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Deng D, Zhang T, Ma L, Zhao W, Huang S, Wang K, Shu S, Chen X. PD-L1/PD-1 pathway: a potential neuroimmune target for pain relief. Cell Biosci 2024; 14:51. [PMID: 38643205 PMCID: PMC11031890 DOI: 10.1186/s13578-024-01227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/01/2024] [Indexed: 04/22/2024] Open
Abstract
Pain is a common symptom of many diseases with a high incidence rate. Clinically, drug treatment, as the main method to relieve pain at present, is often accompanied by different degrees of adverse reactions. Therefore, it is urgent to gain a profound understanding of the pain mechanisms in order to develop advantageous analgesic targets. The PD-L1/PD-1 pathway, an important inhibitory molecule in the immune system, has taken part in regulating neuroinflammation and immune response. Accumulating evidence indicates that the PD-L1/PD-1 pathway is aberrantly activated in various pain models. And blocking PD-L1/PD-1 pathway will aggravate pain behaviors. This review aims to summarize the emerging evidence on the role of the PD-L1/PD-1 pathway in alleviating pain and provide an overview of the mechanisms involved in pain resolution, including the regulation of macrophages, microglia, T cells, as well as nociceptor neurons. However, its underlying mechanism still needs to be further elucidated in the future. In conclusion, despite more deep researches are needed, these pioneering studies indicate that PD-L1/PD-1 may be a potential neuroimmune target for pain relief.
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Affiliation(s)
- Daling Deng
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Lulin Ma
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Wenjing Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Kaixing Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Shaofang Shu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Key Laboratory of Anesthesiology and Resuscitation, Huazhong University of Science and Technology, Ministry of Education, Wuhan, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
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Farley P, Abraham P, Griffin RL, Jansen JO. Pain in Trauma Patients: Measurement and Predisposing Factors. J Surg Res 2023; 291:321-329. [PMID: 37506431 DOI: 10.1016/j.jss.2023.06.008] [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: 06/09/2022] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Acute pain is common after injury. This study intended to evaluate the feasibility of quantifying pain experience over an entire admission using "area under the pain curve" and to identify factors associated with increased pain. METHODS This retrospective single-center study included all trauma patients admitted from 2013 to 2020. Maximum pain scores were extracted for each day. Pain was defined as area under the curve (AUC) of maximum pain scores/day plotted against time. Injury patterns were analyzed by dichotomizing Abbreviated Injury Scale (AIS) scores (AIS < 3 versus AIS ≥ 3) for each body region. Urinary drug screen results were collected from admission data. A general linear model was used to determine which injury patterns, mechanisms, and age groups were predictive of increased AUC in all patients together and separate by operative and nonoperative groups. RESULTS We identified 21,640 patients, of which 70% were male and 83% had suffered blunt injury. Overall injury severity was associated with increased pain experience. Serious head injury, younger age, and older age (compared to 45-49 y) were associated with decreased pain. Spinal injuries, thoraco-abdominal injuries, and combined thoracic and lower extremity injuries were predictive of increased pain. Compared to patients with no positive test for illicit substances or documentation of prehospital narcotic medications, the pain experience was greater for both, those who had been administered a narcotic in the prehospital setting and those who tested positive for illicit substances. CONCLUSIONS This study extends the concept of total pain experience using AUC methodology. Our results demonstrate associations between increased pain and certain patterns of injury, ages, and presence of drugs on admission. Measuring total pain experience could assist in comparing pain-management strategies. Future research should focus on validating pain experience against quality-of-life measurements.
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Affiliation(s)
- Paige Farley
- Oregon Health and Sciences University, Portland, Oregon
| | - Peter Abraham
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell L Griffin
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Jan O Jansen
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, Alabama.
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Zhou Y, Wang B, Duan K, Bai Z, Hu X, Xu M, Li X, Gao Y, Li J, Yang M, Zhang Y, Zhang W, Dai R, Shen Y, Wu Z, Jiang Y, Yu S, Ouyang W, Wang S. Preemptive QP001, a fast-acting meloxicam formulation, provides analgesia and reduces opioid consumption following abdominal surgery: a randomized controlled trial. Inflammopharmacology 2023; 31:2401-2410. [PMID: 37646897 DOI: 10.1007/s10787-023-01322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND QP001, a novel meloxicam formulation, has been developed to manage moderate to severe postoperative pain. This study aimed to evaluate the efficacy and safety of QP001 injections for moderate to severe pain following abdominal surgery. METHOD This prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial enlisted patients experiencing moderate to severe pain following abdominal surgery. These patients were randomized to receive either QP001 injections (30 mg or 60 mg) or a placebo pre-surgery. The primary efficacy endpoint was the total morphine consumption within 24 h after the first administration. RESULTS A total of 108 patients were enrolled, and 106 patients completed the study. The total morphine consumption in the QP001 30 mg group and 60 mg group, versus placebo group, were significantly lower over the following 24 h (5.11[5.46] vs 8.86[7.67], P = 0.011; 3.11[3.08] vs 8.86[7.67], P < 0.001), respectively. The total morphine consumption in the QP001 30 mg and 60 mg groups, versus placebo group, was also significantly decreased over the following 48 h, including the 24-48 h period (P ≤ 0.001). The QP001 30 mg and 60 mg groups, versus placebo, showed a significant decrease in the area under the curve for pain intensity-time as well as a significant decrease in the effective pressing times of the analgesic pump over the 24 h and 48 h periods (P < 0.05). The QP001 groups, versus placebo, show no significant different in Adverse Events or Adverse Drug Reactions (P > 0.05). CONCLUSION Preoperative/preemptive QP001 provides analgesia and reduces opioid consumption in patients with moderate to severe pain following abdominal surgery, while maintaining a favorable safety profile.
