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Li B, Chen Y, Ma R. Optimizing patient outcomes: the impact of multimodal preemptive analgesia in video-assisted thoracoscopic lobectomy. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae096. [PMID: 38754100 PMCID: PMC11132815 DOI: 10.1093/icvts/ivae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 04/29/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of a multimodal preemptive analgesia management approach, specifically incorporating ultrasound-guided thoracic paravertebral block (UG-TPVB) in conjunction with intravenous analgesia, after video-assisted thoracoscopic (VATS) lobectomy under the guidance of enhanced recovery after surgery. METHODS A total of 690 patients who underwent VATS lobectomy between October 2021 and March 2022 were divided into the UG-TPVB group (group T, n = 345) and the control group (group C, n = 345). Patients in group T received UG-TPVB prior to the induction of general anaesthesia, while group C did not undergo nerve block. A comparison was conducted between the 2 groups regarding various indicators, including postoperative sedation, static/dynamic numeric rating scale scores, intraoperative fentanyl consumption, duration of mechanical ventilation/anaesthesia recovery/hospitalization, postoperative complications and other relevant factors. RESULTS The static/dynamic numeric rating scale scores of group T were lower than those of group C after surgery. Intraoperative fentanyl consumption in group T (0.384 ± 0.095 mg) was lower than that in group C (0.465 ± 0.053 mg). The duration of mechanical ventilation, anaesthesia recovery and hospitalization were significantly shorter in group T compared to group C. Patient satisfaction rate in group T (70.1%) was higher than that in group C (53.6%). All differences were statistically significant (P < 0.05). CONCLUSIONS The multimodal preemptive analgesia management strategy effectively reduces postoperative pain, decreases opioid consumption and promotes faster recovery in patients undergoing VATS lobectomy.
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Affiliation(s)
- Bing Li
- Department of Anesthesiology, Jiangsu Province Hospital and First Affiliated Hospital with Nanjing Medical University, Nanjing City, China
| | - Yu Chen
- Department of Anesthesiology, Jiangsu Province Hospital and First Affiliated Hospital with Nanjing Medical University, Nanjing City, China
| | - Rong Ma
- Department of Anesthesiology, Jiangsu Province Hospital and First Affiliated Hospital with Nanjing Medical University, Nanjing City, China
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Xiang G, Chen C, Chen K, Liu Q, Sun X, Huang Y, Huang L, Jin J, Shang J, Yang D. Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial. Aesthetic Plast Surg 2024; 48:1846-1854. [PMID: 38326498 DOI: 10.1007/s00266-023-03836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method. METHODS This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints. RESULTS The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort. CONCLUSION The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Xiaole Sun
- Department of Gynecology, Peking University Third Hospital, No. 49, Huayuan North Road, Haidian District, Beijing, 100144, China
| | - Yan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Lan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Jing Jin
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Jiantao Shang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China.
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Shukla K, Kiran Pebbili K, Bhagat SV, Rathod R, Kotak BP. Prospective Evaluation of Dental Practitioners' Knowledge, Attitude, and Practice Toward Adult Dental Pain Management: A Cross-Sectional Multicenter Study. Cureus 2024; 16:e55388. [PMID: 38562370 PMCID: PMC10984245 DOI: 10.7759/cureus.55388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Background Dental pain among adults is a prevalent concern impacting oral health and quality of life. Dental pain management presents a significant challenge for dental practitioners in effectively alleviating patient discomfort. Among the medications available, non-steroidal anti-inflammatory drugs (NSAIDs) are considered the most effective analgesics in dental care. While numerous studies have been conducted to assess the role of antibiotics in dental practice, there is a scarcity of studies specifically examining the prescription patterns of analgesics. The primary aim of this study was to evaluate the knowledge, attitudes, and practices of dental practitioners (DPs) in India concerning the management of adult dental pain. Method This survey utilized a computer-aided questionnaire-based approach. A total of 110 dentists, including 16 from metropolitan areas and 84 from non-metropolitan cities practicing at dental healthcare setups, clinics, and hospitals, were interviewed as part of the survey. The participants comprised dental professionals specializing in prosthodontics, endodontics, orthodontics, periodontics, oral surgery, pedodontics, and oral medicine. The study was conducted between September 2022 and January 2023. Results The primary reason patients seek dental consultation, as reported by 95% of dentists, is tooth cavities, followed by tooth sensitivity, post-root canal treatment, and pulpitis. All surveyed dentists prescribed NSAIDs to their patients for managing dental pain. Local anesthesia (LA) was the second choice for 75% of dentists, prescribed to 23% of their patients. The primary use of NSAIDs was for patients experiencing severe pain and to manage post-procedure pain. Eighty percent of DPs recognized ketorolac as a fast-acting molecule, providing immediate relief within 10-15 minutes. Overall, analysis indicated that 98% of DPs are satisfied and 67% are extremely satisfied with ketorolac among monotherapies for dental pain management due to its quick onset of action, fast pain relief, and usefulness in post-surgical pain management. Conclusion NSAIDs like ketorolac, diclofenac, and aceclofenac were the preferred prescriptions for overall dental pain management. Dental practitioners associated ketorolac with fast pain relief, quick onset of action, and effectiveness in post-surgical pain management, emphasizing its lasting effects. The insights from the study contribute to enhancing dental pain management strategies.
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Affiliation(s)
- Kirti Shukla
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, IND
| | | | - Seema V Bhagat
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, IND
| | - Rahul Rathod
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, IND
| | - Bhavesh P Kotak
- Medical Affairs, Dr. Reddy's Laboratories Ltd, Hyderabad, IND
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Messerer B, Stijic M, Sandner-Kiesling A, Brillinger JM, Helm J, Scheer J, Strohmeier CS, Avian A. Is PONV still a problem in pediatric surgery: a prospective study of what children tell us. Front Pediatr 2023; 11:1241304. [PMID: 37964809 PMCID: PMC10642485 DOI: 10.3389/fped.2023.1241304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Postoperative nausea and vomiting (PONV) is an unpleasant complication after surgery that commonly co-occurs with pain. Considering the high prevalence among pediatric patients, it is important to explore the main risk factors leading to PONV in order to optimize treatment strategies. The objectives of this study are as follows: (1) to determine the prevalence of PONV on the day of surgery by conducting interviews with pediatric patients, (2) to assess PONV prevalence in the recovery room and on the ward by analyzing nursing records, and (3) to collect information on PONV risk factors on the day of surgery and the following postoperative days. We wanted to investigate real-life scenarios rather than relying on artificially designed studies. Methods A prospective analysis [according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines] of PONV on the day of surgery and the following postoperative days was conducted by evaluating demographic and procedural parameters, as well as conducting interviews with the children under study. A total of 626 children and adolescents, ranging in age from 4 to 18 years, were interviewed on the ward following their surgery. The interviews were conducted using a questionnaire, as children aged 4 and above can participate in an outcome-based survey. Results On the day of surgery, several multivariable independent predictors were identified for PONV. The type of surgery was found to be a significant factor (p = 0.040) with the highest odds ratio (OR) in patients with procedural investigations [OR 5.9, 95% confidence interval (CI): 1.8-19.2], followed by abdominal surgery (OR 3.1, 95% CI: 0.9-11.1) when inguinal surgery was used as the reference category. In addition, the study identified several predictors, including the amount of fentanyl administered during anesthesia (µg/kg body weight) (OR 1.4, 95% CI: 1.1-1.8), intraoperative use of piritramide (OR 2.6, 95% CI: 1.5-4.4) and diclofenac (OR 2.0, 95% CI: 1. 3-3.1), opioid administration in the recovery room (OR 3.0, 95% CI: 1.9-4.7), and piritramide use on the ward (OR 4.5, 95% CI: 1.7-11.6). Conclusions The main risk factors for PONV include the intraoperative administration of opioids during the recovery room stay and at the ward, the intraoperative use of non-opioids (diclofenac), and the specific type of surgical procedure. Real-life data demonstrated that in clinical praxis, there is a gap between the adherence to established guidelines and the use of antiemetic prophylaxis in surgeries that are generally not associated with a high PONV prevalence. Further efforts are needed to improve the existing procedures and thus improve the overall outcome.
