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Jacobson A, Mack D, Herrera G, Bowe SN, Highland KB, Patzkowski MS. Incidence of Surgically Managed Post-Tonsillectomy Hemorrhage Associated With NSAID Prescribing for Postoperative Pain Management. Mil Med 2024:usae194. [PMID: 38758073 DOI: 10.1093/milmed/usae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/28/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Tonsillectomy ranks high among the most common pediatric surgical procedures in the United States. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, are routinely prescribed to manage post-tonsillectomy pain, but may carry the risk of hemorrhage. MATERIALS AND METHODS This retrospective, longitudinal, secondary-data analysis study compared the incidence of surgically managed post-tonsillectomy hemorrhage (sPTH) in pediatric patients prescribed ibuprofen at Brooke Army Medical Center (BAMC) after tonsillectomy compared to a similar cohort of pediatric patients at the Children's Hospital of Philadelphia (CHOP) not prescribed ibuprofen. Additional regression analysis examined predictors of sPTH at BAMC. RESULTS The odds of sPTH was lower in patients who were prescribed ibuprofen at BAMC, relative to patients who were not at CHOP (OR 0.57, 95% CI, 0.37, 0.87; P < 0.01). In a generalized linear model evaluating BAMC patient data, there was a lack of a relationship between reason for tonsillectomy (tonsillitis versus tonsillar obstruction), primary procedure (tonsillectomy-only versus tonsillectomy with adenoidectomy), and presence of a co-occurring procedure. CONCLUSIONS Post-tonsillectomy ibuprofen prescribing practices were not associated with an elevated risk of sPTH, relative to patients at CHOP not exposed to ibuprofen.
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Affiliation(s)
- Andrew Jacobson
- Department of Anesthesia, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Douglas Mack
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Germaine Herrera
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation, Inc., Rockville, MD 20852, USA
- Defense and Veterans Center for Integrative Pain Management, Bethesda, MD 20814, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Michael S Patzkowski
- Department of Anesthesia, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234-6200, USA
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
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Johnson BZ, O'Halloran E, Stevenson AW, Wood FM, Fear MW, Linden MD. Non-severe burn injury causes sustained platelet hyperreactivity. Burns 2024; 50:585-596. [PMID: 37945506 DOI: 10.1016/j.burns.2023.10.011] [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: 04/26/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Individuals who present to a hospital for treatment of a burn of any magnitude are more frequently hospitalised for ischemic heart disease, even decades after injury. Blood platelets are key mediators of cardiovascular disease. To investigate platelet involvement in post-burn cardiovascular risk, platelet reactivity was assessed in patients at 2- and 6-weeks after non-severe (TBSA < 20%) burn injury, and in a murine model 30 days after 8% TBSA full-thickness burn injury. Platelets were stimulated with canonical agonists and function reported by GPIIb/IIIa PAC1-binding site, CD62P expression, and formation of monocyte-platelet aggregates. In vivo thrombosis in a modified Folts model of vascular injury was assessed. Burn survivors had elevated frequencies of circulating monocyte-platelet aggregates, and platelets were hyperreactive, primarily to collagen stimulation. Burn plasma did not cause hyper-reactivity when incubated with control platelets. Platelets from burn injured mice also demonstrated increased response to collagen peptides but did not show any change in thrombosis following vascular injury. This study demonstrates the persistence of a small but significant platelet hyperreactivity following burn injury. Although our data does not suggest this heightened platelet sensitivity modulates thrombosis following vascular injury, the contribution of sub-clinical platelet hyperreactivity to accelerating atherogenesis merits further investigation.
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Affiliation(s)
- Blair Z Johnson
- Burn Injury Research Unit, University of Western Australia, Perth, Australia; School of Biomedical Science, University of Western Australia, Perth, Australia
| | - Emily O'Halloran
- Burn Injury Research Unit, University of Western Australia, Perth, Australia
| | - Andrew W Stevenson
- Burn Injury Research Unit, University of Western Australia, Perth, Australia; School of Biomedical Science, University of Western Australia, Perth, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, University of Western Australia, Perth, Australia; Burns Service of Western Australia, WA Department of Health, Nedlands, Australia
| | - Mark W Fear
- Burn Injury Research Unit, University of Western Australia, Perth, Australia; School of Biomedical Science, University of Western Australia, Perth, Australia
| | - Matthew D Linden
- School of Biomedical Science, University of Western Australia, Perth, Australia.
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3
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Garg I, Wang D. Complications of Spinal Cord Stimulator Trials and Implants: A Review. Curr Pain Headache Rep 2023; 27:837-842. [PMID: 38010489 DOI: 10.1007/s11916-023-01190-7] [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] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Spinal cord stimulation (SCS) has been used for decades to alleviate chronic pain. A growing body of literature suggests that the procedure is not without risks. Understanding the risks of SCS implantation can help treating physicians formulate individualized care plans that promote patient safety and minimize risks. RECENT FINDINGS The overall complication rate associated with SCS has been reported to be 31.9 to 43%. The most common complication in the literature appears to be electrode migration. Other complications ranging in rates of occurrence include hematoma formation, infection, spinal cord injury, and cerebrospinal fluid (CSF) leak. Case reports of syrinx formation, foreign body reaction, and fibrosis have also been described. Our review shows that there are strategies available to reduce and prevent complications. In addition, close monitoring and early intervention may prevent some of the adverse neurological outcomes. Nevertheless, additional research regarding patient and procedural factors is necessary to improve the safety profile of this intervention.
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Affiliation(s)
- Ishan Garg
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Dajie Wang
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Badi HA, Tanzer M, Nooh A, Hall B, Hart A. A Short Course of Celecoxib Prevents Heterotopic Ossification Following Cementless Total Hip Arthroplasty. Life (Basel) 2023; 13:life13040944. [PMID: 37109473 PMCID: PMC10142707 DOI: 10.3390/life13040944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/19/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Heterotopic ossification (HO) is a common complication after total hip arthroplasty (THA) and can result in pain and loss of motion of the hip. This is the first study in the literature to determine if a short course of Celecoxib is effective in the prevention of HO in patients undergoing cementless THA. In this retrospective study of prospectively collected data, consecutive patients undergoing a primary cementless THA were reviewed at a 2-year follow-up. The Control group consisted of 104 hips that did not receive Celecoxib (Control group), while the 208 hips in the Celecoxib group received 100 mg twice daily for 10 days. Radiographs, patient-recorded outcome measures and range of motion (ROM) were evaluated. Overall, there was a significantly decreased incidence of HO in the Celecoxib group (18.7%) than in the Control group (31.7%) (p = 0.01). The odds that a patient developed HO using Celecoxib were 0.4965 times the odds that a patient developed HO without treatment. Clinically, the Celecoxib group demonstrated significantly greater improvement in their mean WOMAC stiffness (0.35 vs. 0.17, p = 0.02) and physical function scores (3.26 vs. 1.83, p = 0.03) compared to those in the Control group, but there was no difference in the ROM between the two groups. This study is the first to demonstrate that the lowest dose of Celecoxib for a short course of only 10 days is a simple and effective prophylactic treatment option that can significantly reduce the incidence of HO following cementless THA.