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Affiliation(s)
- Yingyong Zhou
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Bin Wang
- General Surgery, Guiyang Baijun Taikang Hospital, Chenzhou, China
| | - Kaiming Duan
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhihong Bai
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xianwen Hu
- Department of Anesthesiology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Mingjun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Li
- Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yuanli Gao
- Department of Anesthesiology, Maanshan People's Hospital, Ma'anshan, China
| | - Jiangang Li
- Department of Anesthesiology, Qujing No.1 Hospital, Qujing, China
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Ying Zhang
- Department of Anesthesiology, The Affiliated Traditional Chinese Medical Hospital of Southwest Medical University, Luzhou, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruping Dai
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yufei Shen
- Gynecology Department, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ziteng Wu
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Yan Jiang
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Sen Yu
- Nanjing Delova Biotech Co., Ltd, Nanjing, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Saiying Wang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.
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Tang S, Jin Y, Hou Y, Wang W, Zhang J, Zhu W, Zhang W, Gu X, Ma Z. Predictors of Chronic Pain in Elderly Patients Undergoing Total Knee and Hip Arthroplasty: A Prospective Observational Study. J Arthroplasty 2023; 38:1693-1699. [PMID: 37142067 DOI: 10.1016/j.arth.2023.04.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) after total knee arthroplasty and total hip arthroplasty (TKA and THA) is an important clinical problem in which many factors play a role. The risk factors for CPSP in elderly individuals are currently unknown. Therefore, our aim was to predict the risk factors for CPSP after TKA and THA and to provide help regarding early screening and interventions for elderly individuals at risk. METHODS In this prospective observational study, we collected and analyzed 177 TKA patients and 80 THA patients. Based on pain results at the 3-month follow-up, they were divided into the no chronic postsurgical pain and CPSP groups, respectively. The preoperative baseline conditions, including pain intensity (Numerical Rating Scale) and sleep quality (Pittsburgh Sleep Quality Index), as well as intraoperative and postoperative factors, were compared. Factors with P < .05 were included in binary regression analyses to establish prediction models for CPSP after TKA and THA. RESULTS The prevalence of CPSP was 20.9% after TKA and 7.5% after THA. The preoperative sleep disorders were an independent risk factor of CPSP after TKA, but no risk factors of CPSP after THA were identified. CONCLUSION This study indicated that the prevalence of CPSP after TKA was significantly higher than after THA, and that preoperative sleep disorders were an independent risk factor for CPSP after TKA, which may aid clinicians in screening people at risk for CPSP for primary prevention.
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Affiliation(s)
- Suhong Tang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yinan Jin
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yunfan Hou
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wenwen Wang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Jinwei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wei Zhu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xiaoping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China
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5
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Qiao B, Song X, Zhang W, Xu M, Zhuang B, Li W, Guo H, Wu W, Huang G, Zhang M, Xie X, Zhang N, Luan Y, Zhang C. Intensity-adjustable pain management with prolonged duration based on phase-transitional nanoparticles-assisted ultrasound imaging-guided nerve blockade. J Nanobiotechnology 2022; 20:498. [PMID: 36424657 PMCID: PMC9694595 DOI: 10.1186/s12951-022-01707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Background The lack of a satisfactory strategy for postoperative pain management significantly impairs the quality of life for many patients. However, existing nanoplatforms cannot provide a longer duration of nerve blockage with intensity-adjustable characteristics under imaging guidance for clinical applications. Results To overcome this challenge, we proposed a biocompatible nanoplatform that enables high-definition ultrasound imaging-guided, intensity-adjustable, and long-lasting analgesia in a postoperative pain management model in awake mice. The nanoplatform was constructed by incorporating perfluoropentane and levobupivacaine with red blood cell membranes decorated liposomes. The fabricated nanoplatform can achieve gas-producing and can finely escape from immune surveillance in vivo to maximize the anesthetic effect. The analgesia effect was assessed from both motor reactions and pain-related histological markers. The findings demonstrated that the duration of intensity-adjustable analgesia in our platform is more than 20 times longer than free levobupivacaine injection with pain relief for around 3 days straight. Moreover, the pain relief was strengthened by repeatable ultrasound irradiation to effectively manage postoperative pain in an intensity-adjustable manner. No apparent systemic and local tissue injury was detected under different treatments. Conclusion Our results suggest that nanoplatform can provide an effective strategy for ultrasound imaging-guided intensity-adjustable pain management with prolonged analgesia duration and show considerable transformation prospects. Supplementary Information The online version contains supplementary material available at 10.1186/s12951-022-01707-z.
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Affiliation(s)
- Bin Qiao
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Xinye Song
- grid.452435.10000 0004 1798 9070Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011 People’s Republic of China
| | - Weiyi Zhang
- grid.452435.10000 0004 1798 9070Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011 People’s Republic of China
| | - Ming Xu
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Bowen Zhuang
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Wei Li
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Huanling Guo
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Wenxin Wu
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Guangliang Huang
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Minru Zhang
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Xiaoyan Xie
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Nan Zhang
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
| | - Yong Luan
- grid.452435.10000 0004 1798 9070Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011 People’s Republic of China
| | - Chunyang Zhang
- grid.412615.50000 0004 1803 6239Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 People’s Republic of China
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Stamer UM, Liguori GA, Rawal N. Thirty-five Years of Acute Pain Services: Where Do We Go From Here? Anesth Analg 2020; 131:650-656. [DOI: 10.1213/ane.0000000000004655] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet 2019; 393:1537-1546. [PMID: 30983589 DOI: 10.1016/s0140-6736(19)30352-6] [Citation(s) in RCA: 399] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/20/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
Over the past decade there has been an increasing reliance on strong opioids to treat acute and chronic pain, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 1999, and this pattern is now occurring globally. Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause of this problem. Chronic postsurgical pain, occurring in approximately 10% of patients who have surgery, typically begins as acute postoperative pain that is difficult to control, but soon transitions into a persistent pain condition with neuropathic features that are unresponsive to opioids. Research into how and why this transition occurs has led to a stronger appreciation of opioid-induced hyperalgesia, use of more effective and safer opioid-sparing analgesic regimens, and non-pharmacological interventions for pain management. This Series provides an overview of the epidemiology and societal effect, basic science, and current recommendations for managing persistent postsurgical pain. We discuss the advances in the prevention of this transitional pain state, with the aim to promote safer analgesic regimens to better manage patients with acute and chronic pain.
