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Lee YJ, Bettick D, Rosenberg C. Improving Pain Self-Efficacy in Orthopedic Surgery Patients Through Video-Based Education: A Quality Improvement Project. Pain Manag Nurs 2024; 25:451-458. [PMID: 38719657 DOI: 10.1016/j.pmn.2024.04.008] [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: 01/07/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Effective pain management following discharge is critical for postoperative recovery, with pain self-efficacy serving as a crucial component in this process. Patient education plays a key role in enhancing self-efficacy. Among various educational modalities, a growing body of evidence supports the efficacy of video-based methods. LOCAL PROBLEM A lack of evidence-based pain education programs for patients undergoing elective orthopedic surgery was identified at an urban academic hospital on the East Coast of the United States. This quality improvement project aimed to develop and assess a video-based pain education program, focusing on pain self-efficacy and self-reported preparedness among adult patients prescribed opioids for postsurgical pain. METHODS This project adopted a pretest-posttest design, utilizing the knowledge-to-action framework. Data collection spanned 3 months. Among the 69 patients screened for eligibility, 13 participants were included in the analysis. The primary intervention consisted of a 15-minute educational video covering essential pain management aspects. Following the intervention, pain self-efficacy and self-reported preparedness were evaluated using the Pain Self-Efficacy Questionnaire and a five-point Likert scale, respectively. RESULTS Median (IQR) scores on the Pain Self-Efficacy Questionnaire increased significantly from 20 (16) to 32 (14) (p < .01). Mean (SD) scores for patients' self-reported preparedness also increased from 21.92 (6.53) to 31.85 (2.41) (p < .01). All participants reported being satisfied or very satisfied with the educational intervention. CONCLUSION Video-based education is a time-efficient and cost-effective approach. Healthcare providers can consider integrating video education to enhance pain self-efficacy in the postoperative phase, thus enhancing postsurgical pain outcomes and overall recovery experience.
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Affiliation(s)
- Yoon-Jae Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Dianne Bettick
- Department of Quality, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224, USA
| | - Carol Rosenberg
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, 21205, USA
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Kuo YF, Kim E, Westra J, Wilkes D, Raji MA. Pain Control Associated With Gabapentinoid Prescription After Elective Total Knee Arthroplasty. J Arthroplasty 2024; 39:941-947.e1. [PMID: 37871858 DOI: 10.1016/j.arth.2023.10.028] [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: 06/09/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Gabapentinoid (GABA) prescribing has substantially increased as a nonopioid analgesics for surgical conditions. We examined the effectiveness of GABA use for postoperative pain control among patients receiving total knee arthroplasty (TKA). METHODS This retrospective cohort study using 2016 to 2019 data from a 20% national sample of Medicare enrollees included patients aged 66 and over years who received an elective TKA, were discharged to home, received home health care, and had both admission and discharge assessments of pain (n = 35,186). Study outcomes were pain score difference between admission and discharge and less-than-daily pain interfering with activity at discharge. Opioid and GABA prescriptions after surgery and receipt of nerve block within 3 days of surgery were also assessed. RESULTS There were 30% of patients who had a pain score decrease of 3 to 4 levels and 55.8% had pain score decreases of 1 to 2 levels. In multivariable analyses, receiving a nerve block was significantly associated with pain score reduction. A GABA prescription increased the magnitude of pain score reduction among those receiving a nerve block. Results from inverse probability weighted analysis with propensity score showed that coprescribing of GABA and low-dose opioid was associated with significantly lower pain scores. CONCLUSIONS Post-TKA opioid use was not associated with pain score reduction. Receiving a nerve block was associated with a modest pain score reduction. Co-prescribing GABA with low-dose opioid or receiving a nerve block was associated with increasing magnitudes of pain reduction. Further research should identify alternatives to opioid use for managing postoperative TKA pain.
