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Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Rep 2023; 8:e1075. [PMID: 37181639 PMCID: PMC10168527 DOI: 10.1097/pr9.0000000000001075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 05/16/2023] Open
Abstract
Assessment and management of postoperative pain after hospital discharge is very challenging. We conducted a systematic review to synthesize available evidence on the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. The previously published protocol for this review was registered in PROSPERO. MEDLINE and EMBASE databases were searched until November 2020. We included observational postsurgical pain studies in the posthospital discharge setting. The primary outcome for the review was the proportion of study participants with moderate-to-severe postoperative pain (eg, pain score of 4 or more on a 10-point Numerical Rating Scale) within the first 1 to 14 days after hospital discharge. This review included 27 eligible studies involving a total of 22,108 participants having undergone a wide variety of surgical procedures. The 27 studies included ambulatory surgeries (n = 19), inpatient surgeries (n = 1), both ambulatory and inpatient surgeries (n = 4), or was not specified (n = 3). Meta-analyses of combinable studies provided estimates of pooled prevalence rates of moderate-to-severe postoperative pain ranging from 31% 1 day after discharge to 58% 1 to 2 weeks after discharge. These findings suggest that moderate-to-severe postoperative pain is a common occurrence after hospital discharge and highlight the importance of future efforts to more effectively evaluate, prevent, and treat postsurgical pain in patients discharged from the hospital.
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Affiliation(s)
- Rex Park
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
- School of Policy Studies, Queen's University, Kingston, Canada
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Dziadzko M, Bouteleux A, Minjard R, Harich J, Joubert F, Pradat P, Pantel S, Aubrun F. Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients-study protocol for a randomized controlled trial. Trials 2022; 23:422. [PMID: 35598000 PMCID: PMC9123724 DOI: 10.1186/s13063-022-06387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Successful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects. Methods A total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge. Discussion The developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses. Trial registration ClinicalTrials.govNCT03754699. Registered on November 27, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06387-6.
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Affiliation(s)
- Mikhail Dziadzko
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France. .,RESHAPE Lab, U1920, INSERM and Claude Bernard Lyon 1 University, Lyon, France. .,Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Axelle Bouteleux
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Raphael Minjard
- Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,Center of Research in Clinical Psychopathology and Psychology (CRPPC) University Lumière Lyon 2, Lyon, France
| | - Jack Harich
- BS Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Fanny Joubert
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Solene Pantel
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Frederic Aubrun
- Department of Anesthesiology and Intensive Care Medicine, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,RESHAPE Lab, U1920, INSERM and Claude Bernard Lyon 1 University, Lyon, France.,Department of Pain treatment, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
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Implementation of Smart Pump Technology With Home Infusion Providers: An Assessment of Clinician Workflow and Patient Satisfaction. JOURNAL OF INFUSION NURSING 2019; 41:344-349. [PMID: 30399070 PMCID: PMC6237252 DOI: 10.1097/nan.0000000000000302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While hospitals have adopted smart pump technology (SPT) featuring drug libraries and medication safety software, most home infusion providers (HIPs) continue to use traditional infusion pumps that don't offer drug libraries or medication safety software. As infusion delivery is moving from the hospital to the home, the purpose of this study was to determine whether SPT was a feasible alternative at both a hospital-based and a rural HIP. HIP personnel were trained on an ambulatory infusion pump. Patients requiring home infusion used the pump and recorded daily pump interactions for 5 to 7 days. After the creation of a drug library, clinicians felt comfortable programming pumps after 7 uses. Patients reported 100% overall satisfaction, and the majority of alarms were resolved without contacting the HIP. Ambulatory SPT can be implemented successfully by HIPs and can be used effectively by patients.
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Abstract
The concept of fast-track or ambulatory surgery appeared to facilitate early recovery and discharge from the hospital and early resumption of normal daily activities after elective surgical procedures as well to reduce the health-care costs. Multimodal/balanced analgesia is an increasingly popular approach for this. The use of conventional modalities including central neuraxial blockade and opioids cannot be extended to patients undergoing fast-track surgery. Hence, an aggressive perioperative analgesic regimen/protocol is required for effective pain relief, with minimal side effects and which could be managed easily by the patient or the relatives at home away from the hospital setting. Pharmacological therapy and regional anesthesia techniques have been utilized for postoperative pain management. The use of perineural, incisional, and intra-articular catheters and local anesthetic administration through elastomeric and electronic pumps is promising approach for effective pain management at home. The key to successful pain management of such procedures requires individually tailored education to patients or caregivers including information on treatment options for postoperative pain and use of multimodal analgesia. This review provides an overview of the current armamentarium of drugs and modalities available for effective management of patients undergoing day care surgeries and sheds light on newer modalities available.
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Affiliation(s)
- Anudeep Jafra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
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Gómez-López L, Sala-Blanch X, Gambús Cerrillo PL, López Gutiérrez A, Agustí Lasús M, Anglada Casas MT. Outpatient intravenous multimodal elastomeric pump with methadone in ambulatory surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:306-313. [PMID: 29665978 DOI: 10.1016/j.redar.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Analgesia in Ambulatory Surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included. PATIENTS AND METHODS An observational study, physical status ASA I-II, underwent ambulatory surgeries with moderate-severe postoperative pain. Analgesia was administered for 48h by an intravenous multimodal elastomeric pump (methadone, tramadol, dexketoprofen and ondansetron at low doses). Visual Analogue Scale (VAS) at rest and movement were evaluated at 24 and 48h. Andersen Scale, Lattinen Test, rescue analgesia and side-effects were recorded at 24h after surgery. RESULTS We included 73 patients: 37% abdominal wall surgery, 30% hemorrhoidectomies and 33% perineal surgery. Median VAS score at rest and movement were 0 and 3 at 24h, and 0 and 2 at 48h. At 24h, Andersen's Scale score was ≤1 in 89%, and Lattinen Test ≤6 in 90% of patients. Rescue medication was administered in 30% of patients. Two patients had vomiting at 24 and 48h. Minor catheter and pump dysfunctions were observed in 8% of patients. CONCLUSIONS Multimodal analgesia with intravenous methadone administered by elastomeric perfusion at home is effective and safe. However, monitoring is needed to diagnosis dysfunction of devices.
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Affiliation(s)
- L Gómez-López
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España.
| | - X Sala-Blanch
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - P L Gambús Cerrillo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - A López Gutiérrez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - M Agustí Lasús
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España
| | - M T Anglada Casas
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínic de Barcelona, Barcelona, España
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Villalba J, Peñalver J, Torner P, Serra M, Planell J. Home-based intravenous analgesia with elastomeric pump as an outpatient procedure for pain control after anterior cruciate ligament repair. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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