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Leiv Arne Rosseland

Publications and source records attributed to Leiv Arne Rosseland.

8 recordsLinked to original sources
PubMed2006

Adding propacetamol to ketorolac increases the tolerance to painful pressure.

UNLABELLED: Combining an NSAID and paracetamol (acetaminophen) has in some studies given superior analgesia compared with the single drugs. In other trials no additive effect has been found. We have investigated the effect of this drug combination on the pressure pain tolerance threshold (PPTT), a reproducible correlate to clinical pain. The aim of this double blind, randomised, placebo controlled, crossover study was to evaluate the effect of i.v. propacetamol 2 g (= paracetamol 1 g) and ketorolac 30 mg, individually and in combination, on PPTT in 16 volunteers on four separate days. PPTT was measured 15 min before and at 45, 60, 90 and 150 min after the start of test drug administration. The pressure stimuli were applied on the base of a fingernail, increasing by 30 kPa/s until the pressure pain tolerance threshold was reached. For the total observation period (150 min), only the combination (propacetamol+ketorolac) increased significantly PPTT compared with baseline (P<0.04), while PPTT decreased significantly after placebo (P<0.01). The combination (propacetamol+ketorolac) and ketorolac alone increased PPTT compared with placebo (combination vs. placebo and ketorolac vs. placebo, P<0.001) and with propacetamol (combination vs. propacetamol and ketorolac vs. propacetamol, P<0.001). The combination was significantly better than ketorolac alone (P<0.04). After propacetamol 2 g, PPTT did not change significantly neither compared with placebo or baseline. CONCLUSIONS: Tolerance to repeated painful pressure (PPTT) decreased after placebo. Ketorolac 30 mg caused an increase in PPTT compared with placebo but not with baseline. Adding propacetamol 2 g to ketorolac 30 mg significantly increased PPTT. These findings support the practice of combining paracetamol with an NSAID for relief of acute pain.

Acetaminophen↗
PubMed2004

Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery.

A gender difference in the incidence of acute pain may be a confounder in analgesic trials. We have tested the hypothesis that the incidence of acute pain after knee arthroscopic procedures is greater in women than men. We performed three RCTs on intra-articular analgesics in which no postoperative analgesia was given until the need for such treatment was documented by scoring moderate-to-severe pain on a verbal rating scale (VRS 0-4; n=219), and a 0-100 mm visual analogue pain scale (VAS) within 2 h postoperatively. All trials were performed with an intra-articular catheter technique. The design allowed us to study the natural course of pain after arthroscopic surgery until analgesia was required. Women reported more pain of at least moderate intensity than men (84 vs 57%; P<0.0001), indicating that being female is a risk factor for early postoperative pain (RR 1.47, 95% confidence interval from 1.23 to 1.74). The VAS score corresponding to moderate and severe pain is similar in men and women. Only short acting anaesthetics were given in order to minimise carry-over effects. Since previous trials on arthroscopic analgesics neither measured baseline pain nor stratified for gender, a difference between treatment groups could result from an uneven distribution regarding these factors. Our findings have major implications for the interpretation of previously published trials on intra-articular analgesia.

Adolescent↗
PubMed2003

Intra-articular (IA) catheter administration of postoperative analgesics. A new trial design allows evaluation of baseline pain, demonstrates large variation in need of analgesics, and finds no analgesic effect of IA ketamine compared with IA saline.

All previous studies of intra-articular (IA) analgesic drugs for postarthroscopy pain have administered test-drugs at the end of the arthroscopic procedure, before any baseline pain could be assessed. Assay sensitivity has often not been documented or has been assumed to be present if a placebo control group had significant pain during the observation period. We present an improved study design employing an IA catheter for test-drug administration only in patients with moderate-to-severe baseline pain within 2h postoperatively. Using this technique we explored the incidence of moderate-to-severe pain and possible predisposing factors for pain through a close follow-up of all patients. The study incorporated an explanatory study of IA ketamine. A double-blind, double-dummy technique was used. Summed pain intensity differences 0-120 min after test medication was the primary outcome variable. Of 77 patients assessed for inclusion, only 45 had moderate or severe pain. Significantly more women (78%) than men (45%) had moderate-to-severe pain (P<0.005). Those not included continued to have no or mild pain and consumed less rescue analgesics than those who had high baseline pain. Mean baseline pain in the patient group with moderate or severe pain was 50mm on a 0-100 m visual analogue scale (VAS) (SD=15.1)(n=45). Mean VAS in the patient group with no or mild pain was 7.5mm (SD=8.7)(n=32). The new method for IA analgesic trials solves the problem with undesirable inclusion of patients with no or mild pain. We observed rapid onset and significant pain relief after IA injection of 10 ml saline with or without ketamine 10mg, but no difference between these two test medications. Intra-muscular ketamine 10mg showed significantly better early pain relief, global evaluation, and longer time to rescue analgesic, compared with IA ketamine 10mg.

Analgesics↗
PubMed2002

[Postoperative urinary retention].