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Affiliation(s)
- Yong-Fang Kuo
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas; Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Emily Kim
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Denise Wilkes
- Department and Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Shi G, Liu G, Gao Q, Zhang S, Wang Q, Wu L, He P, Yu Q. A random forest algorithm-based prediction model for moderate to severe acute postoperative pain after orthopedic surgery under general anesthesia. BMC Anesthesiol 2023; 23:361. [PMID: 37932714 PMCID: PMC10626723 DOI: 10.1186/s12871-023-02328-1] [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: 05/23/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Postoperative pain is one of the most common complications after surgery. In order to detect early and intervene in time for moderate to severe postoperative pain, it is necessary to identify risk factors and construct clinical prediction models. This study aimed to identify significant risk factors and establish a better-performing model to predict moderate to severe acute postoperative pain after orthopedic surgery under general anesthesia. METHODS Patients who underwent orthopedic surgery under general anesthesia were divided into patients with moderate to severe pain group (group P) and patients without moderate to severe pain group (group N) based on VAS scores. The features selected by Lasso regression were processed by the random forest and multivariate logistic regression models to predict pain outcomes. The classification performance of the two models was evaluated through the testing set. The area under the curves (AUC), the accuracy of the classifiers, and the classification error rate for both classifiers were calculated, the better-performing model was used to predict moderate to severe acute postoperative pain after orthopedic surgery under general anesthesia. RESULTS A total of 327 patients were enrolled in this study (228 in the training set and 99 in the testing set). The incidence of moderate to severe postoperative pain was 41.3%. The random forest model revealed a classification error rate of 25.2% and an AUC of 0.810 in the testing set. The multivariate logistic regression model revealed a classification error rate of 31.3% and an AUC of 0.764 in the testing set. The random forest model was chosen for predicting clinical outcomes in this study. The risk factors with the greatest and second contribution were immobilization and duration of surgery, respectively. CONCLUSIONS The random forest model can be used to predict moderate to severe acute postoperative pain after orthopedic surgery under general anesthesia, which is of potential clinical application value.
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Affiliation(s)
- Gaoxiang Shi
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
- Department of Anesthesiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Geliang Liu
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Qichao Gao
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
| | - Shengxiao Zhang
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Qi Wang
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
| | - Li Wu
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China
| | - Peifeng He
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China.
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China.
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, China.
| | - Qi Yu
- Institute of Medical Data Science, Shanxi Medical University, Taiyuan, China.
- Shanxi Key Laboratory of Big Data for Clinical Decision, Shanxi Medical University, Taiyuan, China.
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, China.
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, China.
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Liu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100822. [PMID: 37927993 PMCID: PMC10625022 DOI: 10.1016/j.lanwpc.2023.100822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 11/07/2023]
Abstract
Background Postoperative pain poses a significant challenge to the healthcare system and patient satisfaction and is associated with chronic pain and long-term narcotic use. However, systemic assessment of the quality of postoperative pain management in China remains unavailable. Methods In this cross-sectional study, we analyzed data collected from a nationwide registry, China Acute Postoperative Pain Study (CAPOPS), between September 2019 and August 2021. Patients aged 18 years or above were required to complete a self-reported pain outcome questionnaire on the first postoperative day (POD1). Perioperative pain management and pain-related outcomes, including the severity of pain, adverse events caused by pain or pain management, and perception of care and satisfaction with pain management were analyzed. Findings A total of 26,193 adult patients were enrolled. There were 48.7% of patients who had moderate-to-severe pain on the first day after surgery, and pain severity was associated with poor recovery and patient satisfaction. The systemic opioid use was 68% on the first day after surgery, and 89% of them were used with intravenous patient-controlled analgesia, while the rate of postoperative nerve blocks was low. Interpretation Currently, almost half of patients still suffer from moderate-to-severe pain after surgery in China. The relatively high rate of systemic opioid use and low rate of nerve blocks used after surgery suggests that more effort is needed to improve the management of acute postoperative pain in China. Funding National Key Research and Development Program of China (No. 2018YFC2001905).
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Affiliation(s)
- Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
| | - Saisong Xiao
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- Department of Anesthesia, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Huikai Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Xuecai Lv
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Aisheng Hou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yandong Jiang
- Department of Anesthesiology, McGovern Medical School, University of Texas, Houston Health Science Center, Houston, TX, 77030, USA
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese People's Liberation Army, Beijing, 100853, China
- National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Jiang L, Yang Q, Li Q, Jiang B, Laba C, Feng Y. Optimal Duration of High-Fidelity Simulator Training for Bronchoscope-Guided Intubation: A Noninferiority Randomized Trial. Simul Healthc 2023:01266021-990000000-00074. [PMID: 37440425 DOI: 10.1097/sih.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The optimal simulator training duration for flexible optical bronchoscopic (FOB) intubation is unknown. This study aimed to determine whether a learning curve-based training modality was noninferior to a fixed training time modality in terms of clinical FOB intubation time. METHODS This multicenter, randomized, noninferiority study was conducted from May to August 2022. Anesthesiology residents or interns were enrolled. Eligible participants were randomized in a 1:1 ratio to receive new learning curve-based simulator training (individualized training time based on performance, group New) or reference fixed training time simulator training (1 hour, group Reference). The primary outcome was the time to complete FOB intubation in patients, which was defined as the time from the introduction of the FOB into the mouth until the first capnography visualization. The margin for detecting clinical significance was defined as 10 seconds. RESULTS A total of 32 participants were included in the analysis (16 in each group). All trainees successfully intubated the patients. The mean intubation time (95% confidence interval [CI]) was 81.9 (65.7-98.1) seconds in group New and 97.0 (77.4-116.6) seconds in group Reference. The upper bound of the 1-sided 97.5% CI for the mean difference of clinical intubation time between groups was 9.3 seconds. Noninferiority was claimed. The mean duration of the training in group New was 28.4 (95% CI, 23.5-33.4) minutes. The total number of training procedures on simulators in group New was significantly less than that in group Reference (P < 0.01). CONCLUSIONS The clinical FOB intubation time in group New was noninferior to that in group Reference.