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Affiliation(s)
- Brigitte Messerer
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Marko Stijic
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- University Clinic for Neurology, Clinical Department for Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Andreas Sandner-Kiesling
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Johanna M. Brillinger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jasmin Helm
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Jacqueline Scheer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christof Stefan Strohmeier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Kaila V, Bonthu V, Moturi K, Raju US, Lakshmi PDN, Budumuru A. Efficacy of Lornoxicam as a Pre-emptive Analgesic in Mandibular Third Molar Surgery - A Comparative Study. Ann Maxillofac Surg 2023; 13:139-143. [PMID: 38405568 PMCID: PMC10883213 DOI: 10.4103/ams.ams_134_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction The most common complication following third molar surgery is pain. The purpose of the study is to determine the efficacy of lornoxicam as a preventive analgesic in patients undergoing surgical removal of impacted mandibular third molars. Materials and Methods This study included 26 participants aged 18-28 years with bilateral symmetrical third molars. Group A, the control group, received lornoxicam 8 mg 1 h after surgery, whereas Group B, the study group, received lornoxicam 8 mg 1 h before surgery. All patients were evaluated for pain at the 1st, 2nd, 4th, 6th, 8th and 12th post-operative hours. The number of rescue analgesics taken within 24 h of the procedure, as well as the first occurrence of pain postoperatively, was recorded and analysed. Results Using the Mann-Whitney U-test and Friedman's analysis, the resulting data were statistically analysed. When Group B was compared to Group A, there was a significant difference in pain reduction levels in the immediate post-operative hours. When compared to Group A, Group B had a lower need for rescue analgesics within the first 24 h postoperatively. Discussion Following mandibular third molar surgery, pre-emptive use of lornoxicam is effective in reducing post-operative pain and reducing the need for rescue analgesic consumption.
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Affiliation(s)
- Vini Kaila
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Vineela Bonthu
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Kishore Moturi
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - U Shivaji Raju
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - P Divya Naga Lakshmi
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - Anil Budumuru
- Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
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Kellner B, Duffee L. Liposomal Bupivacaine in Dentistry and Oral and Maxillofacial Surgery. A Review of Human and Veterinary Literature. J Vet Dent 2023:8987564231157041. [PMID: 36855302 DOI: 10.1177/08987564231157041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This article reviews the human and veterinary literature regarding liposome encapsulated bupivacaine use in dentistry and oral and maxillofacial surgery. The purpose of this review is to present available information on this local anesthetic in a manner that will allow veterinary dentists and oral and maxillofacial surgeons to use evidence-based information when considering incorporating liposomal bupivacaine into their practice. The twelve human clinical studies and three veterinary reports that met the literature search criteria do not support the use of liposomal bupivacaine in veterinary dentistry and oral and maxillofacial surgery.
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Affiliation(s)
- Bill Kellner
- Dentistry and Oromaxillofacial Surgery, Burlington Emergency and Veterinary Specialists, Williston, USA
| | - Lauren Duffee
- Anesthesia, 302399Massachusetts Veterinary Referral Hospital, Woburn, USA
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Efficacy of intraoperative sedation combined with preemptive analgesia for single-level kyphoplasty under local anesthesia: A randomized clinical trial. J Orthop Sci 2022; 27:1215-1221. [PMID: 34756518 DOI: 10.1016/j.jos.2021.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Kyphoplasty is widely used for Osteoporotic Vertebral Compression Fracture (OVCF) under general or local anesthesia, more attention was paid to its post-operative efficacy. Patients' pain and discomfort control strategies during surgery have not been taken seriously. OBJECTIVE This study aimed at assessing the efficacy of preoperative preemptive analgesia combined with intraoperative sedation for pain and tension relief in OVCF patients undergoing kyphoplasty under local anesthesia. METHODS We enrolled 128 patients with single-level OVCF who underwent kyphoplasty in our hospital from July 2013 to July 2016. The patients were randomly allocated into three groups: conventional group (i.e., local anesthesia with 0.5% lidocaine (1); n = 42), preemptive group (i.e, (1) + oral 200 mg Celecoxib on the night before surgery with intravenous 40 mg parecoxib sodium an hour before surgery (2); n = 43), and combined group (i.e., (1) + (2) + continuous intravenous 0.5 μg/kg/h dexmedetomidine intraoperatively; n = 43). Hemodynamic variations (heart rate, blood pressure, pulse oxygen saturation (SpO2)), Pain Visual Analogue Score (VAS), Ramsay score, and adverse events were recorded during perioperative period. RESULTS Blood pressure and heart rate were more stable with significantly smaller values in the combined group than in the conventional and preemptive groups both intra- and postoperatively. In contrast, SpO2 showed no significant difference among the groups throughout the perioperative period. Intraoperative VAS scores revealed significant differences among the groups with the combined group having the smallest values followed by the preemptive group. Similarly, intraoperative Ramsay scores reflected significantly more favorable effects of sedation in the combined than in conventional group. Both VAS and Ramsay scores showed no significant differences among the groups postoperatively, and no differences in complication incidences were noted among the groups as well. CONCLUSIONS For kyphoplasty under local anesthesia for single-level OVCF, intraoperative sedation combined with preemptive analgesia worked better in mitigating pain and tension intraoperatively and in preventing hemodynamic changes intra- and post-operatively, as compared to local anesthesia alone or additional preemptive analgesia.
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Passias BJ, Johnson DB, Schuette HB, Secic M, Heilbronner B, Hyland SJ, Sager A. Preemptive multimodal analgesia and post-operative pain outcomes in total hip and total knee arthroplasty. Arch Orthop Trauma Surg 2022; 143:2401-2407. [PMID: 35499774 DOI: 10.1007/s00402-022-04450-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Use of multimodal analgesia (MMA) prior to orthopedic surgery has been adopted by many practitioners as a strategy to minimize use of opioid medications. The purpose of this investigation was to quantify the effect of a preemptive three-drug regimen (acetaminophen, celecoxib, and gabapentin) in terms of post-operative opioid consumption and pain control in the field of total joint arthroplasty. METHODS A retrospective chart review was conducted on 1691 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and stratified by whether they received a preemptive three medication analgesic therapy (acetaminophen, celecoxib, and gabapentin) within 30 to 60 min prior to entering the operating room. Post-operative opioid consumption as well as subjectively reported patient pain scores were assessed throughout their hospital stay. RESULTS A total of 1416 eligible patients were identified with 485 undergoing THA and 931 undergoing TKA. Statistically significant reductions in oral morphine equivalents were shown on post-operative day zero and two within the TKA cohort, and non-significant reductions were demonstrated in other intervals for both procedure types. Statistically significant reductions in patient reported pain scores were shown in nearly every time interval in both procedure types. CONCLUSION The receipt of preemptive acetaminophen, celecoxib, and gabapentin 30-60 min prior to total joint arthroplasty demonstrated modest reductions in opioid requirements post-operatively. Patients receiving preemptive MMA reported lower pain scores throughout nearly every time interval during their admission after surgery. Further investigations are warranted regarding optimal preoperative medication therapies to promote adequate post-operative pain control-and ultimately diminished opioid consumption-in the setting of total joint arthroplasty.
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Affiliation(s)
- Braden J Passias
- Department of Orthopedic Surgery, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA.
| | - David B Johnson
- Department of Orthopedic Surgery, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
| | - Hayden B Schuette
- Department of Orthopedic Surgery, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
| | - Michelle Secic
- Secic Statistical Consltng Incorporated, 9685 Campton Ridge Dr, Chardon, OH, 44024, USA
| | - Brian Heilbronner
- Department of Pharmacy, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
| | - Sarah J Hyland
- Department of Pharmacy, OhioHealth Grant Medical Center, 285 East State Street, Columbus, OH, 43215, USA
| | - Andrew Sager
- Department of Pharmacy, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH, 43228, USA
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Mazhar H, Samudrawar R, Tamgadge P, Wasekar R, Tiwari RVC, Tiwari H. Preemptive Oral Ketorolac with Local Tramadol Versus Oral Ketorolac in Third Molar Surgery: A Comparative Clinical Trial. J Maxillofac Oral Surg 2022; 21:227-234. [PMID: 35400910 PMCID: PMC8934834 DOI: 10.1007/s12663-020-01400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Aims To assess preemptive analgesic efficacy of oral ketorolac with submucous placebo versus oral ketorolac with submucous tramadol during impacted mandibular third molar surgery. Methodology A double-blind, split-mouth clinical study was carried on 40 patients having bilateral impacted mandibular third molars. They were divided as group A comprising of 40 patients in whom oral ketorolac with submucous tramadol was administered and group B comprising of 40 patients in whom oral ketorolac with submucous placebo was administered. The study parameters included were pain intensity scores, duration to take 1st rescue analgesia, need of analgesic intake during the first 24 h postoperatively and patient's experience. Results The patient's experience was found to be better in the group A as compared to group B while evaluating mean pain intensity scores (VRS, VAS); need of postoperative analgesics and drug-related complications. Conclusion Preemptive oral ketorolac with tramadol in comparison to oral ketorolac results in better pain relief, longer pain free intervals with minimum rescue analgesics requirement & lesser postoperative analgesics consumption.