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Affiliation(s)
- Hamid Al Badi
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Anas Nooh
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Brandon Hall
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
| | - Adam Hart
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, QC H3G 1A4, Canada
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Koshman YE, Bielinski AL, Bird BM, Green JR, Kowalkowski KL, Lai-Zhang J, Mahalingaiah PK, Sawicki JW, Talaty NN, Wilsey AS, Zafiratos MT, Van Vleet TR. Disconnect between COX-2 selective inhibition and cardiovascular risk in preclinical models. J Pharmacol Toxicol Methods 2023; 120:107251. [PMID: 36792039 DOI: 10.1016/j.vascn.2023.107251] [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: 07/19/2022] [Revised: 11/20/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Secondary pharmacology profiling is routinely applied in pharmaceutical drug discovery to investigate the pharmaceutical effects of a drug at molecular targets distinct from (off-target) the intended therapeutic molecular target (on-target). Data from a randomized, placebo-controlled clinical trial, the APPROVe (Adenomatous Polyp Prevention on VIOXX, rofecoxib) trial, raised significant concerns about COX-2 inhibition as a primary or secondary target, shaping the screening and decision-making processes of some pharmaceutical companies. COX-2 is often included in off-target screens due to cardiovascular (CV) safety concerns about secondary interactions with this target. Several potential mechanisms of COX-2-mediated myocardial infarctions have been considered including, effects on platelet stickiness/aggregation, vasal tone and blood pressure, and endothelial cell activation. In the present study, we focused on each of these mechanisms as potential effects of COX-2 inhibitors, to find evidence of mechanism using various in vitro and in vivo preclinical models. METHODS Compounds tested in the study, with a range of COX-2 selectivity, included rofecoxib, celecoxib, etodolac, and meloxicam. Compounds were screened for inhibition of COX-2 vs COX-1 enzymatic activity, ex vivo platelet aggregation (using whole blood from multiple species), ex vivo canine femoral vascular ring model, in vitro human endothelial cell activation (with and without COX-2 induction), and in vivo cardiovascular assessment (anesthetized dog). RESULTS The COX-2 binding assessment generally confirmed the COX-2 selectivity previously reported. COX-2 inhibitors did not have effects on platelet function (spontaneous aggregation or inhibition of aggregation), cardiovascular parameters (mean arterial pressure, heart rate, and left ventricular contractility), or endothelial cell activation. However, rofecoxib uniquely produced an endothelial mediated constriction response in canine femoral arteries. CONCLUSION Our data suggest that rofecoxib-related cardiovascular events in humans are not predicted by COX-2 potency or selectivity. In addition, the vascular ring model suggested possible adverse cardiovascular effects by COX-2 inhibitors, although these effects were not seen in vivo studies. These results may also suggest that COX-2 inhibition alone is not responsible for rofecoxib-mediated adverse cardiovascular outcomes.
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Affiliation(s)
- Yevgeniya E Koshman
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America.
| | - Aimee L Bielinski
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Brandan M Bird
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Jonathon R Green
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Kenneth L Kowalkowski
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Jie Lai-Zhang
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | | | - James W Sawicki
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Nari N Talaty
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Amanda S Wilsey
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Mark T Zafiratos
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
| | - Terry R Van Vleet
- AbbVie Inc., 1 North Waukegan Rd., North Chicago, IL 60064, United States of America
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Giordano T, Durkin A, Simi A, Shannon M, Dailey J, Facey H, Ballester L, Wetmore RF, Germiller JA. High-Dose Celecoxib for Pain After Pediatric Tonsillectomy: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2023; 168:218-226. [PMID: 35412873 DOI: 10.1177/01945998221091695] [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: 12/01/2021] [Accepted: 03/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric tonsillectomy causes significant postoperative pain. Newer nonsteroidal anti-inflammatory drugs such as celecoxib control pain without increasing bleeding risk, but in prior studies provided only modest pain reduction at standard doses. We aimed to determine if high-dose celecoxib (double the usual pediatric dose) is effective for pain, without increasing bleeding or other risks. STUDY DESIGN Randomized double-blind trial. SETTING Pediatric tertiary center. METHODS Children aged 3 to 11 years undergoing total tonsillectomy were randomized to receive celecoxib (6 mg/kg/dose) or placebo, twice daily, for up to 10 days. All cases were supplemented with acetaminophen and oxycodone as needed. All participants and personnel were blinded to treatment group. Subjects recorded coanalgesic consumption, pain, diet, and activity. RESULTS The celecoxib group (n = 68) consumed 0.72 mg/kg of oxycodone, as compared with 1.12 mg/kg in the placebo group (n = 62), a 36% difference that was not significant. However, multivariate analysis by treatment group, separate from pain levels, confirmed that this reduction was due to celecoxib treatment (P = .03). In subjects with more prolonged pain (n = 88), celecoxib reduced consumption by 52% (P = .02). Celecoxib showed greater benefit for subjects in the prolonged pain group than for those in the lesser pain group (P = .006). Incidence of adverse events was similar between groups. Minor hemorrhage occurred in 4.6% (5 placebo, 3 celecoxib). CONCLUSION High-dose celecoxib is effective in controlling pain after tonsillectomy, with no adverse effects in this relatively small sample. It reduces narcotic consumption, and its impact appears greater in children with higher degrees of pain. Celecoxib can be considered an effective alternative to ibuprofen after tonsillectomy. This trial was registered at ClinicalTrials.gov: NCT02934191.
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Affiliation(s)
- Teresa Giordano
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexandra Durkin
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrea Simi
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Megan Shannon
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia Dailey
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Facey
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lance Ballester
- Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ralph F Wetmore
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John A Germiller
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gupta A, Jeyaraman M, Maffulli N. Common Medications Which Should Be Stopped Prior to Platelet-Rich Plasma Injection. Biomedicines 2022; 10:biomedicines10092134. [PMID: 36140235 PMCID: PMC9495905 DOI: 10.3390/biomedicines10092134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 01/22/2023] Open
Abstract
Osteoarthritis (OA) is an extremely prevalent joint condition in the United States, affecting over 30 million people [...]
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Affiliation(s)
- Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- South Texas Orthopaedic Research Institute, STORI Inc., Laredo, TX 78045, USA
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 110048, India
| | - Madhan Jeyaraman
- South Texas Orthopaedic Research Institute, STORI Inc., Laredo, TX 78045, USA
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 110048, India
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute University, Chennai 600095, India
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Ortopedica” Department, Hospital of Salerno, 84124 Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
- Correspondence:
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Hamilton C, Alfille P, Mountjoy J, Bao X. Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review. J Thorac Dis 2022; 14:2276-2296. [PMID: 35813725 PMCID: PMC9264080 DOI: 10.21037/jtd-21-1740] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/24/2022] [Indexed: 12/11/2022]
Abstract
Background and Objective Thoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research. Methods We searched PubMed and Google Scholar databases from inception to May 2021 using the terms “thoracic surgery”, “thoracic surgery AND pain management”, “thoracic surgery AND analgesia”, “thoracic surgery AND regional anesthesia”, “thoracic surgery AND epidural”. We considered articles written in English and available to the reader. Key Content and Findings There is a wide variety of strategies for treating acute pain after thoracic surgery, including multimodal opioid and non-opioid systemic analgesics, regional anesthesia including TEA and paravertebral blocks (PVB), and a recent expansion in the use of novel fascial plane blocks especially for thoracoscopy. The body of literature on the effectiveness of different approaches for thoracotomy and thoracoscopy is a rapidly expanding field and area of active debate. Conclusions The optimal analgesic approach for thoracic surgery may depend on patient factors, surgical factors, and institutional factors. Although TEA may provide optimal analgesia after thoracotomy, PVB and emerging fascial plane blocks may offer effective alternatives. A tailored approach using multimodal systemic therapies and regional anesthesia is important, and future studies comparing techniques are necessary to further investigate the optimal approach to improve patient outcomes.
