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66 active trials for Acute Pain

Intravenous Lidocaine in Total Knee Replacement

Osteoarthritis of knees and hips is a common medical problem present in elderly, which poses signi?cant impairment to their mobility, independence, and quality of life. Despite the availability of conservative treatment, such as simple analgesics and physiotherapy, total joint replacement is the only curative option for this disease entity. The latter, however, is not without risk. A study by Poulakka has demonstrated that patients with poor pain control in the postoperative period were three to ten times more likely to develop chronic pain, which may signi?cantly impair the patients' functional status and quality of life. Optimal pain control is therefore essential in facilitating rehabilitation and in preventing long-term morbidities. Lidocaine [2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide] is an amide local anaesthetic that is characteristically fast in onset and short in duration of action. As such, it has long been used for providing regional anaesthesia for operation, but with limited role in terms of post operative analgesia. Recently, intravenous infusion of lidocaine has been shown to be safe and e?ective in reducing post operative pain (resting and dynamic), opioid consumption, and chronic post-surgical pain. The mechanism of action involves both peripheral and central actions. In addition to blockade of the Voltage-gated Sodium Channel of the peripheral nerves, lidocaine also inhibits priming of the PolyMorphoNuclear granulocyte (PMN) by inducing a time-dependent inhibition of intracellular G-protein signalling molecule (Gq); thus reducing release of cytokines and Reactive Oxygen Species Centrally, lidocaine also causes blockade of NMDA receptors and Neurokinin Receptors of the Wide-Dynamic Range Neurons in the dorsal horn of spinal cord; thus reduces glutamate activity. We therefore hypothesize that the use of intravenous lidocaine may reduce acute pain and improve the range of knee ?exion after total knee replacement. Currently, there is strong evidence supporting its use in laparoscopic and open abdominal surgeries. There is, however, a paucity of studies in orthopedic surgeries. To date, there is no randomized controlled trial that studied its e?ect in total knee replacement.

Start: January 2019

Gabapentin as a Pre-emptive Analgesic in Oral and Maxillofacial Surgical Procedures

The purpose of this study is to assess the effectiveness of pre-operative administration of gabapentin 900 mg in management of acute post-operative pain in patients undergoing oral and maxillofacial surgical procedures.

Start: September 2019

Comparison of Treatment by IM Ketamine to IV Ketamine in Patients With Renal Colic

Patients who present to the emergency department (ED), with acute pain due to renal colic, are often treated with opioids. Treatment with opioids has many disadvantages - cardio-respiratory depression, nausea, vomiting and long term dependence. For these reasons, there is a constant search for a way to reduce the use of opioids. ketamine has been proven to augmented the analgesic effect of opioids, and thus reduce the use and adverse effects of opioids. Different studies about the use of Ketamine as a sedition agent have shown that Ketamine given IM versus IV has longer duration of effect with less adverse effects. The study we are conducting is designed to test and analyze the safety and efficacy of IV Ketamine with IV Morphine compared to IV Ketamine and morphine with IM placebo in a setting of acute pain due to, or suspected renal colic in the ED. When both ways of administration are given by the protocol as is customary for treatment of pain in the Emergency Medicine department, and will be a prospective, randomized, double blind, controlled study.

Start: August 2019

Analgesic Efficacy of Duloxetine in Patients Undergoing Lumbar Discectomy

Duloxetine is a serotonin-norepinephrine reuptake inhibitor primarily used for treatment of major depression and anxiety. Duloxetine also has been used in the treatment of chronic pain conditions, such as osteoarthritis and musculoskeletal pain. There are few studies examining its effect for acute pain. The objective of this study is to evaluate the analgesic effect of duloxetine for patients undergoing lumbar discectomy.

Start: January 2018

Comparison of the Effectiveness of Preemptive Paracetamol and Ibuprofen in Acute Postoperative Pain

This study will evaluate two different analgesic regimen used for acute postoperative pain.

Start: February 2017

The Effect of Light Therapy on Post-Surgical Pain

Surgical pain may require significant amount of opioids. This is a serious medical problem, especially in the elderly. New methods are needed to help control surgical pain. This study investigates the pain-reducing effects of green light therapy on elderly patients. Our preclinical work illustrated that green light therapy relieved pain in rats. There were no side effects exhibited by the rats. Given the safety profile of the green light therapy, we propose a clinical trial to enroll patients scheduled for elective (non-emergency) knee replacement. The patients will be exposed to green light for 3 weeks prior to their surgery and for 10 additional weeks post-surgery. We will assess the efficacy of the green light therapy by comparing the amount of pain medications required by the treatment group (green light patients) vs the control group (white light) in the elderly patients. We will also assess the degree of pain relief, side effects, and inflammatory mediators for both groups. Our hypothesis is that green light therapy will reduce the need for opioids and the negative side effects associated with opioid use. Additionally, we will assess for increased mobility and independence in the elderly.

Start: October 2018