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Affiliation(s)
- Heena Mazhar
- Department of Oral & Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh India
| | - Ratna Samudrawar
- Oral Medicine & Radiology, EJHS Wellness Center, Adilabad, Telangana India
| | - Prashant Tamgadge
- Department of Oral & Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh India
| | - Rashmi Wasekar
- Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wadhamna Road, Hingna, Nagpur, Maharashtra India
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Vozza I, Cristalli MP. COMPARATIVE ANALGESIC EFFECTS OF SINGLE-DOSE PREOPERATIVE ADMINISTRATION OF PARACETAMOL (ACETAMINOPHEN) 500 mg PLUS CODEINE 30 mg AND IBUPROFEN 400 mg ON PAIN AFTER THIRD MOLAR SURGERY. J Evid Based Dent Pract 2021; 21:101611. [PMID: 34922726 DOI: 10.1016/j.jebdp.2021.101611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Efficacy and rapid onset of postsurgical oral pain relief are critical to improve clinical outcomes and reduce the risk of excessive dosing with analgesic drugs. PURPOSE To compare analgesic effects of preoperative administration of paracetamol 500 mg plus codeine 30 mg in single-tablet and effervescent formulation to ibuprofen 400 mg, and placebo in the management of moderate to severe postoperative pain after mandibular third molar surgery. MATERIALS AND METHODS One hundred twenty healthy outpatients aged 15-29 years undergoing surgical removal of 1 bony impacted mandibular third molar were enrolled in this, single-center, prospective, randomized, triple-blind parallel-group, placebo-controlled, clinical trial. Study participants were randomly assigned to three treatment arms. According to the concealed allocation, each patient 30 minutes before surgery received paracetamol 500 mg plus codeine 30 mg (group APAP/COD), ibuprofen 400 mg (group IBU) or placebo (group PLA). Rescue therapy allowed in the postoperative period was paracetamol 500 mg plus codeine 30 mg in groups APAP/COD and PLA and ibuprofen 400 mg in group IBU. Patients recorded on Numerical Rating Scale-11 (NRS-11) the pain intensity, total number of postoperative-supplement medications and time of the first intake, until 12-hours after surgery and over extra 2 days, RESULTS: Over postoperative 3 days, patients in the APAP/COD group (2.33 ± 1.99) displayed significantly (P< .001) less pain intensity than IBU (3.43 ± 2.47) and placebo (3.57 ± 2.62) groups. The first-day postoperative pain was significantly (P < .001) higher in group PLA than in groups APAP/COD and IBU, but not between the latter 2 groups. However, at 2 hours postdose, the IBU group displayed average pain intensity lower than APAP/COD group (P> .05). On the next 2 days, pain intensity was significantly (P< .001) lower in group APAP/COD than in groups IBU and PLA but failed to reach statistical significance between groups IBU and PLA. Although the time to the first using rescue therapy was longer (445.88 ± 159.96 minute) in group IBU, compared to groups APAP/COD (392.67 ± 138.90 minutes) and PLA (323.00 ± 143.95 minutes), the number of supplemented tablets was significantly higher in group IBU (2.89 ± 2.13) than in groups APAP/COD (1.24 ± 1.79) (P= .001) and PLA (1.53 ± 1.67) (P = .008). No adverse events were registered for all groups. CONCLUSIONS Within the limits of the present study, over postoperative 3 days, a statistically significant intensity pain reduction and decreased rescue therapy consumption were recorded in the paracetamol-codeine group than to ibuprofen group. Nevertheless, lower pain intensity at 2 hours postdose and longer time using rescue therapy was found in the ibuprofen group without statistical significance. No adverse events occurred over the studied period.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy.
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Iole Vozza
- Department of Oral and Maxillofacial Sciences, Sapienza, University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza, University of Rome, Rome, Italy
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Hyderi AF, Racelis MC. A Comparison of Patient Outcomes Using Multimodal Analgesia Versus Opioid-Based Pain Management in Total Joint Arthroplasty. Orthop Nurs 2021; 40:360-365. [PMID: 34851879 DOI: 10.1097/nor.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multimodal analgesia (MMA) pain management following total joint arthroplasty (TJA) is gaining momentum as a best practice. Many forces in healthcare are coming together challenging orthopaedic teams to reevaluate postoperative pain management following surgery including the opioid crisis and pressures to improve patient experience with early discharges following surgery. Measuring the effect of adjustments to pain management is an important step. This retrospective, observational study evaluated the effect of a multimodal postoperative analgesia regimen on patient outcomes and opioid use at a Midwest academic medical center. Two cohorts of patients were compared. Those who underwent TJA from November 2016 to April 2017 and received pain management by the traditional supplemental "as-needed" opioid-based pain management order set and patients who underwent TJA from September 2017 to February 2018 whose pain was managed by the scheduled multimodal pain management order set. For patients in the MMA group, there was a significant difference in pain control on postoperative day 1 (p = .04) in addition to decreased hospital length of stay (LOS) (p = .0001). Opioid consumption in the MMA group was lower compared to the traditional supplemental "as-needed" opioid-based pain management cohort. Implementation of the MMA regimen at this institution led to improved postoperative pain control, reduced LOS, less consumption of opioids, antiemetic, and antipruritic medications in TJA patient population.
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Affiliation(s)
- Alifiya F Hyderi
- Alifiya F. Hyderi, PharmD, BCPS, Clinical Pharmacy Specialist, Rush University Medical Center, Chicago, IL.,Mary Carol Racelis, MSN, APRN, ACNS-BC, ONC-A, Clinical Nurse Specialist, Rush University Medical Center, Chicago, IL
| | - Mary Carol Racelis
- Alifiya F. Hyderi, PharmD, BCPS, Clinical Pharmacy Specialist, Rush University Medical Center, Chicago, IL.,Mary Carol Racelis, MSN, APRN, ACNS-BC, ONC-A, Clinical Nurse Specialist, Rush University Medical Center, Chicago, IL
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12
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La Monaca G, Pranno N, Annibali S, Polimeni A, Pompa G, Cristalli MP. Effects of ibuprofen administration timing on oral surgery pain: A randomized clinical trial. Oral Dis 2021; 28:796-804. [PMID: 33486855 DOI: 10.1111/odi.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare the analgesic effect of ibuprofen 400 mg given 30 min before or immediately after third molars surgery under local anaesthesia. MATERIALS AND METHODS The single-centre, randomized, split-mouth, triple-blind, clinical trial involved 38 outpatients, for a total of 76 bilateral symmetrical fully bone impacted mandibular third molars. Each patient was undergone to separate surgical sessions for the right and left side, and ibuprofen was randomly administered 30 min before or immediately after the intervention. Study participants recorded pain intensity using Numerical Rating Scale-11, the timing of rescue therapy intake and overall tablets consumption over 3 days. RESULTS The overall pain intensity score was lower in the group receiving ibuprofen immediately after (3.13 ± 2.46) than before (3.58 ± 2.40) surgery, with statistically significant differences only on the second and third days. The mean time to the first using rescue therapy was longer in the postoperative (598.33 ± 422.62 min) than in the preoperative (406.25 ± 149.79 min) analgesic treatment group (p = .123). The number of supplemented ibuprofen tablets did not differ (p = .530) between both groups. CONCLUSIONS Within the limits of the present study, ibuprofen administration immediately after surgery seemed to be more effective than preoperative administration.
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Affiliation(s)
- Gerardo La Monaca
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Pranno
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Susanna Annibali
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Pompa
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Paola Cristalli
- Department of Biotechnologies and Medical Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Amorim KDS, Gercina AC, Ramiro FMS, Medeiros LDA, de Araújo JSM, Groppo FC, Souza LMDA. Can local anesthesia with ropivacaine provide postoperative analgesia in extraction of impacted mandibular third molars? A randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:512-518. [PMID: 33223455 DOI: 10.1016/j.oooo.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/02/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the local anesthesia efficacy of ropivacaine 0.75% compared to lidocaine 2% with 1:100,000 epinephrine for postoperative analgesia following extraction of impacted mandibular third molars. STUDY DESIGN In this randomized, double-blind crossover clinical trial, 30 participants underwent surgical removal of bilateral impacted mandibular third molars under local anesthesia using ropivacaine 0.75% or lidocaine 2% with 1:100,000 epinephrine. The pain was recorded on a visual analog scale at 4, 8, 12, 24, and 48 h postoperatively. The use of analgesics and the presence of adverse effects were recorded. RESULTS The duration of soft tissue anesthesia in the ropivacaine group was significantly longer than that in the lidocaine group. The lidocaine group recorded significantly higher visual analog scale scores at all postoperative time intervals, except in the final 48-h period. Analgesic use was higher in the lidocaine group. Rescue medication was used by 2 patients in each group (6.7%). Significantly more postoperative bleeding was seen in the ropivacaine group. CONCLUSION Ropivacaine 0.75% injection before the surgical procedure may be associated with preventive analgesia for extraction of impacted mandibular third molars.
