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Pessano S, Gloeck NR, Tancredi L, Ringsten M, Hohlfeld A, Ebrahim S, Albertella M, Kredo T, Bruschettini M. Ibuprofen for acute postoperative pain in children. Cochrane Database Syst Rev 2024; 1:CD015432. [PMID: 38180091 PMCID: PMC10767793 DOI: 10.1002/14651858.cd015432.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Children often require pain management following surgery to avoid suffering. Effective pain management has consequences for healing time and quality of life. Ibuprofen, a frequently used non-steroidal anti-inflammatory drug (NSAID) administered to children, is used to treat pain and inflammation in the postoperative period. OBJECTIVES 1) To assess the efficacy and safety of ibuprofen (any dose) for acute postoperative pain management in children compared with placebo or other active comparators. 2) To compare ibuprofen administered at different doses, routes (e.g. oral, intravenous, etc.), or strategies (e.g. as needed versus as scheduled). SEARCH METHODS We used standard Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, CINAHL and trials registries in August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 17 years and younger, treated for acute postoperative or postprocedural pain, that compared ibuprofen to placebo or any active comparator. We included RCTs that compared different administration routes, doses of ibuprofen and schedules. DATA COLLECTION AND ANALYSIS We adhered to standard Cochrane methods for data collection and analysis. Our primary outcomes were pain relief reported by the child, pain intensity reported by the child, adverse events, and serious adverse events. We present results using risk ratios (RR) and standardised mean differences (SMD), with the associated confidence intervals (CI). We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 43 RCTs that enroled 4265 children (3935 children included in this review). We rated the overall risk of bias at the study level as high or unclear for 37 studies that had one or several unclear or high risk of bias judgements across the domains. We judged six studies as having a low risk of bias across all domains. Ibuprofen versus placebo (35 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen probably reduces child-reported pain intensity less than two hours postintervention compared to placebo (SMD -1.12, 95% CI -1.39 to -0.86; 3 studies, 259 children; moderate-certainty evidence). Ibuprofen may reduce child-reported pain intensity, two hours to less than 24 hours postintervention (SMD -1.01, 95% CI -1.24 to -0.78; 5 studies, 345 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events compared to placebo (RR 0.79, 95% CI 0.51 to 1.23; 5 studies, 384 children; low-certainty evidence). Ibuprofen versus paracetamol (21 RCTs) No studies reported pain relief reported by the child or a third party, or serious adverse events. Ibuprofen likely reduces child-reported pain intensity less than two hours postintervention compared to paracetamol (SMD -0.42, 95% CI -0.82 to -0.02; 2 studies, 100 children; moderate-certainty evidence). Ibuprofen may slightly reduce child-reported pain intensity two hours to 24 hours postintervention (SMD -0.21, 95% CI -0.40 to -0.02; 6 studies, 422 children; low-certainty evidence). Ibuprofen may result in little to no difference in adverse events (0 events in each group; 1 study, 44 children; low-certainty evidence). Ibuprofen versus morphine (1 RCT) No studies reported pain relief or pain intensity reported by the child or a third party, or serious adverse events. Ibuprofen likely results in a reduction in adverse events compared to morphine (RR 0.58, 95% CI 0.40 to 0.83; risk difference (RD) -0.25, 95% CI -0.40 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 4; 1 study, 154 children; moderate-certainty evidence). Ibuprofen versus ketorolac (1 RCT) No studies reported pain relief or pain intensity reported by the child, or serious adverse events. Ibuprofen may result in a reduction in adverse events compared to ketorolac (RR 0.51, 95% CI 0.27 to 0.96; RD -0.29, 95% CI -0.53 to -0.04; NNTB 4; 1 study, 59 children; low-certainty evidence). AUTHORS' CONCLUSIONS Despite identifying 43 RCTs, we remain uncertain about the effect of ibuprofen compared to placebo or active comparators for some critical outcomes and in the comparisons between different doses, schedules and routes for ibuprofen administration. This is largely due to poor reporting on important outcomes such as serious adverse events, and poor study conduct or reporting that reduced our confidence in the results, along with small underpowered studies. Compared to placebo, ibuprofen likely results in pain reduction less than two hours postintervention, however, the efficacy might be lower at two hours to 24 hours. Compared to paracetamol, ibuprofen likely results in pain reduction up to 24 hours postintervention. We could not explore if there was a different effect in different kinds of surgeries or procedures. Ibuprofen likely results in a reduction in adverse events compared to morphine, and in little to no difference in bleeding when compared to paracetamol. We remain mostly uncertain about the safety of ibuprofen compared to other drugs.