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Affiliation(s)
- Paul Glare
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Karin R Aubrey
- Pain Management Research Institute, University of Sydney, Sydney, NSW, Australia; Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC.
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Webb CAJ, Kim TE. Establishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing. Anesthesiol Clin 2018; 36:333-344. [PMID: 30092932 DOI: 10.1016/j.anclin.2018.04.005] [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: 11/26/2022]
Abstract
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics. Standardization of regional anesthesia procedures and billing practices can promote consistent outcomes and efficiency.
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Affiliation(s)
- Christopher A J Webb
- Department of Anesthesiology and Perioperative Medicine, Kaiser Permanente South San Francisco Medical Center, 1200 El Camino Real, South San Francisco, CA 94080, USA; Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, 521 Parnassus Avenue, San Francisco, CA 94143, USA
| | - T Edward Kim
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Abstract
As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.
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Medrzycka-Dabrowka W, Dąbrowski S, Gutysz-Wojnicka A, Gawroska-Krzemińska A, Ozga D. Barriers Perceived by Nurses in the Optimal Treatment of Postoperative Pain. Open Med (Wars) 2017; 12:239-246. [PMID: 28828405 PMCID: PMC5553189 DOI: 10.1515/med-2017-0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital. In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.
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Affiliation(s)
| | - Sebastian Dąbrowski
- Anesthesiology and Intensive Care Unit, Specialistic HospitalGdańsk-Zaspa, Poland
| | | | | | - Dorota Ozga
- Department of Emergency Medicine, Faculty of Medicine, University of Rzeszow, RzeszowPoland
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11
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Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017; 15:22-29. [DOI: 10.1016/j.sjpain.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Background and aim
Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.
Methods
A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.
Results
When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.
Conclusions
This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.
Implications
Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.
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Affiliation(s)
- Viveka Andersson
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Department of Medicine , Hallands Hospital Varberg , Träslövsvägen 68, 432 37 , Varberg , Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine , Institute of Medicine, The Sahlgrenska Academy , University of Gothenburg , Box 457, 405 30 , Gothenborg , Sweden
- Spenshult Research and Development Centre , Bäckagårdsvägen 47, 302 74 , Halmstad , Sweden
| | - Ingela Henoch
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Angered Local Hospital , Halmtorget 1, 424 65 , Gothenburg , Sweden
| | - Kerstin Wickström Ene
- Department of Research, Development and Education , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Eva Otterström-Rydberg
- Department of Anesthesia and Intensive Care , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Hanna Simonsson
- Department of Surgery , Hallands Hospital , Halmstad , Lasarettsvägen, 302 33 Halmstad , Sweden
| | - Karin Ahlberg
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
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Mędrzycka-Dąbrowska WA, Dąbrowski S, Basiński A, Pilch D. Perception of barriers to postoperative pain management in elderly patients in Polish hospitals with and without a "Hospital Without Pain" Certificate - a multi-center study. Arch Med Sci 2016; 12:808-18. [PMID: 27478463 PMCID: PMC4947611 DOI: 10.5114/aoms.2015.54768] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2005-2050, the global population of elderly people will increase by 12%. This will lead to increased demand for such healthcare services as hospital care or surgical interventions. Pain in elderly patients is a substantial problem. Insufficiently controlled postoperative pain continues to be a widespread phenomenon. Pain management in Poland is usually based on nursing care supervised by an anesthesiologist or surgeon. The aim of the study was to identify barriers to effective nurse-controlled analgesia in postoperative pain management in elderly patients in hospitals with and without a Hospital Without Pain certificate. MATERIAL AND METHODS The study was conducted after the approval of the study protocol by the Independent Bioethics Committee for Scientific Research of the Medical University of Gdansk. The study project was multicenter and was conducted from July 2012 to December 2013. The research was questionnaire-based and used the Polish version of the Nurses' Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The project included 676 nurses from hospitals awarded the Hospital Without Pain Certificate and 926 respondents from hospitals without the certificate. RESULTS After calculating the overall average result in particular groups, healthcare system-related problems were first among the barriers hindering pain management in elderly patients M = (C = 3.81, N/C = 3.87). Patient-related barriers were second (M = 3.77). Physician- and nurse-related barriers took the subsequent positions, with very similar scores M = (C = 3.47, N/C = 3.44) and M = (C = 3.46, N/C = 3.44), respectively. CONCLUSIONS The greatest barriers to pain management in elderly patients are related to the healthcare system. Nurses from Hospital Without Pain certified hospitals devoted significantly more time to relieving pain through non-pharmacological methods.
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Affiliation(s)
| | - Sebastian Dąbrowski
- Anesthesiology and Intensive Care Unit, District Health Center, Malbork, Poland
| | - Andrzej Basiński
- Clinical Emergency Department, Medical University of Gdansk, Gdansk, Poland
| | - Dorota Pilch
- Nursing Department, Pomeranian University, Szczecin, Poland
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Wioletta MD, Sebastian D, Andrzej B. Perception of barriers to postoperative pain management in elderly patients in Polish hospitals - a multicentre study. J Nurs Manag 2016; 24:1049-1059. [PMID: 27271360 DOI: 10.1111/jonm.12405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/29/2022]
Abstract
AIM The purpose of the paper was to compare the prevalence of barriers to optimum postoperative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. BACKGROUND It is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. METHODS A questionnaire-based study of 1602 nurses working at clinical, provincial and municipal hospitals. RESULTS In the clinical hospitals barriers more often related to a poorly organised systems of care and obstacles in discussing pain management within the team. In provincial and municipal hospitals lack of uninform pain measurement was more evident. CONCLUSIONS Despite the availability of effective pain treatments in hospitals difficulties continue with communication, poorly organised care and limited access to clinical guidelines. IMPLICATIONS FOR NURSING MANAGEMENT Although there are possibilities of pain relief after surgery, they are still used insufficiently. Postoperative pain management in Poland needs considerable improvement. This study can contribute to the improvement of pain management quality by supporting and developing practical guidelines or management algorithms for nurses, facilitating the effective implementation of new pain management practices.
