioid-naive patients undergoing major spine surgery.. Patients undergoing >3 levels of thoracic and/or lumbar spine surgery were enrolled in this prospective, randomized, double-blind study to receive either alvimopan or placebo prior to and following surgery. Opioid consumption; pain scores; and time of first oral intake, flatus, and bowel movement were recorded.. A total of 24 patients were assigned to the active group and 25 were assigned to the placebo group. There was no significant difference in demographics between the groups. Postoperatively, the alvimopan group reported earlier time to first solid intake [median (range): alvimopan: 15 h (3-25) vs placebo: 17 h (3-46), P < .001], passing of flatus [median (range): alvimopan: 22 h (7-63) vs placebo: 28 h (10-58), P < .001], and first bowel movement [median (range): alvimopan: 50 h (22-80) vs placebo: 64 h (40-114), P < .001]. The alvimopan group had higher pain scores (maximum, minimum, and median); however, there was no significant difference between the groups with postoperative opioid use.. This study shows that the perioperative use of alvimopan significantly reduced the time to return of bowel function with no increase in postoperative opioid use despite a slight increase in pain scores.

Topics: Adult; Analgesics, Opioid; Constipation; Double-Blind Method; Female; Gastrointestinal Agents; Gastrointestinal Motility; Humans; Middle Aged; Pain; Piperidines; Prospective Studies; Receptors, Opioid, mu; Recovery of Function; Spinal Diseases; Young Adult

A randomized, placebo-controlled, double-blind study to evaluate the effect of intravenously (IV) administered acetaminophen on postoperative pain in children and adolescents undergoing surgery for idiopathic scoliosis or spondylolisthesis.. To evaluate effectiveness of IV-administered acetaminophen on postoperative analgesia, opioid consumption, and acetaminophen concentrations after major spine surgery in adolescents.. Scoliosis surgery is associated with severe postoperative pain, most commonly treated with IV-administered opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs), as adjuvant to opioids, improve analgesia and reduce the need for opioids. However, by inhibiting cyclo-oxygenase enzymes peripherally, NSAIDs may inhibit bone healing. Acetaminophen, a centrally acting analgesic, does not have the adverse effects of NSAIDs and has improved analgesia in children after another orthopedic surgery.. In an institutional review board approved study, 36 American Society of Anesthesiology patient classification I to III patients of 10 to 18 years of age were analyzed. Acetaminophen 30 mg/kg, administered IV or 0.9% NaCl was administered at the end of scoliosis or spondylolisthesis surgery, and thereafter twice at 8-hour intervals. Timed blood samples for acetaminophen determination were taken between 0.25 and 20 hours after the first dose. All patients received standard propofol-remifentanil anesthesia. Pain scores (visual analogue scale [VAS], 0-10), opioid consumption, and adverse effects were recorded.. In the surgical ward, 7 (39%) patients in the acetaminophen and 13 (72%) in the placebo group had a VAS pain score 6 or more (P < 0.05). There were fewer hours with VAS score 6 or more in the acetaminophen group compared with the placebo group (8.7% vs. 17.8% of the hours, P < 0.05). There was no difference in oxycodone consumption during the 24-hour follow-up between the 2 groups.. IV-administered acetaminophen 90 mg/kg/day, adjuvant to oxycodone, did improve analgesia, but did not diminish oxycodone consumption during 24 hours after major spine surgery in children and adolescents. All acetaminophen concentrations were in nontoxic levels.

Topics: Acetaminophen; Administration, Intravenous; Adolescent; Analgesics, Non-Narcotic; Analgesics, Opioid; Child; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Nausea; Oxycodone; Pain, Postoperative; Piperidines; Propofol; Remifentanil; Scoliosis; Spinal Diseases; Spondylolisthesis; Treatment Outcome; Vomiting

Clinical case series.. To study the combined use of modifications of stimulation methods and adjustments of anesthetic regimens on the reliability of motor-evoked potential (MEP) monitoring in a large group of children undergoing spinal surgery.. Monitoring of MEPs is advocated during spinal surgery, but systematic data from children are sparse.. A total of 134 consecutive procedures in 108 children <18 years of age were analyzed. MEPs were elicited by transcranial electrical stimulation (TES) and supplemented by temporal and spatial facilitation. The standard anesthesia regimen consisted of propofol, nitrous oxide, and remifentanil. Propofol was replaced with ketamine if no reliable MEPs could be recorded. In children <6 years of age, a ketamine-based anesthesia was used.. With temporal facilitation alone, reliable MEPs were obtained in 78% (105 of 134) of the procedures and, if combined with spatial facilitation, in 96% (129 of 134) of the procedures. Reliable MEPs were documented in 98% (111 of 113) of children >6 years and in 86% (18 of 21) in children <6 years of age.. Combining spatial facilitation with a TES protocol improved monitoring of corticospinal motor pathways during spinal surgery in children. A ketamine-based anesthetic technique was preferred in children <6 years of age.

Topics: Adolescent; Anesthetics, Intravenous; Child; Child, Preschool; Electric Stimulation; Evoked Potentials, Motor; Female; Humans; Infant; Ketamine; Male; Monitoring, Intraoperative; Nitrous Oxide; Piperidines; Propofol; Remifentanil; Reproducibility of Results; Spinal Diseases

Topics: Aminopyrine; Clinical Trials as Topic; Dipyrone; Drug Combinations; Drug Evaluation; Humans; Muscle Cramp; Pain; Piperidines; Spinal Diseases