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Affiliation(s)
- Sara Pessano
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Natasha R Gloeck
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Luca Tancredi
- Geriatrie, Hessing Stiftung, Augsburg, Germany
- Medical School, Regiomed, Coburg, Germany
| | - Martin Ringsten
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ameer Hohlfeld
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sumayyah Ebrahim
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Matteo Bruschettini
- Cochrane Sweden, Department of Research and Education, Skåne University Hospital, Lund University, Lund, Sweden
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Lee DJ, Grose E, Brenna CTA, Philteos J, Lightfoot D, Kirubalingam K, Chan Y, Palmer JN, Adappa ND, Lee JM. The benefits and risks of non-steroidal anti-inflammatory drugs for postoperative analgesia in sinonasal surgery: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2023; 13:1738-1757. [PMID: 36762711 DOI: 10.1002/alr.23140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) have emerged as an alternative to opioids for optimal postoperative pain management. However, the adoption of NSAIDs in sinonasal surgery has been impeded by a theoretical concern for postoperative bleeding. Our objective is to systematically review the efficacy and safety of NSAIDs for patients undergoing sinonasal surgery. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO International Clinical Trials Registry Platform were searched from inception to January 27, 2022. Randomized controlled trials (RCTs) and comparative observational studies in any language were considered. Screening, data extraction, and risk of bias assessment were performed in duplicate. Our outcomes were postoperative pain scores, requirement for rescue analgesia, and postoperative adverse events (epistaxis, nausea/vomiting). RESULTS Out of 4661 records, 15 RCTs (enrolling 1210 patients) and two observational studies were included. Following endoscopic sinus surgery, there was no difference in pain scores between NSAIDs and non-NSAIDs groups (standardized mean differences [SMD] 0.44 units better, 95% CI -0.18 to 1.05). Following septorhinoplasty, NSAIDs decreased pain scores compared to non-NSAID regimens (SMD 1.14 units better, 95% CI 0.61 to 1.67 units better). Overall, NSAIDs reduced the need for rescue medication with a relative risk (RR) of 0.45 (95% CI 0.24 to 0.84). In addition, NSAIDs decreased the risk of nausea with an RR of 0.62 (95% CI 0.42 to 0.91) and did not increase the risk of epistaxis (RR 0.72, 95% CI 0.23-2.22). CONCLUSION Among patients undergoing sinonasal surgery, NSAIDs are beneficial in postoperative pain management and avoidance of postoperative nausea without increasing the risk of postoperative epistaxis.
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Affiliation(s)
- Daniel J Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elysia Grose
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Connor T A Brenna
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David Lightfoot
- St. Michael's Hospital Health Sciences Library, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Yvonne Chan
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Shafiee A, Arabzadeh Bahri R, Teymouri Athar MM, Beiky M, Rostaii O, Golpayegani G, Soltani Abhari F. Pain management following septorhinoplasty surgery: evidence from a systematic review. Eur Arch Otorhinolaryngol 2023; 280:3931-3952. [PMID: 37272951 DOI: 10.1007/s00405-023-08044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE We investigated recent evidence on the analgesics available for postoperative pain management among patients undergoing septoplasty or rhinoplasty surgery. METHODS Studies were retrieved from MEDLINE (through PubMed), Web of Science, and Embase up to 3 August 2022. RESULTS Forty-seven studies including 3717 patients were included. There were 45 randomized clinical trials and 2 observational cohort studies. Most of the studies were recently published and conducted in Turkey (n = 27). The majority of the studies performed the intervention preoperatively (n = 26), 11 studies postoperatively, 6 studies intraoperative, 2 studies preoperative plus intraoperative, and 2 studies performed the intervention with preoperative plus postoperative timing. The most evaluated medication was lidocaine (n = 10), followed by levobupivacaine (n = 4), and gabapentin (n = 4). Regarding post-operative pain assessment, the most used scale was the visual analog scale (VAS) (n = 36). Compared to controls, almost all interventions showed a significant benefit in managing post-operative pain. Although it should be mentioned regarding the comparison between opioids and NSAIDs consumption after surgery for pain management, most studies did not show a significant difference between the groups. No major side effects except nausea and vomiting were observed among the reviewed studies. CONCLUSION This study summarized the most recent options that are available to manage pain following septorhinoplasty surgery. Recent investigations showed local interventions vs pre/post-operative analgesic medications are highly suggested to be replaced with opioids and NSAIDs as they have shown prominent efficacy with no significant adverse events. Future research is advised to determine the best dosage and administration techniques.