BACKGROUND: Retention of urine is a common postoperative problem. MATERIALS AND METHODS: We present two patients with postoperative urinary retention. Current opinions on monitoring and treatment are reviewed. RESULTS: One male postoperative patient was transferred from the postanaesthesia care unit after orthopaedic surgery under spinal anaesthesia. Shortly thereafter he collapsed. Hypotension and bradycardia were treated with intravenous ephedrine and atropine. Urinary retention was suspected and the bladder catheterised for 1,000 ml urine. A follow-up examination revealed no sequelae. A female patient was operated for haemorrhoids under epidural anaesthesia. The second postoperative day she was catheterised for 1,500 ml of urine. Two years later she had an ovarian cyst removed under general anaesthesia. Postoperative urinary retention developed with bladder overdistension (volume > 1,000 ml). A follow-up examination showed rest urine of 25 to 75 ml, and a chronic bladder dysfunction. The incidence of postoperative urinary retention varies depending upon type of surgery, gender, age, and preoperative history of urinary tract dysfunction. Method of anaesthesia or postoperative pain treatment is not correlated to incidence of urinary retention, but excessive intravenous volume load during the operation is. INTERPRETATION: Postoperative urinary retention should be monitored in all patients after surgery. All patients with history of difficulties with micturition need close supervision to avoid urinary bladder overdistention.

Adult↗
PubMed2002

[The dying patient's preferences when end-of-life decisions are made].

BACKGROUND, MATERIAL AND METHODS: In this presentation we discuss end-of-life decisions on the basis of the history of a young patient with motor neuron disease and pneumonia. RESULTS: The patient wanted treatment for an acute pneumonia. Weaning from the respirator turned out to be difficult and the patient's condition was complicated by pneumothorax. He refused further treatment and managed to disconnect the respirator. He even tried self-extubation, but did not succeed, as his muscle strength was impaired. After two days the pneumothorax had spontaneously resorbed and the patient was awake. He refused further treatment and demanded that all therapy be stopped. A meeting was held of the ad hoc established local clinical ethical committee. The patient was conscious, mentally alert and well informed. The respirator was stopped and the orotracheal tube removed. The physician and nurse stayed bedside, ready to intervene if the patient wanted the ventilator treatment re-established, or to give pharmacological treatment for pain, respiratory distress, or anxiety. The patient was calm for five minutes, after that he started to feel respiratory distress. After a short while consciousness was lost, and he died after 30 minutes. INTERPRETATION: Ethical challenges are discussed. The story illustrates the importance of good communication between patient and doctor to facilitate the patient's autonomy.

Adult↗
PubMedDate not supplied

No evidence for analgesic effect of intra-articular morphine after knee arthroscopy: a qualitative systematic review.

BACKGROUND AND OBJECTIVES: Intra-articular (IA) injection of morphine has been the subject of many randomized clinical trials (RCTs). Both negative and positive results have been obtained in trials with a preemptive design, and the question of efficacy remains unresolved. Recent RCTs on patients whose inclusion was delayed until a baseline pain of at least moderate intensity was documented have illuminated the pitfalls of IA analgesic trials. Previously published systematic reviews may have included flawed RCTs in the analyses. METHODS: A systematic, qualitative review of RCTs on the analgesic efficacy of IA morphine after knee arthroscopic surgery. RESULTS: Of the 67 screened RCTs, 46 RCTs (43 publications) of IA morphine were included. Thirty-six trials were placebo controlled. Twenty-three of these RCTs were of low scientific quality; randomization and blinding were not adequately described or the method used for statistical analysis of repeated measurements was unsound. Among the 13 RCTs with usable information, 4 of the positive outcomes may be explained by the uneven distribution of patients whose natural course was low postoperative pain intensity. Uneven sex distribution may be a confounding factor in one of these trials. Seven negative and 2 positive trials had reliable information. The only RCT with documented control over baseline pain intensity was negative. Most positive trials had small sample size. Publication bias favors the reporting and publication of positive trials more often than negative ones. CONCLUSIONS: There are few well-controlled RCTs on IA morphine, and the negative trials of higher quality counter the evidence from the numerous positive ones of lower quality. The quality of most published trials is poor, and performing meta-analysis on these data is not meaningful. Properly controlled trials, in which early postoperative pain intensity is documented, suggest that there is no added analgesic effect of IA morphine compared with saline alone.

Analgesia↗
PubMedDate not supplied

Intra-articular morphine 5 mg after knee arthroscopy does not produce significant pain relief when administered to patients with moderate to severe pain via an intra-articular catheter.

BACKGROUND AND OBJECTIVES: Intra-articular (IA) morphine for postoperative analgesia after knee arthroscopy is controversial. The IA catheter technique for test drug administration allows baseline pain assessment before inclusion. Results from one such randomized controlled trial (RCT) in patients with moderate to severe pain have shown equal effects of IA saline with or without morphine 2 mg. However, the IA catheter technique may have an unintended placebo effect. The aims of this placebo-controlled RCT were (1) to compare the analgesic effect of IA saline 1 mL (placebo) with morphine 5 mg given through an IA catheter and (2) to analyze the impact on pain of immediate or delayed removal of the IA catheter. METHODS: Sixty patients operated under general anesthesia had an IA catheter inserted at the end of arthroscopy. Patients who reported moderate or severe postoperative pain during the following hour were randomized to IA saline 1 mL (placebo) or IA morphine 5 mg and to immediate or delayed removal of IA catheter. RESULTS: Forty of 60 patients (67%) developed moderate to severe pain within 1 hour. In addition, 5 patients experienced intolerable pain and were excluded. Significantly more women (24/26) than men (26/39) reported at least moderate pain (P = .018) during the first hour after surgery. There were no differences between IA morphine 5 mg and placebo in pain intensity or pain relief at any time during the 48-hour observation period. There was no detectable effect on pain intensity of early compared with late removal of the IA catheter. CONCLUSIONS: IA morphine 5 mg does not produce clinically significant pain relief in patients with moderate or severe pain after knee arthroscopy.

Adult↗