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Affiliation(s)
- Casey Hamilton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Alfille
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremi Mountjoy
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Xiaodong Bao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
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Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies. Plast Reconstr Surg Glob Open 2022; 10:e4310. [PMID: 35572190 PMCID: PMC9094416 DOI: 10.1097/gox.0000000000004310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/13/2022]
Abstract
Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods A review study based on multimodal analgesia was conducted. Results We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.
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Noor N, LaChute C, Root M, Rogers J, Richard M, Varrassi G, Urits I, Viswanath O, Khater N, Kaye AD. A Comprehensive Review of Celecoxib Oral Solution for the Acute Treatment of Migraine. Health Psychol Res 2022; 10:34265. [DOI: 10.52965/001c.34265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nazir Noor
- Mount Sinai Medical Center, Miami Beach, FL
| | - Courtney LaChute
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
| | - Mathew Root
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
| | - Jasmine Rogers
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
| | - Madeleine Richard
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
| | | | - Ivan Urits
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Omar Viswanath
- Innovative Pain and Wellness, Scottsdale, AZ; Department of Anesthesiology, University of Arizona College of Medicine – Phoenix, Phoenix, AZ; Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE; Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Nazih Khater
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
| | - Alan D. Kaye
- Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA
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Kao DS, Zhang SW, Vap AR. A Systematic Review on the Effect of Common Medications on Platelet Count and Function: Which Medications Should Be Stopped Before Getting a Platelet-Rich Plasma Injection? Orthop J Sports Med 2022; 10:23259671221088820. [PMID: 35434168 PMCID: PMC9008823 DOI: 10.1177/23259671221088820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/21/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Platelet-rich plasma (PRP) exerts its effect through the release of growth
factors and cytokines from the platelet concentrate. Certain medications may
affect platelet count or function, resulting in decreased efficacy of PRP
injections. Purpose: To systematically review the literature regarding common medications and
their effects on platelets to establish guidelines for which medications
should be stopped before obtaining a PRP injection. Study Design: Systematic review; Level of evidence, 2. Methods: This review was performed in accordance with the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search for
studies assessing the effect of common medications on platelet count or
platelet function was performed of the PubMed, Cochrane Library, Web of
Science, and OpenGrey databases. Inclusion criteria were as follows: drug
studied was aspirin, acetaminophen, a nonsteroidal anti-inflammatory drug
(NSAID), a statin, or gabapentin; human participants; and article in the
English language. Risk of bias was assessed using the Cochrane Risk of Bias
tool and the Risk of Bias in Non-randomised Studies—of Interventions
tool. Results: A total of 1711 studies were identified through the initial search, with 20
studies meeting all inclusion criteria. No studies involving gabapentin met
all inclusion criteria. Patients treated with aspirin (268 patients) or
acetaminophen (13 patients) showed a significant decrease in platelet
aggregation. Statin therapy (73 patients) did not result in a significant
decrease in platelet aggregation. Patients who took NSAIDs (172 patients)
demonstrated significantly decreased platelet aggregation only when treated
with nonselective formulations. Those treated with cyclooxygenase
(COX)-2–selective NSAIDs showed no significant difference in platelet
aggregation. Treatment with aspirin, acetaminophen, statins, or NSAIDs did
not lead to a significant decrease in platelet count. Conclusion: Aspirin, acetaminophen, and nonselective NSAIDs should be considered for
suspension before a PRP injection because of their potential to diminish the
effects of the injection. COX-2–selective NSAIDs and statins do not need to
be withheld before a PRP injection.
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Affiliation(s)
- David S. Kao
- Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | | | - Alexander R. Vap
- Virginia Commonwealth University Health System, Richmond, Virginia, USA
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12
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McEvoy MD, Raymond BL, Krige A. Opioid-Sparing Perioperative Analgesia Within Enhanced Recovery Programs. Anesthesiol Clin 2022; 40:35-58. [PMID: 35236582 DOI: 10.1016/j.anclin.2021.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Opioid-based analgesia in the perioperative period can provide excellent pain control, but this approach exposes the patient to avoidable side effects and possible harm. Optimal analgesia, an approach that targets the fastest functional recovery with adequate pain control while minimizing side effects, can be achieved with opioid minimization. Many different options for nonopioid multimodal analgesia exist and have been shown to be efficacious, with certain modalities being more beneficial for specific surgeries. This review will present the evidence and practical tips for these management strategies.
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Affiliation(s)
- Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA.
| | - Britany L Raymond
- Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, TVC 4619, Nashville, TN 37221, USA; Perioperative Medicine Fellowship, Hi-RiSE Perioperative Optimization Clinic, Perioperative Consult Service, VUMC ERAS Executive Steering Committee, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC 4648, Nashville, TN 37232, USA
| | - Anton Krige
- Department of Anaesthesia and Critical Care, Royal Blackburn Teaching Hospital, Haslingden Road, Blackburn BB2 3HH, UK
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13
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Singla N, Bertoch T, Shenoy S, Munjal S. Efficacy and safety of single-dose DFN-15 for treatment of acute postsurgical dental pain: a randomized, double-blind, placebo-controlled study. Pain 2022; 163:91-99. [PMID: 34252915 PMCID: PMC8675044 DOI: 10.1097/j.pain.0000000000002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT The analgesic efficacy and safety of DFN-15, a new oral liquid formulation of celecoxib with more rapid absorption than the capsule, were evaluated in the treatment of acute pain in adult patients after dental surgery. In this randomized, double-blind, placebo-controlled, dose-ranging study, 120 otherwise healthy adults who underwent the extraction of bilateral impacted mandibular third molar teeth and experienced moderate to severe pain postsurgery were randomly assigned, in a 1:1:1:1 ratio, to receive one dose of either placebo or DFN-15 at 3 doses: 62.5, 125, and 250 mg. Participants were evaluated at prespecified time points over 8 hours after study drug administration, using several instruments, including the 11-point Numerical Pain Rating Scale, 5-point Pain Relief Scale, and 5-point Treatment Satisfaction Scale. Rescue analgesic (oxycodone / acetaminophen) was permitted. The primary endpoint was the summed pain intensity difference (SPID) over the 6-hour postdose period (SPID6), which was compared between each DFN-15 dose and placebo using analysis of covariance. Other assessments of pain relief, use of rescue medication, and safety were also analyzed. All 3 doses of DFN-15 were significantly superior to placebo in SPID6 (least square mean difference over placebo: -756.6, -1120.7, and -1355.1, P < 0.0001 for all comparisons). In addition, DFN-15 was generally superior to placebo in other endpoints, including reduction of pain intensity, speed and magnitude of pain relief, treatment satisfaction, and rescue medication use. DFN-15 was similar to placebo in the incidence of adverse events with no apparent dose-related effects.