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Affiliation(s)
- Arman Shafiee
- Department of Psychiatry and Mental Health, Alborz University of Medical Sciences, Karaj, Iran.
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | | | | | - Maryam Beiky
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Omid Rostaii
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Golshid Golpayegani
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Ding X, Cui X, Cui X, Wang S. Letter to the editor regarding "The benefits and risks of non-steroidal anti-inflammatory drugs for postoperative analgesia in sinonasal surgery: A systematic review and meta-analysis". Int Forum Allergy Rhinol 2023; 13:1836-1837. [PMID: 37408300 DOI: 10.1002/alr.23235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Xiaoxu Ding
- Department of Otorhinolaryngology-Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiangguo Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiao Cui
- Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Sai Wang
- Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Zhang G, Li Q, Wang P. The analgesic efficacy of ketamine for septorhinoplasty: a meta-analysis study. Eur Arch Otorhinolaryngol 2023; 280:4083-4089. [PMID: 37027028 DOI: 10.1007/s00405-023-07933-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The analgesic efficacy of ketamine supplementation was not well-established for septorhinoplasty and this meta-analysis aimed to compare ketamine supplementation with placebo for the postoperative pain control of septorhinoplasty. METHODS We systematically searched several databases, including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of ketamine supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by random effect model. RESULTS Five RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, ketamine supplementation was associated with significantly decreased pain scores at 30 min (SMD = - 3.84; 95% CI = - 6.73 to - 0.96; P = 0.009), pain scores at 1 h (SMD = - 2.70; 95% CI = - 3.79 to - 1.61; P < 0.00001), pain scores at 2 h (SMD = - 1.83; 95% CI = - 3.01 to - 0.64; P = 0.003), rescue analgesics (OR = 0.08; 95% CI = 0.04 to 0.17; P < 0.00001), but unraveled no obvious impact on pain scores at 4 h (SMD = - 1.13; 95% CI = - 3.37 to 1.12; P = 0.32) or the incidence of nausea and vomiting (OR = 0.71; 95% CI = 0.30 to 1.72; P = 0.45). CONCLUSIONS Ketamine supplementation was effective to improve pain relief after septorhinoplasty.
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Affiliation(s)
- Guofen Zhang
- Department of Otorhinolaryngologic, Chongqing Liang Jiang New Area Traditional Chinese Medicine Hospital, Chongqing, China
| | - Quli Li
- Department of Otorhinolaryngologic, Liangjiang New District People's Hospital, Chongqing, China
| | - Ping Wang
- Department of Otorhinolaryngologic, Liangjiang New District People's Hospital, Chongqing, China.
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Alshehri AA. Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial. Int Arch Otorhinolaryngol 2023; 27:e471-e477. [PMID: 37564463 PMCID: PMC10411065 DOI: 10.1055/s-0042-1749386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/17/2022] [Indexed: 08/12/2023] Open
Abstract
Introduction Septorhinoplasty operates on the nose's bone and cartilage and is ensued by severe postoperative pain. Objective The objective of this study is to evaluate the effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methods A total of 150 patients undergoing septorhinoplasty were randomly assigned into 3 groups with 50 patients in each group. The control group (group A) was administered 100 ml saline solution; the paracetamol group (group B) was administered 1,000 mg of IV paracetamol in 100 ml of saline solution; and the ibuprofen group (group C) was administered 800 mg of IV ibuprofen in 100 ml of saline solution before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using the visual analogue scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results In comparison with group A, the score in the VAS of groups B and C was statistically lower in all the time intervals ( p < 0.05). In the 1 st and 6 th hours postoperatively, group C's score in the VAS in was lower than that of group B ( p < 0.05). In the control group, total opioid consumption was highest in all time intervals ( p < 0.05). In group C, total opioid consumption was significantly lower than in group B in the 0 to 6 and 6 to 12 hours intervals. ( p < 0.05). Conclusion The single-dose preemptive administration of ibuprofen has a more profound postoperative analgesic effect than paracetamol in the first 6 hours after septorhinoplasty. After the first 6 hours postsurgery, there is no difference between ibuprofen and paracetamol in terms of analgesic effect.