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Affiliation(s)
| | - Dąbrowski Sebastian
- Anaesthesiology and Intensive Care Unit, District Health Centre in Malbork, Malbork, Poland
| | - Basiński Andrzej
- Clinical Emergency Department, Medical University of Gdańsk, Gdańsk, Poland
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Farooq F, Khan R, Ahmed A. Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting. Indian J Anaesth 2016; 60:248-52. [PMID: 27141107 PMCID: PMC4840804 DOI: 10.4103/0019-5049.179450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved. METHODS A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19. RESULTS Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good. CONCLUSION The survey of patients' satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.
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Affiliation(s)
- Fizzah Farooq
- Department of Anaesthesiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Robyna Khan
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
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Borracci T, Prencipe D, Masotti A, Nella A, Tuccinardi G, Margiacchi L, Villa G, Pinelli F, Romagnoli S, De Gaudio AR, Zagli G. The experience of setting up a resident-managed Acute Pain Service: a descriptive study. BMC Anesthesiol 2016; 16:14. [PMID: 26904968 PMCID: PMC4763422 DOI: 10.1186/s12871-016-0179-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background The benefits of an Acute Pain Service (APS) for pain management have been widely reported, but its diffusion is still limited. There are two APS models: anesthesiologist-based and a nurse-based model. Here we describe the development of a different APS model managed by anesthesia residents, and we report the first year of activity in a tertiary Italian university hospital (Careggi University Hospital, Florence, IT). Methods Patients were included in the APS were those undergoing abdominal and urologic surgery causing moderate or severe postsurgical pain. The service was provided for patients, beginning upon their exit from the operating room, for 4, 12, 24 and 48 h for iv, and up to 72 h for epidural therapy. Vital signs, static/dynamic VAS, presence of nausea/vomiting, sedation level, and Bromage scale in case of epidural catheter, were monitored. Results From September 2013 to April 2015, a total of 1054 patients who underwent major surgery were included in the APS: 542 from abdominal surgery and 512 from urological surgery. PCA and epidural analgesia were more adopted in general surgical patients than in urology (48 % vs 36 % and 15 % vs 2 %, respectively; P < 0.0001). Patients who underwent to abdominal surgery had a significantly higher self-administration of morphine (30.3 vs 22.7 mg; P = 0.0315). Elastomeric pump was the analgesic of choice in half of the urologic patients compared to a quarter of the general surgical patients (P < 0.0001). Among the different surgical techniques, epidural analgesia was used more in open (16.5 %) than in videolaparoscopic (1.9 %) and robotic technique (1.1 %), whereas PCA was predominant in videolaparoscopic (46.5 %) and robotic technique (55.5 %) than in open technique (31.4 %). Conclusions The creation of APS, managed by anesthesia residents, may represent an alternative between specialist-based and nurse-based models.
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Affiliation(s)
- Tommaso Borracci
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Prencipe
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Anita Masotti
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandra Nella
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Lucia Margiacchi
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gianluca Villa
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Fulvio Pinelli
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Angelo Raffaele De Gaudio
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Giovanni Zagli
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Liu D, Ma J, Zhang Z, Yu A, Chen X, Feng C, Lei W. Management of Postoperative Pain in Medical Institutions in Shandong Province in China. Medicine (Baltimore) 2016; 95:e2690. [PMID: 26871800 PMCID: PMC4753895 DOI: 10.1097/md.0000000000002690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to investigate current situation of postoperative pain management in medical institutions in Shandong Province.A questionnaire was developed on the basis of guidelines of acute pain and pain quality assessment scale. The questionnaire was used to obtain information regarding the nature and scale of the medical institution, structure of pain management organization, implementation of pain assessment, and analgesic techniques and processes used in clinical practice. A multistage stratified and cluster sampling method was employed to investigate the current situation of postoperative pain management in 168 medical institutions in Shandong Province.For acute pain service (APS), 32% of the hospitals established postoperative pain management organizations similar to APS. For pain evaluation, 57.1% of the hospitals evaluated pain as the fifth vital sign, and 47.0% of the hospitals evaluated pain at rest and during activity. Furthermore, 43.0% of the surveyed hospitals employed patient-controlled analgesia mode, of which hospitals employing brachial plexus block, lumbar plexus block, and femoral nerve block analgesia accounted for 5.0%, 1.0%, and 4.0%, respectively. The survey revealed that 51.0% of the hospitals educated patients about pain and pain management, of which patients were postoperatively educated by ward nurses in 5.0% and patients were educated by APS during ward rounds in 2.0%.There is a lack of standardized postoperative pain management, the involvement of nurses in pain management is scarce, and the pain assessment and education and application of advanced analgesic management techniques were found to be inadequate in medical institutions in Shandong Province.
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Affiliation(s)
- Donghua Liu
- From the Department of Anesthesiology (DL, ZZ, AY, CF); Department of Operating room, Liaocheng People's Hospital, Liaocheng (JM, XC), and Department of Anesthesiology, Shandong Provincial Affiliated to Shandong University, Jinan, Shandong Province, China (WL)
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Tedore T, Weinberg R, Witkin L, Giambrone GP, Faggiani SL, Fleischut PM. Acute Pain Management/Regional Anesthesia. Anesthesiol Clin 2015; 33:739-751. [PMID: 26610627 DOI: 10.1016/j.anclin.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Effective and efficient acute pain management strategies have the potential to improve medical outcomes, enhance patient satisfaction, and reduce costs. Pain management records are having an increasing influence on patient choice of health care providers and will affect future financial reimbursement. Dedicated acute pain and regional anesthesia services are invaluable in improving acute pain management. In addition, nonpharmacologic and alternative therapies, as well as information technology, should be viewed as complimentary to traditional pharmacologic treatments commonly used in the management of acute pain. The use of innovative technologies to improve acute pain management may be worthwhile for health care institutions.
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Affiliation(s)
- Tiffany Tedore
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Roniel Weinberg
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Lisa Witkin
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Gregory P Giambrone
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Susan L Faggiani
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Peter M Fleischut
- Department of Anesthesiology, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY 10065, USA.