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Affiliation(s)
- Neil Singla
- Lotus Clinical Research, Pasadena, CA, United States
| | - Todd Bertoch
- JBR Clinical Research, Salt Lake City, UT, United States
| | | | - Sagar Munjal
- Dr Reddy's Laboratories, Princeton, NJ, United States
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14
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Bomberg H, Lorenzana D, Schlickeiser J, Dünki A, Farshad M, Eichenberger U. [Noninvasive Treatments for Acute and Chronic Back Pain]. PRAXIS 2022; 111:797-813. [PMID: 36285410 DOI: 10.1024/1661-8157/a003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
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Affiliation(s)
- Hagen Bomberg
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - David Lorenzana
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - Jannis Schlickeiser
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | - Alexandro Dünki
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | | | - Urs Eichenberger
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
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15
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Jha RM, Raikwar SP, Mihaljevic S, Casabella AM, Catapano JS, Rani A, Desai S, Gerzanich V, Simard JM. Emerging therapeutic targets for cerebral edema. Expert Opin Ther Targets 2021; 25:917-938. [PMID: 34844502 PMCID: PMC9196113 DOI: 10.1080/14728222.2021.2010045] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/20/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Cerebral edema is a key contributor to death and disability in several forms of brain injury. Current treatment options are limited, reactive, and associated with significant morbidity. Targeted therapies are emerging based on a growing understanding of the molecular underpinnings of cerebral edema. AREAS COVERED We review the pathophysiology and relationships between different cerebral edema subtypes to provide a foundation for emerging therapies. Mechanisms for promising molecular targets are discussed, with an emphasis on those advancing in clinical trials, including ion and water channels (AQP4, SUR1-TRPM4) and other proteins/lipids involved in edema signaling pathways (AVP, COX2, VEGF, and S1P). Research on novel treatment modalities for cerebral edema [including recombinant proteins and gene therapies] is presented and finally, insights on reducing secondary injury and improving clinical outcome are offered. EXPERT OPINION Targeted molecular strategies to minimize or prevent cerebral edema are promising. Inhibition of SUR1-TRPM4 (glyburide/glibenclamide) and VEGF (bevacizumab) are currently closest to translation based on advances in clinical trials. However, the latter, tested in glioblastoma multiforme, has not demonstrated survival benefit. Research on recombinant proteins and gene therapies for cerebral edema is in its infancy, but early results are encouraging. These newer modalities may facilitate our understanding of the pathobiology underlying cerebral edema.
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Affiliation(s)
- Ruchira M. Jha
- Department of Neurology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Department of Neurobiology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
- Department of Neurosurgery, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Sudhanshu P. Raikwar
- Department of Neurobiology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Sandra Mihaljevic
- Department of Neurobiology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Joshua S. Catapano
- Department of Neurosurgery, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Anupama Rani
- Department of Neurobiology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Shashvat Desai
- Department of Neurology, Barrow Neurological Institute and St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Volodymyr Gerzanich
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore MD, USA
| | - J. Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore MD, USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore MD, USA
- Department of Physiology, University of Maryland School of Medicine, Baltimore MD, USA
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16
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Nahara I, Takeuchi M, Tanaka S, Yonekura H, Takeda C, Kawakami K. Cardiovascular Safety of Celecoxib after Cardiac Surgery with Cardiopulmonary Bypass: A Retrospective Cohort Study. ANNALS OF CLINICAL EPIDEMIOLOGY 2021; 3:101-108. [PMID: 38505473 PMCID: PMC10760469 DOI: 10.37737/ace.3.4_101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/26/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND Cardiac surgery is a highly invasive procedure resulting in hypercoagulability due to thoracotomy and cardiopulmonary bypass (CPB). The long-term use of selective cyclooxygenase-2 inhibitors has been shown to increase the risk of adverse cardiovascular (CV) events such as myocardial infarction. This study aimed to determine whether short-term prescription of celecoxib increases CV events in patients who have undergone cardiac surgery with CPB. METHODS This retrospective observational study included 16,141 patients (≥20 years) who had undergone cardiac surgery with CPB between April 1, 2008 and March 31, 2016. Patients who underwent coronary artery bypass grafting were excluded. Patients who received celecoxib (n = 904) and acetaminophen (n = 5,002) from postoperative day 0 to 30 were extracted and matched by propensity score (PS). The primary outcomes were all-cause death and CV events, defined as coronary artery disease, ischemic stroke, pulmonary embolism, and venous thrombosis, coded using International Classification of Diseases-10 within 30 days after the first postoperative prescription of either medication. Results were assessed using Kaplan-Meier survival analysis and multivariate Cox regression analysis. RESULTS PS matching created 885 pairs. Multivariate Cox regression analysis showed that prescription of celecoxib after cardiac surgery was not associated with an increase in the primary outcomes when compared with prescription of acetaminophen (hazard ratio, 0.76; 95% confidence interval, 0.35-1.65). CONCLUSIONS The prescription of celecoxib in patients who had undergone cardiac surgery with cardiopulmonary bypass was not statistically different from the prescription of acetaminophen in the incidence of CV events and death.
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Affiliation(s)
- Isao Nahara
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University
| | - Hiroshi Yonekura
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
- Department of Clinical Anesthesiology, Graduate School of Medicine Faculty of Medicine, Mie University
| | - Chikashi Takeda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
- Department of Anesthesia, Kyoto University Hospital
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
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Periprocedural Anticoagulation and Antiplatelet Medications Management for Interventional Radiology Procedures. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Kast RE. Adding high-dose celecoxib to increase effectiveness of standard glioblastoma chemoirradiation. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:481-488. [PMID: 33689795 DOI: 10.1016/j.pharma.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
Over one hundred clinical trials since 2005 have failed to significantly improve the prognosis of glioblastoma. Since 2005, the standard of care has been maximal resection followed by 60Gy irradiation over six weeks with daily temozolomide. With this, a median survival of 2 years can be expected. This short paper reviewed how the pharmacodynamic attributes of an EMA/FDA approved, cheap, generic drug to treat pain, celecoxib, intersect with pathophysiological elements driving glioblastoma growth, such that growth drive inhibition can be expected from celecoxib. The two main attributes of celecoxib are carbonic anhydrase inhibition and cyclooxygenase-2 inhibition. Both attributes individually have been in active study as adjuncts during current cancer treatment, including that of glioblastoma. That research is briefly reviewed here. This paper concludes from the collected data, that starting celecoxib, 600 to 800mg twice daily before surgery and continuing it through the chemoirradiation phase of treatment would be a low-risk intervention with sound rationale.
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Affiliation(s)
- R E Kast
- IIAIGC study centre, 05401 Burlington, VT, USA.
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19
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Neighbors CP, Noller MW, Avillion MP, Neighbors JW, Spaw MC, Biello AR, Theler JM, Camacho M. Implementing a Protocol to Reduce Opioid Prescriptions in Military Otolaryngology: A Quality Improvement Initiative. Mil Med 2021; 187:e154-e159. [PMID: 33394014 DOI: 10.1093/milmed/usaa484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION To compare pain medication refill rates for adult septoplasty and rhinoplasty patients before and after initiating a multimodal analgesic protocol for reducing opioid prescriptions (PROP). MATERIALS AND METHODS Data from 58 adult patients were retrieved by retrospective chart review (19 septoplasties and 10 rhinoplasties before initiating PROP in September 2018 and 21 septoplasties and 8 rhinoplasties after PROP). We selected consecutive septoplasties and rhinoplasties, at which time a new discharge order set was implemented. The new order set consisted of 10 oxycodone tabs (5 mg), 100 acetaminophen tabs (325 mg), and 28 celecoxib tabs (200 mg). The primary outcome variable was the number of initial opioid prescriptions and refills filled by any provider. RESULTS Among the septoplasties, there was a 46% decrease in total morphine milligram equivalent (MME) prescribed, from a mean of 202.0 mg in the non-PROP group (95% CI, 235.4, 174.6) to 108.6 mg in the PROP group (95% CI, 135.8, 81.4), with no difference in refill rates. Among the rhinoplasties, there was a 51% decrease in total MME prescribed, from a mean of 258.8 mg in the non-PROP group (95% CI, 333.4, 184.1) to 126.6 mg in the PROP group (95% CI, 168.1, 85.0) with no difference in refill rates. CONCLUSIONS The outcomes after PROP implementation for septoplasty and rhinoplasty at our institution suggest that opioid prescription rates can be significantly decreased to manage postoperative pain, with no difference in opioid refill rates. The results also warrant further investigation into patient pain, satisfaction, provider efficiency, and healthcare costs.