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Affiliation(s)
- Luyang Jiang
- From the Department of Anesthesiology (L.J., Q.L., B.J., Y.F.), Peking University People's Hospital, Beijing, China; and Department of Anesthesiology (Q.Y., B.J., C.L.), Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China
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Lv X, Zhang H, Gao J, Hou A, Ma Y, Zhou Z, Mi W, Zhang H, Liu Y. Intraoperative dexmedetomidine on postoperative pain in gastrointestinal surgery: an observational study. Int J Surg 2023; 109:887-895. [PMID: 36999795 PMCID: PMC10389438 DOI: 10.1097/js9.0000000000000360] [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: 11/04/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Dexmedetomidine (DEX) is widely used for adjuvant sedation and analgesia in gastrointestinal surgeries. The authors aimed to reassess the effects of intraoperative DEX on acute pain by comprehensive analysis of the multiple dimensions of pain. MATERIALS AND METHODS In this multicentre cohort study, patients undergoing gastrointestinal surgeries were prospectively enrolled in the China Acute Postoperative Pain Study. Patients were divided into DEX and non-DEX groups based on whether DEX was used during surgery. Patient satisfaction with pain treatment (rated on a numeric rating score, 0-10) and other pain-related outcomes were evaluated using the International Pain Outcome Questionnaire on the first postoperative day. The effects of intraoperative DEX were analyzed using logistic or linear regression for dichotomous or continuous variables, respectively. Propensity score matching and subgroup analyses were performed to appraise the correlation between intraoperative DEX and postoperative pain outcomes. RESULTS Of the 1260 patients eligible for analysis, 711 (56.4%) received intraoperative DEX. Propensity score matching resulted in 415 patients in each group. Intraoperative DEX was associated with higher patient satisfaction (β: 0.556; 95% CI: 0.366-0.745), and a decrease in the percentage of time spent in severe pain (β: -0.081; 95% CI: -0.104- -0.058), anxiety (odds ratio: 0.394; 95% CI: 0.307-0.506), helplessness (odds ratio: 0.539; 95% CI: 0.411-0.707), and postoperative opioid consumption (β: -16.342; 95% CI: -27.528- -5.155). CONCLUSIONS Intraoperative DEX was associated with the prognosis of acute postoperative pain in multiple aspects in patients undergoing major gastrointestinal surgery, including increased patient satisfaction, and a reduction in the duration of severe pain, postoperative anxiety and helplessness, and postoperative opioid consumption. Future studies to determine the dose and timing of DEX administration on pain-related outcomes are warranted.
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Affiliation(s)
- Xuecai Lv
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
- Chinese PLA Medical School
| | - Haoyun Zhang
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
| | - Jie Gao
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
| | - Aisheng Hou
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
| | - Yulong Ma
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
| | - Zhikang Zhou
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
| | - Weidong Mi
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
- Chinese PLA Medical School
- National Clinical Research Center for Geriatric Diseases, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing China
| | - Hong Zhang
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
- Chinese PLA Medical School
| | - Yanhong Liu
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital
- Chinese PLA Medical School
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Johnson E, Yoshida M, Hallway A, Byrnes M, Waljee J, Englesbe M, Howard R. "I Prefer to Stay Away": A Qualitative Study of Patients in an Opioid-Sparing Pain Management Protocol. Ann Surg 2023; 277:596-602. [PMID: 34787984 DOI: 10.1097/sla.0000000000005087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore beliefs and behaviors of opioid pain medications among patients undergoing elective surgery. BACKGROUND Opioid dependence after surgery is a major contributor to the ongoing opioid epidemic. Recent efforts by surgeons and health systems have sought to improve the education patients receive regarding safe opioid use after surgery; however, little is known about patients' pre-existing beliefs surrounding opioids. METHODS Semistructured interviews were conducted with patients who underwent 1 of 4 common elective surgical procedures at 1 institution. Patients were specifically asked about their knowledge and beliefs about opioids before surgery and their opinions of opioid-sparing recovery after surgery. Coding was conducted through iterative steps, beginning with an initial cycle of rapid analysis, followed by focused coding, and thematic analysis. RESULTS Twenty-one patients were interviewed. Three major themes emerged regarding patient opinions about using opioids after surgery. First, there was widespread awareness among patients about opioid medications, and preoperatively, patients had specific intentions about using opioids, often informed by this awareness. Second, patients described a spectrum of opioid related behavior which both aligned and conflicted with preoperative intentions. Third, there was tension among patients about opioid-free postoperative recovery, with patients expressing support, opposition, and emphasis on tailoring recovery to patient needs. CONCLUSIONS Patients undergoing common surgical procedures often arrive at their surgical encounter with strong, pre-formed opinions about opioids. Eliciting these preexisting opinions may help surgeons better counsel patients about safe opioid use after surgery.
