1
|
Fang Y. Comment on: Patients' Use of Virtual Reality Technology for Pain Reduction during Outpatient Hysteroscopy: A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2024:S1553-4650(24)00169-9. [PMID: 38641050 DOI: 10.1016/j.jmig.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Yuan Fang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, China.
| |
Collapse
|
2
|
Guo W, Liu Z, Zou D, Liang A. New advances in perioperative care for mothers and newborns undergoing cesarean-section delivery. Asian J Surg 2024; 47:2035-2036. [PMID: 38245418 DOI: 10.1016/j.asjsur.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Affiliation(s)
- Wei Guo
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Zhen Liu
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Dan Zou
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China
| | - Ailin Liang
- Department of Obstetrics and Gynecology, Chengdu BOE Hospital, Chengdu, Sichuan, 610041, China.
| |
Collapse
|
3
|
Huffman C, Olson J, Evans JK, Brady T, Huff S, Bishop B, Abbott E, Wishon K, Washburn K, Coeytaux R. Nurse initiated auricular acupressure for post-operative pain control in patients undergoing TKA or THA: A randomized controlled trial. Int J Orthop Trauma Nurs 2024; 52:101035. [PMID: 37429783 PMCID: PMC10921186 DOI: 10.1016/j.ijotn.2023.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Carolyn Huffman
- Center for Nursing Research, Atrium Health Wake Forest Baptist, Medical Center Blvd, Winston Salem, NC, 27157, USA.
| | - Juli Olson
- Integrative Health Coordinating Center, Veterans Health Administration, Des Moines, IA, 50325, USA
| | - Joni K Evans
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Teresa Brady
- Comprehensive Cancer Center, Atrium Health Wake Forest Baptist, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Sonia Huff
- Atrium Health Wake Forest Baptist, Davie Medical Center, 329 NC Highway 801 North, Bermuda Run, NC, 27006, USA
| | - Brie Bishop
- Atrium Health Wake Forest Baptist Davie Medical Center, USA
| | - Ellen Abbott
- Atrium Health Wake Forest Baptist Davie Medical Center, USA
| | - Karen Wishon
- Atrium Health Wake Forest Baptist Davie Medical Center, USA
| | - Kyle Washburn
- Atrium Health Wake Forest Baptist Pain Center, 605 Cotton Street, NC, 27101, USA
| | - Remy Coeytaux
- Former Professor of Family Medicine and Former Director of Center for Integrative Medicine at Wake Forest University School of Medicine, USA
| |
Collapse
|
4
|
Allen RH, Fortin J, Maurer R, Bartz D, Goldberg AB, Edelman A, Clark MA. Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation. Contraception 2024; 130:110323. [PMID: 37918648 DOI: 10.1016/j.contraception.2023.110323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES This study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting. STUDY DESIGN In this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group. RESULTS We enrolled 149 patients in the local anesthesia group and 155 in the moderate IV sedation group. The mean procedure pain scores were 6.9 (±2.1) out of 10 in the local group and 4.0 (±2.7) in the IV group (p < 0.0001). More women in the IV group (92%) were satisfied or very satisfied with the amount of pain relief they experienced compared to the local group (66%; p < 0.0001). In the univariable model, only being afraid of a minor medical procedure was predictive of less satisfaction with local anesthesia for pain control (relative risk 0.8 [95% CI, 0.6-0.9]). Age, gestational age, anticipated pain, self-reported pain tolerance, self-reported anxiety, discomfort with the abortion decision, and history of prior vaginal or cesarean delivery or induced abortion did not predict satisfaction levels. CONCLUSIONS Fear of minor medical procedures was the only variable that predicted decreased satisfaction with local anesthesia alone for procedural abortion under 12 weeks. IMPLICATIONS Reliable predictors for satisfaction with local anesthesia alone for procedural abortion in the outpatient setting remain elusive. Fear of minor medical procedures may serve as an indicator of decreased satisfaction and could be incorporated into patient counseling. Moderate IV sedation is associated with high satisfaction levels.
Collapse
Affiliation(s)
- Rebecca H Allen
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA.
| | | | | | - Deborah Bartz
- Planned Parenthood League of Massachusetts, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alisa B Goldberg
- Planned Parenthood League of Massachusetts, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Melissa A Clark
- Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
5
|
Zhang L, Zhang H. The efficacy of pregabalin for pain control after thoracic surgery: a meta-analysis. J Cardiothorac Surg 2024; 19:4. [PMID: 38172988 PMCID: PMC10765724 DOI: 10.1186/s13019-023-02449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Pregabalin may have some potential in alleviating pain after thoracic surgery, and this meta-analysis aims to explore the impact of pregabalin on pain intensity for patients undergoing thoracic surgery. METHODS PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin on pain intensity after thoracic surgery. RESULTS Five RCTs were finally included in the meta-analysis. Overall, compared with control intervention for thoracic surgery, pregabalin was associated with significantly reduced pain scores at 0 h (mean difference [MD]=-0.70; 95% confidence interval [CI]=-1.10 to -0.30; P = 0.0005), pain scores at 24 h (MD=-0.47; 95% CI=-0.75 to -0.18; P = 0.001) and neuropathic pain (odd ratio [OR] = 0.24; 95% CI = 0.12 to 0.47; P < 0.0001), but demonstrated no obvious impact on the incidence of dizziness (OR = 1.07; 95% CI = 0.15 to 7.46; P = 0.95), headache (OR = 1.00; 95% CI = 0.30 to 3.35; P = 1.00) or nausea (OR = 1.24; 95% CI = 0.46 to 3.35; P = 0.68). CONCLUSIONS Pregabalin may be effective to alleviate the pain after thoracic surgery.
Collapse
Affiliation(s)
- Li Zhang
- Anesthesia Department Operating Room, Chongqing Liangjiang New Area People's Hospital, Chongqing, China.
| | - Hong Zhang
- Anesthesia Department Operating Room, Chongqing Liangjiang New Area People's Hospital, Chongqing, China.
| |
Collapse
|
6
|
Dominguez A. Current protocol to achieve dental movement acceleration and pain control with Photo-biomodulation. World J Methodol 2023; 13:379-383. [PMID: 38229945 PMCID: PMC10789100 DOI: 10.5662/wjm.v13.i5.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
When designing a study on dental movement acceleration or pain control during orthodontic treatment, it is crucial to consider effective parameters. The objective of this editorial is to compile the most effective parameters supported by evidence that should be considered in future studies to achieve complete parameter homogenization. The protocol currently recommended to homogenize the parameters and facilitate the development of further meta-analysis in terms of acceleration of movement and pain control in orthodontics is Wavelength: 810 nm, 2.2 J per surface, 0.1 W in continuous mode/0.1 W average power in a super-pulsed, sweeping movement, 1mm from the mucosa, 22 seconds along the vestibular surface and 22 seconds along the lingual surface, the recommended speed of movement is 2 mm/sec, 1 application during each orthodontic control, to achieve dental movement acceleration and repeat the dose at 24 h to ensure pain elimination. The energy density and power density will depend on the spot size used in the equipment and the distance from the mucosa. It will strengthen the evidence of photobiomodulation as the best therapy to accelerate tooth movement and at the same time control the pain produced by orthodontic treatments.
Collapse
Affiliation(s)
- Angela Dominguez
- Department of Orthodontics, Faculty of Dentistry, Benemerita Universidad Autónoma de Puebla, Zaragoza de Puebla Calle 4 Sur 104, Puebla, C.P. 72000, Mexico
| |
Collapse
|
7
|
Moss C, Brookhart C, Pandya P, Borahay MA, Mann M, Handa V, Powell AM. Satisfaction with opioid prescription and use after minor gynaecologic surgery: a pilot prospective study. J OBSTET GYNAECOL 2023; 43:2171773. [PMID: 36803625 DOI: 10.1080/01443615.2023.2171773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
To describe predictors of patient satisfaction with pain control including opioid prescribing practices, patients undergoing minor gynaecologic and urogynaecologic surgeries were included in a prospective cohort study. Satisfaction with postoperative pain control by opioid prescription status was analysed using bivariate analysis and multivariable logistic regression, controlling for potential confounders. Among participants completing both postoperative surveys, 112/141 (79.4%) reported pain control satisfaction by day 1-2 and 118/137 (86.1%) by day 14. While we were underpowered to detect a true difference in satisfaction by opioid prescription, there were no differences in opioid prescription among patients satisfied with pain control [52% vs. 60% (p = .43) among satisfied patients at day 1-2 and 58.5% vs. 37% (p = .08) at day 14]. Significant predictors of pain control satisfaction were postoperative day (POD) 1-2 average pain at rest [aOR 0.72 (95% CI 0.52-0.99), p = .04], rating of shared decision-making [aOR 1.16 (95% CI 1.004-1.34), p = .04], amount of pain relief [aOR 1.28 (95% CI 1.07-1.54), p = .008) and POD 14 shared decision-making rating [aOR 1.45 (95% CI 1.19-1.77), p = .002].Impact StatementWhat is already known on this subject? There are little data published on opioid prescription rates after minor gynaecologic procedures and no formal evidence-based guidance for gynaecologic providers for opioid prescribing. Few publications describe rates of opioid prescription and use following minor gynaecologic procedures. In the setting of a dramatic escalation of opioid misuse in the United States over the last decade, we sought to describe our practice of opioid prescription following minor gynaecologic procedures and answer the question of whether patient satisfaction is affected by opioid prescription, fill and use.What do the results of this study add? Though underpowered to detect our primary outcome, our results suggest that patient satisfaction with pain control may primarily be significantly affected by the patient's subjective assessment of shared decision-making with the gynaecologist.What are the implications of these findings for clinical practice and/or further research? Ultimately, these preliminary findings suggest a larger cohort is needed to answer the question of whether pain control satisfaction is influenced by receipt/fill/use of opioids after minor gynaecologic surgery.
Collapse
Affiliation(s)
- Chailee Moss
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn Brookhart
- Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, CA, USA
| | - Prerna Pandya
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Aurora Urogynecology, Kenosha, WI, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melindia Mann
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria Handa
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Maya Powell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
8
|
Wang L, Lu M, Wang S, Wu X, Tan B, Xu J, Zou J, He Y. Combined multiple regional anesthesia for microwave ablation of liver Tumors: Initial experience. Eur J Radiol 2023; 169:111147. [PMID: 37913695 DOI: 10.1016/j.ejrad.2023.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aims to assess the feasibility and safety of combined multiple regional anesthesia (CMRA) as a potential strategy to decrease pain and reliance on intravenous analgesics during and after ultrasound-guided microwave ablation (US-guided-MWA) of liver tumors. METHODS A cohort of 75 patients with a total of 99 liver tumors who underwent US-guided-MWA of liver tumors were enrolled. These patients were randomly allocated into three groups: A, B, and C. Prior to the ablation procedure, Group A patients received a combination of hepatic hilar block (HHB), Transversus abdominis plane block (TAPB), and local anesthesia (LA). Patients in Group B were administered HHB in conjunction with LA, while those in Group C received TAPB and LA. Evaluative parameters included the Numerical Rating Scale (NRS) scores, consumption of morphine, incidence of complications, and factors influencing perioperative pain. RESULTS All patients successfully underwent US-guided-MWA. The peak NRS scores for pain during ablation across the three groups were 2.36 ± 1.19, 3.28 ± 1.59, and 4.24 ± 1.42 respectively (P < 0.01), while the count of patients requiring morphine were 4/25, 8/25, and 13/25 respectively (P < 0.01). Postoperative NRS scores for the three groups at 4, 8, 12, 24, and 36-hour intervals demonstrated a pattern of initial increase followed by a decrease, with the order at each interval being: Group A < Group C < Group B. Factors associated with increased pain included larger tumor size, greater number of tumors, and longer procedure and ablation time (P < 0.05). No major complications were recorded across the three groups. CONCLUSION CMRA offers an effective and safe modality to manage pain during and after US-guided-MWA of liver tumors.