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Affiliation(s)
- Klinger de Souza Amorim
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil.
| | - Anne Caroline Gercina
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Filipe Mazar Santos Ramiro
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
| | - Leonardo de Araújo Medeiros
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
| | - Jaiza Samara Macena de Araújo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Francisco Carlos Groppo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, Piracibaba, São Paulo, Brazil
| | - Liane Maciel de Almeida Souza
- Federal University of Sergipe, Oral Surgery and Anesthesiology Area of Dentistry Department, Aracaju, Sergipe, Brazil
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Niemiec B, Gawor J, Nemec A, Clarke D, McLeod K, Tutt C, Gioso M, Steagall PV, Chandler M, Morgenegg G, Jouppi R. World Small Animal Veterinary Association Global Dental Guidelines. J Small Anim Pract 2020; 61:E36-E161. [PMID: 32715504 DOI: 10.1111/jsap.13132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.
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15
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Liu L, Li B, Cao Q, Zhao B, Gao W, Chen Y, Yu S. Effects of Additional Intraoperative Administration of Sufentanil on Postoperative Pain, Stress and Inflammatory Responses in Patients Undergoing Laparoscopic Myomectomy: A Double-Blind, Randomized, Placebo-Controlled Trial. J Pain Res 2020; 13:2187-2195. [PMID: 32943911 PMCID: PMC7468475 DOI: 10.2147/jpr.s257337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Although pain after laparoscopic surgery is assumed to be minor, many women still suffer from unexpected postoperative pain. Thus, we aimed to assess whether additional intraoperative administration of sufentanil could help to improve postoperative pain and related agitation, stress, and inflammation response in patients undergoing laparoscopic myomectomy. Patients and Methods Forty female patients with uterine myoma scheduled for laparoscopic myomectomy under general anesthesia were randomized to receive sufentanil (group T, n=20) or normal saline (group C, n=20) 1h before the end of the surgery. The postoperative pain, agitation, stress, inflammation, and adverse effects were measured. Results As the primary outcome, the visual analog scale (VAS) pain score was significantly reduced in group T as compared with group C at each measured time point in a post-anesthesia care unit (PACU), VAS 5 min (31.5 ± 2.7 vs 40.6 ± 5.6) (P<0.001), VAS 30 min (36.5 ± 4.5 vs 46.0 ± 2.9) (P<0.001), VAS 1h (37.8 ± 4.0 vs 48.6 ± 5.5) (P<0.001). The secondary outcomes, including the sedation agitation scale (SAS) scores, plasma concentrations of epinephrine and norepinephrine, and the levels of plasma interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) in group T were remarkably lower than those in group C (P < 0.001). The cough cases in group T also showed a significant reduction in comparison with group C (P < 0.05). In addition, the anesthetic recovery time, including the spontaneous breathing recovery time and extubation time, were not significantly different between the two groups, as were the cases of respiratory depression and postoperative delirium (P > 0.05). Conclusion For patients undergoing laparoscopic myomectomy, administration of sufentanil 1 h before the end of surgery shows excellent analgesic and sedative effects, alleviated postoperative stress and inflammatory responses, reduced incidence of cough, without prolonging anesthetic recovery time and increasing adverse reactions.
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Affiliation(s)
- Lian Liu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Bingyu Li
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Bo Zhao
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Wenwei Gao
- Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Yuan Chen
- Department of Academic Research, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, People's Republic of China
| | - Shihua Yu
- Department of Anesthesiology, Renmin Hospital of Hannan District, Wuhan, Hubei 430090, People's Republic of China
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A Double-Blind, Randomized Controlled Trial of Pre-incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post-operative Pain Relief in Open Thyroid and Parathyroid Surgery. World J Surg 2020; 44:2656-2666. [DOI: 10.1007/s00268-020-05458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Xu J, Li H, Zheng C, Wang B, Shen P, Xie Z, Qu Y. The efficacy of pre-emptive analgesia on pain management in total knee arthroplasty: a mini-review. ARTHROPLASTY 2019; 1:10. [PMID: 35240765 PMCID: PMC8796433 DOI: 10.1186/s42836-019-0011-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/06/2019] [Indexed: 12/21/2022] Open
Abstract
Total knee arthroplasty (TKA) is considered a cost-effective and efficacious treatment for patients with end-stage knee arthritis. Meanwhile, TKA has been regarded as one of the most painful orthopaedic surgeries. Pain control after TKA remains a challenging task. Many analgesic innovations are used to reduce the level of pain, but none has been proven to be the optimum choice till now. Multimodal analgesia incorporates the use of analgesic adjuncts with different mechanisms of action to enhance postoperative pain management. This approach is a preferable choice in relieving postoperative pain with minimum side effects. This paper aims to review pre-emptive analgesia for pain management in TKA. We reviewed the application of pre-emptive analgesia, its physiological mechanism, and the techniques.
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Affiliation(s)
- Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Huan Li
- Department of Arthroplasty, The First People's Hospital of Changzhou, Changzhou, 213003, China
| | - Chong Zheng
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Bin Wang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Pengfei Shen
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Zikang Xie
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China
| | - Yuxing Qu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu Province, China.
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Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study. J Oral Maxillofac Surg 2019; 77:1990-1997. [DOI: 10.1016/j.joms.2019.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
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Chilvers CR, Nguyen MH, Robertson IK. Changing from Epidural to Multimodal Analgesia for Colorectal Laparotomy: An Audit. Anaesth Intensive Care 2019; 35:230-8. [PMID: 17444314 DOI: 10.1177/0310057x0703500213] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In April 2002 our practice ceased routine use of epidural analgesia for colorectal laparotomy in favour of a six-drug multimodal regimen comprising ketamine, clonidine, morphine, tramadol, paracetamol and a nonsteroidal antiinflammatory drug. The records of 54 patients who received this multimodal analgesia regimen (MM) after April 2002 were compared to the 59 patients who had previously received epidural analgesia (EPI). Patients had the same surgeon and anaesthetist. Daily pain score (verbal rated 0-10) at rest (mean) over the first three postoperative days was satisfactorily low with both MM (1.2 ± 1.2) and EPI (0.4 ± 0.4). Over this period there was little difference between the maximum pain score at rest (MM 2.3 ± 1.9 vs. EPI 2.2 ± 1.7, P=0.58). Major complications and side-effects occurred solely in EPI patients: epidural abscess (1), respiratory depression (2), pneumonia (3), venous thromboembolism (3), delirium (7), high block (7) and motor block (3). Hypotension requiring intervention was 4.8 times more frequent in the EPI group (95% CI 2.1-11). Antiemetic use was similar between groups; on average 13 patients in the MM groups (24%) and 15 patients in the EPI groups (26%) received antiemetics each day. MM patients had shorter anaesthetic preparation time (20±8 min vs. 32±8 min, P<0.001), shorter high-dependency unit stay (0.4 ± 1.2 days vs. 4.5 ± 0.9 days, P <0.001), and shorter hospital stay(10±4 days vs. 13±8 days, P=0.003). In our practice, changing from epidural to multimodal analgesia produced comparable pain relief with reduction in anaesthesia preparation time, high-dependency unit stay and hospital stay and the requirement for staff interventions. There was also a reduction in the incidence of major complications and side-effects.
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Affiliation(s)
- C R Chilvers
- Department of Anaesthesia, Launceston General Hospital, Launceston, Tasmania, Australia
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Barr Grzesh RL, Treszezamsky AD, Fenske SS, Rascoff LG, Moshier EL, Ascher-Walsh C. Use of Paracervical Block Before Laparoscopic Supracervical Hysterectomy. JSLS 2018; 22:JSLS.2018.00023. [PMID: 30356343 PMCID: PMC6174006 DOI: 10.4293/jsls.2018.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Some patients who undergo laparoscopic hysterectomy request overnight admission for pain management, thus increasing costs for a surgery that is safe for same-day discharge. We wanted to evaluate whether a paracervical block of bupivacaine with epinephrine before laparoscopic supracervical hysterectomy would decrease overnight admission rates, postoperative pain, and pain medication requirement Methods: This was a randomized, double-blind, placebo-controlled, parallel-group trial (Canadian Task Force classification I) at an academic medical center. Patients undergoing laparoscopic supracervical hysterectomy were randomized to a 20-mL paracervical injection of either 0.25% bupivacaine with epinephrine or 20 mL normal saline before skin incision. All providers, except the circulating nurse, were blinded. The primary outcome was overnight hospital admission rate. Secondary outcomes included postoperative pain medication use and pain scores. Analysis included t test, χ2, Wilcoxon, and ANOVA. Results: One hundred thirty-two patients were enrolled—68 in the treatment group and 64 in the placebo group. Demographics were similar between groups. The unplanned overnight admission rate was 34% for the treatment group and 27% for the placebo group (P = .25). After discharge, the treatment group used on average 8.5 tablets of narcotics, whereas the placebo group used 11.7 tablets (P = .07). The treatment group took 13.1 tablets of nonnarcotic analgesics compared to 11.2 in the placebo group (P = .57). Both groups reported similar pain scores. Conclusion: Paracervical block with bupivacaine and epinephrine before laparoscopic supracervical hysterectomy did not decrease overnight admission rate or affect postoperative pain. Postoperative opiate use was minimally decreased.