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Affiliation(s)
| | - Michael W Noller
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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20
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Kano K, Kawamura K, Miyake T. Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective, single-blind, randomized controlled trial. Med Oral Patol Oral Cir Bucal 2021; 26:e64-e70. [PMID: 33037803 PMCID: PMC7806347 DOI: 10.4317/medoral.23983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar. MATERIAL AND METHODS This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery. RESULTS There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration. CONCLUSIONS Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment.
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Affiliation(s)
- K Kano
- Graduate School of Dentistry, Osaka Dental University Kuzuhahanazono-cho 8-1, Hirakata-shi Osaka 573-1211, Japan
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21
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Roy PJ, Weltman M, Dember LM, Liebschutz J, Jhamb M. Pain management in patients with chronic kidney disease and end-stage kidney disease. Curr Opin Nephrol Hypertens 2020; 29:671-680. [PMID: 32941189 PMCID: PMC7753951 DOI: 10.1097/mnh.0000000000000646] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This review evaluates current recommendations for pain management in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) with a specific focus on evidence for opioid analgesia, including the partial agonist, buprenorphine. RECENT FINDINGS Recent evidence supports the use of physical activity and other nonpharmacologic therapies, either alone or with pharmacological therapies, for pain management. Nonopioid analgesics, including acetaminophen, topical analgesics, gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and TCA may be considered based on pain cause and type, with careful dose considerations in kidney disease. NSAIDs may be used in CKD and ESKD for short durations with careful monitoring. Opioid use should be minimized and reserved for patients who have failed other therapies. Opioids have been associated with increased adverse events in this population, and thus should be used cautiously after risk/benefit discussion with the patient. Opioids that are safer to use in kidney disease include oxycodone, hydromorphone, fentanyl, methadone, and buprenorphine. Buprenorphine appears to be a promising and safer option due to its partial agonism at the mu opioid receptor. SUMMARY Pain is poorly managed in patients with kidney disease. Nonpharmacological and nonopioid analgesics should be first-line approaches for pain management. Opioid use should be minimized with careful monitoring and dose adjustment.
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Affiliation(s)
- Payel Jhoom Roy
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Melanie Weltman
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | - Laura M. Dember
- Renal, Electrolyte and Hypertension Division, Department of Medicine, and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine
| | - Jane Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine
| | - Manisha Jhamb
- Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh
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22
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Santos CMT, Pereira CU, Chaves PHS, Tôrres PTRDL, Oliveira DMDP, Rabelo NN. Options to manage postcraniotomy acute pain in neurosurgery: no protocol available. Br J Neurosurg 2020; 35:84-91. [PMID: 32966104 DOI: 10.1080/02688697.2020.1817852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The physical processes of incision, traction and hemostasis used for craniotomy, stimulate nerve fibers and specific nociceptors, resulting in postoperative pain. During the first 24 h after craniotomy, 87% of patients have postoperatory pain. The rate of suffering pain after craniotomy falls 3% for every year of life. The objective of this study is to review the available therapeutic options to help physicians treating this pain, and discuss pain mechanisms, pathophysiology, plasticity, risk factors and psychological factors. This is a narrative review of the literature from 1970 to June 2019. Data were collected by doing a search in PubMed, EMBASE, Cochrane Reviews and a manual search of all relevant literature references. The literature includes some drugs treatment: Opioids, codeine, morphine, and tramadol, anti-inflammatory non-steroids such as cyclooxygenase-2 inhibitors, gabapentin. It discusses: side effects, pharmacodynamics and indications of each drug, anatomy and Inervation of Skull and its Linigs, pathogenesis of pain Post-craniotomy, scalp nerve block, surgical nerve injury, neuronal plasticity, surgical factors and chronic post-surgical pain.
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23
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Zakaryan A, Ginosyan K. Perioperative Management of Patients With Ankylosing Spondylitis Undergoing Spine Surgery. Front Pharmacol 2020; 11:1017. [PMID: 32742263 PMCID: PMC7364138 DOI: 10.3389/fphar.2020.01017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arman Zakaryan
- Department of Neurosurgery, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Knarik Ginosyan
- Department of Rheumatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
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24
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Bobian M, Gupta A, Graboyes EM. Acute Pain Management Following Head and Neck Surgery. Otolaryngol Clin North Am 2020; 53:753-764. [PMID: 32682530 DOI: 10.1016/j.otc.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acute pain management following major head and neck (HN) surgery is complex. Multimodal analgesia (MMA) regimens including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, and locoregional anesthetics are safe and effective in this population (including patients undergoing HN free flap surgery). Special considerations for patients undergoing HN free flap surgery include judicious use of steroids and attention to donor site pain. Evidence for specific analgesic regimens following transoral robotic surgery is limited but should include MMA and perioperative dexamethasone. Further study is required to optimize combinations, dosages, and duration of perioperative analgesia medications, opioid and nonopioid, for patients undergoing major HN surgery.
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Affiliation(s)
- Michael Bobian
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Annika Gupta
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA.
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25
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Fonseca NM, Pontes JPJ, Perez MV, Alves RR, Fonseca GG. [SBA 2020: Regional anesthesia guideline for using anticoagulants update]. Rev Bras Anestesiol 2020; 70:364-387. [PMID: 32660771 DOI: 10.1016/j.bjan.2020.02.006] [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: 11/22/2019] [Revised: 02/10/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022] Open
Abstract
The development of protocols to prevent perioperative Venous Thromboembolism (VTE) and the introduction of increasingly potent antithrombotic drugs have resulted in concerns of increased risk of neuraxial bleeding. Since the Brazilian Society of Anesthesiology (SBA) 2014 guideline, new oral anticoagulant drugs were approved by international regulating agencies, and by ANVISA. Societies and organizations that try to approach concerns through guidelines have presented conflicting perioperative management recommendations. As a response to these issues and to the need for a more rational approach, managements were updated in the present narrative revision, and guideline statements made. They were projected to encourage safe and quality patient care, but cannot assure specific results. Like any clinical guide recommendation, they are subject to review as knowledge grows, on specific complications, for example. The objective was to assess safety aspects of regional analgesia and anesthesia in patients using antithrombotic drugs, such as: possible technique-associated complications; spinal hematoma-associated risk factors, prevention strategies, diagnosis and treatment; safe interval for discontinuing and reinitiating medication after regional blockade.
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Affiliation(s)
- Neuber Martins Fonseca
- Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brasil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento (CET), Uberlândia, MG, Brasil; Comissão de Normas Técnicas da Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil.
| | - João Paulo Jordão Pontes
- Hospital Santa Genoveva de Uberlândia, CET/SBA, Uberlândia, MG, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; European Diploma in Anaesthesiology and Intensive Care, European Society of Anaesthesiology, Bruxelas, Bélgica
| | - Marcelo Vaz Perez
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; Conselho Editorial da Revista Brasileira de Anestesiologia, São Paulo, SP, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Rodrigues Alves
- Hospital Santa Genoveva de Uberlândia, CET/SBA, Uberlândia, MG, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Gabriel Gondim Fonseca
- Irmandade da Santa Casa de Misericórdia de São Paulo, Anesthesiology Specialization, São Paulo, SP, Brasil
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26
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Fonseca NM, Pontes JPJ, Perez MV, Alves RR, Fonseca GG. SBA 2020: Regional anesthesia guideline for using anticoagulants update. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32660771 PMCID: PMC9373103 DOI: 10.1016/j.bjane.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Neuber Martins Fonseca
- Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Disciplina de Anestesiologia, Uberlândia, MG, Brasil; Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Centro de Ensino e Treinamento (CET), Uberlândia, MG, Brasil; Comissão de Normas Técnicas da Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil.
| | - João Paulo Jordão Pontes
- Hospital Santa Genoveva de Uberlândia, CET/SBA, Uberlândia, MG, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil; European Diploma in Anaesthesiology and Intensive Care, European Society of Anaesthesiology, Bruxelas, Bélgica
| | - Marcelo Vaz Perez
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; Conselho Editorial da Revista Brasileira de Anestesiologia, São Paulo, SP, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Rodrigues Alves
- Hospital Santa Genoveva de Uberlândia, CET/SBA, Uberlândia, MG, Brasil; Título Superior em Anestesiologia (TSA), Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brasil
| | - Gabriel Gondim Fonseca
- Irmandade da Santa Casa de Misericórdia de São Paulo, Anesthesiology Specialization, São Paulo, SP, Brasil
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Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury 2020; 51 Suppl 2:S28-S36. [PMID: 31079833 DOI: 10.1016/j.injury.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.