Collapse
Affiliation(s)
- Lu Wang
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Man Lu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Shishi Wang
- From the School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075 China.
| | - Xiaobo Wu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Bo Tan
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jinshun Xu
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Jie Zou
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| | - Yi He
- From the Ultrasound Medical Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041 China.
| |
Collapse
|
9
|
Hite MA, McCutcheon T, Feng MP, Ford MM, Geiger TM, Hopkins MB, Muldoon RL, Irlmeier R, Fa A, Ye F, Hawkins AT. Opioid Utilization in Outpatient Anorectal Surgery: An Opportunity for Improvement. J Surg Res 2023; 291:105-115. [PMID: 37354704 DOI: 10.1016/j.jss.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/19/2023] [Accepted: 05/16/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The opioid epidemic has resulted in close examination of postsurgical prescribing patterns. Little is known about postoperative opioid use in outpatient anorectal procedures. This study evaluated patient opioid use and created prescribing recommendations for these procedures. METHODS One hundred and four patients undergoing outpatient anorectal procedures from January to May 2018 were surveyed on opioid consumption, surgical experience, and pain satisfaction. Patients were grouped into three tiers based on opioid usage. Multivariable models were used to determine factors associated with poor pain control. RESULTS Patient satisfaction with pain control was 85.6%. Twenty five percent of patients reported leftover medication and 9.6% of patients requested opioid refills. Opioid prescribing recommendations were generated for each tier using 50th percentile with interquartile ranges. On multivariable modeling, the high-tier group was associated with poorer pain control. CONCLUSIONS We created opioid quantity prescribing guidelines for common outpatient anorectal procedures. A multimodal approach to pain control utilizing nonopioids may reduce healthcare utilization.
Collapse
Affiliation(s)
- Melissa A Hite
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tonna McCutcheon
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael P Feng
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Molly M Ford
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy M Geiger
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - M Benjamin Hopkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roberta L Muldoon
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea Fa
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander T Hawkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
10
|
Keane OA, Ourshalimian S, Odegard M, Goldstein RY, Andras LM, Kim E, Kelley-Quon LI. Prescription Opioid Use for Adolescents With Neurocognitive Disability Undergoing Surgery: A Pilot Study. J Surg Res 2023; 291:237-244. [PMID: 37478647 PMCID: PMC10578681 DOI: 10.1016/j.jss.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Parents frequently report retaining unused opioid pills following their child's surgery due to fear of untreated postoperative pain. Assessment of pain in adolescents with neurocognitive disability is challenging. We hypothesized that parents of adolescents with neurocognitive disability may report less opioid use and higher opioid pill retention. METHODS Adolescents (13-20 y) undergoing elective surgery (posterior spinal fusion, hip reconstruction, arthroscopy, tonsillectomy) were prospectively enrolled from a tertiary children's hospital from 2019 to 2020. Only adolescents prescribed opioids at discharge were included. Parents completed a preoperative survey collecting sociodemographic characteristics and two postoperative surveys at 30- and 90-d. Neurocognitive disability was determined at time of enrollment by caregiver report, and included adolescents with cerebral palsy, severe autism spectrum disorder, and discrete syndromes with severe neurocognitive disability. RESULTS Of 125 parent-adolescent dyads enrolled, 14 had neurocognitive disability. The median number of opioid pills prescribed at discharge did not differ by neurocognitive disability (29, interquartile range {IQR}: 20.0-33.3 versus 30, IQR: 25.0-40.0, P = 0.180). Parents of both groups reported similar cumulative days of opioid use (7.0, IQR: 3.0-21.0 versus 6.0, IQR:3.0-10.0, P = 0.515) and similar number of opioid pills used (4, IQR: 2.0-4.5 versus 12, IQR: 3.5-22.5, P = 0.083). Parents of both groups reported similar numbers of unused opioid pills (17, IQR: 12.5-22.5 versus 19, IQR: 8.0-29.0, P = 0.905) and rates of retention of unused opioids (15.4% versus 23.8%, P = 0.730). CONCLUSIONS The number of opioid pills prescribed did not differ by neurocognitive disability and parents reported similar opioid use and retention of unused opioid pills. Larger studies are needed to identify opportunities to improve postoperative pain control for children with neurocognitive disability.
Collapse
Affiliation(s)
- Olivia A Keane
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Marjorie Odegard
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rachel Y Goldstein
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Lindsay M Andras
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Eugene Kim
- Division of Pain Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, California
| |
Collapse
|
11
|
Khargi R, Yaghoubian AJ, Blake RM, Ricapito A, Connors C, Gallante B, Khusid JA, Atallah W, Gupta M. Opioid-free percutaneous nephrolithotomy: an initial experience. World J Urol 2023; 41:3113-3119. [PMID: 37733089 DOI: 10.1007/s00345-023-04600-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The opioid epidemic in the United States is an ongoing public health crisis that is in part fueled by excessive prescribing by physicians. Percutaneous nephrolithotomy (PCNL) is a procedure that conventionally involves opioid prescriptions for adequate post-operative pain control. We aimed to evaluate the feasibility of a non-opioid pain regimen by evaluating post-operative outcomes in PCNL patients discharged without opioids. MATERIALS AND METHODS As a quality improvement measure to reduce opioid consumption our department began routinely prescribing oral ketorolac instead of oxycodone-acetaminophen for pain control after PCNL. We retrospectively compared patients undergoing PCNL who had received ketorolac prescriptions (NSAID) to those who received oxycodone-acetaminophen prescriptions (NARC). Demographic, operative, and post-operative factors were obtained and compared in both groups. Peri-operative factors and demographics were compared using either Chi-squared tests, Mann-Whitney U tests. Surgical outcomes were compared between the two groups using Chi-squared tests and Fisher's exact tests. Multivariate logistic regression analysis was performed to determine whether ketorolac use was an independent predictor of post-surgical pain-related encounters. Primary outcome was unplanned pain-related healthcare encounters inclusive of office phone calls, unscheduled office visits, and emergency department (ED) visits. Secondary outcome measures were non-pain-related healthcare encounters, hospital readmissions, pain-related rescue medications prescribed, and post-op complications. RESULTS There were similar demographics and peri-operative characteristics amongst patients in both cohorts. There was no significant difference identified between NSAID and NARC regarding unplanned pain-related encounters (8/70, 11.4% vs. 10/70, 14.3%, p = 0.614). However, NARC experienced more unplanned phone calls (42, 60% vs. 24, 34.3%, p = 0.004). Multivariate analysis revealed only prior stone surgery was predictive of pain-related encounters after PCNL (p = 0.035). CONCLUSION Our results show that there were no significant differences in pain-related encounters between those who received ketorolac and oxycodone-acetaminophen following PCNL. A non-opioid pathway may mitigate the potential risk associated with opioid prescription without compromising analgesia. Prospective comparative studies are warranted to confirm feasibility.
Collapse
Affiliation(s)
- Raymond Khargi
- Department of Urology, Icahn School of Medicine, New York, NY, USA.
| | | | - Ryan M Blake
- Department of Urology, Icahn School of Medicine, New York, NY, USA
| | - Anna Ricapito
- Department of Urology and Kidney Transplant, University of Foggia, Foggia, Italy
| | | | - Blair Gallante
- Department of Urology, Icahn School of Medicine, New York, NY, USA
| | | | - William Atallah
- Department of Urology, Icahn School of Medicine, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine, New York, NY, USA
| |
Collapse
|
12
|
Vinstrup J, Bláfoss R, López-Bueno R, Calatayud J, Villadsen E, Clausen T, Doménech-García V, Andersen LL. Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up. J Pain 2023; 24:1820-1829. [PMID: 37201673 DOI: 10.1016/j.jpain.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.
Collapse
Affiliation(s)
- Jonas Vinstrup
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark
| | - Rúni Bláfoss
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark; Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | - Joaquin Calatayud
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Ebbe Villadsen
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark
| | - Thomas Clausen
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark
| | - Víctor Doménech-García
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Department of Musculoskeletal Disorders, Copenhagen, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
13
|
Kei KF, Chen C, Kang YN. Further Studies are Still Needed to Test Whether Fat Grafting Reduce Postmastectomy Pain. Aesthetic Plast Surg 2023; 47:2199-2202. [PMID: 37202482 DOI: 10.1007/s00266-023-03351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND To test the effects of autologous fat grafting for reducing postmastectomy pain is important since post-operative pain bothers many patients with postmastectomy pain syndrome (PMPS), and one session autologous fat grafting for this condition is also investigated in some studies. Most of them show the positive effect on pain control, but the most recent randomized controlled trial (RCT) does not. The relatively small sample size with incomplete follow-up in the RCT might limit the certainty of evidence, and cases for the final analysis is lesser than expected numbers by sample size determination. Besides, there is no futility analysis to show the non-significant finding could be conclusive evidence. To check the conclusiveness of comparative evidence on this topic becomes a critical task for guiding clinicians and further studies in the future, therefore the purpose of this letter is to test whether evidence on fat grafting for alleviating pain amongst patients with PMPS is conclusive using sequential analysis. METHODS This supplementary analysis used the data from the comparative evidence on fat grafting for PMPS based on the most recent RCT and previous systematic reviews. Complete data of pain score of two comparative studies from Italy were presented in a pooled report, therefore, this letter used data of pooled report for the Italy studies. Pooled mean difference (MD) in pain score between fat grafting and control groups was based on random-effects model. Quantitative synthesis consisted of cumulative meta-analysis and leave-one out sensitivity analysis due to heterogeneity from clinical setting across the included studies. Then, sequential analysis was further done with a conservative effect size (standardized mean difference = 0.2), type I error (α = 0.05), and power of 0.80 based on O'Brien Flemming method. All analyses were carried out using R version 4.1 via RStudio for Microsoft Windows. RESULTS Sequential analysis exhibited a non-significant and inconclusive evidence on fat grafting for pain control in PMPS if this synthesis included the newest RCT. Although the pooled result with unmet expectation of z-score in sequential analysis, it might not fall in futility. If the newest RCT was removed from the synthesis, sequential analysis showed significant but inconclusive evidence on fat grafting for pain control in PMPS. CONCLUSION There is no conclusive evidence to support or refuse the use of fat grafting in postmastectomy pain control. This topic is worthy of further studies in investigating the effects of fat grafting on pain control amongst patients with PMPS. LEVEL OF EVIDENCE V This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Kin Fung Kei
- Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, 111, Sec. 3, Xinglong Rd., Taipei, 11696, Taiwan.
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
14
|
Katou R, Mano T, Masuda T. Serratus anterior fascia plane block for pain control in patients with multiple rib fractures. J Phys Ther Sci 2023; 35:673-677. [PMID: 37670765 PMCID: PMC10475645 DOI: 10.1589/jpts.35.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/09/2023] [Indexed: 09/07/2023] Open
Abstract
[Purpose] Respiratory physiotherapy plays an important role in the management of acute respiratory disturbance; however, chest pain often impedes patients from performing respiratory physiotherapy. In this study, we investigated whether pain due to multiple rib fractures can be managed with intermittent serratus anterior fascia plane (SAP) block. [Participants and Methods] We performed intermittent SAP blocks in three consecutive patients with pain due to multiple rib fractures based on the level of pain. The level of pain and differences in expiratory/inspiratory chest expansion were evaluated before and after performing the SAP block. [Results] All three patients reported an improvement in the severity of pain and increase in the thoracic range of motion after receiving the SAP block. No adverse events associated with intermittent SAP blocks were observed in any of the patients. [Conclusion] We report the cases of three patients who completed respiratory physiotherapy after receiving intermittent SAP blocks for the management of pain due to multiple rib fractures. SAP blocks are associated with a low risk of complications as the ribs are not punctured while performing SAP blocks.
