Made available in DSpace on 2014-10-09T12:26:16Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:10:32Z (GMT). No. of bitstreams: 1 13707.pdf: 1360257 bytes, checksum: c3e632331f4dc215d42873a09ef248bb (MD5) / Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia) / IPEN/D-MPLO / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo

Orientador: Valéria Nobre Leal de Souza Oliva / Banca: Paulo Sérgio Patto dos Santos / Banca: Juan Carlos Duque Moreno / Resumo: A utilização da anestesia local peridural tem alcançado grande ênfase nos últimos anos, sobretudo com a utilização de opióides. O presente trabalho teve como objetivo investigar a utilização da ropivacaína isolada ou em associação a diferentes opióides, na anestesia peridural de cadelas submetidas à ovariosalpingohisterectomia (OSH) eletiva. Participaram do estudo duplamente encoberto 32 cadelas sadias, adultas, de diferentes raças, pesando entre seis e 15 kg e pré-medicadas com acepromazina (0,05mg/kg, IM) associada ao midazolam (0,2mg/kg, IM), distribuídas em quatro grupos distintos: Grupo 1: ropivacaína: 0,3 mL/kg; Grupo 2: ropivacaína + morfina (0,1 mg/kg); Grupo 3: ropivacaína + butorfanol (0,1 mg/kg); e Grupo 4: ropivacaína + tramadol (0,5 mg/kg) administrados pela via peridural. Em cada momento experimental foram mensurados: freqüência cardíaca; freqüência respiratória; pressão arterial sistólica; temperatura retal; pressão parcial dos gases sangüíneos (arterial); pH sangüíneo; além da avaliação não-paramétrica do grau de sedação, grau de sangramento e de relaxamento muscular seguindo tabelas de escores. Os dados foram submetidos à ANOVA e comparados pelos testes de Kruskal-Wallis, Friedman, Dunn e Tukey (p< 0,05). Concluiu-se que a utilização da ropivacaína isolada ou associada à morfina, ao butorfanol ou ao tramadol pela via peridural não promoveu depressão cardiorrespiratória ou alterações hemodinâmicas significativas, sendo que a ropivacaína associada ao butorfanol permitiu a realização de OSH em cadelas. / Abstract: The use of epidural local anesthesia has been reaching great emphasis for the last years, overcoat with the opioids using. This research ained the use of ropivacaine with or without association the different opioids, for epidural anesthesia biches submitted the elective ovariosalpingohisterectomy (OSH). 32 bitches tool part is this double-blind study, adult, different breed, weighing between 6 and 15kg and pré-medicated with acepromazine (0.05mg/kg, IM) associated to the midazolam (0.2mg/kg, IM), distributed in for different groups: Group 1: ropivacaine: 0.3 mL/kg; Group 2: ropivacaine + morphine (0.1 mg/kg); Group 3: ropivacaine + butorphanol (0.1 mg/kg); and Group 4: ropivacaine + tramadol (0.5 mg/kg) administered epidural. The following parameters were studied: heart frequency; breathing frequency; systolic arterial pressure; rectal temperature; blood gas partial pressures (arterial); blood pH; besides non-parametric of sedation grade, bleeding grade and muscular relaxation following tables scores. The results were submitted by ANOVA and compared by Kruskal-Wallis, Friedman, Dunn and Tukey test (p< 0.05). It was conclude that the use of only ropivacaine or associated with morphine, with butorphanol or tramadol for the epidural administration didn't promote depression cardiorrespiratory or significant hemodinamycs alterations and the ropivacaine associated to the butorphanol allowed OSH in bitches accomplishment. / Mestre

Made available in DSpace on 2014-10-09T12:35:32Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:04:01Z (GMT). No. of bitstreams: 0 / O presente estudo avaliou os efeitos letais e subletais de dipirona sódica e paracetamol para organismos de água doce. O efeito letal foi determinado pela realização de ensaios agudos com D. similis, C. dubia, C. silvestrii e D. rerio. A influência da temperatura, tipo de água de diluição e fotoperíodo na ecotoxicidade aguda foram avaliadas. Os efeitos subletais foram determinados por meio de ensaios de embrioxicidade com D. similis (20°C), crônicos individuais e populacionais com D. similis, C. dubia e C. silvestrii. A influência da temperatura na ecotoxicidade crônica individual e populacional foi determinada. Os