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Affiliation(s)
- Emily Johnson
- University of Michigan Medical School, Ann Arbor, MI
| | - Maxwell Yoshida
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI
| | | | - Mary Byrnes
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, MI
- Department of Surgery, Michigan Medicine, Ann Arbor, Mi
| | - Jennifer Waljee
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, MI
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI
| | - Michael Englesbe
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI
- Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI
| | - Ryan Howard
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, MI
- Department of Surgery, Michigan Medicine, Ann Arbor, Mi
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Ayres JM, Dallman J, Nolte JA, Higginbotham N, Baker J, Horton G, Salava J, Sojka J, Templeton KJ, Malancea RI, Heddings A. Managing Post-Operative Pain in Orthopedic Patients: An International Comparison. Kans J Med 2023; 16:56-60. [PMID: 36845259 PMCID: PMC9957592 DOI: 10.17161/kjm.vol16.18744] [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: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences. Methods Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed. Results Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients. Conclusions Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.
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Affiliation(s)
- Jack M Ayres
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Johnathan Dallman
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jack A Nolte
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Nicholas Higginbotham
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jordan Baker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Greg Horton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jonathon Salava
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - John Sojka
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Kimberly J Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Radu Ioan Malancea
- Department of Orthopedic Surgery, Spitalul Judetean de Urgenta Mavromati Botosani, Botosani, Romania
| | - Archie Heddings
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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Watson MB, Wood BA, Tubog TD. Utilization of Ketamine in Total Knee and Hip Joint Arthroplasty: An Evidence-Based Review. J Perianesth Nurs 2023; 38:139-147. [PMID: 35985972 DOI: 10.1016/j.jopan.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the efficacy of ketamine in total knee and hip arthroplasty. DESIGN Evidence-based review. METHODS Following the guidelines outlined in the PRISMA statement, a comprehensive search was conducted using Google Scholar, PubMed, CINAHL, Cochrane Collaboration, and other grey literature. Only randomized controlled studies and pre-appraised evidence such as systematic review and meta-analysis examining the effects of ketamine in total knee and hip arthroplasty were included. The quality appraisal of the literature was conducted using the proposed algorithm described in the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. FINDINGS Three systematic reviews and meta-analyses and 2 randomized controlled trials involving 1284 patients were included in this review. The use of ketamine reduced pain scores within the 24 hours after surgery. In addition, evidence suggests that patients who were treated with ketamine consumed fewer opioids 24 and 48 hours after surgery. Furthermore, ketamine reduced the incidence of postoperative nausea and vomiting with no effects on the incidence of hallucinations and central nervous system side effects. All studies included in the review were categorized as Level I and rated Grade A implying strong confidence in the true effects of ketamine in all outcome measures in the review. CONCLUSIONS The current evidence demonstrates the viability of ketamine as a safe and effective alternative to opioids in the perioperative setting with major total joint arthroplasty surgery. Decreased pain scores and opioid consumption up to 48 hours into the postoperative period were observed in a number of the appraised articles.