Collapse
Affiliation(s)
- Ryota Katou
- Department of Rehabilitation Medicine, Nara Prefecture
General Medical Center, Japan
| | - Tomoo Mano
- Department of Rehabilitation Medicine, Nara Prefecture
General Medical Center, Japan
- Department of Neurology, Nara Medical University: 840
Shijo-cho, Kashihara, Nara 634–8521, Japan
| | - Takashi Masuda
- Department of Rehabilitation Medicine, Nara Prefecture
General Medical Center, Japan
| |
Collapse
|
15
|
Pirie KP, Wang A, Yu J, Teng B, Doane MA, Myles PS, Riedel B. Postoperative analgesia for upper gastrointestinal surgery: a retrospective cohort analysis. Perioper Med (Lond) 2023; 12:40. [PMID: 37464387 DOI: 10.1186/s13741-023-00324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Thoracic epidural analgesia is commonly used for upper gastrointestinal surgery. Intrathecal morphine is an appealing opioid-sparing non-epidural analgesic option, especially for laparoscopic gastrointestinal surgery. METHODS Following ethics committee approval, we extracted data from the electronic medical records of patients at Royal North Shore Hospital (Sydney, Australia) that had upper gastrointestinal surgery between November 2015 and October 2020. Postoperative morphine consumption and pain scores were modelled with a Bayesian mixed effect model. RESULTS A total of 427 patients were identified who underwent open (n = 300), laparoscopic (n = 120) or laparoscopic converted to open (n = 7) upper gastrointestinal surgery. The majority of patients undergoing open surgery received a neuraxial technique (thoracic epidural [58%, n = 174]; intrathecal morphine [21%, n = 63]) compared to a minority in laparoscopic approaches (thoracic epidural [3%, n = 4]; intrathecal morphine [12%, n = 14]). Intrathecal morphine was superior over non-neuraxial analgesia in terms of lower median oral morphine equivalent consumption and higher probability of adequate pain control; however, this effect was not sustained beyond postoperative day 2. Thoracic epidural analgesia was superior to both intrathecal and non-neuraxial analgesia options for both primary outcomes, but at the expense of higher rates of postoperative hypotension (60%, n = 113) and substantial technique failure rates (32%). CONCLUSIONS We found that thoracic epidural analgesia was superior to intrathecal morphine, and intrathecal morphine was superior to non-neuraxial analgesia, in terms of reduced postoperative morphine requirements and the probability of adequate pain control in patients who underwent upper gastrointestinal surgery. However, the benefits of thoracic epidural analgesia and intrathecal morphine were not sustained across all time periods regarding control of pain. The study is limited by its retrospective design, heterogenous group of upper gastrointestinal surgeries and confounding by indication.
Collapse
Affiliation(s)
- Katrina P Pirie
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia.
- Central Clinical School, Monash University, Melbourne, Australia.
| | - Andy Wang
- Sydney Medical School (Northern), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
- Chris O'Brien Lifehouse, Sydney, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Joanna Yu
- Department of Anaesthesia and Perioperative Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Bao Teng
- Department of Anaesthesia and Perioperative Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Matthew A Doane
- Sydney Medical School (Northern), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Anaesthesia and Perioperative Medicine, Royal North Shore Hospital, Sydney, Australia
- Kolling Research Institute, Sydney, Australia
- Northern Sydney Anaesthesia Research Institute, Sydney, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia
| |
Collapse
|
16
|
Castle JP, Jildeh TR, Abbas MJ, Hennekes ME, Buckley PJ, Shabet CL, Cotter DL, Moutzouros V. Patient factors influencing the choice of opioid versus non-opioid postoperative analgesia following common sports procedures: a prospective survey study. J Orthop 2023; 40:1-6. [PMID: 37124142 PMCID: PMC10130914 DOI: 10.1016/j.jor.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose Despite established opioid-free protocols for postoperative analgesia after common orthopaedic sports procedures, many patients continue to request opioids postoperatively. The purpose of this study was to elucidate patient factors influencing preferences for opioid versus nonopioid postoperative analgesia. Methods Patients (age >/ = 15) without a history of a documented chronic pain disorder who were scheduled for one of ten sports procedure types from August 2020 to May 2021 were eligible for inclusion. Patients were excluded if undergoing revision surgery, had concomitant injuries, had opioids use >3 months preoperatively, or unable to read English. Recruitment ended after 100 patients enrolled. At the patients' preoperative visit, patients were administered a written survey assessing pain medication preferences. Participants completed the Opioid Risk Tool survey, as well as Visual Analog Scale and Patient-Reported Outcome Measurement Information System surveys. Results One hundred patients participated in the study. Forty-two patients preferred opioids versus 58 patients preferring nonopioid postoperative analgesia. Patients preferring opiates were more likely to have had previous surgery (90.2% vs. 69.6%, p = 0.023) with post-operative pain managed with opiates (87.5% vs 55.4%, p = 0.003), higher preoperative Visual Analog Scale score (6±3.5 vs. 3±2, p < 0.001), reported post-operative pain as a reason for opioids preference (88.1% vs 20.0%, p < 0.001), and were less concerned about addiction (4.8% vs. 45.5%, p < 0.001) and side effects (11.9% vs. 52.7%, p < 0.001). For every unit increase in Visual Analog Scale score, the odds of preferring opioid pain control increased 1.41 times. Conclusions Patients with a history of prior surgery utilizing opioid pain control, higher Visual Analog Scale scores preoperatively, and concern for inadequately managed postoperative pain were more likely to prefer opioid pain control following common orthopaedic sports procedures. Patients may benefit from increased preoperative education about opioid risks and the role of multimodal pain management regimens.
Collapse
Affiliation(s)
- Joshua P. Castle
- Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
- Corresponding author.
| | - Toufic R. Jildeh
- Michigan State University College of Human Medicine, 4660 Hagadorn Rd Suite 420, East Lansing, MI, 48823, USA
| | | | | | | | - Christina L. Shabet
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 40109, USA
| | - Daniel L. Cotter
- Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA
| | | |
Collapse
|
17
|
Silver J, Pavano C, Bellas N, Hewitt C, Torre B, Solomito M, Kostyun R, Esmende S. Cannabis use is associated with decreased opioid prescription fulfillment following single level anterior cervical discectomy and fusion (ACDF). N Am Spine Soc J 2023; 14:100226. [PMID: 37440986 PMCID: PMC10333711 DOI: 10.1016/j.xnsj.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 07/15/2023]
Abstract
Background Recently, there has been increasing legalization of marijuana within the United States, however data are mixed with respect to its efficacy in treating acute pain. Our goal was to identify a difference in opioid utilization in patients with known cannabis use before anterior cervical discectomy and fusion (ACDF) compared with those that report no cannabis use. Methods This study was a retrospective case-control design using PearlDiver. Patients who underwent a single level ACDF between January 2010 and October 2020, were included. Patients were placed in the study group if they had a previous diagnosis of cannabis use, dependence, or abuse. Patients were excluded if they were under the age of 18 or if they had filled an opioid prescription within 3 months of their procedure. A control group was then created using a propensity score match on age, gender, and Charleston comorbidity index (CCI), and had no diagnosis of cannabis use. The primary outcome was the number of morphine milliequivalents (MME) dispensed per prescription following surgery. Results A total of 1,339 patients were included in each group. The number of patients filling prescriptions was lower in the cannabis group than in the control group at 3 days postoperatively (p<.001). The average total MME per day as prescribed was lower in the cannabis group than the control group at 60 days post-op (48.5 vs. 59.4, respectively; p=.018). Conclusions Patients who had a previous diagnosis of cannabis use, dependence or abuse filled fewer opioid prescriptions postoperatively (at 3 days postoperatively) and required lower doses (reduced average daily MME, at 60 days postoperatively) when compared with the control group.
Collapse
Affiliation(s)
- Jacob Silver
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Colin Pavano
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Nicholas Bellas
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Cory Hewitt
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | - Barrett Torre
- UConn Health Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States
| | | | - Regina Kostyun
- Hartford Hospital, Bone and Joint Institute, Hartford, CT
| | - Sean Esmende
- Hartford Hospital, Bone and Joint Institute, Hartford, CT
| |
Collapse
|
18
|
Forni M, Thorbergsson PT, Gällentoft L, Thelin J, Schouenborg J. Sustained and potent analgesia with negligible side effects enabled by adaptive individualized granular stimulation in rat brainstem. J Neural Eng 2023; 20. [PMID: 37160125 DOI: 10.1088/1741-2552/acd3b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/09/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To clarify if an adaptive current stimulation protocol, in which current amplitude is modulated during continuous stimulation, provides better efficacy than constant current stimulation protocol with respect to analgesia caused by individualized stimulation in rat periaqueductal gray matter (PAG)/dorsal raphe nuclei (DRN). 
Approach. Ultrathin microelectrodes adapted for recording (n=6) and stimulation (n=16) were implanted in rat primary somatosensory cortex and PAG/DRN, respectively. In each animal included (n=12), a subset of PAG/DRN microelectrodes (n=1-3 per animal) was selected that on simultaneous stimulation blocked nociceptive withdrawal reflexes in awake unrestrained animals without noticeable side effects. Analgesic effects were subsequently assessed from both nociceptive withdrawal reflexes and intracortical pain-related responses on CO2 laser hindpaw stimulation. The analgesic effects of adaptive current PAG/DRN stimulation comprising incremental increases of 5µA/microelectrode (initial median current 30µA/microelectrode) when effects declined were compared to the effects of constant current stimulation. Behavioral effects and brain state related changes were analyzed using quantitative movement analysis and electrocorticography (ECoG, recorded on top of the dura mater), respectively. Tissue reactions and probe placement in PAG/DRN were assessed with immunohistochemistry.
Main results. Powerful and sustained (4 hours) analgesia was achieved with the adaptive current protocol within a rather wide area of PAG/DRN. Analgesic after-effects were seen for up to 30 min. Behavioral and brain state related side effects were minimal. Moreover, 6 weeks after implantation, there were no traces of bleedings, only small glial reactions and small but not statistically significant loss of neurons nearby indicating that the 6 microelectrode stimulation employed is biocompatible. 
Significance. The results indicate that sustained and powerful analgesia with minimal side effects can be achieved by granular and individualized stimulation in PAG/DRN using an adaptive current stimulation protocol. This microelectrode technology and stimulation 10 paradigm thus has the potential of providing a highly efficient and safe pain therapy.
Collapse
Affiliation(s)
- Matilde Forni
- Experimental medical sciences, Lund University, Medicon Village, House 404, Scheelevagen 8, Lund, 22381, SWEDEN
| | | | - Lina Gällentoft
- Lund University, Medicon Village, House 404, Scheelevägen 8, Lund, 22381, SWEDEN
| | - Jonas Thelin
- Lund University, Medicon Village, House 404, Scheelevägen 8, Lund, 22381, SWEDEN
| | - Jens Schouenborg
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, Medicon Village, House 404A2, Scheelevägen 8, Lund, 22381, SWEDEN
| |
Collapse
|
19
|
Ribeiro ACS, Taira AR, Santos VC, Brair VL, Lopes MPF, Balaro MFA, Souza-Fabjan JMG, da Fonseca JF, Ungerfeld R, Brandão FZ. Use of meloxicam with or without dipyrone in non-surgical embryo recovery in hair sheep: effects on animal welfare. Reprod Domest Anim 2023. [PMID: 37151194 DOI: 10.1111/rda.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/09/2023]
Abstract
The aim of this study was to determine the effectiveness of meloxicam with or without dipyrone on the welfare of ewes subjected to non-surgical embryo recovery (NSER). Two studies were carried out using 51 multiparous Santa Inês ewes. All animals received a standard estrous synchronization treatment and a superovulatory protocol. In Study 1, 12 ewes received meloxicam (GM) before cervical transposition (1 mg.kg-1 , i.v.), repeated 24 h after (1 mg.kg-1 , i.m.), while the other 10 received a saline solution, remaining as a control group (GC1). In Study 2, ewes were allocated into a group of 15 ewes treated as GM of Study 1 associated with dipyrone (GMD; 50 mg.kg-1 , i.m.) before cervical transposition, 12 h, and 24 h after, or a control group (GC2) of 14 ewes treated with saline solution. In both studies, heart, and respiratory rates (RR), cortisol, glucose, total proteins, albumin, and globulins blood concentration were recorded before sedation (BS), after sedation (AS), after cervical transposition, immediately after collection (IAC), and 0.5, 1.5, 3, 6, 12, 24, and 48 h after embryo collection (hAC). In Study 1, RR tended to be greater in GC1 (P=0.08), serum total proteins and globulins values were lower and serum albumin values were greater in this group than GM (P=0.003, P<0.0001, and P<0.0001, respectively). In Study 2, treatment of GMD tended to reduce the glycemia at AS (P=0.052) and reduced it at 3hAC (P<0.0001), and 6hAC (P=0.03). It also tended to reduce cortisol concentrations (P=0.10). The other variables varied with NSER without interaction with the experimental treatments. In conclusion, in this study condition, NSER in sheep induced transient changes indicative of stress and possibly pain, therefore, affecting animal welfare. The administration of meloxicam was ineffective to reduce those responses, and the association of dipyrone had only slight effects without modifying the main welfare indicative responses in ewes subjected to NSER.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Rodolfo Ungerfeld
- Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | | |
Collapse
|
20
|
Ghasemi S, Bakhtiari F, Rahimi Asl P, Babaloo A, Ghasemi A. Evaluation of the effect of Echium amoenum on pain control after clinical crown lengthening surgery. J Adv Periodontol Implant Dent 2023; 15:56-59. [PMID: 37645557 PMCID: PMC10460778 DOI: 10.34172/japid.2023.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 04/13/2023] [Indexed: 08/31/2023]
Abstract
Background Pain after periodontal surgeries is one of the most common complications. Echium amoenum is among the important therapeutic herbs in Iranian traditional medicine. Various studies have shown its pain control properties. This study aimed to evaluate this herb's efficacy in controlling pain after periodontal surgeries. Methods In this randomized clinical trial, 50 patients referred to Tabriz Dental School for clinical crown lengthening surgery were divided into two equal groups: control and test. In the test group (using E. amoenum), 24 hours before surgery, E. amoenum was administered to the patient at home every 12 hours, and a dose of E. amoenum was administered one hour before the procedure. The postoperative pain was assessed using VAS 30 minutes, 1 hour, and 3 hours after the surgery and verbal rating scale (VRS) 24, 48, and 72 hours postoperatively. A chi-square test was used to compare the pain severity between the two groups. Results The VAS index was significantly lower in the E. amoenum group compared to the control group (30 minutes, 1 hour, and 3 hours after the procedure) (P<0.05). In both groups, pain severity increased significantly up to 3 hours postoperatively (P<0.05). In the first 24 hours, the VRS index of the E. amoenum group was significantly lower than that of the control group (P<0.05), with no significant differences between the two groups at 48 and 72 hours (P>0.05). Conclusion The E. amoenum herb reduced the pain severity after clinical crown lengthening surgeries.