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Affiliation(s)
- Daniel M Gessner
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - Jean-Louis Horn
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St., Mailcode 6342, Redwood City, CA, 94063, USA.
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The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions. Clin Spine Surg 2020; 33:E135-E140. [PMID: 31693519 DOI: 10.1097/bsd.0000000000000913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A prospective observational study with a historical reference group. OBJECTIVES The main objectives of this study were to determine the impact of preventative multimodal analgesia (PMA) on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery. SUMMARY OF BACKGROUND DATA PMA addresses the multiple pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use. MATERIALS AND METHODS This study compared postoperative opioid requirement and analgesic effect in a total of 101 patients undergoing elective, 1-level or 2-level transforaminal lumbar interbody fusion surgeries for symptomatic lumbar degenerative disk disease. The PMA patient group included 51 consecutive patients who received 1000 mg of acetaminophen, 300-900 mg of gabapentin, and 200-400 mg of celecoxib 1 hour before their index procedure. The reference group included 50 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively.Multiple linear regression was used to evaluate the effect of PMA on postoperative pain and MED over 4 postoperative days, while controlling for all variables likely to influence these outcomes, including age, sex, baseline opioid use, duration of surgery, postoperative intrathecal morphine use and the administration of muscle relaxants and anticonvulsants. RESULTS The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from -0.54 to -0.99 (34.8%-54.2% MED reduction) for the postoperative opioid requirement and from -0.59 to -1.16 (28.9%-37.3% visual analog scale reduction) for postoperative pain indicating that these measures were reduced by about ½ to 1 SD in the PMA patient group. CONCLUSIONS PMA is a highly effective and safe method for postoperative pain management in patients undergoing elective lumbar fusion surgeries by improving pain control and reducing opioid requirement. LEVEL OF EVIDENCE Level III.
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Solar P, Mackerle Z, Joukal M, Jancalek R. Non-steroidal anti-inflammatory drugs in the pathophysiology of vasospasms and delayed cerebral ischemia following subarachnoid hemorrhage: a critical review. Neurosurg Rev 2020; 44:649-658. [PMID: 32124117 DOI: 10.1007/s10143-020-01276-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition associated with the development of early brain injury (EBI) and delayed cerebral ischemia (DCI). Pharmacological treatment of vasospasm following aSAH currently mainly comprises nimodipine administration. In the past few years, many drugs that can potentially benefit cases of subarachnoid hemorrhage have become available. The objective of this review is to critically assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) following aSAH. A systematic literature review was conducted following PRISMA guidelines. The search was aimed at studies addressing aSAH and NSAIDs during the 2010 to 2019 period, and it yielded 13 articles. Following the application of search criteria, they were divided into two groups, one containing 6 clinical articles and the other containing 7 experimental articles on animal models of aSAH. Inflammatory cerebral changes after aneurysm rupture contribute to the development of EBI, DCI and cerebral vasospasm. It appears that NSAIDs (especially coxibs) are even more effective in reducing vasospasm than nimodipine. Other beneficial effects of NSAIDs include reduction in mortality, improved functional outcome and increased hypoaggregability. However, despite these positive effects, there is only one randomized, double-blind, placebo-controlled trial showing a tendency towards a better outcome with lower incidence of vasospasm or mortality in patients following aSAH.
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Affiliation(s)
- Peter Solar
- Department of Neurosurgery - St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic
- Department of Neurosurgery, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic
- Cellular and Molecular Neurobiology Research Group, Department of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdenek Mackerle
- Department of Neurosurgery - St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic
- Department of Neurosurgery, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic
| | - Marek Joukal
- Cellular and Molecular Neurobiology Research Group, Department of Anatomy, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery - St. Anne's University Hospital Brno, Faculty of Medicine, Masaryk University, Kamenice 753/5, 625 00, Brno, Czech Republic.
- Department of Neurosurgery, St. Anne's University Hospital Brno, Pekarska 53, 656 91, Brno, Czech Republic.
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Scibelli G, Maio L, Savoia G. Corrected and republished from: Regional anesthesia and antithrombotic agents: instructions for use. Minerva Anestesiol 2020; 86:341-353. [DOI: 10.23736/s0375-9393.20.14494-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Davidson JC, Rahim S, Hanks SE, Patel IJ, Tam AL, Walker TG, Weinberg I, Wilkins LR, Sarode R. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part I: Review of Anticoagulation Agents and Clinical Considerations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30:1155-1167. [PMID: 31229332 DOI: 10.1016/j.jvir.2019.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jon C Davidson
- Department of Interventional Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shiraz Rahim
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sue E Hanks
- Department of Radiology, University of Southern California, Los Angeles, California
| | | | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas.
| | - T Gregory Walker
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Luke R Wilkins
- Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Ravi Sarode
- Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern Medical Center, Dallas, Texas
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Patel IJ, Rahim S, Davidson JC, Hanks SE, Tam AL, Walker TG, Wilkins LR, Sarode R, Weinberg I. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations. J Vasc Interv Radiol 2019; 30:1168-1184.e1. [DOI: 10.1016/j.jvir.2019.04.017] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 02/06/2023] Open
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Hamburger J, Beilin Y. Systemic adjunct analgesics for cesarean delivery: a narrative review. Int J Obstet Anesth 2019; 40:101-118. [PMID: 31350096 DOI: 10.1016/j.ijoa.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/24/2019] [Accepted: 06/28/2019] [Indexed: 01/12/2023]
Abstract
It is critical to adequately treat postoperative cesarean delivery pain. The use of parenteral or neuraxial opioids has been a mainstay, but opioids have side effects that can be troubling and the opioid crisis in the United States has highlighted the necessity to utilize analgesics other than opioids. Other analgesic options include neuraxial analgesics, nerve blocks such as the transversus abdominis plane block, and non-opioid parenteral and oral medications. The goal of this article is to review non-opioid systemic analgesic adjuncts following cesarean delivery, focusing on their efficacy and side effects as well as their impact on reduction of opioid requirements after surgery.