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Affiliation(s)
- Rachel L Barr Grzesh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | | | - Suzanne S Fenske
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Lauren G Rascoff
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
| | - Erin L Moshier
- Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Charles Ascher-Walsh
- Department of Obstetrics, Gynecology and Reproductive Science, Division of Gynecology
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Parameswaran A, Ganeshmurthy MV, Ashok Y, Ramanathan M, Markus AF, Sailer HF. Does Sphenopalatine Ganglion Block Improve Pain Control and Intraoperative Hemodynamics in Children Undergoing Palatoplasty? A Randomized Controlled Trial. J Oral Maxillofac Surg 2018; 76:1873-1881. [DOI: 10.1016/j.joms.2018.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/24/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
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22
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Kaka U, Rahman NA, Abubakar AA, Goh YM, Fakurazi S, Omar MA, Chen HC. Pre-emptive multimodal analgesia with tramadol and ketamine-lidocaine infusion for suppression of central sensitization in a dog model of ovariohysterectomy. J Pain Res 2018; 11:743-752. [PMID: 29695926 PMCID: PMC5905489 DOI: 10.2147/jpr.s152475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The effects of pre-emptive infusion of ketamine-lidocaine with tramadol on the suppression of central sensitization were investigated in a dog ovariohysterectomy model. Patients and methods Twelve dogs were randomly assigned to two groups: ketamine-lidocaine-tramadol (KLT) and tramadol (T) groups. Both groups received intravenous tramadol 4 mg/kg body weight as premedication. Immediately after induction, the KLT group received ketamine and lidocaine at 0.5 and 2 mg/kg loading dose, followed by continuous rate infusion of 50 and 100 µg/kg/min, respectively, for 2 hours. Dogs in T group received saline bolus and continuous rate infusion at equi-volume. Intraoperatively, hemodynamic responses to surgical stimulation were recorded, whereas postoperative pain was evaluated using an algometer and short form of the Glasgow composite measure pain scale. Results Intraoperatively, hemodynamic responses to surgical stimulation were obtunded to a greater degree in KLT compared to T group. Postoperatively, the pain scores increased only for the first hour in KLT group, compared to 12 hours in T group. Mechanical thresholds at the abdomen decreased postoperatively between 12 and 60 hours in KLT group versus the entire 72 hours in T group. Thresholds at tibia and radius in both groups increased in the immediate 1 hour postoperatively, but decreased thereafter. Significant decrement of thresholds from baseline were detected in the tibia at 24, 42, and 60 hours in KLT group compared to 24-72 hours in T group, and in the radius between 36 and 48 hours in T group, but none in KLT group. Conclusion Addition of pre-emptive ketamine-lidocaine infusion to single intravenous dose of tramadol enhanced attenuation of central sensitization and improved intra- and postoperative analgesia.
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Affiliation(s)
- Ubedullah Kaka
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine.,Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nor-Alimah Rahman
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine
| | - Adamu Abdul Abubakar
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine.,Department of Veterinary Surgery and Radiology, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Yong Meng Goh
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine
| | - Sharida Fakurazi
- Laboratory of Vaccines and Immunotherapeutics, Institute of Bioscience.,Department of Human Anatomy, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mohamed Ariff Omar
- Department of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine
| | - Hui Cheng Chen
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine
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Post-procedural Care in Interventional Radiology: What Every Interventional Radiologist Should Know-Part I: Standard Post-procedural Instructions and Follow-Up Care. Cardiovasc Intervent Radiol 2017; 40:481-495. [PMID: 28078378 DOI: 10.1007/s00270-017-1564-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/31/2016] [Indexed: 02/08/2023]
Abstract
Interventional radiology (IR) has evolved into a full-fledged clinical specialty with attendant patient care responsibilities. Success in IR now requires development of a full clinical practice, including consultations, inpatient admitting privileges, and an outpatient clinic. In addition to technical excellence and innovation, maintaining a comprehensive practice is imperative for interventional radiologists to compete successfully for patients and referral bases. A structured approach to periprocedural care, including routine follow-up and early identification and management of complications, facilitates efficient and thorough management with an emphasis on quality and patient safety.
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Esparza-Villalpando V, Chavarria-Bolaños D, Gordillo-Moscoso A, Masuoka-Ito D, Martinez-Rider R, Isiordia-Espinoza M, Pozos-Guillen A. Comparison of the analgesic efficacy of preoperative/postoperative oral dexketoprofen trometamol in third molar surgery: A randomized clinical trial. J Craniomaxillofac Surg 2016; 44:1350-5. [DOI: 10.1016/j.jcms.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/20/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022] Open
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Isiordia-Espinoza MA, Pozos-Guillen A, Martinez-Rider R, Perez-Urizar J. Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial. Med Oral Patol Oral Cir Bucal 2016; 21:e637-43. [PMID: 27475688 PMCID: PMC5005104 DOI: 10.4317/medoral.21077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/30/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Preemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery. MATERIAL AND METHODS A parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects. RESULTS Patients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol. CONCLUSIONS According to the VAS and UAC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery.
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Affiliation(s)
- M-A Isiordia-Espinoza
- Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, Av. Dr. Manuel Nava #2, Zona Universitaria, C.P. 78290, San Luis Potosí, S.L.P. México,
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Sindjelic R, Davidovic L, Vlajkovic G, Markovic M, Kuzmanović I. Pain Associated with Carotid Artery Surgery Performed under Carotid Plexus Block: Preemptive Analgesic Effect of Ketorolac. Vascular 2016; 14:75-80. [PMID: 16956475 DOI: 10.2310/6670.2006.00013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Carotid artery surgery (CAS) performed under cervical plexus block is frequently associated with significant intra- and postoperative pain. To evaluate whether preoperative administration of ketorolac may improve analgesia in this type of surgery, 80 patients scheduled for CAS under cervical plexus block were randomly allocated to receive intravenously either 30 mg of ketorolac or placebo 30 minutes before surgery. Verbal rating scale pain scores during surgery and 3 and 6 hours after surgery, the number of patients requiring additional analgesia, and the total analgesic consumption both during and within 6 hours after surgery were significantly lower, whereas the time to first postoperative analgesia was significantly shorter in the ketorolac group than in the control group. The results of this prospective, randomized, double-blind study show that a single 30 mg dose of ketorolac administered intravenously 30 minutes before surgery reduces intraoperative pain and preempts postoperative pain in patients undergoing CAS under carotid plexus block.
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Affiliation(s)
- Radomir Sindjelic
- Department of Ophthalmic Anesthesia, Institute for Anesthesia and Reanimation, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro
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Pre-surgical regional blocks in orthognathic surgery: prospective study evaluating their influence on the intraoperative use of anaesthetics and blood pressure control. Int J Oral Maxillofac Surg 2016; 45:783-6. [DOI: 10.1016/j.ijom.2015.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/21/2015] [Accepted: 09/16/2015] [Indexed: 11/21/2022]
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Song IK, Park YH, Lee JH, Kim JT, Choi IH, Kim HS. Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children. Paediatr Anaesth 2016; 26:438-43. [PMID: 26890267 DOI: 10.1111/pan.12864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preemptive analgesia is an anti-nociceptive treatment that starts before surgery and prevents the establishment of central sensitization. Whether preemptive analgesia is more effective than conventional regimens for managing postoperative pain remains controversial. This study evaluated the efficacy of intravenous preemptive analgesia for acute postoperative pain control in pediatric patients. METHODS In this prospective randomized controlled trial, 51 children aged 3-7 years, scheduled for corrective osteotomy were randomized into control (group C) or preemptive (group P) group. Both groups received standardized general anesthesia, including intravenous patient-controlled analgesia (IV-PCA) with fentanyl, which was started before skin incision in group P or 5 min thereafter in group C. IV-PCA data, pain scores using verbal rating scale (VRS) and Wong-Baker FACES(®) pain rating scale (WBFS), emergence agitation score (EAS) using the Pediatric Anesthesia Emergence Delirium (PAED) scale, analgesic requirements, and complications were recorded. RESULTS The primary outcome, pain score at postoperative 1 h, showed no difference between the groups. Both groups did not demonstrate emergence agitation (PAED cutoff value ≥ 12), although the EAS at admission to the postanesthetic care unit (PACU) was lower in group P than in group C (P = 0.002; mean difference 4.85, 95% CI 1.97-7.73). There were no differences in the delivered volume of IV-PCA, frequency of pushing the IV-PCA button, effective push attempts, VRS, WBFS, EAS at discharge from the PACU, additional analgesic requirements, and complications. CONCLUSION Preemptive analgesia using IV-PCA with fentanyl showed no significant advantages for postoperative analgesia after corrective osteotomy in pediatric patients.