Collapse
Affiliation(s)
- Shima Ghasemi
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Fatemeh Bakhtiari
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Pariya Rahimi Asl
- Student Research Committee, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Amirreza Babaloo
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Atieh Ghasemi
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
21
|
Sulistio M, Ling N, Finkelstein T, Tee HJ, Gorelik A, Kissane D, Michael N. The Edmonton Classification System for Cancer Pain in Patients with Bone Metastasis: a descriptive cohort study. Support Care Cancer 2023; 31:305. [PMID: 37106261 PMCID: PMC10140090 DOI: 10.1007/s00520-023-07711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE We describe the prevalence of the Edmonton Classification System for Cancer Pain (ECS-CP) features in patients with bone metastasis and cancer-induced bone pain (CIBP) and the relationship between ECS-CP features, pain intensity, and opioid consumption. METHODS We assessed ECS-CP features and recoded pain mechanisms and opioid use in adult patients with bone metastasis. Validated measures were used to assess pain intensity, incident pain, psychological distress, addictive behavior, and cognition. RESULTS Among 147 eligible patients, 95.2% completed the assessment. Mean participant age was 73.2 years, the majority female (52.1%) with breast cancer occurring most commonly (25.7%). One or more ECS-CP features were present in 96.4% and CIBP in 75.7% of patients. The median average and worst pain scores were 3 and 6, respectively. Neuropathic pain was the most prevalent pain mechanism (45.0%) and was associated with breakthrough pain frequency (p=0.014). Three-quarters had incident pain, which was strongly associated with a higher average and worst pain scores (3.5 and 7, p<0.001 for both), background oral morphine equivalent daily dose (26.7mg, p=0.005), and frequency of daily breakthrough analgesia (1.7 doses/day, p=0.007). Psychological distress (n=90, 64.3%) was associated with a significantly higher average pain score (4, p=0.009) and a slightly higher worst pain score (7, p=0.054). Addictive behaviour and cognitive dysfunction were relatively uncommon (18.6% and 12.9%, respectively). CONCLUSION There is a need to promote standardized assessment and classification of pain syndromes such as CIBP. The ECS-CP may allow us to consider CIBP in a systematic manner and develop personalized pain interventions appropriate to the pain profile. TRIAL REGISTRATION Retrospectively registered in ANZCTR ACTRN12622000853741 (16/06/2022).
Collapse
Affiliation(s)
- Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia.
| | - Natalie Ling
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Tara Finkelstein
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hoong Jiun Tee
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
| | - Alexandra Gorelik
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
- Sacred Heart Health Service, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 181-183 Wattletree Rd, Mlavern, VIC, 3144, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia Sydney, Sydney, NSW, Australia
| |
Collapse
|
22
|
La Rosa GRM, Marcianò A, Priolo CY, Peditto M, Pedullà E, Bianchi A. Effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis: a scoping review. Clin Oral Investig 2023:10.1007/s00784-023-05012-3. [PMID: 37014504 DOI: 10.1007/s00784-023-05012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The aim of this scoping review was to determine the effectiveness of the platelet-rich fibrin in the control of pain associated with alveolar osteitis. MATERIALS AND METHODS Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A literature search was conducted in the PubMed and Scopus databases to identify all clinical studies on the application of platelet-rich fibrin in the control of pain caused by alveolar osteitis. Data were extracted independently by two reviewers and qualitatively described. RESULTS The initial search returned 81 articles, with 49 identified after duplicates removal; of these, 8 were selected according to the inclusion criteria. Three of the eight studies were randomized controlled clinical trials, and four were non-randomized clinical studies, two of which were controlled. One study was case series. In all of these studies, pain control was evaluated using the visual analog scale. Overall, the use of platelet-rich fibrin resulted effective in the control of pain determined by alveolar osteitis. CONCLUSIONS Within the limits of this scoping review, the application of platelet-rich fibrin in the post-extra-extraction alveolus reduced the pain associated with alveolar osteitis in almost all the included studies. Nevertheless, high-quality randomized trials with adequate sample size are warranted to draw firm conclusions. CLINICAL RELEVANCE Pain associated with alveolar osteitis causes discomfort to the patient and is challenging to be treated. Use of platelet-rich fibrin could be a promising clinical strategy for pain control in alveolar osteitis if its effectiveness will be confirmed by further high-quality studies.
Collapse
Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Antonia Marcianò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlotta Ylenia Priolo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Matteo Peditto
- Postgraduate School of Oral Surgery, Department of Biomedical, Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Alberto Bianchi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
23
|
Al-Saati MF, Alaqaili SI, Alshammari FA, ElRaei MAN, Albaiz AA, Tushinski D, Al-Mohrej OA. The efficacy and safety of subcutaneous continuous local infiltration analgesia with ropivacaine in patients undergoing total knee arthroplasty: a comparative study. BMC Musculoskelet Disord 2023; 24:214. [PMID: 36949441 PMCID: PMC10032015 DOI: 10.1186/s12891-023-06263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/22/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Continuous local infiltration analgesia (CLIA) can be administered via intraarticular or periarticular techniques in patients undergoing total knee arthroplasty (TKA). The purpose of this investigation was to retrospectively report a single-center experience of epidural analgesia with subcutaneous CLIA versus epidural analgesia without CLIA among patients undergoing TKA. METHODS This single-center retrospective study was conducted in Saudi Arabia. From January 01, 2014, to December 30, 2020, medical records of all patients who underwent TKA were reviewed. Patients who received subcutaneous CLIA with epidural analgesia were assigned to the intervention group, whereas those who received epidural analgesia without subcutaneous CLIA were assigned to the control group. The efficacy endpoints included: (i) postoperative pain scores at 24 h, 48 h, 72 h, and 3 months; (ii) postoperative opioid consumption at 24 h, 48 h, 72 h, and 24-72 h (cumulative); (iii) length of hospital stay; and (iv) postoperative functional recovery of the knee 3 months post-operation, according to the Knee Injury and Osteoarthritis Outcome Score. RESULTS At rest and during mobilization, the CLIA group (n = 28) achieved significantly lower postoperative pain scores 24 h, 48 h, 72 h, and 3 months post-operation than the non-CLIA group (n = 35). Subgroup analysis revealed that the CLIA group achieved significantly less opioid consumption 24 h and 48 h post-operation than the non-CLIA group. There was no difference between the groups regarding the length of hospital stay or functional scores 3 months post-operation. There was no significant difference between the groups regarding the rate of wound infection, other infections, and readmission within 30 days. CONCLUSION Subcutaneous CLIA is a technically feasible and safe procedure without major adverse events but with reduced postoperative pain scores (at rest and during mobilization) and opioid consumption. Additional larger studies are warranted to confirm our results. Moreover, a head-to-head comparison between subcutaneous CLIA and periarticular or intraarticular CLIA is an interesting prospective investigation.
Collapse
Affiliation(s)
- Maad F Al-Saati
- Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Sadiq I Alaqaili
- Department of Orthopedic Surgery, Dammam Medical Complex, Dammam, Saudi Arabia
| | - Farah A Alshammari
- College of Medicine, Princess Nourah Bint Andulrahman University, Riyadh, Saudi Arabia
| | - Mohamed A N ElRaei
- Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Alia A Albaiz
- Department of Epidemiology and Biostatistics, Health Science Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Daniel Tushinski
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Omar A Al-Mohrej
- Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
24
|
Sharma A, Sharma R, Sharma M, Panadan JJ, Ansari MA, Dalai S. Comparative evaluation of effect of different premedication agents on efficacy of Articaine: A randomized contol trial. J Oral Biol Craniofac Res 2023; 13:218-223. [PMID: 36741857 PMCID: PMC9894783 DOI: 10.1016/j.jobcr.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/18/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Type of study Original Research. Aims To comparatively evaluate the effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis. Materials and methods The primary objective of our study is to evaluate the effect of premedication agents on efficacy of Articaine as an oral anesthetic. Our secondary objective is to comparatively evaluate the efficacy of Diclofenac patch, Ibuprofen tablet, Paracetamol tablet and Placebo as a premedication agent. Patients with 25-40 years age, no systemic disease, no history of medication for that complaint, with pain on Heft Parker Visual Analog Scale between 55 mm and 170 mm (VAS), no tenderness on percussion, cold test and EPT negative- Positive, giving proper consent, coming to the Department of Conservative Dentistry and Endodontics were allowed to participate. The exclusion criteria include the following- Non-vital teeth, pregnant and lactating women, allergic to Articaine and NSAIDs, active systemic disease, immune-compromised patients, taken analgesics in last 24 h, root fractures, restoration extending to pulp10 and periapical pathologies (except periodontal ligament widening).Preoperatively pain was recorded using Heft Parker VAS (Visual Analog Scale). Cold testing, palpation, percussion and EPT were carried out. 40 patients having symptomatic irreversible pulpitis were randomly divided into 4 groups: group 1 Placebo (n = 10), group 2-Diclofenac patch (n = 10), group-3 Ibuprofen tablets (n = 10), group 4-Paracetamol tablets (n = 10). After 1 h of premedication, all patients were administered IANB injection using 4% Articaine (Septanest with adrenaline 1/100000, Septodont, France) containing epinephrine 1:100000. 15 mins after administration of IANB, patients were asked about symptomatic numbness and was tested with Endo frost and EPT and Outcome was recorded. If lip numbness was present, Electric Pulp Testing and Cold Test give negative result then endodontic access opening was performed and pain was recorded using visual analog scale. The study was conducted for a period of 1.5 years. Results During the access cavity preparation only 1 subject in the Group III reported pain while in other groups none of the subjects reported pain of any type. When the intergroup comparison was made of intensity of pain 15 min after LA and during access cavity preparation, the difference between the groups was statistically non-significant when analyzed using One Way ANOVA. The intragroup comparison between three time intervals revealed significant reduction in the pain scores from the pre-treatment levels in all the four groups. Conclusions The results of the study showed that there is no significant effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis.