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Affiliation(s)
- J Hamburger
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, USA.
| | - Y Beilin
- Department of Anesthesiology, Pain and Perioperative Medicine, Department of Obstetrics, Genecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, USA
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Soffin EM, Gibbons MM, Ko CY, Kates SL, Wick EC, Cannesson M, Scott MJ, Wu CL. Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Anesth Analg 2019; 128:454-465. [DOI: 10.1213/ane.0000000000003663] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Oltman J, Militsakh O, D'Agostino M, Kauffman B, Lindau R, Coughlin A, Lydiatt W, Lydiatt D, Smith R, Panwar A. Multimodal Analgesia in Outpatient Head and Neck Surgery: A Feasibility and Safety Study. JAMA Otolaryngol Head Neck Surg 2019; 143:1207-1212. [PMID: 29049548 DOI: 10.1001/jamaoto.2017.1773] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Justin Oltman
- College of Medicine, University of Nebraska Medical Center, Omaha
| | - Oleg Militsakh
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Mark D'Agostino
- Department of Anesthesiology, Nebraska Methodist Hospital, Omaha
| | - Brittany Kauffman
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Robert Lindau
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Andrew Coughlin
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - William Lydiatt
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Daniel Lydiatt
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Russell Smith
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Estabrook Cancer Center, Nebraska Methodist Hospital, Omaha
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Dunkman WJ, Manning MW. Enhanced Recovery After Surgery and Multimodal Strategies for Analgesia. Surg Clin North Am 2018; 98:1171-1184. [DOI: 10.1016/j.suc.2018.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Jakubowski M, Szahidewicz-Krupska E, Doroszko A. The Human Carbonic Anhydrase II in Platelets: An Underestimated Field of Its Activity. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4548353. [PMID: 30050931 PMCID: PMC6046183 DOI: 10.1155/2018/4548353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/24/2018] [Indexed: 12/15/2022]
Abstract
Carbonic anhydrases constitute a group of enzymes that catalyse reversible hydration of carbon dioxide leading to the formation of bicarbonate and proton. The platelet carbonic anhydrase II (CAII) was described for the first time in the '80s of the last century. Nevertheless, its direct role in platelet physiology and pathology still remains poorly understood. The modulation of platelet CAII action as a therapeutic approach holds promise as a novel strategy to reduce the impact of cardiovascular diseases. This short review paper summarises the current knowledge regarding the role of human CAII in regulating platelet function. The potential future directions considering this enzyme as a potential drug target and important pathophysiological chain in platelet-related disorders are described.
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Affiliation(s)
- Maciej Jakubowski
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Ewa Szahidewicz-Krupska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. Reg Anesth Pain Med 2018; 43:263-309. [DOI: 10.1097/aap.0000000000000763] [Citation(s) in RCA: 442] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cramer JD, Wisler B, Gouveia CJ. Opioid Stewardship in Otolaryngology: State of the Art Review. Otolaryngol Head Neck Surg 2018; 158:817-827. [DOI: 10.1177/0194599818757999] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brad Wisler
- Department of Anesthesiology, United States Air Force, Wright Patterson Air Force Base, Dayton, Ohio, USA
| | - Christopher J. Gouveia
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Kantak AP, Shah NN. Extensive Surgical Wound Lavage Reduces the Incidence and Severity of Heterotopic Ossification in Primary Total Hip Replacement: A Study of 175 Hip Replacements. Hip Pelvis 2017; 29:234-239. [PMID: 29250497 PMCID: PMC5729165 DOI: 10.5371/hp.2017.29.4.234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/04/2017] [Accepted: 08/25/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose One of the local factors contributing to the formation of heterotopic ossification includes bone debris generated during the surgery. This risk can be partially nullified by use of saline wash. Our research aim was to ascertain if extensive intraoperative lavage can reduce the incidence and severity of heterotopic ossification in primary total hip arthroplasty. Materials and Methods A retrospective case control radiological study of 145 patients (175 hip replacements). The control group received minimal intra-operative lavage (<1,000 mL); consisted of 90 primary hip replacements. The index group received extensive saline lavage (>3,000 mL), and included 85 primary hip replacements. Brooker classification was used to grade radiographs at one year for development of heterotopic ossification. Results Sixty-six patients in control group had heterotopic ossification, with six showing a significant grade (grade 3 or 4). Thirty-five patients in the index group had heterotopic ossification with no incidence of severe grade. Majority patients in the index group showed a predominantly grade 1 heterotopic ossification; 28 out of 35, as compared to 37 out of 66 in control group. There was a statistically significant difference in the incidence (P<0.05) as well as severity of heterotopic ossification between the groups (P<0.05). Conclusion We conclude that use of extensive lavage during total hip replacement reduces the incidence as well as severity of heterotopic ossification.
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Affiliation(s)
- Avadhoot P Kantak
- Department of Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom
| | - Nirav N Shah
- Department of Orthopaedic Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing, United Kingdom
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Walker C, Biasucci LM. Cardiovascular safety of non-steroidal anti-inflammatory drugs revisited. Postgrad Med 2017; 130:55-71. [DOI: 10.1080/00325481.2018.1412799] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Chris Walker
- Global Product Director, Pfizer, Walton Oaks, UK
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Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition). Reg Anesth Pain Med 2017; 43:225-262. [DOI: 10.1097/aap.0000000000000700] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schug SA, Parsons B, Li C, Xia F. The safety profile of parecoxib for the treatment of postoperative pain: a pooled analysis of 28 randomized, double-blind, placebo-controlled clinical trials and a review of over 10 years of postauthorization data. J Pain Res 2017; 10:2451-2459. [PMID: 29066931 PMCID: PMC5644539 DOI: 10.2147/jpr.s136052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Nonselective, nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 (COX-2) inhibitors are associated with safety issues including cardiovascular, renal, and gastrointestinal (GI) events. Objective To examine the safety of parecoxib, a COX-2 inhibitor, for the management of postoperative pain. Design Pooled analysis of 28 placebo-controlled trials of parecoxib and review of postauthorization safety data. Main outcome measures Prespecified safety events commonly associated with COX-2 inhibitors and/or NSAIDs. In the clinical trial analysis, the frequency of each event was compared between treatment groups using a chi-square test. In the postauthorization review, the number of confirmed cases, along with outcome, was presented for each event. Results In the clinical trial analysis, GI-related events occurred in ~0.2% of patients in the parecoxib and placebo groups. Renal failure and impairment was similar between parecoxib (1.0%) and placebo (0.9%). The occurrence of arterial (parecoxib=0.3%; placebo=0.2%) and venous (parecoxib=0.2%; placebo=0.1%) cardiovascular embolic and thrombotic events was similar between groups. Hypersensitivity reactions including anaphylactic reactions (parecoxib=8.7%; placebo=8.6%), hypotension (parecoxib=2.6%; placebo=2.1%), angioedema (parecoxib=2.5%; placebo=2.8%), and severe cutaneous adverse reactions (0% in both groups) were similar between groups. Incision site or other skin/tissue infections occurred in <0.1% of patients in both groups. The occurrence of these events (total reports/serious reports) in the postauthorization database, based on 69,567,300 units of parecoxib, was as follows: GI ulceration-related events (35/35), renal failure and impairment (77/68), cardiovascular embolic and thrombotic events (66/64), hypersensitivity reactions including hypotension-related events (32/25) and severe cutaneous adverse events (17/17), and masking signs of inflammation (18/18). A majority of reported outcomes were classified as recovered or recovering. Conclusions Potentially serious safety events occur infrequently with parecoxib, which high-lights its safety in patients with postoperative pain.
