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Martinez GJ, Lautenschlager KA, Aden JK, Maani CV, Lopez EM, McCallin JP. Effects of Multimodal Analgesia on Recovery From Percutaneous Spinal Cord Stimulator Implantation. Neuromodulation 2023; 26:252-259. [PMID: 31851404 DOI: 10.1111/ner.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We aimed to determine the relationship between number and type of analgesic modalities utilized and postoperative pain after percutaneous spinal cord stimulator implantation. Secondary measures include opioid requirements, discharge times, and effects of specific modalities. MATERIALS AND METHODS This single-center retrospective cohort at Brooke Army Medical Center from April 2008 through July 2017 reviewed 70 patients undergoing stimulator implantation by a pain specialist. Data included: home opioid regimen; preoperative/postoperative medications and pain; intraoperative medications; and discharge times. Analysis utilized a Wilcoxon nonparametric mode, and chi-square testing for specific modalities. We compared outcomes based on the number of modalities administered and whether patients received specific medications. RESULTS Patients averaged receiving 3.8 modalities (standard deviation 1.4). Patients receiving ≥5 modalities had increased pain from preoperative to postoperative scores by two points, while those who received ≤4 had no increase (p < 0.01). Patients receiving ketamine had a median three point increase in pain scores from their baseline vs no change for others (p < 0.05). Patients receiving four modalities had shorter phase one recovery times vs ≤ 2 (median 66 vs 91.5 min; p = 0.01). Patients receiving ≥4 modalities had shorter times vs ≤3 (median 74 vs 88.5 min; p < 0.01). Patients receiving NSAIDs had shorter times than others (median 78 vs 87 min; p < 0.05). CONCLUSIONS Ketamine administration and use of ≥5 analgesic modalities were associated with more postoperative pain for unclear reasons. Patients receiving NSAIDs or ≥4 analgesic modalities had shorter recovery times. These data may lead to further work that could optimize ambulatory practices for stimulator implantation. More work is warranted on this subject.
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Affiliation(s)
- Greggory J Martinez
- Department of Anesthesia and Perioperative Services, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Karl A Lautenschlager
- Department of Anesthesia and Perioperative Services, Brooke Army Medical Center, Fort Sam Houston, TX, USA; Department of Pain Management, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - James K Aden
- Research Division, Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Christopher V Maani
- Department of Anesthesia and Perioperative Services, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Edward M Lopez
- Department of Pain Management, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - John P McCallin
- Department of Pain Management, Brooke Army Medical Center, Fort Sam Houston, TX, USA
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Hassabou NF, Elseweidy MM. Histopathological changes in submandibular gland and dorsal tongue of experimental rats due to prolonged tramadol intake focusing on novel modulatory effect of 10-dehydrogingerdione. Arch Oral Biol 2021; 130:105223. [PMID: 34371226 DOI: 10.1016/j.archoralbio.2021.105223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This project aims to develop a framework to illustrate the degenerative effects induced by prolonged tramadol intake in salivary glands and tongue tissues. We strive in this work to investigate the probable role of 10-dehydrogingerdione (10-DHGD) in regeneration of these tissues. DESIGN Forty male albino rats were designated for the study and categorized into four groups. Group (1) received no drugs and served as normal control group. Group (2) received tramadol intra peritoneal (20 mg /kg) body weight daily for 45 days. Group (3) received freshly prepared 10-DHGD orally in a dose level (10 mg /kg). Group (4) received combination of tramadol and 10 DHGD for 45 days. Histological examination is that routine testing that was done in all studied subjects to demonstrate any cytological changes with hematoxylin and eosin (H&E) in the submandibular glands and dorsal tongue tissues along with histochemical investigation using periodic acid-Schiff (PAS) and immunohistochemical presentation of Caspase-3. RESULTS Submandibular salivary glands and dorsal tongue tissues showed degenerative changes in tramadol treated group while control and 10-DHGD groups presented with no cytological or morphological changes. Histochemical investigation revealed marked reduction in PAS staining reaction in tramadol group as compared to other studied groups. Regarding to immunoreactivity of caspase-3 when all groups were compared, the differences in mean values of area percentage were statistically significant. CONCLUSIONS Tramadol provoked oxidative damage and apoptosis in oral tissues, which significantly decreased by 10-DHGD intake as it may exert an ameliorative effect that help alleviating these degenerative effects.