critérios para aceitabilidade para o controle (número de neonatas) nos ensaios populacionais com D. simlis (20 e 25°C) e C. dubia, foram estabelecidos. Nos ensaios de ecotoxicidade aguda, D. similis (20°C) foi mais sensível a dipirona sódica que a 25°C e, para paracetamol, D. similis (25°C) foi mais sensível. A água de diluição influenciou na ecotoxicidade aguda apenas do paracetamol e o fotoperíodo não influenciou na ecotoxicidade aguda de ambos os fármacos. Os valores de CL(I);96H obtidos para D. rerio foram 3670 e 590mg.L-1 para dipirona sódica e paracetamol, respectivamente. Dipirona sódica e paracetamol induziram malformações nas neonatas e embriões de D. similis e os valores de CI50 obtidos foram 21,1 e 94,00mg.L-1, respectivamente. Os valores de CI50 nos ensaios crônicos individuais com dipirona sódica para D. similis (20°C e 25°C) foram 7,53mg.L e 8,08mg.L-1, respectivamente. Para C. dubia e C. silvestrii a CI50 para ensaios crônicos individuais com dipirona sódica foram 5,38 e 3,57mg.L-1, respectivamente. Nos ensaios crônicos individuais com paracetamol, a CI50 para D. similis (20°C) foi 21,84mg.L-1 e 10,72mg.L-1 para D. similis (25°C). Para C. dubia e C. silvestrii a CI50 nos ensaios crônicos individuais com paracetamol foram 7,24 e 4,15mg.L-1, respectivamente. Como critérios de aceitabilidade para os ensaios crônicos populacionais estabeleceu-se para o controle de D. similis (20 e 25°C) e C. dubia 137, 143 e 80 neonatas, respectivamente. Os valores de CI50 nos ensaios populacionais com D. similis (20 e 25°C), C. dubia e C. silvestrii para dipirona sódica foram 8,84, 10,82, 4,68 e 2,81mg.L-1, respectivamente. Para os ensaios populacionais com paracetamol os valores de CI50 para D. similis (20 e 25°C), C. dubia e C. silvestrii foram 9,57, 10,1, 6,48 e 4,26mg.L-1, respectivamente. Os valores das concentrações que causaram ecotoxicidade aguda e crônica não são superiores as concentrações destes compostos no ambiente porém, de acordo com a classificação baseada na Diretiva Européia 93/67/EEC, estes compostos são classificados como nocivos para o ambiente. / Tese (Doutoramento) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:26:16Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:10:32Z (GMT). No. of bitstreams: 1 13707.pdf: 1360257 bytes, checksum: c3e632331f4dc215d42873a09ef248bb (MD5) / Dissertacao (Mestrado Profissionalizante em Lasers em Odontologia) / IPEN/D-MPLO / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP; Faculdade de Odontologia, Universidade de Sao Paulo, Sao Paulo

Class of 2016 Abstract / Objectives: Pain management in the pediatric population is crucial when providing emergency medical care, as inadequate pain control is a significant cause of morbidity and mortality. The use of adjunctive therapy can potentially decrease opioid requirements, thereby reducing potential opioid related adverse effects. The purpose of this study was to evaluate the use of adjunctive therapy and impact on morphine dose requirements for pediatric pain management in the emergency department (ED). Methods: This study was an IRB approved retrospective review of pediatric patients ages 1 to 18 years, who received intravenous (IV) morphine therapy in the ED. Patients were excluded based on opioid-tolerance (using opioids prior to ED visit), diagnosis of sickle cell disease, and oncologic disorders. Data collection included baseline demographics, medical diagnoses and comorbidities, morphine total dose by weight, type, dose by weight and frequency of adjunctive analgesia agents, and pain scores. Results: The use of adjunctive analgesia in addition to morphine did not reduce the total morphine doses given, repeat morphine dose requirements, admission rates, or length of stay but did increase the time to a repeat dose of morphine. In those patients who received adjunctive analgesia before morphine, we saw a statistically significant decrease in the total amount of morphine received, total morphine doses given, repeat morphine dose requirements, and admission rates. Conclusions: In pediatric patients who require pain management in the ED, adjunctive analgesia should be given before morphine to reduce the amount of morphine required.