Collapse
Affiliation(s)
- Anjali Sharma
- Department of Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
| | - Rohit Sharma
- Department of Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
| | - Madhurima Sharma
- Department of Prosthodontics and crown and bridge, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
| | - John Johnson Panadan
- Department of Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
| | - M Abbas Ansari
- Department of Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
| | - Sasmita Dalai
- Department of Conservative Dentistry and Endodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
- Department of Public Health Detistry, India
| |
Collapse
|
25
|
He D, Li Y, Wang Y. Pregabalin supplementation for the pain relief of septorhinoplasty: a meta-analysis study. Eur Arch Otorhinolaryngol 2023; 280:1201-1207. [PMID: 36048296 DOI: 10.1007/s00405-022-07602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pregabalin supplementation may have some potential in improving pain relief in patients with septorhinoplasty, and this meta-analysis aims to explore the impact of pregabalin supplementation on pain control for septorhinoplasty. METHODS PubMed, EMbase, Web of science, EBSCO and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of pregabalin supplementation on pain control for septorhinoplasty. RESULTS Six RCTs were finally included in the meta-analysis. Overall, when compared with control intervention for septorhinoplasty, pregabalin intervention showed significantly reduced pain scores at 1 h (SMD - 1.05; 95% CI - 1.85 to - 0.24; P = 0.01), 2 h (SMD - 1.01; 95% CI - 1.83 to - 0.20; P = 0.02), 6 h (SMD - 1.00; 95% CI - 1.47 to - 0.54; P < 0.0001) and 12 h (SMD - 0.69; 95% CI - 1.35 to - 0.02; P = 0.04), as well as rescue analgesics (OR 0.17; 95% CI 0.07 to 0.44; P = 0.0002), but had no notable influence on nausea and vomiting (OR 0.67; 95% CI 0.30 to 1.46; P = 0.31), or drowsiness (OR 1.22; 95% CI 0.64 to 2.35; P = 0.54). CONCLUSIONS Pregabalin supplementation benefits to pain control after septorhinoplasty.
Collapse
Affiliation(s)
- Dongsheng He
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
| | - Ying Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Yan Wang
- Department of Anesthesiology, First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
| |
Collapse
|
26
|
Abdildin Y, Tapinova K, Nugumanova M, Viderman D. Transversus abdominis plane block in adult open liver surgery patients: A systematic review with meta-analysis of randomized controlled trials. J Visc Surg 2023:S1878-7886(22)00174-6. [PMID: 36775697 DOI: 10.1016/j.jviscsurg.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIM OF THE STUDY The objective of this meta-analysis is to evaluate the efficacy of Transversus Abdominis Plane Block (TAPB) in pain control and recovery after open hepatic surgery. METHODS We searched for the articles in PubMed, Google Scholar, and the Cochrane Library published before March 2022. We included randomized controlled trials (RCTs) comparing TAPB with a placebo in adult patients after open liver surgery. Meta-analysis was conducted in RevMan 5.4. Methodological quality was assessed via the Jadad/Oxford scale and Cochrane Risk of Bias tool. RESULTS Five RCTs with 347 patients were included. All studies had an acceptable Jadad score or higher. For pain at rest at 24hours postoperatively, the standardized mean difference (SMD) with a 95% confidence interval (CI) was -1.08 [-1.97, -0.18], P-value 0.02, favoring TAPB. Models for total opioid consumption, nausea and vomiting, and duration of hospital stay did not demonstrate a difference between the groups. The model for time to first flatus favored TAPB with SMD with a 95% CI of -1.48 [-2.72, -0.24], P-value 0.02. DISCUSSION Our meta-analysis of five RCTs favored TAPB regarding pain control at rest and time to first flatus. Due to the small sample size and considerable heterogeneity, more RCTs are needed. REGISTRATION NUMBER CRD42022320565.
Collapse
Affiliation(s)
- Y Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Avenue, Astana, 010000, Kazakhstan.
| | - K Tapinova
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, 5/1 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan.
| | - M Nugumanova
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Avenue, Astana, 010000, Kazakhstan.
| | - D Viderman
- Nazarbayev University School of Medicine (NUSOM), Department of Biomedical Sciences, 5/1 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan; Department of Anesthesiology, Intensive Care and Pain Medicine, National Research Oncology Center, 3 Kerey and Zhanibek Khans Street, Astana, 020000, Kazakhstan.
| |
Collapse
|
27
|
Leyda-Menéndez AM, Vidigal EA, Abanto J, Ribelles-Llop M. Efficacy of two behavioural management techniques during inferior alveolar nerve block administration in pre-school children: a randomised clinical trial. Eur Arch Paediatr Dent 2023; 24:85-93. [PMID: 36260279 DOI: 10.1007/s40368-022-00758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate and compare the efficacy of the hands-eyes-mouth distraction technique (HEM-DT) in reducing anxiety and pain levels and improving the behaviour of pre-school children during inferior alveolar nerve block (IANB) administration to that of the covering patient's vision technique (CPV-T). METHODS This study included 52 children aged 3-5 years old with primary dentition, no history of receiving local anaesthesia, and whose treatments required an IANB. These children were randomly assigned into two groups: HEM-DT (G1; n = 26) and CPV-T (G2; n = 26). Anxiety and pain levels were assessed using the Facial Image Scale and the Wong-Baker Scale, respectively, while the patient's behaviour was evaluated using the Frankl Behaviour Scale. This study was divided into two sessions including the treatment session (administration of IANB) and the control session (7 days after anaesthesia). Chi-square test, the Mann-Whitney U test and Wilcoxon test were used for statistical analyses. RESULTS The patients' anxiety levels did not increase 7 days after IANB in G1 (p value = 0.798); however, higher anxiety levels were observed in the G2 group (p value = 0.039). No significant differences in pain levels and behaviour were observed between the groups during administration of anaesthesia (p value > 0.005). CONCLUSION HEM-DT and CPV-T showed efficacy in terms of pain and behaviour during IANB administration. Pre-school children in the HEM-DT group exhibited lower anxiety levels in the control session. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION ClinicalTrials.gov (NCT02591797). October 28, 2015.
Collapse
Affiliation(s)
- A M Leyda-Menéndez
- Department of Dentistry, Faculty of Health Sciences, CEU-Cardenal Herrera University, Valencia, Spain.
| | - E A Vidigal
- Division of Pediatric Dentistry, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - J Abanto
- Department of Pediatric Dentistry, Faculty of Dentistry, International University of Catalunya, Barcelona, Spain
| | - M Ribelles-Llop
- Department of Dentistry, Faculty of Health Sciences, CEU-Cardenal Herrera University, Valencia, Spain
| |
Collapse
|
28
|
Lung BE, Le R, McLellan M, Callan K, Donnelly M, Yi J, Birring P, McMaster WC, Yang S, So DH. Repeat High-Dose Dexamethasone May Improve Recovery 48 Hours after Total Hip Arthroplasty. Arch Bone Jt Surg 2023; 11:188-196. [PMID: 37168585 PMCID: PMC10165209 DOI: 10.22038/abjs.2022.65130.3124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/21/2022] [Indexed: 05/13/2023]
Abstract
Objectives Perioperative dexamethasone is an effective anti-emetic and systemic analgesic in total hip arthroplasty (THA) that may reduce opioid consumption and enhance rapid recovery. However, there is no consensus on the optimal perioperative dosing that is safe and effective for faster rehabilitation and improved pain control while maintaining safe blood glucose levels. Methods A retrospective review of 101 primary THA patients at a single institution who received perioperative dexamethasone was conducted. Patients were stratified by dexamethasone induction dosage (10 mg as high, <6mg as low) and whether a repeat dose was given 16-24 hours postoperatively. Age, gender, BMI, diabetes status, and ASA were controlled between groups. The pain was evaluated with inpatient morphine milligram equivalents (MME) requirements and visual analog scale (VAS) at 8, 16, and 24 hours postoperatively. Mobility was assessed by inpatient ambulation distance, Boston AM-PAC mobility score, and percentage of gait assistance as determined by a physical therapist. Secondary outcomes included postoperative nausea and vomiting (PONV) limiting therapy sessions, PONV requiring breakthrough anti-emetics, glucose levels, surgical site infection, wound healing complications, and discharge destination. Results Compared to patients receiving one dose of high or low dexamethasone, patients receiving two dosages of high-dose dexamethasone had significantly further ambulation distance and lower percentage of gait assistance on postoperative day 2. A generalized linear model also predicted that any repeat dexamethasone, regardless of dosage, significantly improved ambulation distance and gait assistance compared to the one-dose cohort. There was no statistically significant difference between VAS scores, MME requirements, PONV, postoperative glucose levels >200, discharge destination, or risk of infection between groups. Conclusion A repeat high-dose dexamethasone, the morning after surgery, may improve percentage of gait assistance and ambulation endurance on postoperative day two. There was no risk of uncontrolled glucose levels or infections compared to receiving one dose of dexamethasone at induction.
Collapse
Affiliation(s)
- Brandon E. Lung
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Ryan Le
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Maddison McLellan
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Kylie Callan
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Megan Donnelly
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Justin Yi
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Paramveer Birring
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - William C. McMaster
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - Steven Yang
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| | - David H. So
- University of California, Irvine Department of Orthopedic Surgery, Orange, CA; USA
| |
Collapse
|
29
|
Steffen DA, Najafi A, Binkert CA. Postinterventional Patient Comfort After Uterine Artery Embolization and Superior Hypogastric Nerve Block. Cardiovasc Intervent Radiol 2023; 46:152-157. [PMID: 36352125 DOI: 10.1007/s00270-022-03290-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the duration and effect of superior hypogastric nerve block (SHNB) with ropivacaine and clonidine on postinterventional pain levels and opioid requirements in patients undergoing uterine artery embolization. MATERIALS AND METHODS Postinterventional pain levels (numeric rating scale, NRS 0-10) and opioid doses were retrospectively analyzed in 53 patients undergoing transfemoral uterine artery embolization and intraprocedural superior hypogastric nerve block during 24 h. A mixture of 150 mg of ropivacaine and 150 µg of clonidine was used for the block. RESULTS Postinterventional pain averaged between 1.4 and 2.0 during the first 9 h, after which a small but significant increase was observed (NRS 1.7 ± 1.6 vs. NRS 2.6 ± 2.2, p < 0.001). 70% of patients did not exceed a tolerable pain threshold of NRS 4 during the first 9 h after the intervention. Thirty-three patients (62%) did not require any opioid medication. Mean iv morphine dose was 3.1 ± 4.7 mg, whereas 71% of opioid doses were administered after 9 h. CONCLUSION Superior hypogastric nerve block using a mixture of ropivacaine and clonidine provides good pain relief for 9 h after uterine artery embolization requiring only very low amounts of additional opioids.
Collapse
Affiliation(s)
- Dominik A Steffen
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Arash Najafi
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christoph A Binkert
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
| |
Collapse
|
30
|
Laoruengthana A, Rattanaprichavej P, Kositanurit I, Saenghirunvattana C, Samapath P, Pongpirul K. Adductor Canal Block Combined with Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) versus Periarticular Injection for Total Knee Arthroplasty. Clin Orthop Surg 2022; 14:514-521. [PMID: 36518937 PMCID: PMC9715935 DOI: 10.4055/cios21108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The combination of the adductor canal block (ACB) and the infiltration of anesthetic solution into the interspace between the popliteal artery and capsule of the knee (iPACK) has become increasingly used to augment rapid recovery protocols in total knee arthroplasty (TKA). However, its efficacy in comparison with periarticular anesthetic injection (PAI) alone has yet to be evaluated. Hence, we conducted a retrospective study to compare PAI and ACB + iPACK for controlling pain after TKA. METHODS Propensity scores, incorporating American Society of Anesthesiologists scores, body mass index, age, and sex, were used to match the ACB + iPACK group with the PAI group. All patients received the identical surgical technique and postoperative care. Outcome measures were visual analog scale (VAS) for pain, morphine consumption, knee flexion angle, straight leg raising (SLR), postoperative nausea vomiting (PONV), and length of stay (LOS) after the surgery. RESULTS After matching by propensity score, there were 49 patients with comparable demographic data in each group. The VAS and morphine requirements of the PAI and ACB + iPACK groups were not different during the first 48 hours after TKA. At 72 hours postoperatively, the VAS of the ACB + iPACK was 0.97 higher than that of the PAI group (p = 0.020). Knee flexion angle, SLR, PONV, and LOS were not significantly different between groups. No procedure-related complications were identified in either group. CONCLUSIONS The anesthesiologist-administered ACB + iPACK was as effective as surgeon-administered PAI in controlling pain in the first 48 hours after TKA. However, the ACB + iPACK group had higher intensity of pain than did the PAI group at 72 hours after TKA.