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Affiliation(s)
- Nadia Fathy Hassabou
- Oral and Maxillofacial Histopathology Department, Faculty of Dentistry, October 6 University, Giza, Egypt.
| | - Mohamed M Elseweidy
- Biochemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig, 44519, Egypt.
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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Otachi JK, Vundi N, Surratt HL. Examining Factors Associated with Non-Fatal Overdose among People Who Inject Drugs in Rural Appalachia. Subst Use Misuse 2020; 55:1935-1942. [PMID: 32552243 PMCID: PMC9121392 DOI: 10.1080/10826084.2020.1781179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Overdose (OD) deaths have continued to rise in the United States posing a critical public health challenge. Various factors have been associated with increased likelihood of OD, including history of injection drug use. Purpose: This study examined multi-level factors associated with non-fatal OD among current people who inject drugs (PWID) in Appalachian Kentucky. Methods: This cross-sectional study utilized data from 324 PWID recruited via Respondent-Driven Sampling techniques in three Appalachian counties. The analysis focused on correlates of overdose history among people who inject drugs (PWID). Findings: Approximately 36.7% of our sample reported having overdosed in their lifetime, with only 21.4% currently having access to a naloxone kit for OD reversal. Respondents who had injected fentanyl alone or in combination with another drug (OR = 4.26, 95% CI= 2.31,7.86) had 4 times higher odds of an OD than those who did not. Our study found those who injected buprenorphine as primary drug (OR = 0.29, 95% CI = 0.10,0.81) had lower odds of OD compared to those who injected heroin. Conclusions/Importance: Given an increase in OD prevalence among PWID in the U.S, and especially among people living in the Appalachian region of Kentucky, assessing factors associated with OD is critical in development of tailored public health interventions to address the disparate rates of non-fatal OD in this vulnerable population.
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Affiliation(s)
- Janet K Otachi
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Nikita Vundi
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Hilary L Surratt
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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St Marie B, Broglio K. Managing Pain in the Setting of Opioid Use Disorder. Pain Manag Nurs 2019; 21:26-34. [PMID: 31648905 DOI: 10.1016/j.pmn.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/27/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
SPECIFIC CLINICAL ISSUE Healthcare providers are challenged with managing pain and minimizing morbidity and mortality associated with opioid use disorder. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE The purpose of this article is to guide acute and ambulatory care clinicians in managing pain in patients with opioid use disorder. Included in this article is a review of medications used for opioid use disorder, a discussion of the management of patients with active opioid use disorder and acute or chronic pain, and a discussion of the management of acute and chronic pain in people in recovery both on and off medications for opioid use disorder.
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Affiliation(s)
| | - Kathleen Broglio
- Section of Palliative Medicine, Geisel School of Medicine at Dartmouth, Collaboratory for Implementation Sciences at Dartmouth, Lebanon, New Hampshire
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Cornett EM, Budish R, Latimer D, Hart B, Urman RD, Kaye AD. Management of Challenging Pharmacologic Issues in Chronic Pain and Substance Abuse Disorders. Anesthesiol Clin 2018; 36:615-626. [PMID: 30390782 DOI: 10.1016/j.anclin.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug abuse and addiction are persistent problems in the United States and around the world. This is an ongoing issue for health care providers, as substance abuse is seen in 25% to 40% of patients admitted to hospitals for general treatment. Many patients with substance use disorders have a higher risk for adverse events; however, only a small percentage will volunteer information regarding prior substance use. This article discusses the present opioid crisis, mechanisms behind chronic pain and substance abuse, current clinical findings, treatment therapies, and abuse deterrents.
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Affiliation(s)
- Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Rebecca Budish
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Dustin Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Brendon Hart
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis street, Boston, MA 02115, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA; Department of Pharmacology, LSU Health Science Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
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Abstract
Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients' participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.
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Affiliation(s)
- Jie Luo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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