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Affiliation(s)
- Ali Abdullah Alshehri
- ORL&HNs and Facial Plastic Surgery, College of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
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Liang Z, Xu Y, Xue Z. The analgesic efficacy of pregabalin versus placebo for septorhinoplasty: A meta-analysis. Medicine (Baltimore) 2023; 102:e33259. [PMID: 37058015 PMCID: PMC10101281 DOI: 10.1097/md.0000000000033259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/22/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND The analgesic efficacy of pregabalin supplementation for septorhinoplasty remains elusive. This meta-analysis was conducted to compare pregabalin supplementation with placebo for the postoperative pain control of septorhinoplasty. METHODS We systematically searched several databases including PubMed, EMbase, Web of Science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of pregabalin supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by fixed or random-effect model based on the heterogeneity. RESULTS Seven RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, pregabalin supplementation was associated with significantly decreased pain scores at 1 h (standard mean difference [SMD] = -1.45; 95% confidence interval [CI] = -2.43 to -0.47; P = .004), pain scores at 2 hours (SMD = -1.01; 95% CI = -1.83 to -0.20; P = .02), pain scores at 6 hours (SMD = -1.00; 95% CI = -1.47 to -0.54; P < .0001), number of rescue analgesics (odd ratio [OR] = 0.18; 95% CI = 0.08-0.39; P < .0001) and analgesic consumption (SMD = -2.78; 95% CI = -5.05 to -0.51; P = .02), but unraveled no obvious impact on the incidence of nausea and vomiting (OR = 0.55; 95% CI = 0.24-1.27; P = .16). CONCLUSIONS Pregabalin supplementation was effective to improve pain relief after septorhinoplasty.
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Affiliation(s)
- Zanmei Liang
- Wenzhou PanHealth International Medica, Wenzhou, China
| | - Yang Xu
- Wenzhou PanHealth International Medica, Wenzhou, China
| | - Zhihui Xue
- Wenzhou PanHealth International Medica, Wenzhou, China
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Phillips SJ, Peck CJ, Pourtaheri N, Reategui A, Carney M, Dinis J, Park KE, Maniskas S, Lopez J, Steinbacher DM. Decreasing Inpatient Opioid Use Following Orthognathic Surgery. J Craniofac Surg 2021; 32:2808-2811. [PMID: 34727482 DOI: 10.1097/scs.0000000000008001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Strategies to decrease postoperative opioid use are important for mitigating the immediate and long-term risks associated with their use. We aimed to investigate the impact of perioperative various factors on inpatient opioid needs for patients undergoing orthognathic surgery. METHODS This was a retrospective cohort study of all patients who underwent orthognathic surgery performed by the senior author from 2012 to 2018. Patients were grouped into intravenous (IV) acetaminophen and no-IV acetaminophen cohorts. Opioid medications received by patients during hospital stay were converted to mean morphine equivalents (MME) for comparison. Additional factors that influenced opioid consumption, such as transexamic acid (TXA) and postoperative nausea and vomiting (PONV), were identified using univariate analysis. Factors found to have statistical significance were added to a multivariate linear regression model. RESULTS 319 patients were included. Those who received IV acetaminophen had lower rates of total opioid use (57.3 versus 74.8 MME; P = 0.002) and postoperative opioid use (24.0 versus 37.7 MME; P < 0.001). Perioperative prothrombotic agents, such as TXA, were associated with lower total and postoperative MME (P = 0.005, P = 0.002). Multivariate regression analysis showed that increased PONV resulted in increased postoperative opioid use, whereas perioperative acetaminophen lowered total and postoperative quantities. CONCLUSIONS Perioperative IV acetaminophen is an effective method for decreasing inpatient opioid analgesia after orthognathic surgery. Intravenous TXA and PONV control may provide additional benefit to decreasing inpatient opioid consumption. More research as to the mechanisms and ideal clinical applications for both IV acetaminophen and TXA are warranted.