The potent analgesic property of acetylsalicylic acid and acetaminophen makes these the most commonly used analgesics in the world. Easy accessibility and cost effectiveness of these agents are attractive to patients seeking pain relief. However, the abuse of nonnarcotic analgesics such as acetaminophen and acetylsalicylic acid by alcoholics and patients seeking to relieve dysphoric moods is well documented. These agents therefore impact on the brain neurotransmitter levels and therefore all processes involved in the synthesis and metabolism of neurotransmitters may be affected. The use of non-narcotic analgesics has been reported to reduce the incidence of neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). The mode of action by which acetylsalicylic acid and acetaminophen elicit neuroprotection is however unclear as many mechanisms of action have been inconclusively postulated. The first part of this study aims to elucidate the various mechanisms by which acetylsalicylic acid and acetaminophen affect the enzymes responsible for the catabolism of tryptophan, which is a precursor for the mood elevating neurotransmitter serotonin, as well as to investigate whether these agents alter the interplay between serotonin and pineal indole metabolism. The second part of this study focuses on the neuroprotective properties of acetylsalicylic acid and acetaminophen utilizing the neurotoxic metabolite of the kynurenine pathway, quinolinic acid and the potent Parkinsonian neurotoxin, 1-methyl-4-phenylpyridinium (MPP+). The ability of acetylsalicylic acid and acetaminophen to alter TRP metabolism was determined by investigating the effects of these agents on the primary enzymes of the kynurenine pathway i.e. tryptophan 2, 3-dioxygenase and indoleamine 2,3-dioxygenase as well as to investigate whether these agents would have any effects on 3-hydroxyanthranilic acid oxygenase. 3-Hydroxyanthranilic acid oxygenase is the enzyme responsible for the synthesis of quinolinic acid. Acetylsalicylic acid and acetaminophen alter tryptophan metabolism by inhibiting tryptophan 2, 3-dioxygenase and indoleamine 2,3-dioxygenase thus increasing the availability of tryptophan for the production of serotonin. Acetylsalicylic acid and acetaminophen also inhibit 3-hydroxyanthranilic acid oxygenase thus implying that these agents could reduce quinolinic acid production. Acetaminophen administration in rats induces a rise in serotonin and norepinephrine in the forebrain. Acetylsalicylic acid curtails the acetaminophen-induced rise in brain norepinephrine levels as well as enhances serotonin metabolism, indicating that analgesic preparations containing both agents would be advantageous, as this would prevent acetaminophen-induced mood elevation. The results from the pineal indole metabolism study show that acetylsalicylic acid enhances pineal metabolism of serotonin whereas acetaminophen induces an increase in melatonin levels in the pineal gland. Neuronal damage due to oxidative stress has been implicated in several neurodegenerative disorders such as AD and PD. The second part of the study aims to elucidate and characterize the mechanism by which acetylsalicylic acid and acetaminophen afford neuroprotection. The hippocampus is an important region of the brain responsible for memory. Agents such as quinolinic acid that are known to induce stress in this area have detrimental effects and could lead to various types of dementia. The striatum is also a vulnerable region to oxidative stress and hence (MPP+), which is toxic for this particular region of the brain, was also used as a neurotoxin. The results show that ASA and acetaminophen alone and in combination, are potent superoxide anion scavengers. In addition, the results imply that these agents offer protection against oxidative stress and lipid peroxidation induced by several neurotoxins in rat brain particularly, the hippocampus and striatum. Histological studies, using Nissl staining and Acid fuchsin, show that acetylsalicylic acid and acetaminophen are able to protect hippocampal neurons against quinolinic acidinduced necrotic cell death. Immunohistochemical