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Affiliation(s)
- In-Kyung Song
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Hee Park
- Department of Anesthesiology and Pain medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea
| | - In Ho Choi
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea
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Cobaugh DJ, Gainor C, Gaston CL, Kwong TC, Magnani B, McPherson ML, Painter JT, Krenzelok EP. The opioid abuse and misuse epidemic: implications for pharmacists in hospitals and health systems. Am J Health Syst Pharm 2015; 71:1539-54. [PMID: 25174015 DOI: 10.2146/ajhp140157] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The current epidemic of prescription opioid abuse and misuse in the United States is discussed, with an emphasis on the pharmacist's role in ensuring safe and effective opioid use. SUMMARY U.S. sales of prescription opioids increased fourfold from 1999 to 2010, with an alarming rise in deaths and emergency department visits associated with the use of fentanyl, hydrocodone, oxycodone, and other opioid medications. Signs and symptoms of opioid toxicity may include altered mental status, hypoventilation, decreased bowel motility, central nervous system and respiratory depression, peripheral vasodilation, pulmonary edema, hypotension, bradycardia, and seizures. In patients receiving long-term opioid therapy for chronic pain, urine drug testing is an important tool for monitoring and assessment of therapy; knowledge of opioid metabolic pathways and assay limitations is essential for appropriate use and interpretation of screening and confirmatory tests. In recent years, there has been an increase in federal enforcement actions against pharmacies and prescription drug wholesalers involved in improper opioid distribution, as well as increased reliance on state-level prescription drug monitoring programs to track patterns of opioid use and improper sales. Pharmacies are urged to implement or promote appropriate guidelines on opioid therapy, including the use of pain management agreement plans; policies to ensure adequate oversight of opioid prescribing, dispensing, and waste disposal; and educational initiatives targeting patients as well as hospital and pharmacy staff. CONCLUSION Pharmacists in hospitals and health systems can play a key role in recognizing the various forms of opioid toxicity and in preventing inappropriate prescribing and diversion of opioids.
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Affiliation(s)
- Daniel J Cobaugh
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh.
| | - Carl Gainor
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Cynthia L Gaston
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Tai C Kwong
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Barbarajean Magnani
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Mary Lynn McPherson
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Jacob T Painter
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
| | - Edward P Krenzelok
- Daniel J. Cobaugh, Pharm.D., DABAT, FAACT, is Vice President, ASHP Research and Education Foundation, Bethesda, MD. Carl Gainor, J.D., Ph.D., is Clinical Assistant Professor of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. Cynthia L. Gaston, Pharm.D., BCPS, is Medication Use Policy Analyst, UW Health, Madison, WI. Tai C. Kwong, Ph.D., is Professor of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, and Director, Hematology and Chemistry Labs, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY. Barbarajean Magnani, Ph.D., M.D., is Chair and Pathologist-in-Chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, and Professor and Chair, Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA. Mary Lynn McPherson, Pharm.D., BCPS, CPE, is Professor and Vice Chair, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore. Jacob T. Painter, Pharm.D., M.B.A., Ph.D., is Assistant Professor of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock. Edward P. Krenzelok, Pharm.D., FAACT, FEAPCCT, DABAT, is Professor Emeritus, School of Pharmacy, University of Pittsburgh
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Costa FWG, Esses DFS, de Barros Silva PG, Carvalho FSR, Sá CDL, Albuquerque AFM, Bezerra TP, Ribeiro TR, Sá Roriz Fonteles C, Soares ECS. Does the Preemptive Use of Oral Nonsteroidal Anti-inflammatory Drugs Reduce Postoperative Pain in Surgical Removal of Third Molars? A Meta-analysis of Randomized Clinical Trials. Anesth Prog 2015; 62:57-63. [PMID: 26061574 DOI: 10.2344/0003-3006-62.2.57] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to investigate the effectiveness of preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in third-molar surgery. A PubMed literature search was conducted for articles restricted to the English language using the following terms (DeCS/MeSH) or combinations: analgesia, third molar, and preemptive. From a total of 704 articles, 6 (n=420 subjects) were selected. All studies presented a low risk of bias (Cochrane criteria) but exhibited high heterogeneity of methods. Two studies were excluded from the meta-analysis because they did not have adequate numeric values (dichotomous data) for the calculations. Preemptive analgesia showed no significant benefit (n=298, P=.2227, odds ratio: 2.30, 0.60-8.73) in reducing postoperative pain after removal of lower impacted third molars. However, there was a probable direct relationship between the effectiveness of NSAIDs in preemptive analgesia for removal of third molars and its selectivity for the cyclooxygenase-2 (COX-2). Preemptive analgesia did not have a significant effect in reducing postoperative pain after removal of lower impacted third molars. More homogeneous and well-delineated clinical studies are necessary to determine a possible association between NSAIDs' selectivity for COX-2 and treatment effectiveness.
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Affiliation(s)
| | | | | | | | - Carlos Diego Lopes Sá
- Postgraduate Student, Division of Oral Surgery, Post-program in Dentistry, Federal University of Ceará, Fortaleza-CE, Brazil
| | | | - Tácio Pinheiro Bezerra
- Professor, Division of Oral Surgery, Walter Cantídio University Hospital, Fortaleza-CE, Brazil
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I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery. Mediators Inflamm 2015; 2015:965925. [PMID: 26273146 PMCID: PMC4529951 DOI: 10.1155/2015/965925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/13/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. METHODS Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. RESULTS Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. CONCLUSION Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.
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Liporaci Junior JLJ. Assessment of preemptive analgesia efficacy in surgical extraction of third molars. Rev Bras Anestesiol 2015; 62:502-10. [PMID: 22793965 DOI: 10.1016/s0034-7094(12)70148-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 09/12/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Literature on preemptive analgesia is controversial. Reliability of results and difficult reproducibility of research contribute for non-elucidation of the subject. The aim of this study is to test the efficacy of oral ketoprofen (150 mg) preemptively administrated two days before third molar surgery, compared with postoperative administration in the same patient. METHODS Thirteen patients underwent surgical removal of bilateral third molar in two separate procedures. In a random and double blind procedure, oral ketoprofen 150 mg was administered every 12 hours two days before surgery and, after the procedure, the same drug was administered for three days. On the other side, a control (placebo) was used orally every 12 hours two days before surgery and, after the procedure, ketoprofen 150 mg was administered every 12 hours for three days. Postoperative pain was assessed by visual analogue scale, nominal scale, and amount of rescue analgesics consumed. RESULTS There was no statistically significant difference in postoperative pain between the preemptive treatment and control. CONCLUSION In this experimental model, preemptive analgesia was not effective in reducing postoperative pain in surgical extraction of third molar compared with the postoperative administration of the same drug.
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Intranasal Dexmedetomidine on Stress Hormones, Inflammatory Markers, and Postoperative Analgesia after Functional Endoscopic Sinus Surgery. Mediators Inflamm 2015. [PMID: 26199465 PMCID: PMC4496499 DOI: 10.1155/2015/939431] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background. A strong ongoing intraoperative stress response can cause serious adverse reactions and affect the postoperative outcome. This study evaluated the effect of intranasally administered dexmedetomidine (DEX) in combination with local anesthesia (LA) on the relief of stress and the inflammatory response during functional endoscopic sinus surgery (FESS). Methods. Sixty patients undergoing FESS were randomly allocated to receive either intranasal DEX (DEX group) or intranasal saline (Placebo group) 1 h before surgery. Stress hormones, inflammatory markers, postoperative pain relief, hemodynamic variables, blood loss, surgical field quality, body movements, and satisfaction were assessed. Results. Plasma epinephrine, norepinephrine, and blood glucose levels were significantly lower in DEX group as were the plasma IL-6 and TNF-α levels (P < 0.05). The weighted areas under the curve (AUCw) of the VAS scores were also significantly lower in DEX group at 2–12 h after surgery (P < 0.001). Furthermore, hemodynamic variables, blood loss, body movements, discomfort with hemostatic stuffing, surgical field quality, and satisfaction scores of patients and surgeons were significantly better (P < 0.05) in DEX group. Conclusions. Patients receiving intranasal DEX with LA for FESS exhibited less perioperative stress and inflammatory response as well as better postoperative comfort with hemostatic stuffing and analgesia.