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Affiliation(s)
- Sarah J Phillips
- Plastic and Oral and Maxillofacial SUrgery, Yale New Haven Health, New Haven CT
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Kim SY, Lee S, Lee Y, Kim H, Kim KM. Effect of single dose preoperative intravenous ibuprofen on postoperative pain and opioid consumption: a systematic review and meta-analysis. Korean J Anesthesiol 2021; 74:409-421. [PMID: 33611881 PMCID: PMC8497907 DOI: 10.4097/kja.21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background Ibuprofen, a well-known analgesic, is commonly used as a component of a multimodal analgesic approach for postoperative pain. This systematic review and meta-analysis aimed to investigate whether a single-dose preoperative intravenous ibuprofen can reduce postoperative pain and opioid consumption. Methods PubMed/MEDLINE, Embase, Cochrane Library (CENTRAL), and Web of Science databases were searched to identify relevant studies published up to May 2020. Randomized controlled trials comparing preoperative single-dose intravenous ibuprofen effect with the control group on postoperative pain and opioid consumption after surgery under general anesthesia were included. Results Six studies involving 366 participants were included. Single-dose administration of intravenous ibuprofen preoperatively significantly reduced postoperative pain score on a scale of 0-10 at 1 h (MD: -1.64, 95% CI [-2.56, -0.72], P < 0.001, I2 = 95%), at 4-6 h (MD: -1.17, 95% CI [-2.09, -0.26], P < 0.001, I2 = 94%), and 24 h (MD: -0.58, 95% CI [-0.99, -0.18], P < 0.001, I2 = 90%). Cumulative opioid consumption, presented as fentanyl equivalents, was also reduced significantly in the ibuprofen group compared to placebo group until postoperative 4-6 h (MD: -56.35 μg, 95% CI [-101.10, -11.60], P < 0.001, I2 = 91%) and 24 h (MD: -131.39 μg, 95% CI [-224.56, -38.21], P < 0.001, I2 = 95%). Conclusions Preoperative single-dose intravenous ibuprofen can reduce postoperative pain and opioid consumption until 24 h postoperatively. Considering the high heterogeneity and small number of studies included, care should be taken when generalizing these findings.
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Affiliation(s)
- Su Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Yeji Lee
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyunho Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Santos BFE, Costa FO, Pinto Júnior AAC, Araújo AVA, Cyrino RM, Cota LOM. Postoperative pain and edema control following different protocols of preemptive analgesia in the surgical removal of impacted third molars: A triple-blind parallel randomized placebo-controlled clinical trial. J Craniomaxillofac Surg 2021; 49:694-704. [PMID: 33994294 DOI: 10.1016/j.jcms.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
This randomized controlled clinical trial aimed to evaluate the preemptive effects of acetaminophen, ibuprofen, ketoprofen, nimesulide or dexamethasone on postoperative pain and edema in the surgical removal of impacted third molars. Participants underwent bilateral surgeries at 2 different times and were randomly given the test drug or placebo (split-mouth). Postoperative pain, edema and rescue medication were evaluated at different times. Study power was >80% for the observed effect size in the crossover repeated measures design. Differences between test drug and placebo were the response variable. Generalized Estimation Equation models were adjusted for each outcome. Sample comprised 5 groups (n = 20 each). Ibuprofen and nimesulide showed higher overall effects on pain scores over time, with no differences between them (p = 0.557). Acetaminophen showed significantly lower overall effects in edema control over time, when compared to other test drugs, that showed similar effects. Lower quantity of rescue medication were also observed for ibuprofen and nimesulide, with no differences between them (p = 0.999). Ibuprofen and nimesulide showed beneficial overall preemptive effects. Hence, in the decision-making process for preemptive analgesia in impacted third molar surgeries, ibuprofen and nimesulide should be considered on a case-by-case basis as the drugs of choice.