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The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival. Perioper Med (Lond) 2014; 3:10. [PMID: 25485103 PMCID: PMC4256808 DOI: 10.1186/s13741-014-0010-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/04/2014] [Indexed: 02/08/2023] Open
Abstract
Background The benefit of the post-anaesthesia care unit (PACU) with respect to an early detection of postoperative complications is beyond dispute. From a patient perspective, prevention and optimal management of pain, nausea and vomiting (PONV) are also of utmost importance. The aims of the study were therefore to prospectively measure pain and PONV on arrival to the PACU and before discharge and to determine the relationship of pain and PONV to the length of stay in the PACU. Methods Postoperative pain was assessed over 30 months using a numeric rating scale on admittance to the PACU and before discharge; in addition, PONV was recorded. Statistical analysis was done considering gender, age, American Society of Anesthesiologists (ASA) classification, surgical speciality, anaesthesia technique, duration of anaesthesia, intensity of nursing and length of stay. Results Data of 12,179 patients were available for analysis. The average length of stay in the PACU was 5.7 ± 5.9 h, whereas regular PACU patients stayed for 3.2 ± 1.9 h and more complex IMC patients stayed for 15.1 ± 6.0 h. On admittance, 27% of patients were in pain and the number decreased to 13% before discharge; 3% experienced PONV. Risk factors for increased pain determined by multivariate analysis were female gender; higher ASA classification; general, cardiac and orthopaedic surgery and prolonged case duration. In more complex IMC patients, pain scores were higher on arrival but dropped to similar levels before discharge compared to regular PACU patients. Female gender and postoperative pain were risk factors for postoperative vomiting. Pain and PONV on arrival correlated with length of stay in the PACU. Pain- or PONV-free patients stayed almost half of the time in the PACU compared to patients with severe pain or vomiting on arrival. Conclusions The majority of PACU patients had good pain control, both on admittance and before discharge, and the overall incidence of PONV was low. Managing patients in the PACU could achieve a significant reduction of pain and PONV. The level of pain and presence of PONV on admittance to the PACU correlate with and act as predictors for increased length of PACU stay.
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van Boekel RLM, Steegers MAH, Verbeek-van Noord I, van der Sande R, Vissers KCP. Acute Pain Services and Postsurgical Pain Management in the Netherlands: A Survey. Pain Pract 2014; 15:447-54. [DOI: 10.1111/papr.12192] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/10/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Regina L. M. van Boekel
- Department of Anesthesiology Pain & Palliative Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Monique A. H. Steegers
- Department of Anesthesiology Pain & Palliative Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Inge Verbeek-van Noord
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
| | | | - Kris C. P. Vissers
- Department of Anesthesiology Pain & Palliative Medicine; Radboud University Medical Center; Nijmegen the Netherlands
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Abstract
Acute pain is a symptom that originates from actual ongoing or impending tissue damage. Pain is an individual subjective experience and varies markedly among individuals. For this reason, patient involvement is essential, with the most reliable indicator of severity being patient self-report. The main objective of postoperative pain management is the achievement of fast rehabilitation, recovery of all normal functions and reduction of postoperative morbidity. Sufficient evidence supports the hypothesis that effective analgesia modifies many of the adverse sequelae that accompany acute pain and assists in recovery. Nevertheless, despite the availability of drugs and techniques for its effective management, postoperative pain remains undertreated. It is now accepted that the solution to the problem of inadequate pain relief lies not only in the development of new analgesic drugs or technologies but also in the development of an appropriate organization to utilize existing expertise. Methods used to control postoperative pain are numerous; this review focuses on pharmacological and anesthetic methods.
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Affiliation(s)
- Yigal Leykin
- Santa Maria degli Angeli Hospital, Department of Anesthesia and Intensive Care, Pordenone, Italy.
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Ayad AE. Acute pain services; an Egyptian experience. PAIN MEDICINE 2013; 15:336-8. [PMID: 24238385 DOI: 10.1111/pme.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amany E Ayad
- Anesthesia and Pain, Cairo University, Cairo, Egypt
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Abstract
Pediatric pain services were first established in larger pediatric centers over two decades ago. Children's acute pain was poorly managed at the time owing to misconceptions, safety concerns, and variability in practice. While many larger pediatric centers now have acute pain services, there remains a need for better pain management in facilities and geographic locations with fewer resources. Institutional acknowledgement and desire to change, appropriate staffing, and funding are major obstacles. Better recognition and assessment as well safer and more efficacious treatment of pain are the principal objectives when establishing a pain service. It is important to determine whether the proposed service intends to treat acute, chronic, procedural, and/or cancer and palliative pain as each requires different skills and resources. An ideal and comprehensive pediatric pain service should be equipped to diagnose and treat acute, persistent (chronic), procedural, and cancer/palliative pain. It is not feasible or necessary for every hospital to manage all. Establishing the scope of practice (based on case mix and caseload) in any given hospital will determine which resources are desired. Country-specific standards, local staffing, and fiscal constraints will influence which resources are available.
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Affiliation(s)
- Sabine Kost-Byerly
- Department of Anesthesiology/Critical Care Medicine, Charlotte Bloomberg Children's Center, Johns Hopkins University, Baltimore, MD 21287, USA.
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Tighe PJ, Lucas SD, Edwards DA, Boezaart AP, Aytug H, Bihorac A. Use of machine-learning classifiers to predict requests for preoperative acute pain service consultation. PAIN MEDICINE 2012; 13:1347-57. [PMID: 22958457 DOI: 10.1111/j.1526-4637.2012.01477.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this project was to determine whether machine-learning classifiers could predict which patients would require a preoperative acute pain service (APS) consultation. DESIGN Retrospective cohort. SETTING University teaching hospital. SUBJECTS The records of 9,860 surgical patients posted between January 1 and June 30, 2010 were reviewed. OUTCOME MEASURES Request for APS consultation. A cohort of machine-learning classifiers was compared according to its ability or inability to classify surgical cases as requiring a request for a preoperative APS consultation. Classifiers were then optimized utilizing ensemble techniques. Computational efficiency was measured with the central processing unit processing times required for model training. Classifiers were tested using the full feature set, as well as the reduced feature set that was optimized using a merit-based dimensional reduction strategy. RESULTS Machine-learning classifiers correctly predicted preoperative requests for APS consultations in 92.3% (95% confidence intervals [CI], 91.8-92.8) of all surgical cases. Bayesian methods yielded the highest area under the receiver operating curve (0.87, 95% CI 0.84-0.89) and lowest training times (0.0018 seconds, 95% CI, 0.0017-0.0019 for the NaiveBayesUpdateable algorithm). An ensemble of high-performing machine-learning classifiers did not yield a higher area under the receiver operating curve than its component classifiers. Dimensional reduction decreased the computational requirements for multiple classifiers, but did not adversely affect classification performance. CONCLUSIONS Using historical data, machine-learning classifiers can predict which surgical cases should prompt a preoperative request for an APS consultation. Dimensional reduction improved computational efficiency and preserved predictive performance.