Collapse
Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Inthiporn Kositanurit
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Chao Saenghirunvattana
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Parin Samapath
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
31
|
Mariscal G, Morales J, Pérez S, Rubio-Belmar PA, Bovea-Marco M, Bas JL, Bas P, Bas T. Meta-analysis of the efficacy of ketamine in postoperative pain control in adolescent idiopathic scoliosis patients undergoing spinal fusion. Eur Spine J 2022; 31:3492-3499. [PMID: 36253657 DOI: 10.1007/s00586-022-07422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/08/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE In this meta-analysis, we aim to compare ketamine use versus a control group (saline solution) during induction of anesthesia in adolescent idiopathic scoliosis patients undergoing fusion surgery in terms of postoperative opioid consumption, pain control, and side effects. METHODS A PubMed search of studies published over the last 20 years using the descriptor/terms "ketamine AND scoliosis" was performed. Baseline characteristics of each article were obtained and efficacy measures analyzed (morphine equivalent treatment at 24, 48, and 72 h postoperatively, complications (vomiting/nausea and pruritus), length of hospital stay (days); and pain score (VAS)) (Review Manager 5.4 software package). RESULTS Five randomized clinical trials were included. Morphine administration showed statistically significant differences at 24 and 48 h (MD - 0.15, 95% CI - 0.18 to - 0.12) and (MD - 0.26, 95% CI - 0.31 to - 0.21) between the ketamine and control (saline solution), respectively. No intergroup differences were found regarding nausea/vomiting and pruritus (OR 0.77, 95% CI 0.35 to 1.67) and (OR 0.71, 95% CI 0.31 to 1.62), respectively, same as for the pain score (MD - 0.75, 95% CI - 1.71 to 0.20). CONCLUSIONS The use intraoperative and postoperative continuous low doses of ketamine significantly reduces opioid use throughout the first 48 h in patients with AIS who undergo posterior spinal fusion.
Collapse
Affiliation(s)
- Gonzalo Mariscal
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain.
| | - Jorge Morales
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Silvia Pérez
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Pedro Antonio Rubio-Belmar
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Miquel Bovea-Marco
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Jose Luis Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Paloma Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| | - Teresa Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital of Valencia, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, València, Spain
| |
Collapse
|
32
|
Kellam PJ, Dekeyser GJ, Marchand LS, Rothberg DL, Higgins TF, Haller JM. Periarticular multimodal analgesia in decreasing perioperative pain in tibial plateau fractures: A double blind randomized controlled pilot study. Injury 2022; 53:4123-8. [PMID: 36207154 DOI: 10.1016/j.injury.2022.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The use of periarticular multimodal analgesia injections is increasing and has become commonplace in some surgeries. However, there is no data on the effectiveness of local periarticular multimodal analgesia for tibial plateau fractures. We hypothesized that closed tibial plateau fracture patients receiving the local multimodal analgesic medications would experience a decrease in VAS pain scores. METHODS Patients aged between 18 and 79 with an isolated closed tibial plateau fracture (AO 41-B and C) were prospectively enrolled and randomized in a 1:1 double blinded fashion to either a placebo or active medication treatment arm. After ORIF, gel-foam sponges soaked in either multimodal analgesic solution or normal saline. Patients were followed for 24 h post-operatively with Visual Analog pain Scores (VAS). Patients were monitored post-operatively for complications including compartment syndrome, infection, and non-union. RESULTS The planned study was terminated prior to completion due to higher than anticipated rates of infection (18%), distributed equally among active (3) and placebo (2) groups, raising concerns that this may have been due to the presence of the delivery device. Twenty-eight patients were enrolled, 15 in the active group and 13 in the placebo group. Patients in the active medication group had significantly decreased pain scores at hours 4 (p = 0.005, 4.2 vs 6.9), 8 (p = 0.05, 5 vs 7), and 12 (p = 0.02, 3.8 vs 6.2). Pain scores at hours 16 (p = 0.10, 4.5 vs 6.5), 20 (p = 0.08, 4.6 vs 6.4), and 24 (p = 0.10, 4.8 vs 6.5) were also decreased but did not reach significance. DISCUSSION The use of local multimodal periarticular analgesic for closed tibial plateau fractures appears to be beneficial for short-term pain control post-operatively. Concerns regarding an implantable delivery vehicle leading to infection has warranted a change in method of drug administration. Completion of the full study will permit us to validate or refute these findings. LEVEL OF EVIDENCE Therapeutic Level 1.
Collapse
|
33
|
Toolyodpun S, Laoruengthana A, Kositanurit I, Podjanasupawun S, Saenghirunvattana C, Pongpirul K. Effect of multiple analgesic pathways including local infiltration analgesia, peripheral nerve blocks, and intrathecal morphine for controlling pain after total knee arthroplasty. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03405-w. [PMID: 36260155 DOI: 10.1007/s00590-022-03405-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA). METHODS This retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS). RESULTS Group A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04). CONCLUSION Triple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS.
Collapse
Affiliation(s)
- Siriluk Toolyodpun
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Inthiporn Kositanurit
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
| | | | | | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
34
|
Zhang K, Yan W, Li H, Chen J, Wang Q, Chai Y, Yuan L, Zhu G. Comparison of Mirabegron plus Tamsulosin and Tamsulosin Monotherapy for the Treatment of Ureteral Stent-Related Symptoms: A Prospective Randomized Study. Urol Int 2022; 106:1226-1232. [PMID: 36244331 DOI: 10.1159/000526607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/13/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to compare the efficacy of mirabegron plus tamsulosin to tamsulosin monotherapy in terms of ureteral stent-related discomfort after ureteroscopic lithotripsy. METHODS A total of 102 patients undergoing ureteroscopic lithotripsy and silicone ureteral stent placement were enrolled in this study. Patients were randomized 1:1 to receive either tamsulosin 0.4 mg once daily or mirabegron 50 mg + tamsulosin 0.4 mg once daily during the stenting period. Before the operation, the IPSS, QOL, and pain score were collected. On the day of ureteral stent removal, the USSQ, analgesic usage amount was collected and recorded. RESULTS The median USSQ-body pain score in the tamsulosin group and tamsulosin + mirabegron group was 15 and 16, respectively (p = 0.530). The median analgesic usage in the two groups was 3 and 2, respectively (p = 0.170). The median USSQ-urinary symptoms, USSQ-general health, USSQ-work performance, USSQ-sexual matters, and USSQ-additional problems in the two groups were 26 and 26 (p = 0.194), 11 and 12 (p = 0.068), 12 and 13 (p = 0.105), 2 and 2 (p = 0.437), 9 and 9 (p = 0.533), respectively. The international patients used more analgesics than Chinese patients (6 vs. 1, p = 0.015). CONCLUSION Compared to tamsulosin alone, tamsulosin + mirabegron showed no additional benefit on the ureteral stent-related pain control after ureteroscopic lithotripsy and silicone stent placement. There was no significant difference on the analgesic usage and USSQ scores between the two groups. Chinese patients request fewer analgesics than international patients.
Collapse
Affiliation(s)
- Kai Zhang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China,
| | - Wei Yan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Li
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Jie Chen
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Qian Wang
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Yali Chai
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Lihua Yuan
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| | - Gang Zhu
- Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China
| |
Collapse
|
35
|
Mortada H, AlKhashan R, Alhindi N, AlWaily HB, Alsadhan GA, Alrobaiea S, Arab K. The management of perioperative pain in craniosynostosis repair: a systematic literature review of the current practices and guidelines for the future. Maxillofac Plast Reconstr Surg 2022; 44:33. [PMID: 36239849 DOI: 10.1186/s40902-022-00363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Craniosynostosis is a condition characterized by a premature fusion of one or more cranial sutures. The surgical repair of craniosynostosis causes significant pain for the child. A key focus of craniosynostosis repair is developing effective strategies to manage perioperative pain. This study aimed to review perioperative pain control strategies for craniosynostosis repair systematically. Methods Guidelines for reporting systematic reviews and meta-analyses were used in the design of this review. In May 2022, the following databases were used to conduct the literature search: MEDLINE, Cochrane, EMBASE, and Google Scholar. A search was performed using MeSH terms “craniosynostosis,” “pain management,” and “cranioplasty.” Results The literature review yielded 718 publications. After applying our inclusion criteria, 17 articles were included, accounting for a total of 893 patients. During the postoperative period, most studies used multimodal analgesia, primarily opioids, and acetaminophen. In the postoperative period, oral ibuprofen was the most commonly used NSAID, rectal codeine, and acetaminophen were the most commonly used weak opioids, and continuous remifentanil infusion was the most commonly used potent opioid. Conclusion The authors determined the best pain management options for pediatric patients undergoing cranioplasty by analyzing the most commonly used analgesics. A high-quality clinical trial comparing different types of analgesic combinations would be a valuable addition to the present literature.
Collapse
|
36
|
Guenther M, Görlich D, Bernhardt F, Pogatzki-Zahn E, Dasch B, Krueger J, Lenz P. Virtual reality reduces pain in palliative care-A feasibility trial. BMC Palliat Care 2022; 21:169. [PMID: 36195865 PMCID: PMC9533542 DOI: 10.1186/s12904-022-01058-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.
Collapse
Affiliation(s)
- Miriam Guenther
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Burkhard Dasch
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Janina Krueger
- Specialized Outpatient Palliative Care Service Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany. .,Department of Palliative Care, University of Muenster, Albert-Schweitzer-Campus 1, Building W 30, D-48149, Muenster, Germany.
| |
Collapse
|
37
|
Sadeq F, DePamphilis MA, Dabek RJ, Bojovic B, Fuzaylov G, Driscoll DN. Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis. Burns 2022; 48:1166-1171. [PMID: 34862091 DOI: 10.1016/j.burns.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures. METHODS This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed. RESULTS In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant. CONCLUSION In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
Collapse
Affiliation(s)
- Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Matthew A DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
| | - Robert J Dabek
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States
| | - Branko Bojovic
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Gennadiy Fuzaylov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel N Driscoll
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States.
| |
Collapse
|
38
|
Liu KY, Lu YJ, Lin YC, Wei PL, Kang YN. Transversus abdominis plane block for laparoscopic colorectal surgery: A meta-analysis of randomised controlled trials. Int J Surg 2022; 104:106825. [PMID: 35953018 DOI: 10.1016/j.ijsu.2022.106825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The effectiveness of transversus abdominis plane block (TAP) on pain management after laparoscopic colorectal surgery (CRS) remains unclear since the only relevant meta-analysis on this topic did not separate laparoscopic CRS from open CRS. The aim of the study was to compare the analgesic efficacy and safety of TAP with non-TAP in patients undergoing laparoscopic CRS. METHODS Four databases were searched for randomized controlled trials (RCTs) on this topic using relevant keywords. Two authors independently completed evidence selection, data extraction, and critical appraisal. Available data were pooled in the random-effects model, and point estimates with 95% confidence interval (CI) were reported for postoperative pain at rest and on coughing, opioid consumption, length of hospital stay, and adverse events. RESULTS A total of 14 RCTs (n = 1216) contributed to the present synthesis. Pooled result showed that patients in the TAP group had lower pain at rest than those in the non-TAP group at postoperative 2-h (mean difference [MD] = -1.42; P < 0.05), 4-h (MD = -0.97; P < 0.05), 12-h (MD = -0.75; P < 0.05), and 24-h (MD = -0.61; P < 0.05). Patients in the TAP group also had lower postoperative pain on coughing than those in the non-TAP group on the first day (MD = -1.02; P < 0.05). Moreover, TAP had lesser postoperative opioid consumption than non-TAP (standardized mean difference, -0.26; P < 0.05; I-square = 20%), and there were non-significant differences in hospital stay and adverse event between the two groups. CONCLUSION Intraoperative TAP is a safe and feasible pain management for laparoscopic CRS, particularly it is recommended when patient-controlled analgesia is not delivered. Therefore, laparoscopic TAP block might be a favorable administered strategy.