investigations show that QA induces apoptotic cell death in the hippocampus, which is inhibited by ASA and acetaminophen. In addition, ASA and acetaminophen inhibited MPP+ induced apoptotic cell death in the rat striatum. The study also sought to elucidate possible mechanisms by which ASA and acetaminophen exert neuroprotective effects in the presence of MPP+ as these agents are shown to prevent the MPP+-induced reduction in dopamine levels. The results show that acetylsalicylic acid and acetaminophen inhibit the action of this neurotoxin on the mitochondrial electron transport chain, a common source of free radicals in the cell. In addition, these agents were shown to block the neurotoxic effects of MPP+ on the enzymatic defence system of the brain i.e. superoxide dismutase, glutathione peroxidase and catalase. The reduction in glutathione levels induced by MPP+ is significantly inhibited by acetylsalicylic acid and acetaminophen. The results imply that these agents are capable of not only scavenging free radicals but also enhance the cell defence mechanism against toxicity in the presence of MPP+. These agents also block the MPP+-induced inhibition of dopamine uptake into the cell. This would therefore reduce auto-oxidation of dopamine thus implying another mechanism by which these agents exert a neuroprotective role in MPP+-induced neurotoxicity. The discovery of neuroprotective properties of acetylsalicylic acid and acetaminophen is important considering the high usage of these agents and the increased incidence in neurological disorders. The findings of this thesis point to the need for clinical studies to be conducted as the results show acetylsalicylic acid and acetaminophen to have a definite role to play as antioxidants. This study therefore provides novel information regarding the neuroprotective effects of these agents and favours the use of these agents in the treatment of neurodegenerative disorders, such as AD and PD, in which oxidative stress is implicated.

A randomized, prospective, parallel, double-blind, double-dummy clinical trial was conducted to determine the analgesic efficacy and time to onset of analgesia following intravenous and intramuscular administration of ketorolac (15 and 30 mg), and oral ibuprofen 800 mg. A random sample of 100 patients aged 18 to 65, with acute musculoskeletal pain, were enrolled from the University of California Davis Medical Center, Emergency Department. Patients were categorized into five equal groups and received, either ketorolac 30 mg (IV or IM), ketorolac 15 mg (IV or IM) or ibuprofen 800 mg (PO) tablet as medication medication. Pain intensity was evaluated with a 100-mm visual analog scale at baseline and 5, 10, 15, 30, 45, 60, 120, 180, and 240 minutes after dosing. A verbal rating scale, consisting of five rankings was also used to evaluate pain intensity and pain relief. The time to onset of analgesia was defined as the time at which pain intensity score reached 25% and 50% of the baseline score in 25% and 50% of the patients. The prevalence of side effects was elicited in each patient. Patients who received ketorolac (30 mg IV) showed a greater decrease in pain intensity compared with patients in all other groups (p < 0.005). Ketorolac (30 mg IV) provided greater pain relief compared with patients receiving ketorolac (15 mg IV), ketorolac (15 mg IM) or ibuprofen 800 mg (p < 0.011). Fifty percent pain relief before the end of the study was achieved by 50% of patients in one group only- ketorolac (30 rng IV). Ketorolac (30 mg IV) was found to have a quicker time to onset of action compared to ibuprofen 800 mg (p = 0.025) and ketorolac (15 mg IV) (p < 0.001). When the criterion of 25% pain relief for 25% of the patients was used, ketorolac (30 mg IV) was found to have a quicker time to onset of action compared with all other groups (p < 0.025). Thus, ketorolac (30 mg IV) provided a greater degree of pain relief and a quicker time to onset of analgesia than all other groups, presenting with acute musculoskeletal pain. Ketorolac (30 mg IM), ketorolac (15 mg IM), ketorolac (15 mg IV) and ibuprofen 800 mg provided comparable analgesia.