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Affiliation(s)
- Bianca Fernanda Espósito Santos
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Renata Magalhães Cyrino
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís Otávio Miranda Cota
- School of Dentistry, Department of Dental Clinics, Oral Pathology and Oral Surgery, Periodontology Division, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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No Opioids after Septorhinoplasty: A Multimodal Analgesic Protocol. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3305. [PMID: 33425613 PMCID: PMC7787342 DOI: 10.1097/gox.0000000000003305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/09/2020] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Background: From a public health perspective, nasal surgery accounts for many unused opioids. Patients undergoing septorhinoplasty require few opioids, and efforts to eliminate this need may benefit both patients and the public. Methods: A multimodal analgesic protocol consisting of 15 components encompassing all phases of care was implemented for 42 patients. Results: Median age and BMI were 34 years and 23, respectively. Most were women (79%), White (79%), primary surgeries (62%), and self-pay (52%). Comorbid conditions were present in 74% of the patients, with anxiety (33%) and depression (21%) being the most common. Septoplasties (67%) and osteotomies (45%) were common. The median operative time was 70 minutes. No patients required opioids in recovery, and median time in recovery was 63 minutes. Ten (24%) patients required an opioid prescription after discharge. In those patients, median time to requirement was 27 hours (range 3–81), and median total requirement was 20 mg morphine equivalents (range 7.5–85). Protocol compliance inversely correlated to opioid use (P = 0.007). Compliance with local and regional anesthetic (20% versus 63%, P = 0.030) as well as ketorolac (70% versus 100%, P = 0.011) was lower in patients who required opioids. Patients who required opioids were less likely to be administered a beta blocker (0% versus 34%, P = 0.041). Pain scores were higher in opioid users on postoperative days 1–5 (P < 0.05). No complications occurred in those requiring opioids, and satisfaction rates were equivalent between groups. Conclusion: This protocol allowed us to safely omit opioid prescriptions in 76% of patients following septorhinoplasty, without adverse effects on outcomes or patient satisfaction.
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Meraj TS, Bresler A, Zuliani GF. Acute Pain Management Following Facial Plastic Surgery. Otolaryngol Clin North Am 2020; 53:811-817. [PMID: 32593429 DOI: 10.1016/j.otc.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Facial plastic surgery, including septorhinoplasty, aging face procedures, otoplasty, and oculoplastic procedures, has varying levels of evidence for the management of acute pain after surgery. This article discusses the available evidence in these procedures and discusses the authors' recommendations for the treatment of postoperative pain, with a focus on decreasing the reliance on opioid pain medication.
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Affiliation(s)
- Taha S Meraj
- Department of Otolaryngology, Wayne State University, 4201 St Antoine 5E-UHC, Detroit, MI 48201, USA
| | - Amishav Bresler
- Department of Otolaryngology, Rutgers University, 90 Bergen Street, Suite 8100, Newark, NJ 07208, USA
| | - Giancarlo F Zuliani
- Department of Otolaryngology, Wayne State University, Detroit, MI, USA; Zuliani Facial Aesthetics, 50 West Big Beaver, #280, Bloomfield Hills, MI 48304, USA.
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Chocron Y, Aljerian A, Thibaudeau S. Upper-Extremity Nerve Decompression Under Local Anesthesia: A Systematic Review of Methods for Reduction of Postoperative Pain and Opioid Consumption. Hand (N Y) 2020; 15:447-455. [PMID: 30983414 PMCID: PMC7370381 DOI: 10.1177/1558944719843635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Opioid abuse is a major health concern in North America. Data have shown an alarming increase in opioid-related deaths and complications, which has shed light on current prescription practices across many specialties, including hand surgery. To that end, we sought to conduct a focused literature review to determine the available modalities to decrease postoperative pain and opioid consumption following upper-extremity nerve decompression procedures, taking advantage of the homogeneity and inherent pain pathways of this specific patient cohort. Methods: A systematic review of the literature was conducted. Primary studies evaluating perioperative and intraoperative modalities for postoperative pain reduction and analgesic consumption following upper-extremity nerve decompression procedures under local anesthesia were included. Studies implementing modalities requiring non-hand surgeon expertise (ie, intravenous sedation), as well as studies that include non-nerve decompression procedures, were excluded. Results: A total of 1478 studies were identified, and 9 studies were included after full-text review. Six studies evaluated intraoperative and 3 studies evaluated preoperative and postoperative modalities. Successful interventions included buffered anesthetic, the use of hyaluronidase, and varying techniques and mixtures for anesthetic administration. No successful preoperative or postoperative modalities were identified. Conclusion: Despite data reporting on the dangers associated with current opioid prescription practices, evidence-based modalities to decrease postoperative pain and opioid consumption are limited in general. Several intraoperative modalities do exist, and nonopioid oral analgesics, standardized opioid protocols, and reduced postoperative prescriptions can be used. Large randomized controlled trials evaluating perioperative modalities for pain reduction are needed to further address this issue.