Collapse
Affiliation(s)
- Kai-Yuan Liu
- Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Jung Lu
- Division of Colorectal Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Cih Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan 3. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yi-No Kang
- Evidence-based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
39
|
Karlsdottir BR, Zhou PP, Wahba J, Mott SL, Goffredo P, Hrabe J, Hassan I, Kapadia MR, Gribovskaja-Rupp I. Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections. Int J Colorectal Dis 2022; 37:1799-1806. [PMID: 35796873 DOI: 10.1007/s00384-022-04208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses. METHODS A retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018. Patient demographics, preoperative factors, surgical approach, and perioperative pain management were evaluated to determine standard conversion morphine milligram equivalents required for postoperative days 0 to 3 and total hospital stay. RESULTS Five hundred and ninety-two patients: 46% male, median age 58 years undergoing colorectal resections for indications including cancer, inflammatory bowel disease, and diverticulitis were identified. Less opioid use was found to be associated with female gender (β = - 42), patients who received perioperative lidocaine infusion (β = - 30), and older adults (equivalents/year) (β = - 4, all p < 0.01). Preoperative opioid use, preoperative abdominal pain, epidural use, and smoking were all independently associated with increased postoperative opioid requirements. CONCLUSIONS In this study of patients undergoing elective colorectal resection, factors that were associated with higher perioperative opioid use included male gender, smoking, younger age, preoperative opioid use, preoperative abdominal pain, and epidural use. Perioperative administration of lidocaine was associated with decreased opioid requirements. Understanding risk factors and stratifying postoperative pain regimens may aid in improved pain control and decrease long-term dependency.
Collapse
Affiliation(s)
| | - Peige P Zhou
- Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Joyce Wahba
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Paolo Goffredo
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer Hrabe
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Irena Gribovskaja-Rupp
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
- Division of Gastrointestinal, Minimally Invasive & Bariatric Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| |
Collapse
|
40
|
Wang HY, Xiao Q, Luo ZY, Pei FX, Wang D, Zhou ZK. A new cocktail formula with diprospan of local infiltration analgesia in primary total hip arthroplasty: A prospective, randomized, controlled, observer-blinded study. Orthop Surg 2022; 14:1799-1807. [PMID: 35822607 PMCID: PMC9363723 DOI: 10.1111/os.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to observe the analgesic effect of the cocktail formulation with diprospan during total hip arthroplasty (THA). METHODS From September 2018 to April 2019, 120 patients undergoing primary unilateral THA were included in this prospective, randomized, observer-blinded study. Patients were randomized into three groups, according to the different local infiltration analgesia (LIA) strategies: LIA with ropivacaine (the ropivacaine group, n = 40), LIA with a new cocktail containing ropivacaine, diprospan, and morphine (the cocktail group, n = 40), and the control group (n = 40). The primary outcomes included postoperative pain scores. The resting visual analogue scale (VAS) scores were measured at 2, 6, and 12 h after the surgery (a.m. and p.m.) on postoperative day (POD) 1, POD2, and the day of discharge. Movement VAS scores were assessed at 6 h, 12 h after the operation (a.m. and p.m.) on POD1, POD2, and the day of discharge. The secondary outcomes included opioid consumption, postoperative hospital stay, range of motion of the hip at discharge, patient satisfaction, and the results of the follow-up. RESULTS After the screening, 120 patients were randomized into three groups (40 patients in each group). All of the patients completed the trial. The resting VAS scores in the ropivacaine group and cocktail group at 2 h were lower than those in the control group (P < 0.001 and P < 0.001, respectively, F = 17.054), and the same trend was also postoperatively found at 6 h (p = 0.005 and P = 0.002, F = 6.212). Twelve hours after the operation, the pain score in the cocktail group was lower than that in the other two groups, but only the difference between the cocktail group and the control group was statistically significant (P = 0.018, F = 3.144). From the morning of the first postoperative day to the a.m. on POD 2, the VAS scores in the cocktail group were significantly lower than those in the ropivacaine group and the control group. Furthermore, the movement VAS scores in the ropivacaine group and the cocktail group were better than those in the control group at 6 and 12 h post-operation (P < 0.05). The per capita opioid consumption in the cocktail group was less than that in the ropivacaine group and the control group within 24 h post-operation. There were no significant differences in the comparison of additional indicators among the three groups. CONCLUSION The new cocktail with diprospan had a better result and longer duration time for early postoperative pain control in primary THA via the posterolateral approach under general anesthesia, especially for treating resting pain.
Collapse
Affiliation(s)
- Hao-Yang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Xiao
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhen-Yu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
41
|
McDonald V, Wang Y, Patel A, Betcher R, Fontenot AC, Scoggin S, Black D. Laparoscopic guided liposomal bupivacaine injection compared to transversus abdominus plane block for postoperative pain after robotic gynecologic oncology surgery. Gynecol Oncol 2022; 166:432-437. [PMID: 35817618 DOI: 10.1016/j.ygyno.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if laparoscopically guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine provides superior postoperative pain control when compared to ultrasound-guided block (US-Tap) with liposomal bupivacaine at the time of robotic surgery for gynecology oncology patients. METHODS This was a prospective randomized controlled trial assigning patients to one of two cohorts: Cohort 1 consisted of US-Tap administered before the procedure using liposomal bupivacaine, Cohort 2 consisted of Lap-Tap administration with laparoscopic visualization using the medication above. Primary outcomes were pain scores and total opioid use in Oral Morphine Equivalents (OME) during the first 72 h after surgery. Secondary outcomes were postoperative pain satisfaction and oral narcotic requirements. RESULTS There was a significant increase in oral narcotic use in the first 24 h in the US-Tap cohort compared to the Lap-Tap cohort: Lap-Tap mean = 6.73 ± 8.22 OME versus US-Tap mean = 12.69 ± 12.94 p = 0.018 OME. The increase was equivalent to one additional Hydrocodone-Acetaminophen 7.5 mg/325 mg in the first 24 h after surgery. However, total oral narcotic use over the first 72 h was not significantly different between the two cohorts: Lap-Tap mean = 21.73 ± 19.83 OME, US-Tap mean = 32.50 ± 29.47, p = 0.062 OME. In addition, there was no significant difference in satisfaction or pain scores between the US-Tap and Lap-Tap groups at 24, 48, or 72-hours. CONCLUSIONS Lap-Taps are comparable to US-Tap for postoperative analgesia during the first 72-h after surgery when performing robotic-assisted gynecologic oncology surgery.
Collapse
Affiliation(s)
- Victoria McDonald
- Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America
| | - Yuping Wang
- Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America
| | - Alpesh Patel
- Willis Knighton Health System, 2508 Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71118, United States of America
| | - Raymond Betcher
- Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America
| | - Anna Claire Fontenot
- Houston Methodist, 1401 Saint Joseph Parkway, Susan K. Strake Building, 2nd floor, 2 SKS, Houston, TX 77002, United States of America
| | - Stewart Scoggin
- Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America
| | - Destin Black
- Louisiana State University Health Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130, United States of America; Willis Knighton Health System, 2508 Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71118, United States of America.
| |
Collapse
|
42
|
Yuan L, Geng L, Wu D, Dai T, Feng G, Du X. A randomized controlled trial for evaluating pain response in patients with spinal metastases following local versus whole vertebral radiotherapy: study protocol for phase II clinical trial. BMC Neurol 2022; 22:226. [PMID: 35725414 PMCID: PMC9208224 DOI: 10.1186/s12883-022-02746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with bone metastasis often experience severe pain that is difficult to control and seriously affects quality of life. Radiotherapy is an effective way to relieve pain in these patients. Currently, there is no standard recommended range of radiotherapy targets for vertebral metastasis. The effect of radiotherapy on pain relief varies among patients, and some patients with metastases have serious side effects. METHODS This study aims to verify whether reducing the radiotherapy range for vertebral metastases can achieve the same effect as whole vertebral radiotherapy while minimizing side effects. Sixty-six patients with pain caused by vertebral metastasis were randomly divided into two groups. The study group is receiving partial vertebrae body radiotherapy at the regions of abnormal signal, suspected invasion, and adjacent subclinical focus of vertebral metastasis, and the control group is receiving the same dose of radiotherapy on whole vertebrae body where metastasis occurred. After radiotherapy, along-term follow-up of patients will determine pain relief and side effects. DISCUSSION The expected results of this study are that local irradiation of vertebral metastases can achieve a palliative effect of pain control not less than total vertebral irradiation with fewer side effects. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (No: ChiCTR1900023401 ).
Collapse
Affiliation(s)
- Li Yuan
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China
| | - Lidan Geng
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China
| | - Danfeng Wu
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China
| | - Tangzhi Dai
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China
| | - Gang Feng
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, No. 12 Changjiaxiang, Mianyang, 621000, China.
| |
Collapse
|
43
|
Esce AR, Meiklejohn DA. Ibuprofen prescription following adult tonsillectomy reduces postoperative opioid use. Am J Otolaryngol 2022; 43:103436. [PMID: 35429845 DOI: 10.1016/j.amjoto.2022.103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Based on a 2018 American Academy of Otolaryngology - Head and Neck Surgery survey, an average of 37 tablets of opioid medication, or about a week's worth of medication, were prescribed after adult tonsillectomy. Nearly 15% of patients will still be taking opioids one year after an initial weeklong prescription, according to data from the Centers for Disease Control and Prevention. Non-steroidal anti-inflammatory medications have traditionally been avoided in adult tonsillectomy patients due to concern for increased bleeding risk from platelet dysfunction, despite little evidence supporting this claim. This study sought to demonstrate that ibuprofen prescriptions after tonsillectomy could be a safe and effective way to reduce postoperative opioid use. METHODS This study was a retrospective chart review of patients undergoing tonsillectomy with one surgeon over three years. Half of the patients received a prescription for postoperative opioid medications and were counseled against taking ibuprofen. The other half of patients were prescribed ibuprofen following surgery and only provided with opioid analgesia as a rescue medication. The New Mexico Prescription Monitoring System was used to verify opioid prescriptions. Descriptive statistics and logistic regression were used to analyze the data. RESULTS Ninety-nine patients were included in analysis, with 53 in the first group that did not receive ibuprofen and 46 in the second group that did receive ibuprofen. There was no difference in the bleeding rate between the two groups. Significantly fewer patients in the ibuprofen group filled postoperative opioid prescriptions when compared to the group that did not receive ibuprofen (40% vs. 96.2%, p < 0.0001, OR = 0.02). CONCLUSION Ibuprofen is a safe and effective analgesic following adult tonsillectomy and significantly reduces the proportion of patients who must fill a postoperative opioid prescription.
Collapse
Affiliation(s)
- Antoinette R Esce
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, MSC10 5610, University of New Mexico, Albuquerque, NM 87131, United States of America.
| | - Duncan A Meiklejohn
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, MSC10 5610, University of New Mexico, Albuquerque, NM 87131, United States of America
| |
Collapse
|
44
|
Fowler KG, Byraiah G, Burt C, Lee DB, Miller RJ. Nitrous Oxide Use for Intrauterine System Placement in Adolescents. J Pediatr Adolesc Gynecol 2022; 35:159-164. [PMID: 34748915 DOI: 10.1016/j.jpag.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the impact of nitrous oxide on patient-reported pain for placement of intrauterine systems (IUSs) in adolescents STUDY DESIGN: : Prospective observational study SETTING: : IUS placement in an ambulatory clinic compared with placement with nitrous oxide in a hospital-based sedation unit PARTICIPANTS: : English-speaking adolescents aged 12 to 20 presenting to a pediatric and adolescent gynecologist with a medical indication for IUS placement MAIN OUTCOME MEASURES: : Patient-reported procedural pain measured on a visual analog scale 2 minutes post IUS insertion procedure. Secondary outcome measurement of likelihood of recommending an IUS to a peer. RESULTS Seventy-four patients agreed to participate. Forty-five patients underwent IUS placement in the clinic. Controlling for age, history of dysmenorrhea, and body mass index, a significant time (change in reported pain scores pre- vs post IUS insertion) by treatment (nitrous oxide vs standard of care) interaction was observed for patient-reported pain (b = -29.32 mm, P < 0.01). Patients receiving nitrous oxide were more likely to recommend an intrauterine placement than patients who received the current standard of care for pain management (b = 0.47, P = 0.02) after controlling for age, baseline pain score, and dysmenorrhea history. CONCLUSION Patient-reported pain was attenuated for patients who received nitrous oxide relative to those who received standard IUS placement. Patient-reported satisfaction was higher for patients who received nitrous oxide relative to those who received standard IUS placement.