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Yong SL, Walsh T, Coulthard P. Protective analgesia for postoperative pain following third molar surgery. Hippokratia 2015. [DOI: 10.1002/14651858.cd008692.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sin Leong Yong
- School of Dentistry, The University of Manchester; Oral and Maxillofacial Surgery; Higher Cambridge Street Manchester UK M15 6FH
| | - Tanya Walsh
- School of Dentistry, The University of Manchester; Coupland III Building, Oxford Road Manchester UK M13 9PL
| | - Paul Coulthard
- School of Dentistry, The University of Manchester; Department of Oral and Maxillofacial Surgery; Coupland III Building, Oxford Road Manchester UK M13 9PL
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Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci 2015; 22:930-8. [DOI: 10.1016/j.jocn.2015.01.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/16/2015] [Indexed: 01/05/2023]
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Amr YM, Amin SM. Comparative study between effect of pre- versus post-incisional transversus abdominis plane block on acute and chronic post-abdominal hysterectomy pain. Anesth Essays Res 2015; 5:77-82. [PMID: 25885305 PMCID: PMC4173367 DOI: 10.4103/0259-1162.84199] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: The prevalence of persistent chronic pain after abdominal hysterectomy is 5–32%. Our objectives were to determine the influence of transversus abdominis plane (TAP) block on the incidence of acute and chronic post-hysterectomy pain and to examine potential associations between time of block administration, either before surgical incision (preemptive) or after end of surgical procedure and its effect. Materials and Methods: Seventy-five patients undergoing elective total abdominal hysterectomy under general anesthesia were allocated randomly to receive TAP block either pre-incisional, or before emergence from anesthesia or sham block (just a needle puncture, control group). Pain was evaluated postoperatively at rest and movement by visual analogue scale. Peri-operative analgesic requirements, sedation, postoperative nausea and vomiting scores were recorded. Patients were questioned at three, and six months after surgery for type and severity of chronic pain. Results: Pain scores were significantly higher in Group II versus Group I (P<0.05), but both demonstrated significantly lower pain scores than control Group. Analgesic requirements decreased significantly in patients received TAP block (P<0.0001) with more significant decrease in the pre-incisional group. The incidence of chronic pain was significantly reduced in the pre-incisional group than others. The incidence of sedation was noted to be higher in the control group (61%) versus other groups (18% and 32% respectively), at time point 12 h postoperatively but was comparable between 12, 48 h (awake and alert). Incidence of postoperative nausea and vomiting (PONV) was reduced in patients who received TAP block (16% and 29%) in Group I and II respectively versus 66.5% in Group III. There were no complications attributed to the TAP block. Results: Pain scores were significantly higher in Group II versus Group I (P<0.05), but both demonstrated significantly lower pain scores than control Group. Analgesic requirements decreased significantly in patients received TAP block (P<0.0001) with more significant decrease in the pre-incisional group. The incidence of chronic pain was significantly reduced in the pre-incisional group than others. The incidence of sedation was noted to be higher in the control group (61%) versus other groups (18% and 32% respectively), at time point 12 h postoperatively but was comparable between 12, 48 h (awake and alert). Incidence of postoperative nausea and vomiting (PONV) was reduced in patients who received TAP block (16% and 29%) in Group I and II respectively versus 66.5% in Group III. There were no complications attributed to the TAP block. Conclusions: TAP block seems to be an acceptable choice for postoperative analgesia; pre-incisional TAP block appeared to reduce the severity of acute pain, analgesic requirements with its undesirable side-effects and incidence of chronic pain in comparison with blockade before emergence from anesthesia.
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Affiliation(s)
- Yasser Mohamed Amr
- Department of Anesthesia, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Sabry M Amin
- Department of Anesthesia, Tanta University Hospital, Tanta University, Tanta, Egypt
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Kang KH, Kim BS, Kang H. The benefits of preincision ropivacaine infiltration for reducing postoperative pain after robotic bilateral axillo-breast approach thyroidectomy: a prospective, randomized, double-blind, placebo-controlled study. Ann Surg Treat Res 2015; 88:193-9. [PMID: 25844353 PMCID: PMC4384283 DOI: 10.4174/astr.2015.88.4.193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 01/09/2023] Open
Abstract
Purpose The aim of this study was to evaluate the effects of preoperative ropivacaine infiltration in patients undergoing robotic thyroidectomy using the bilateral axillary breast approach method. Methods Using a randomized, double-blind study design, 34 consecutive female patients who underwent robotic thyroidectomy were randomly assigned to receive local infiltration to the skin flap site using either only 0.9% saline solution, 3 mL/kg (group C, n = 17) or 0.1% ropivacaine with saline, 3 mg/kg (group L, n = 17). Local anesthetic was administered prior to skin incision after the induction of general anesthesia. Postoperative pain was rated at 2, 6, 18, 30, 42, and 66 hours postoperatively by visual analogue scale (VAS) score. The bottom hit counts (BHC) from patient controlled analgesia and fentanyl consumption were evaluated. CRP levels, mean blood pressure (BP), and heart rate (HR) were also evaluated. Results VAS pain scores were significantly lower in group L than in group C from 2 to 42 hours (P < 0.05). Fentanyl use for analgesia and BHC were also significantly lower in group L compared with group C during the first postoperative 6 and 2 hours, respectively (P < 0.05). The total consumption of fentanyl was significantly lower in group L than in group C (P = 0.009). No significant differences were noted for baseline, postoperative mean BP, or HR. Conclusion Preoperative infiltration using ropivacaine with saline to all flap sites is a safe and effective method for reducing postoperative pain and postoperative fentanyl consumption in patients with robotic thyroidectomy.
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Affiliation(s)
- Kyung Ho Kang
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Abstract
Opioids are commonly used for the management of pain in patients with musculoskeletal disorders; however, national attention has highlighted the potential adverse effects of the use of opioid analgesia in this and other nonmalignant pain settings. Chronic opioid users undergoing orthopaedic surgery represent a particularly challenging patient population in regard to their perioperative pain control and outcomes. Preoperative evaluation provides an opportunity to estimate a patient's preoperative opioid intake, discuss pain-related fears, and identify potential psychiatric comorbidities. Patients using high levels of opioids may also require referral to an addiction specialist. Various regional blockade and pharmaceutical options are available to help control perioperative pain, and a multimodal pain management approach may be of particular benefit in chronic opioid users undergoing orthopaedic surgery.
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Bafna U, Rajarajeshwaran K, Khandelwal M, Verma AP. A comparison of effect of preemptive use of oral gabapentin and pregabalin for acute post-operative pain after surgery under spinal anesthesia. J Anaesthesiol Clin Pharmacol 2014; 30:373-7. [PMID: 25190946 PMCID: PMC4152678 DOI: 10.4103/0970-9185.137270] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Pregabalin has been claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. We conducted a study to compare the effect of oral gabapentin and pregabalin with control group for post-operative analgesia. MATERIALS AND METHODS A total of 90 ASA grade I and II patients posted for elective gynecological surgeries were randomized into 3 groups (group A, B and C of 30 patients each). One hour before entering into the operation theatre the blinded drug selected for the study was given with a sip of water. Group A- received identical placebo capsule, Group B- received 600mg of gabapentin capsule and Group C - received 150 mg of pregabalin capsule. Spinal anesthesia was performed at L3-L4 interspace and a volume of 3.5 ml of 0.5% bupivacaine heavy injected over 30sec through a 25 G spinal needle. VAS score at first rescue analgesia, mean time of onset of analgesia, level of sensory block at 5min and 10 min interval, onset of motor block, total duration of analgesia and total requirement of rescue analgesia were observed as primary outcome. Hemodynamics and side effects were recorded as secondary outcome in all patients. RESULTS A significantly longer mean duration of effective analgesia in group C was observed compared with other groups (P < 0.001). The mean duration of effective analgesia in group C was 535.16 ± 32.86 min versus 151.83 ± 16.21 minutes in group A and 302.00 ± 24.26 minutes in group B. The mean numbers of doses of rescue analgesia in the first 24 hours in group A, B and C was 4.7 ± 0.65, 4.1 ±0.66 and 3.9±0.614. (P value <0.001). CONCLUSION We conclude that preemptive use of gabapentin 600mg and pregabalin 150 mg orally significantly reduces the postoperative rescue analgesic requirement and increases the duration of postoperative analgesia in patients undergoing elective gynecological surgeries under spinal anesthesia.
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Affiliation(s)
- Usha Bafna
- Department of Anesthesiology, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Mamta Khandelwal
- Department of Anesthesiology, SMS Medical College, Jaipur, Rajasthan, India
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O'Neill KR, Lockney DT, Bible JE, Crosby CG, Devin CJ. Bupivacaine for pain reduction after iliac crest bone graft harvest. Orthopedics 2014; 37:e428-34. [PMID: 24810818 DOI: 10.3928/01477447-20140430-52] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
Iliac crest bone graft remains the gold standard in achieving spinal arthrodesis, but chronic pain from graft harvest occurs in up to 39% of patients. Studies have shown that a single administration of local anesthetic reduces short-term pain, but they have not adequately investigated possible longer-term benefits. The goal of this study was to determine whether local administration of bupivacaine after iliac crest bone graft harvesting reduces pain and improves patient-reported outcomes. In this prospective, randomized, controlled, and blinded clinical study, 40 patients were identified who underwent posterior spine fusion with iliac crest bone graft and were randomized to receive either bupivacaine (treatment group, n=20) or saline (control group, n=20) at the iliac crest bone graft site. Pain at the harvest site was determined by a series of 12 visual and numeric pain scale assessments. Short Form-12 mental and physical component scores, EuroQol-5D, and Oswestry Disability Index assessments were made, along with determination of patient satisfaction and self-reported outcome of surgery. Baseline pain and outcome assessments were statistically similar (P>.05). Average pain scores were lower for all 12 assessments in the treatment group at mean follow-up of 5 weeks (significant differences in 6 assessments) and 20 weeks (significant differences in 2 assessments). No significant differences were found in Short Form-12 and EuroQol-5D scores. For patients who underwent lumbar fusion, the treatment group had significantly improved Oswestry Disability Index scores (mean±SD=10.8±7.1 vs 18.7±5.9, P=.012). Significantly more patients in the treatment group reported that surgery met all expectations (90% vs 50%, P=.016). This study is the 1st to show that a single administration of bupivacaine at the iliac crest bone graft harvest site during posterior spine fusion surgery can result in improved outcomes and reduced pain far beyond the anesthetic duration of activity.