An alternative complementary approach was used to verify the antinociceptive effect of 4 CMMs aqueous extracts in a Drosophila adult model. Drosophila adults were subjected to CMM treatments and then placed on an in-house-designed heating device for noxious heat stimulation. Their behavioral outputs were quantified and expressed as heat avoidance index (AI) for revealing the degree of antinociceptive effect of CMMs. By comparing the AI value of non-CMM treated control group with CMM-treated groups at temperature challenge 32&deg;C, it was found that an AI value of 0.2 was obtained for non-CMM-treated control group whereas CMMs-treated groups showed AI values ranged from 0.33 to 0.4. The increase of AI value in those CMM-treated groups means that Drosophila adults became more susceptible to noxious heat stimulation. This indicates that those identified CMMs by the larvae model possess strong and versatile antinoceiceptive activities in Drosophila adults. / In addition, reverse transcription PCR (RT PCR) analysis was performed to study the effects of CMMs on the mRNA expression of three nociceptive-related genes painless, nompC and CG4536. These three genes all belong to the Transient Receptor Potential (TRP) families and have been shown to be involved in heat response. The results indicate that the gene expression level for nompC was significantly down-regulated with fold changes ranging from 0.2 to 0.7 upon 2 hrs treatment of three aqueous CMM extracts Citrus aurantium, Angelica dahurica and Vitex trifolia. However, there is no significant difference in gene expression level for painless and CG4536. / In this study, it has been demonstrated that Drosophila are feasible to use for screening CMMs with antinociceptive activity. While the data of the relative gene expression level for those target genes observed in this study may also serve as biomarkers for providing more evidence to investigate drugs have antinociceptive effects. In the future, such information paves the way for further development in the study of antinociceptive drugs. / Nociception is the reception of signals in the central nervous system (CNS) triggered by specialized sensory receptors which received stimuli such as electrical, thermal, mechanical, or chemical and response to escape from danger. Similar to humans, the fruitfly Drosophila display evolutionarily conserved nociceptive response that makes it suitable for in vivo nociceptive study. In this study, Drosophila larvae were used as initial screening model to investigate the antinociceptive effect that was caused by 61 randomly selected Chinese Medicinal Materials (CMMs). Upon noxious heat stimulation, 73% of larvae in the control group produced a stereotypical rolling behavior within 1 s. Among those tested CMMs, the results indicated that 4 aqueous CMMs extracts from Citrus aurantium L. (family: Rutaceae), Angelica dahurica (Fish. ex Hoffm.) Benth. et Hook (family: Umbelliferae), Vitex trifolia L. var. simplicifolia Cham. (family: Verbenaceae) and Panax notoginseng (Burk.) F. H. Chen (family: Araliaceae) were found to have strong antinociceptive effect on Drosophila larvae since less than 40% of the larvae have produced stereotypical rolling behavior within 1 s upon noxious heat stimulation. / "September 2007." / Advisers: Ming Liang Song; Ho Yin Edwin Chan. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4768. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 134-139). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Abstract The purpose of this study was to investigate the clinical implications of a combination of a peripheral opioid, paracetamol (APAP) and ketoprofen (KTP) on the intensity of acute postoperative pain by focusing on tonsillectomy (TE) and third molar extraction. A second focus in the study was to assess the utility of the surgical ultrasonically activated scalpel (HS) technique for TE. In Study I, TE was performed on one side using the HS and on the contralateral side using a “blunt dissection technique”. The first TE study (I) demonstrated that - based on NRS pain scores during the first 10 postoperative hours - intra-operative blood loss and need for haemostasis were greater on the blunt dissection side than on the HS side. Pain scores were higher on the HS side than on the cold dissection side during the second postoperative week. Study III assessed the analgesic effect of a peripheral dose of 4 mg morphine. The peritonsillar