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Affiliation(s)
- Patrick J Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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Rognstad MK, Fredheim OMS, Johannessen TE, Kvarstein G, Skauge M, Undall E, Rustøen T. Attitudes, beliefs and self-reported competence about postoperative pain among physicians and nurses working on surgical wards. Scand J Caring Sci 2012; 26:545-52. [DOI: 10.1111/j.1471-6712.2011.00964.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A survey of acute pain service structure and function in United States hospitals. PAIN RESEARCH AND TREATMENT 2011; 2011:934932. [PMID: 22110935 PMCID: PMC3200061 DOI: 10.1155/2011/934932] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/05/2011] [Accepted: 02/07/2011] [Indexed: 11/18/2022]
Abstract
Although the number of U.S. hospitals offering an acute pain service (APS) is increasing, the typical structure remains unknown. This survey was undertaken to describe the structure and function of the APS in U.S. hospitals only. We contacted 200 non-teaching and 101 teaching U.S. hospitals. The person in charge of postoperative pain management completed and returned the survey. Seventy-four percent of responding hospitals had an organized APS. An APS was significantly more formally organized in academic/teaching hospitals when compared to non-teaching hospitals. Pain assessments included “pain at rest” (97%), “pain on activity” (63%), and reassessment after pain therapy intervention (88.8%). Responding hospitals utilized postoperative pain protocols significantly more commonly in teaching hospitals when compared to non-teaching and VA hospitals. Intravenous patient controlled analgesia (IV-PCA) was managed most commonly by surgeons (75%), while epidural analgesia and peripheral nerve block infusions were exclusively managed by anesthesiologists. For improved analgesia, 62% allowed RNs to adjust the IV-PCA settings within set parameters, 43% allowed RN adjustment of epidural infusion rates, and 21% allowed RN adjustment of peripheral nerve catheter local anesthetic infusion rates.
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Allvin R, Svensson E, Rawal N, Ehnfors M, Kling AM, Idvall E. The Postoperative Recovery Profile (PRP) - a multidimensional questionnaire for evaluation of recovery profiles. J Eval Clin Pract 2011; 17:236-43. [PMID: 20846316 DOI: 10.1111/j.1365-2753.2010.01428.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES The previously developed Postoperative Recovery Profile (PRP) questionnaire is intended for self-assessment of general recovery after surgery. The aim of this study was to further evaluate the questionnaire regarding the construct validity and ability to discriminate recovery profiles between groups. Furthermore, the item variables of greatest importance during the progress of recovery were investigated. METHODS Post-operative recovery was assessed during the period from discharge to 12 months after lower abdominal and orthopaedic surgery. Construct validity was evaluated by comparing the assessments from the PRP questionnaire and a global recovery scale. Recovery profiles of the diagnose groups were displayed by the cumulative proportion recovered participants over time. The importance of item variables was investigated by ranking ordering. RESULTS A total of 158 patients were included. Support was given for good construct validity. The result showed that 7.6% of all possible pairs were disordered when comparing the assessments from the PRP questionnaire and the global recovery scale. Twelve months after discharge the PRP assessments discriminated significantly the recovery profiles of the abdominal and orthopaedic groups. The variable pain was one of the top five most important issues at each follow-up occasion in both study groups. The importance of the item variables was thereby emphasized. CONCLUSIONS The PRP questionnaire allows for evaluation of the progress of post-operative recovery, and can be useful to assess patient-reported recovery after surgical treatment both on individual and group levels. Knowledge about recovery profiles can assist clinicians in determining the critical time points for measuring change.
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Affiliation(s)
- Renée Allvin
- Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
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Schoenwald AV. Two hundred days of nurse practitioner prescribing and role development: a case study report from a hospital-based acute pain management team. AUST HEALTH REV 2011; 35:444-7. [DOI: 10.1071/ah10946] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 01/13/2011] [Indexed: 11/23/2022]
Abstract
Purpose. This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management. Healthcare setting. The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice. Method of data collection. Data were conveniently collected by the NP on prescription and service provision over 200 working days. Main findings. Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics. Principal conclusions. These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required. What is known about the topic? There is little published information on the development of the Nurse Practitioner (NP) role in acute pain services in Australia or overseas. The acute pain role is a new development in Australia and so previous descriptions of NP practice have focussed on other specialty areas such as Emergency or Mental Health. What does this paper add? This report demonstrates positive and safe client outcomes as a result of a NP role in acute pain management. More importantly, it may contribute to accumulating evidence that NPs are safe prescribers of opioids and other analgesics in acute settings. What are the implications for practitioners? Novice NPs and Candidates practising in this specialty need to use this information as support for their own role development and implementation in other acute pain services in Australia.
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Sinatra R. Causes and Consequences of Inadequate Management of Acute Pain. PAIN MEDICINE 2010; 11:1859-71. [DOI: 10.1111/j.1526-4637.2010.00983.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peters ML, Sommer M, van Kleef M, Marcus MAE. Predictors of physical and emotional recovery 6 and 12 months after surgery. Br J Surg 2010; 97:1518-27. [DOI: 10.1002/bjs.7152] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
A proportion of patients do not recover fully from surgery or they develop chronic postsurgical pain. The aim of this study was to examine the incidence and predictors of unfavourable long-term outcome after surgery using a prospective cohort design.