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Affiliation(s)
- Stephan A Schug
- Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - Bruce Parsons
- Medical Affairs/Global Innovative Products, Pfizer, New York, NY, USA
| | - Chunming Li
- Global Innovative Products Statistics, Pfizer, Madison, NJ, USA
| | - Feng Xia
- Safety Surveillance and Risk Management, Worldwide Safety and Regulatory, Worldwide Research and Development, Pfizer, New York, NY, USA
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Comparative population pharmacokinetics and absolute oral bioavailability of COX-2 selective inhibitors celecoxib, mavacoxib and meloxicam in cockatiels (Nymphicus hollandicus). Sci Rep 2017; 7:12043. [PMID: 28947805 PMCID: PMC5612971 DOI: 10.1038/s41598-017-12159-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/04/2017] [Indexed: 12/17/2022] Open
Abstract
Selective COX-2 inhibitors are non-steroidal anti-inflammatory drugs which directly target cyclooxygenase-2 (COX-2), an enzyme mainly responsible for induction of inflammation, pyresis and pain. Although commonly used in avian medicine, limited pharmacokinetic (PK) data in domestic and companion birds are available. In this study, PK parameters and absolute oral bioavailability expressed as percentage (F%) of celecoxib (10 mg/kg BW), mavacoxib (4 mg/kg BW) and meloxicam (1 mg/kg BW) were determined following single oral (PO) and intravenous (IV) administration to cockatiels (Nymphicus hollandicus). The drugs were quantified in plasma by liquid chromatography-tandem mass spectrometry. Data were processed using the nonlinear mixed effects (NLME) approach. In contrast to celecoxib (T1/2el = 0.88 h) and meloxicam (T1/2el = 0.90 h), mavacoxib has a prolonged elimination half-life (T1/2el = 135 h) following oral administration of a commercial formulation (CF). High to complete oral absorption was observed following oral administration of celecoxib (F% = 56-110%) and mavacoxib (F% = 111-113%), CF and standard solutions, respectively. In contrast, the F% of meloxicam was low (F% = 11%). Based on the presented results, a less frequent dosing of mavacoxib is proposed compared to celecoxib and meloxicam. However, pharmacodynamic and safety studies are necessary to further investigate the use of these NSAIDs in cockatiels.
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Gungor S, Aiyer R. Epidural hematoma development contralateral to dura after lumbar transforaminal epidural steroid injection. Pain Manag 2017; 7:367-375. [DOI: 10.2217/pmt-2017-0012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To illustrate the anatomical and pathophysiological risks of epidural hematoma formation, other than direct needle trauma, after lumbar transforaminal epidural steroid injection in the setting of severe central canal stenosis. Case report: This case report presents the development of an epidural hematoma after lumbar transforaminal epidural steroid injection in a patient who has anatomical risk factor of severe lumbar spinal stenosis. The anatomic location of epidural hematoma was at the injected level, but on the contralateral side of the dura at a distance from the needle path. Epidural vascular anatomy and the potential mechanisms of bleeding in the epidural space in the absence of direct needle trauma, including the importance of injection pressures are discussed. Conclusion: This is the first reported case of an epidural hematoma on the contralateral side of the dura at a distance from the needle tip location, in the setting of severe central canal stenosis.
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Affiliation(s)
- Semih Gungor
- Division of Pain Medicine, Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, NY, USA
| | - Rohit Aiyer
- Department of Psychiatry, Hofstra Northwell Health, Staten Island University Hospital, NY, USA
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Garner SE, Fidan D, Frankish RR, Judd M, Shea B, Towheed T, Tugwell P, Wells GA. WITHDRAWN: Celecoxib for rheumatoid arthritis. Cochrane Database Syst Rev 2017; 6:CD003831. [PMID: 28598564 PMCID: PMC6481399 DOI: 10.1002/14651858.cd003831.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds. The NSAIDs known as the selective Cox II inhibitors, of which celecoxib is a member, were developed in order to reduce the GI toxicity, but are more expensive. OBJECTIVES To establish the efficacy and safety of celecoxib in the management of RA by systematic review of available evidence. SEARCH METHODS We searched the following databases up to August 2002: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment Database. The bibliographies of retrieved papers and content experts were consulted for additional references. SELECTION CRITERIA All eligible randomised controlled trials (RCTs) were included. No unpublished RCTs were included in this edition of the review. DATA COLLECTION AND ANALYSIS Data were abstracted independently by two reviewers. Data was analysed using a fixed effects model. A validated checklist was used to score the quality of the RCTs. The planned analysis was to pool, where appropriate continuous outcomes using mean differences and dichotomous outcomes using relative risk ratios. This was not however possible due to the lack of data. MAIN RESULTS Five RCTs were included (4465 participants); three of the studies also enrolled individuals with OA. The comparators were placebo, naproxen, diclofenac and ibuprofen. The evidence reviewed suggests that celecoxib controls the symptoms of RA to a similar degree to that of the active comparators examined (naproxen, diclofenac and ibuprofen). When compared to placebo, the percentage of patients showing improvement according to ACR 20 criteria at week 4 were 42/82 (51%) in the twice daily celecoxib 200mg group and 43/82 (52%) in the twice daily celecoxib 400mg group; these were significantly different from the placebo group in which 25/85 (29%) improved. The six month data reviewed support a reduced rate of UGI complications with celecoxib but there is also evidence to suggest that these benefits may not be evident in the long-term and that celecoxib offers no additional benefit in patients who are also receiving cardio-prophylactic low dose aspirin. AUTHORS' CONCLUSIONS For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper GI complications are maintained in the long-term and its increased cost in comparison to traditional NSAIDs.
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Affiliation(s)
- Sarah E Garner
- National Institute for Health and Care Excellence (NICE)Science Policy and ResearchMidCity Place71 High HolbornLondonUKWC1V 6NA
| | - Dogan Fidan
- Aventis Pharma Ltd.Health Economics UnitFlat 8291 Boardwalk PlaceLondonUKE14 56E
| | - Ruth R Frankish
- National Institute for Clinical ExcellenceAppraisals Team11 StrandLondonUKWC1N 5HR
| | - Maria Judd
- Canadian Health Services Research Foundation/Fondation canadienne de la recherche sur les services de santéResearch Use/Agente principale de programme, Utilisation de la Recherche1565 avenue Carling AvenueSuite/pièce 700OttawaONCanadaK1Z 8R1
| | - Beverley Shea
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaONCanadaK1H 8L6
| | - Tanveer Towheed
- Queen's UniversityDepartment of Medicine and of Community Health and EpidemiologyEtherington Hall‐Room 2066KingstonONCanadaK7L 3N6
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community Medicine501 Smyth RoadOttawaONCanadaK1H 8L6
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Essex MN, Cheung R, Li C, Xie L. Safety of parecoxib when used for more than 3 days for the management of postoperative pain. Pain Manag 2017; 7:383-389. [PMID: 28589749 DOI: 10.2217/pmt-2017-0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM To assess parecoxib safety when used for >3 days for postoperative pain management. METHODS Treatment-emergent adverse event (TEAE) occurrence after day 3 was examined in a pooled analysis of three placebo-controlled trials of parecoxib following general or gynecologic surgery, or total hip arthroplasty. A total of 358 patients received parecoxib, and 318 placebo. RESULTS Mean treatment duration was similar between treatment groups. The overall frequency of all TEAEs after day 3 was also similar between treatment groups. Most TEAEs occurred in <1% of patients after day 3; frequencies were similar between treatment groups. Most TEAEs were considered mild or moderate in severity. CONCLUSION TEAE occurrence in patients receiving parecoxib for >3 days was low and similar to placebo after treatment day 3.
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Affiliation(s)
| | - Raymond Cheung
- Global Medical Affairs, Pfizer Inc., 235 East 42nd St, New York, NY 10017, USA
| | - Chunming Li
- Biostatistics & Analysis, Pfizer Inc., 1 Giralda Farms, Madison, NJ 07940, USA
| | - Li Xie
- China Medical Affairs, Pfizer Investment Co. Ltd, The Fifth Square, Tower B, 8-12/F No. 3-7 Chaoyangmen North Avenue Dongcheng District Beijing, PR China 100010
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