infiltration of morphine locally did not significantly decrease pain compared to the control side. Studies (II and IV) included patients who were scheduled for third molar extraction. In Study II, patients received 1000 mg APAP or 100 mg KTP or both or a placebo to evaluate pain relief after third molar extraction. This study demonstrated that the mean sum of pain intensity differences scores up to the 1.5 h mark and the mean time to onset of pain relief at rest and on swallowing were favoured in the combination group more than in the APAP, KTP, and placebo groups. In Study IV, patients were assigned for a submucosal injection of 2 mg morphine or NaCl into either the non-inflamed (Trial I) or the inflamed (Trial II) peridental tissue, while the active control group received the same drugs in reverse order intramuscular (IM). Postoperative pain intensity at rest and on swallowing was assessed in all studies using the numerical rating scale (NRS). Pain scores in the peripheral morphine group at rest (Trials I and II) and on swallowing (Trial I) were not associated with any further pain reduction. Pain scores on swallowing during the 2–6 hours postoperative period (Trial II) were greater in the IM morphine group. HS TE was associated with decreased pain in the early postoperative period, but there was increased pain and otalgia during the second postoperative week. Locally administered peripheral morphine was not associated with any benefit during the postoperative period after TE. The multimodal analgesia combination of a single dose of KTP and APAP demonstrated the same benefit during the early postoperative period without an increase in side effects. Locally administered peripheral morphine produced significant analgesia on swallowing during the early postoperative stage in inflamed tissue after third molar extraction. / Tiivistelmä Hyvä leikkauksen jälkeinen kivunhoito on yksilöllisesti suunniteltua, turvallista, helppokäyttöistä ja taloudellista. Nykyään pyritään kivunlievityksessä hyödyn-tämään eri vaikutuspaikkoihin kohdistuvia hoitoja eli multimodaalista kivun¬hoitoa. Tämän työn tarkoituksena oli selvittää eri kivunlievitysmenetelmien tehoa ja turvallisuutta kahdessa eri toimenpiteessä: nielurisojen poistoleikkauksen (TE) tai viisaudenhampaan poistoleikkauksen jälkeen. Tutkimuskokonaisuus käsittelee leikkaustekniikan (Ultraääniveitsi), lääke-ainekombinaatioiden ja perifeerisesti annostellun morfiinin vaikutusta post-operatiiviseen kipuun. Tutkimusaineisto koostuu neljästä tutkimuksesta. Kaikki työt olivat satunnaistettuja ja kaksoissokkoutettuja. Kipu mitattiin numeerista asteikolla (Numerical Rating Scale, NRS) sekä levossa että nielemisen aikana enintään 2 viikon ajan. Ultraääniveitsen käytön vaikutusta postoperatiiviseen kipuun verrattiin perinteiseen leikkaustekniikkaan. Potilailta toinen nielurisa poistettiin ultraääni¬veistä käyttäen ja toinen tylpästi irrotellen kylmiä instrumentteja käyttäen. Kipu oli perinteisellä tekniikalla leikatulla puolella voimakkaampi kuin ultraääni¬veitsellä leikatulla puolella leikkauspäivänä. Toisen leikkauksen jälkeisen viikon aikana kipu oli kuitenkin voimakkaampaa ultraääniveitsillä leikatulla puolella. Parasetamolin (APAP), ketoprofeenin (KTP) tuottamaa kivunlievitystä ja näiden yhteisvaikutusta verrattiin viisaudenhampaan poistoleikkauksen jälkeen. KTP ja APAP kombinaatio antoi tehokkaamman kivunlievityksen ja nopeamman hoitovasteen kuin kumpikaan lääke yksin annettuna. Perifeerisesti infiltroidun morfiinin vaikutusta kipuun tutkittiin TE sekä viisaudenhampaan poistoleikkauksen jälkeen. TE jälkeen toiselle puolelle infiltroitiin nielurisan taakse 4 mg morfiinia ja toiselle puolelle fysiologista suolaliuosta. Viisaudenhampaan poistoleikkauksessa paikallisesti infiltroitua 2 mg morfiinia verrattiin lihakseen annettuun samaa lääkkeeseen kahdessa eri tilanteessa, joko tulehtuneeseen tai tulehtumattomaan kudokseen annosteltuna. Paikallisesti infiltroidulla morfiinilla ei todettu kipua lievittävää vaikutusta TE jälkeen. Tulehtuneeseen kudokseen infiltroitu morfiini lievensi leikkauksen jälkeistä nielemiskipua 2–6 tuntia leikkauksesta. Tulehtumattomaan kudokseen infiltroidulla morfiinilla ei saatu lisäetua. Yhteenvetona voidaan todeta, että TE ja viisaudenhampaanpoistoleikkauksen jälkeen kivunhoitoa voidaan optimoida multimodaalisin kivunhoidon keinoin. Tutkimustulokset auttavat potilaskohtaisen yksilöllisen kivunhoidon suunnittelussa.