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Affiliation(s)
- Yehuda Chocron
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Albaraa Aljerian
- Division of Plastic & Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Stephanie Thibaudeau
- Division of Plastic & Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
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A Randomized, Placebo-Controlled, Double-Blind Study that Evaluates Efficacy of Intravenous Ibuprofen and Acetaminophen for Postoperative Pain Treatment Following Laparoscopic Cholecystectomy Surgery. J Gastrointest Surg 2020; 24:780-785. [PMID: 31012040 DOI: 10.1007/s11605-019-04220-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/28/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ibuprofen is a NSAID that has anti-inflammatory, antipyretic, and analgesic effects. The oral form of the drug has been used safely for a long time and is one of the most preferred NSAIDs. It has been shown that ibuprofen is effective in the treatment of postoperative pain; however, there have not been sufficient studies on ibuprofen. We evaluated and compared the influence of IV forms of ibuprofen and acetaminophen on pain management and opioid consumption on patients undergoing laparoscopic cholecystectomy surgery. METHODS Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen; group A (group acetaminophen, n = 30) was administered 1000 mg of IV acetaminophen; and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively. RESULTS Pain scores in group I and group A at all time periods were lower than those in group C (p < 0.05). Group I had significantly lower VAS scores than those in group A at all time periods postoperatively (p < 0.05). Those in group C had significantly higher opioid consumption than the other groups (p < 0.05). Opioid consumption in group I at all time periods postoperatively was significantly lower than those in group A (p < 0.05). Group I had statistically lower rescue medication than the other groups at all time periods. CONCLUSION Our study suggested that IV ibuprofen resulted in lower pain scores and reduced opioid use compared with acetaminophen postoperatively in the first 24 h in patients undergoing laparoscopic cholecystectomy surgery.
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Ciftci B, Ekinci M, Celik EC, Kaciroglu A, Karakaya MA, Demiraran Y, Ozdenkaya Y. Comparison of Intravenous Ibuprofen and Paracetamol for Postoperative Pain Management after Laparoscopic Sleeve Gastrectomy. A Randomized Controlled Study. Obes Surg 2020; 29:765-770. [PMID: 30474791 DOI: 10.1007/s11695-018-3613-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is defined as the first-step bariatric surgery for the treatment of obesity. Opioid analgesics are often preferred for pain management because of their strong analgesic potentials. However, opioids have undesirable adverse effects. OBJECTIVES The objective of this study is to evaluate and compare the influence of IV forms of ibuprofen and paracetamol on pain management and opioid consumption on patients undergoing LSG surgery. SETTING This study was conducted at Istanbul Medipol University Hospital. METHODS Patients were stratified into three groups. Group I (group ibuprofen, n = 30) was administered 800 mg of IV ibuprofen, group P (group paracetamol, n = 30) was administered 1000 mg of IV paracetamol, and group C (control group, n = 30) was given 100 ml of saline solution. We evaluated opioid consumption and VAS scores postoperatively. RESULTS This study included 90 patients who underwent LSG. The use of rescue medication in group I was statistically lower than the other groups. VAS scores in group I and group P at recovery and at 2, 4, 8, 12, and 24 h were lower than those in group C. In particular, the VAS scores in group I at the first 2 h postoperatively were significantly lower than those in group P (p < 0.05). Opioid consumption in group C was significantly higher than the other groups (p < 0.05). CONCLUSION Our study suggested that IV ibuprofen resulted in lower pain scores compared to paracetamol by reducing postoperative opioid use in the first 24 h in patients undergoing LSG surgery.
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Affiliation(s)
- Bahadır Ciftci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey.
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Erkan Cem Celik
- Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Yakutiye, 25070, Erzurum, Turkey
| | - Ahmet Kaciroglu
- Department of Anesthesiology and Reanimation, Fatih Sultan Mehmet Training and Research Hospital, Merkez, 34000, Istanbul, Turkey
| | - Muhammet Ahmet Karakaya
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Yavuz Demiraran
- Department of Anesthesiology and Reanimation, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
| | - Yasar Ozdenkaya
- Department of General Surgery, Istanbul Medipol University, Bagcilar, 34000, Istanbul, Turkey
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Ates İ, Aydin ME, Ahiskalioglu A, Ahiskalioglu EO, Kaya Z, Gozeler MS. Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study. Eur Arch Otorhinolaryngol 2020; 277:1095-1100. [DOI: 10.1007/s00405-020-05801-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
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