Methods
Some 401 patients undergoing various elective surgical procedures filled in the RAND 36-item Health Survey 1·0 health-related quality-of-life questionnaire before operation and at 6 and 12 months of follow-up to assess changes in pain, physical functioning, mental health and vitality. Preoperative psychological assessment was obtained.
Results
Most patients showed improvement in the various aspects of health-related quality of life after surgery, but a considerable proportion (14–24 per cent) still showed deterioration at 6 and 12 months. Multivariable linear regression analysis identified acute postoperative pain, duration of the operation and preoperative physical condition as the most important predictors of long-term pain and physical functioning. Preoperative surgical fear also had a small but significant contribution. The main predictors of mental health and vitality were physical condition before surgery, surgical fear and optimism.
Conclusion
Up to a quarter of patients experienced suboptimal recovery after surgery. Both somatic and psychological factors were associated with the long-term outcome. Optimal recovery could be promoted by effective interventions on malleable factors.
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Affiliation(s)
- M L Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - M Sommer
- Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M van Kleef
- Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M A E Marcus
- Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
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Hartog CS, Rothaug J, Goettermann A, Zimmer A, Meissner W. Room for improvement: nurses' and physicians' views of a post-operative pain management program. Acta Anaesthesiol Scand 2010; 54:277-83. [PMID: 19912126 DOI: 10.1111/j.1399-6576.2009.02161.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The practice of post-operative pain therapy continues to be a problem. We conducted a survey among nurses and physicians about their views of an established post-operative pain management program. METHODS A questionnaire was sent to all nurses and physicians of nine surgical wards (general, trauma, cardio-thoracic and oromaxillofacial surgery and gynecology). Questions were developed from qualitative interviews with staff. Patient data were derived from a post-operative pain registry. RESULTS Seventy-eight physicians and nurses answered; the overall response rate was 23%. Post-operative pain therapy had high personal priority on an 11-point numeric rating scale (mean 9.08+/-1.27 standard deviation), but the success of pain management on the ward was rated as 7.32+/-1.37. Staff rating of success tended to correspond with patients' actual pain ratings. Knowledge of pain therapy was assessed as 6.85+/-1.82; nurses consistently rated levels higher than physicians. Staff over- or underestimated the painfulness of typical procedures and females rated procedures as more painful than men. There was considerable confusion about responsibilities and duties. 10.7% of staff perceived time delays exceeding 6 h between a request for acute pain services (APS) consultation and administration of medication to the patient. Invited comments suggested improvement in personnel education, team coordination, communication with patients and speed of action to increase the quality of pain therapy. CONCLUSION Despite staff's high personal priority and well-established APS and pain management program, post-operative pain therapy still leaves room for improvement. Considerable confusion about responsibilities and duties underlines the importance of better organizational approaches.
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Affiliation(s)
- C S Hartog
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, D-07747 Jena, Germany.
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Buckenmaier CC, Rupprecht C, McKnight G, McMillan B, White RL, Gallagher RM, Polomano R. Pain Following Battlefield Injury and Evacuation: A Survey of 110 Casualties from the Wars in Iraq and Afghanistan. PAIN MEDICINE 2009; 10:1487-96. [DOI: 10.1111/j.1526-4637.2009.00731.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Niemi-Murola L, Pöyhiä R, Onkinen K, Rhen B, Mäkelä A, Niemi TT. Patient satisfaction with postoperative pain management--effect of preoperative factors. Pain Manag Nurs 2007; 8:122-9. [PMID: 17723929 DOI: 10.1016/j.pmn.2007.05.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 03/12/2007] [Indexed: 11/19/2022]
Abstract
Patients often suffer from inadequate treatment of postoperative pain. The purpose of this study was to survey the factors affecting patient satisfaction with postoperative pain management. A questionnaire with 41 items was given on the third postoperative day to 102 patients undergoing major orthopedic or vascular surgery. Intensity of pain was assessed using a 10-cm visual analogue scale (VAS) and given analgesics were recorded. Nurses (n = 74) working on the wards received a questionnaire concerning attitudes toward management of pain. The questionnaires were returned by 75.5% of the patients and 86.3 % of the nurses. Mean VAS on all wards was 2 (scale 0-10). Twenty-eight percent of the patients agreed having hard pain during the day of the operation and 39.3% during the first postoperative night. Eighty percent of the patients were satisfied with pain management, and their satisfaction correlated significantly with received preoperative information (p < .01) and preoperative well-being (p < .01). There is discrepancy between the amount of experienced pain and values of the frequent VAS recordings, which does not seem to be due to the nurses' attitudes toward pain. Preoperative interview is important tool to receive and give information concerning postoperative pain management.
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MESH Headings
- Adult
- Arthroplasty, Replacement/adverse effects
- Attitude of Health Personnel
- Clinical Competence
- Factor Analysis, Statistical
- Female
- Finland
- Hospitals, University
- Humans
- Male
- Middle Aged
- Nursing Assessment
- Nursing Evaluation Research
- Nursing Methodology Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Pain Measurement
- Pain, Postoperative/diagnosis
- Pain, Postoperative/etiology
- Pain, Postoperative/prevention & control
- Pain, Postoperative/psychology
- Patient Education as Topic
- Patient Satisfaction
- Postoperative Care/methods
- Postoperative Care/nursing
- Postoperative Care/psychology
- Preoperative Care/methods
- Preoperative Care/nursing
- Preoperative Care/psychology
- Severity of Illness Index
- Surveys and Questionnaires
- Treatment Outcome
- Vascular Surgical Procedures/adverse effects
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Affiliation(s)
- Leila Niemi-Murola
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
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Tzavellas P, Papilas K, Grigoropoulou I, Zolindaki C, Kouki P, Chrona H, Kostopanagiotou G. A survey of postoperative epidural and intravenous analgesia in Greece. Eur J Anaesthesiol 2007; 24:942-50. [PMID: 17681089 DOI: 10.1017/s0265021507001160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Epidural and intravenous analgesia are widely used for postoperative pain management. Efficacy and safety is enhanced with the establishment of acute pain services. We studied the terms of application of these techniques in Greek hospitals and compared practices between anaesthetic departments with or without acute pain services. METHODS We performed a postal survey regarding departmental policy on the application of epidural and intravenous analgesia, patient monitoring, audit and educational activities, acute pain service teams and proposals for improvement. Pain services were classified according to predetermined quality criteria. Hospitals with or without acute pain services were compared. RESULTS Response rate was 46.3% (51 of 110 departments). Epidural analgesia was used in 49 departments, equally applied as intermittent boluses or continuous infusion. Twenty-two of the 39 departments that were using continuous infusion, used exclusively a lumbar approach. Intravenous analgesia was used by 42 (82%) departments; 13 used exclusively continuous infusion. All eight departments that had an established acute pain service fulfilled the predefined quality criteria compared with only ten of the remaining 43 (P < 0.001). CONCLUSION Our study discloses important issues regarding the use of intravenous and epidural analgesia and postoperative patient monitoring in Greek hospitals. Implementation of acute pain services that are satisfying the quality criteria may help to improve patient care.