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An intensive perioperative regimen of pregabalin and celecoxib reduces pain and improves physical function scores six weeks after total hip arthroplasty: a prospective randomized controlled trial. Pain Res Manag 2014; 18:127-32. [PMID: 23748252 DOI: 10.1155/2013/258714] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the success of total hip arthroplasty (THA), some patients experience persistent pain and poor function after surgery. Predictors of poor outcomes include the presence of significant pre- and postoperative pain. Patients undergoing THA often experience severe, long-standing pain before surgery that may compromise the outcome of the procedure. OBJECTIVES To evaluate the effects of administering pregabalin and celecoxib for two weeks before and three weeks after THA in patients with moderate to severe pain before surgery. The aim was to determine whether patients with well-controlled pain both before surgery and in the acute postoperative period experience less pain and better physical function six weeks after THA. METHODS A randomized, double-blinded, placebo-controlled pilot study was conducted. Group 1 received pregabalin (75 mg twice per day) and celecoxib (100 mg twice per day) for 14 days before THA and for three weeks after discharge. Group 2 received a placebo for the same duration. All patients received pregabalin and celecoxib 2 h before surgery and while in the hospital. RESULTS On the morning of surgery, patients in group 1 reported less pain at rest (mean [± SD] pain intensity measured on a visual analogue scale [VAS] 2.1±1.4) compared with group 2 (3.3±1.9; P=0.04). Patients in group 1 experienced less pain 3 h to 4 h postoperation (P<0.001). There was no difference in morphine consumption between the two groups. Six weeks after THA, movement-evoked pain was lower in group 1 (VAS 0.8±0.6) compared with group 2 (VAS 2.0±1.3; P=0.01). Group 1 reported better physical function, measured using the Western Ontario and McMaster University Osteoarthritis Index questionnaire score (P=0.04). There was no significant difference in 6 min walk test performance between the two groups. CONCLUSION Intensive pain control with pregabalin and celecoxib improves pain and physical function after THA.
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Nasal inhalation of butorphanol in combination with ketamine quickly elevates the mechanical pain threshold in the model of chronic constriction injury to the sciatic nerve of rat. J Surg Res 2014; 186:292-6. [DOI: 10.1016/j.jss.2013.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/04/2013] [Accepted: 08/08/2013] [Indexed: 11/22/2022]
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Farnworth MJ, Adams NJ, Keown AJ, Waran NK, Stafford KJ. Veterinary provision of analgesia for domestic cats (Felis catus) undergoing gonadectomy: a comparison of samples from New Zealand, Australia and the United Kingdom. N Z Vet J 2013; 62:117-22. [DOI: 10.1080/00480169.2013.852447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Aravena P, Benso B, Bertín A, Aravena-Torres R. Efectividad de la profilaxis analgésica con clonixinato de lisina en exodoncias: ensayo clínico aleatorio. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Minghella E, Auckburally A. A preventive multimodal analgesic strategy for bilateral rostral mandibulectomy in a horse. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- E. Minghella
- School of Veterinary Medicine, College of Medical, Veterinary and Life SciencesUniversity of Glasgow UK
| | - A. Auckburally
- School of Veterinary Medicine, College of Medical, Veterinary and Life SciencesUniversity of Glasgow UK
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A common anesthesiology procedure for a patient with an uncommon combination of diseases: a case report. Case Rep Anesthesiol 2013; 2012:748748. [PMID: 23304562 PMCID: PMC3530764 DOI: 10.1155/2012/748748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 11/25/2012] [Indexed: 11/29/2022] Open
Abstract
Administering neuraxial anesthesia to a patient with an underlying neurological disease and a combination of four other pathological disorders can be challenging. We report in this paper the case of a 45-year-old woman with neurological deficit due to ischemic brain infarct, multiple sclerosis, antiphospholipid syndrome, and β-heterozygous thalassemia that was subjected to abdominal hysterectomy and bilateral salpingoophorectomy under epidural anesthesia for ovarian cancer.
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Paul A, Afzal M, Bandyopadhyay K, Mishra A, Mookerjee S. Pre-emptive analgesia: Recent trends and evidences. INDIAN JOURNAL OF PAIN 2013. [DOI: 10.4103/0970-5333.124582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Preemptive analgesia with ropivacaine for pars plana vitrectomy: randomized controlled trial on efficacy and required dose. Retina 2012; 32:912-7. [PMID: 22466467 DOI: 10.1097/iae.0b013e318232c34c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rationale of preemptive analgesia in ocular surgery is avoiding central sensitization because of nociceptive stimuli. The applicability in clinical practice has been argued because evidence for a relevant effect is missing. The present study attempts to demonstrate a clinically relevant pain reduction by preemptive peribulbar ropivacaine injection. METHODS Sixty patients scheduled for vitrectomy under general anesthesia between March and June 2007 were randomly assigned to receive 0.75% ropivacaine with 75 IU of hyaluronidase as peribulbar injection of 1, 3, or 5 mL before or 5 mL after surgery. Control subjects were 30 patients without any additional analgesic treatment. Groups were compared regarding procedure duration, consumed amount of analgesics during and after surgery, and pain 1, 3, and 24 hours postoperatively. RESULTS Postoperative pain was most marked in control subjects and in the group that received the injection after surgery. Before surgery, the dose of 5 mL of ropivacaine was most effective (postoperative pain median = 0), whereas patients who had received 1 mL or 3 mL reported some pain. CONCLUSION The study highlights the benefit of the concept of preemptive analgesia in general: the peribulbar injection of 5 mL of 0.75% ropivacaine before surgery provides a substantial benefit in terms of analgesic demand and postoperative discomfort.
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Gurney MA. Pharmacological options for intra-operative and early postoperative analgesia: an update. J Small Anim Pract 2012; 53:377-86. [DOI: 10.1111/j.1748-5827.2012.01243.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. A. Gurney
- Department of Anaesthesia; Northwest Surgeons; Cheshire; WA7 3FW
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Adarsh ES, Mane R, Sanikop CS, Sagar SM. Effect of pre-operative rectal diclofenac suppository on post-operative analgesic requirement in cleft palate repair: A randomised clinical trial. Indian J Anaesth 2012; 56:265-9. [PMID: 22923826 PMCID: PMC3425287 DOI: 10.4103/0019-5049.98774] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Opioid analgesics used for analgesia are associated with sedation, respiratory depression and post-operative nausea and vomiting. Non-steroidal anti-inflammatory drugs such as diclofenac are a safe and effective alternative with opioid-sparing effect. OBJECTIVE To evaluate the effectiveness of pre-operative rectal diclofenac suppository (1 mg/kg) in cleft palate repair for post-operative analgesia and reduction in post-operative opioid requirements. STUDY DESIGN A randomized clinical trial. METHODS After obtaining approval from the institutional ethical committee, 60 children were allocated by a computer-generated randomisation into two groups of 30 each; group D (Diclofenac group) and group C (Conventional group). Children in group D and group C were similar in all aspects except for the fact that group D children received 1 mg/kg diclofenac suppository after induction. Pain was evaluated using modification of the objective pain scale by Hannallah and colleagues for 6 h post-operatively by an anaesthesiology resident or nursing staff who was blinded to the group. If the pain score was more than 3, rescue analgesic I.V. fentanyl 0.5 μgm/kg was administered. The pain scores at different intervals, number of doses and quantity of rescue analgesic required were noted. RESULTS We observed that pre-operative rectal diclofenac provided effective analgesia in the immediate post-operative period, as evidenced by reduced pain scores and reduced opioid requirement (P=0.00002). There was no evidence of any increased perioperative bleeding in the diclofenac group. CONCLUSION Pre-operative rectal diclofenac reduces opioid consumption and provides good post-operative analgesia.
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Affiliation(s)
- ES Adarsh
- Department of Anaesthesiology, S N Medical College, Bagalkot, India
| | - Rajesh Mane
- Department of Anaesthesiology, JNMC, KLE University, Belgaum, Karnataka, India
| | - CS Sanikop
- Department of Anaesthesiology, JNMC, KLE University, Belgaum, Karnataka, India
| | - SM Sagar
- Department of Anaesthesiology, S N Medical College, Bagalkot, India
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