Collapse
Affiliation(s)
| | | | | | - Daniel B Lee
- Amherst H. Wilder Foundation, St. Paul, Minnesota
| | | |
Collapse
|
45
|
Wong WK, Lee M, Ong CW. Postoperative pain after transcanal endoscopic ear surgery: A systematic literature review. Am J Otolaryngol 2022; 43:103355. [PMID: 34999349 DOI: 10.1016/j.amjoto.2021.103355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Transcanal endoscopic ear surgery is hypothesized to result in less postoperative pain when compared to nonendoscopic techniques due to its minimally invasive nature. In this systematic literature review, we aim to summarize and evaluate the evidence surrounding postoperative pain control and analgesic utilization after transcanal endoscopic ear surgery. DATABASES REVIEWED PubMed, EMBASE, and Cochrane. METHODS A systematic literature search was performed using standardized methodology. Computerized and manual searches were performed to identify studies that evaluated postoperative pain outcomes following endoscopic ear surgery. Only studies that met predetermined criteria were selected and evaluated for quality and bias. Extracted data included demographics, pain scores, analgesic administered as well as the diagnosis and type of surgery undertaken. Exclusion criteria included letters/commentaries and reviews, lack of pain outcome data and studies not concerning endoscopic ear surgery. RESULTS The systematic literature review included 24 studies. Seven were RCTs, 10 were prospective and 7 were retrospective observational studies. A total of 1859 patients were evaluated for surgical approach and postoperative pain levels and analgesic use. Due to the lack of sufficient reporting of the data, a meta-analysis was not applicable. In the qualitative synthesis for the primary outcome, weighted pooled analysis showed that there was a slight reduction in postoperative pain after transcanal endoscopic ear surgery. Based on the Cochrane risk of bias tool, the quality for the finding is low. CONCLUSION There is a small reduction in postoperative pain after transcanal endoscopic ear surgery when compared to nonendoscopic approaches, however, the clinical significance of this reduction is unclear. The evidence was from studies of only low to moderate quality.
Collapse
|
46
|
Mattout HK, Fouda SM. The use of topical nalbuphine in different concentrations to control pain after photorefractive keratectomy. Int Ophthalmol 2022; 42:2145-2153. [PMID: 35020101 DOI: 10.1007/s10792-022-02214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This is a randomized controlled study aiming to evaluate the safety and efficacy of two different concentrations of topical nalbuphine hydrochloride, when used to relieve pain in the first days following photorefractive keratectomy (PRK). METHODS This is a prospective double blinded randomized clinical trial that included 189 patients who had PRK for correction of low and moderate refractive errors. Patients were randomly assigned to three groups according to the eye drops given to relieve pain in the first three postoperative days; the first group received topical nalbuphine with a concentration of 2 mg/ml (Group A = 64 patients), the second group received topical nalbuphine in a concentration of 1 mg/ml (Group B = 69 patients) and the third group received topical artificial tears only (Group C = 56 patients).The patients were asked to rate their pain daily using a numeric rating scale and to record the number of drops instillation times/day. The time needed for complete epithelial healing, best-corrected visual acuity (BCVA) and spherical equivalent after three months were recorded in each group. RESULTS In the first three days, there was a statistically significant difference in pain score among the three groups with lower values in the two topical nalbuphine groups when compared with the control group receiving artificial tears. Moreover, the higher concentration group showed significantly lower pain score and less number of drops used /day in comparison with the lower concentration group.There were no statistically significant differences in epithelial healing time, BCVA and spherical equivalent after three months among the three groups. CONCLUSION The use of topical nalbuphine is effective in relieving pain in the first few days following PRK and this pain relief is not associated with any compromise regarding epithelial healing nor refractive outcome. The pain control with 2 mg/ml concentration is significantly higher than that with 1 mg/ml concentration of nalbuphine. Trial registration numberISRCTN21394752 https://doi.org/10.1186/ISRCTN21394752 The trial is retrospectively registered in ISRCTN registry at March 08, 2021.
Collapse
Affiliation(s)
- Hala Kamal Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Sameh Mosaad Fouda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
47
|
Halepas S, Christiansen C, Koch A, Aziz SR, Shafer DM, Ferneini EM. Opioid-Prescribing Patterns in Connecticut and New Jersey Following Third Molar Extractions. Anesth Prog 2022; 69:9-14. [PMID: 36534769 PMCID: PMC9773415 DOI: 10.2344/anpr-69-02-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/24/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In recent years, opioid misuse has resulted in much scrutiny on providers' prescribing habits. The purpose of this study was to analyze prescribing habits in the context of third molar extractions as a model for promoting better postsurgical pain management. METHODS This was a cross-sectional survey of oral maxillofacial surgeons in Connecticut and New Jersey. A total of 291 practitioners were contacted to complete an online survey using Qualtrics Research Services to determine prescribing habits following third molar extractions. RESULTS The most common approach for postoperative analgesia was nonsteroidal anti-inflammatory drugs (NSAIDs) and an opioid/acetaminophen (APAP) combination as 2 separate prescriptions, reported by 36% of participants. The combination of hydrocodone/APAP was the most common opioid formulation, and an average of 10.93 ± 4.51 opioid pills were prescribed with a maximum of 20 pills reported. Most providers (79%) consistently provided patients with opioid information. Only 22% reported always checking opioid-monitoring programs; however, providers were more likely to check if prescribing more than ∼11 opioid pills (P = .0228). Most reported using dexamethasone (82%) and bupivacaine (56%) intraoperatively, while ketorolac was less common (15%). No association was found between the quantity of opioids prescribed and the use of intraoperative ketorolac, steroids, or bupivacaine (P > .05). CONCLUSION There remains to be a universal standard for using opioids for postoperative pain management in dentistry. Providers should be mindful when prescribing opioids and consider using NSAIDs and APAP for baseline pain plus a separate opioid prescription for breakthrough pain. Additional focus on minimizing the quantity of opioids prescribed and self-reflecting on prescribing and practice habits to further reduce opioid-related complications is warranted.
Collapse
Affiliation(s)
- Steven Halepas
- Resident, Division of Oral and Maxillofacial Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Cameron Christiansen
- Dental Student, School of Dental Medicine, University of Connecticut, Farmington, Connecticut
| | - Alia Koch
- Program Director, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Shahid R. Aziz
- Professor, Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, New Jersey
| | - David M. Shafer
- Chair, Division of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Connecticut, Farmington, Connecticut
| | - Elie M. Ferneini
- Director, Beau Visage Med Spa and Greater Waterbury OMS, Cheshire, Connecticut; Associate Clinical Professor, Department of Surgery, Frank H Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut; Associate Clinical Professor, Division of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Connecticut, Farmington, Connecticut
| |
Collapse
|
48
|
Shamsaddini M, Abrishami R, Farzanegan B, Baniasadi S. Effectiveness of Short-term Use of Gabapentin as Pre-emptive Analgesia in Reducing Pain after Video Assisted Thoracoscopic Surgery. Tanaffos 2022; 21:90-5. [PMID: 36258911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 07/19/2021] [Indexed: 11/01/2022]
Abstract
Background Pain control after thoracoscopy is one of the important issues in patient health care. Pre-emptive analgesia can reduce acute postoperative pain and also prevent chronic pain. This study aimed to evaluate the effectiveness of gabapentin (GABA analog) as pre-emptive analgesia in reducing pain and reducing opiate consumption after video-assisted thoracoscopic surgery (VATS) surgery. Materials and Methods In this study, 67 patients undergoing thoracoscopic surgery were randomly divided into two groups (31 placeboes and 36 gabapentin). Patients received two capsules (300 mg gabapentin capsules or placebo) on the night before surgery and again one hour before surgery. After completion of the operation, all patients were transferred to the recovery. Evaluation of postoperative pain was performed using the visual analog scale (VAS) every 30 minutes and then after 2, 4, 6, 10, 24 hours. If patients had pain (VAS above 3), intravenous morphine was injected to relieve pain and the number of injections and the total dose of morphine administered was recorded. Results There was no significant difference between the two groups regarding VAS, blood pressure (BP), heart rate (HR), respiratory rate (RR) and saturated oxygen level (SaO2), urea, creatinine, and adverse effects. Conclusion Preoperative gabapentin administration did not affect postoperative pain reduction, but morphine consumption in the gabapentin group was decreased during the first 24 hours after VATS.
Collapse
|
49
|
Karabey T, Karagözoğlu Ş. The effect of manual pressure after subcutaneous injection on pain and comfort levels. J Vasc Nurs 2021; 39:134-139. [PMID: 34865724 DOI: 10.1016/j.jvn.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pain experienced after subcutaneous injections can also disturb the comfort of the individual. An individual who experiences pain may refuse treatment by experiencing anxiety for subsequent injections. OBJECTIVE This experimental study was conducted to compare the effects of standard injection application and manual pressure application use on injection pain and comfort level of having an subcutaneous injection. METHODS This study was carried out on a single sample group with pre-post design. The individuals in the sample group constituted both the control and intervention groups of the study. In the sample group, subcutaneous injection was applied to the upper outer side of the right and left arms by the same nurse by applying standard application and manual pressure, and then the pain and comfort levels were determined using the VAS and Comfort Scale. RESULTS It was determined that the mean pain scores of the SC injection application performed by applying manual pressure were statistically significantly lower than the SC injection application using the standard method. Again, it was determined that the mean comfort score of SC injection applied by applying manual pressure was statistically higher (p<0.05). CONCLUSION It has been determined that manual pressure application is a more effective method in reducing pain due to subcutaneous injection compared to the standard application. It was determined that as the pain experienced by the individuals due to subcutaneous injection application decreased, their comfort level increased. In line with these results, it is recommended that health professionals, especially nurses, use non-pharmacological methods with proven efficacy more frequently to relieve pain in SC injection, follow the developments in this field and put them into practice.
Collapse
Affiliation(s)
- Tuba Karabey
- Dr. Gaziosmanpasa University Faculty of Health Science, Tokat, Turkey.
| | - Şerife Karagözoğlu
- Prof. Cumhuriyet University Faculty of Health Science, Division of Nursing, Department of Fundamentals of Nursing, Sivas, Turkey
| |
Collapse
|
50
|
Arshad SA, Ferguson DM, Garcia EI, Hebballi NB, Buchanan AC, Tsao K. Cryoanalgesia is Associated With Decreased Postoperative Opioid Use in Minimally Invasive Repair of Pectus Excavatum. J Surg Res 2021; 271:1-6. [PMID: 34814047 DOI: 10.1016/j.jss.2021.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative pain control is challenging after pectus excavatum repair. We aimed to understand the impact that cryoanalgesia had on opioid utilization and outcomes of pediatric patients undergoing minimally invasive repair of pectus excavatum (MIRPE). METHODS A single-center retrospective cohort study was conducted of all patients (< 18 y) who underwent MIRPE (2011-2019). Patients receiving cryoanalgesia were compared to those who did not. The primary outcome was total postoperative, inpatient, opioid use, measured as milligrams of oral morphine equivalents per kilogram (OME/kg). Univariate and multivariable analyses were performed. RESULTS Of 35 patients, 20 received cryoanalgesia (57%). Baseline characteristics were similar. Patients who received cryoanalgesia had a lower opioid requirement: median 2.3 mg OME/kg (IQR 1.2-3.1), versus 4.9 mg OME/kg (IQR 2.9-5.8), P < 0.001. Accounting for receipt of cryoanalgesia, epidural, and/or patient-controlled analgesia, cryoanalgesia was associated with a 3.3 mg OME/kg reduction in opioid use (P < 0.001). Median length of stay (LOS) was shorter in cryoanalgesia patients: 3.1 d (IQR 2.3-3.4), versus 5.1 d (IQR 4.3-5.4), P < 0.001. Complications within 90 d were similar between groups. CONCLUSIONS Cryoanalgesia is an effective adjunctive pain control modality for patients undergoing MIRPE. Use of cryoanalgesia was associated with lower postoperative opioid requirements and shorter LOS, without increased short-term complications, and should be considered for enhanced recovery after MIRPE.
Collapse
Affiliation(s)
- Seyed A Arshad
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| | - Dalya M Ferguson
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| | - Elisa I Garcia
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| | - Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| | - Allison C Buchanan
- Department of Anesthesiology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
| |
Collapse
|