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Affiliation(s)
- P Tzavellas
- General Hospital of Nikea Pireaus, Department of Anaesthesiology, Iraklion, Athens, Greece.
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Abstract
OBJECTIVE The purpose was to review the literature on the economic benefits associated with Acute Pain Service (APS) programs systematically. APSs have received widespread acceptance and formal support from institutions and organizations, but little is known about its economic benefits. METHODS MEDLINE and other databases were searched for economic evaluations of APSs. The study characteristics and methodological quality was assessed using standardized tools. All costs were adjusted to 2005 US dollars. RESULTS Ten economic evaluations (involving 14,774 patients) were identified that met eligibility criteria. There were wide variations in study designs, methodological quality, and outcome measures. There was insufficient data to identify which APSs model (anesthesiologist-based/nursing support or nurse-based/anesthesiologist supervised) was more cost-effective. The cost of APSs for surgical patients from direct and indirect effects (improved pain management from education in patients not receiving APS) varied from $2.28 to $5.08/patient/d. The level of evidence to support the cost-savings associated with APSs (shorter duration of intensive care unit and hospital stays) were limited to partial economic analyses. There was insufficient evidence to draw conclusions about the cost-effectiveness and cost-benefit of APSs as the quality of life and patient's willingness to pay for an APS intervention were not measured, respectively. The overall quality of published economic evaluations of APSs was poor. CONCLUSIONS There is a lack of high-quality economic studies to support the cost-effectiveness and cost-benefits of APSs.
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Affiliation(s)
- Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, Marcus MAE, Vlaeyen JWS, van Kleef M. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007; 245:487-94. [PMID: 17435557 PMCID: PMC1877005 DOI: 10.1097/01.sla.0000245495.79781.65] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify somatic and psychologic predictors of pain, functional limitations, global perceived recovery, and quality of life 6 months after surgical intervention. SUMMARY BACKGROUND DATA Recent studies have indicated that chronic pain after surgical intervention is more common than previously assumed. Several demographic and somatic predictors of long-term unfavorable outcome have been identified, but little is known about the contribution of psychologic risk factors. METHODS A prospective cohort study, including 625 patients undergoing elective surgery at the University Hospital Maastricht, The Netherlands, was conducted between February and August 2003. Psychologic questionnaires were completed preoperatively and acute postoperative pain was recorded until 4 days after the operation. Six months later, all patients received follow-up questionnaires to assess pain, functional limitations, global perceived recovery, and quality of life. Multivariable logistic regression analyses were used to estimate relative risk of poor outcome in terms of pain, functional limitations, and global recovery. Multivariable linear regression analysis was used to assess associations with quality of life at 6 months. RESULTS The most important somatic predictors of unfavorable outcome were duration of the operation and high levels of acute postoperative pain. Patients reporting high levels of pain 4 days after the operation and patients undergoing an operation of longer than 3 hours were at risk for increased pain, increased functional limitations, poor global recovery, and reported lower levels of quality of life 6 months after the operation. Psychologic variables that influenced long-term outcome were preoperative fear of surgery and optimism. Fear of the long-term consequences of the operation was associated with more pain, poor global recovery, and worse quality of life 6 months later, whereas optimism was associated with better recovery and higher quality of life. CONCLUSIONS This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain, functional limitations, and quality of life 6 months after surgical interventions. It replicates previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome and also identified additional risk factors, namely, long duration of the operation, ASA status, and preoperative fear of surgery.
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Affiliation(s)
- Madelon L Peters
- Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
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Rawal N, Langford RM. Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system. Eur J Anaesthesiol 2007; 24:299-308. [PMID: 17156510 DOI: 10.1017/s026502150600189x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Survey results continue to reveal that postoperative pain is insufficiently managed throughout Europe and the rest of the world. However, the efficient use of existing resources, as well as the introduction of novel technologies, may aid in its improvement. Use of an acute pain service has the potential to improve pain management through specialized patient care and utilization of effective analgesic techniques. Multimodal analgesic techniques, which include adjuvant non-opioids and/or regional analgesic techniques, can provide effective analgesia and reduce the amount of systemic opioids (or obviate the need) for postoperative pain management. Patient-controlled analgesia modalities may also offer improvements to pain management, as in practice they provide pain relief superior to the intermittent administration of bolus doses of opioids. A novel patient-controlled analgesia modality that has been approved by the European Medicines Evaluation Agency (EMEA) for the treatment of acute, moderate-to-severe pain is the needle-free, pre-programmed fentanyl HCl iontophoretic transdermal system. This system was shown in a recent US clinical trial to be comparable in efficacy to a standard regimen of morphine intravenous patient-controlled analgesia. Adverse events associated with the use of the fentanyl iontophoretic transdermal system are generally similar to those experienced by patients using intravenous morphine patient-controlled analgesia. Considerations regarding the selection of patients for treatment with the fentanyl iontophoretic transdermal system are similar to those with other patient-controlled analgesia modalities; sufficient upper limb mobility and alertness are required to operate the system. Utilization of the fentanyl iontophoretic transdermal system, together with the guidance of an effective acute pain service, may lead to improvements in postoperative pain management.
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Affiliation(s)
- N Rawal
- Orebro University Hospital, Department of Anaesthesiology and Intensive Care, Orebro, Sweden.
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