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Affiliation(s)
- Matthew B Watson
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Blake A Wood
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
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Kim K, Biskupiak JE, Babin JL, Ilham S. Positive Association between Peri-Surgical Opioid Exposure and Post-Discharge Opioid-Related Outcomes. Healthcare (Basel) 2022; 11:healthcare11010115. [PMID: 36611576 PMCID: PMC9819163 DOI: 10.3390/healthcare11010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Multiple studies have investigated the epidemic of persistent opioid use as a common postsurgical complication. However, there exists a knowledge gap in the association between the level of opioid exposure in the peri-surgical setting and post-discharge adverse outcomes to patients and healthcare settings. We analyzed the association between peri-surgical opioid exposure use and post-discharge outcomes, including persistent postsurgical opioid prescription, opioid-related symptoms (ORS), and healthcare resource utilization (HCRU). Methods: A retrospective cohort study included patients undergoing cesarean delivery, hysterectomy, spine surgery, total hip arthroplasty, or total knee arthroplasty in an academic healthcare system between January 2015 and June 2018. Peri-surgical opioid exposure was converted into morphine milligram equivalents (MME), then grouped into two categories: high (>median MME of each surgery cohort) or low (≤median MME of each surgery cohort) MME groups. The rates of persistent opioid use 30 and 90 days after discharge were compared using logistic regression. Secondary outcomes, including ORS and HCRU during the 180-day follow-up, were descriptively compared between the high and low MME groups. Results: The odds ratios (95% CI) of high vs. low MME for persistent opioid use after 30 and 90 days of discharge were 1.38 (1.24−1.54) and 1.41 (1.24−1.61), respectively. The proportion of patients with one or more ORS diagnoses was greater among the high-MME group than the low-MME group (27.2% vs. 21.2%, p < 0.01). High vs. low MME was positively associated with the rate of inpatient admission, emergency department admissions, and outpatient visits. Conclusions: Greater peri-surgical opioid exposure correlates with a statistically and clinically significant increase in post-discharge adverse opioid-related outcomes. The study findings warrant intensive monitoring for patients receiving greater peri-surgical opioid exposure.
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Affiliation(s)
- Kibum Kim
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL 60564, USA
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
- Correspondence: ; Tel.: +1-312-413-0152; Fax: +1-312-996-2954
| | - Joseph E. Biskupiak
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
- Pharmacotherapy Outcomes Research Center, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Jennifer L. Babin
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Sabrina Ilham
- Pharmacotherapy Outcomes Research Center, University of Utah Health, Salt Lake City, UT 84112, USA
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12
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Jiang B, Wu Y, Wang X, Gan Y, Wei P, Mi W, Feng Y. The influence of involving patients in postoperative pain treatment decisions on pain-related patient-reported outcomes: A STROBE-compliant registering observational study. Medicine (Baltimore) 2022; 101:e30727. [PMID: 36197159 PMCID: PMC9509085 DOI: 10.1097/md.0000000000030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The evidence regarding the influence of allowing patients to participate in postoperative pain treatment decisions on acute pain management is contradictory. This study aimed to identify the role of patient participation in influencing pain-related patient-reported outcomes (PROs). This is a cross-sectional study. The data were provided by PAIN OUT (www.pain-out.eu). A dataset specific to adult Chinese patients undergoing orthopedic surgery was selected. The PROs were assessed on postoperative day 1. The patient participant was assessed using an 11-point scale. Participants who reported >5 were allocated to the "participation" group, and those who reported ≤5 were allocated to the "nonparticipation" group. A 1:1 propensity score matching was conducted. The primary outcome was the desire for more pain treatment. All other items of PROs were the secondary outcomes comprising pain intensity, interference of pain with function, emotional impairment, adverse effects, and other patient perception. From February 2014 to November 2020, 2244 patients from 20 centers were approached, of whom 1804 patients were eligible and 726 pairs were matched. There was no significant difference between the groups in the desire for more pain treatment either before (25.4% vs 28.2%, risk ratio [95% CI]: 0.90 [0.77, 1.05], P = .18) or after matching (26.7% vs 28.8%, risk ratio [95% CI]: 0.93 [0.79, 1.10], P = .43). After matching, patients in the participation group reported significantly better PROs, including pain intensity (less time spent in severe pain [P < .01]), emotional impairment (less anxiety [P < .01]), interference with function (less interference with sleep [P < .01]), adverse effects (less drowsiness [P = .01]), and patient perception (more pain relief [P < .01] and more satisfaction [P < .01]), than the nonparticipation group. Patient participation in pain treatment decisions was associated with improved pain experience but failed to mitigate the desire for more treatment.
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Affiliation(s)
- Bailin Jiang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yaqing Wu
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Xiuli Wang
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Yu Gan
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Peiyao Wei
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
| | - Weidong Mi
- Anesthesia and Operation Center, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Yi Feng, Department of Anesthesiology, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District 100044, Beijing, China (e-mail: )
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13
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Jiang B, Liu Y, Wu Y, Mi W, Feng Y. A novel methodology to integrate outcomes regarding perioperative pain experience into a composite score: prediction model development and validation. Eur J Pain 2022; 26:2188-2197. [PMID: 36069125 DOI: 10.1002/ejp.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/23/2022] [Accepted: 09/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND An integrated score that globally assesses perioperative pain experience and rationally weights each component has not yet been developed. METHODS A development dataset specific to adult Chinese patients undergoing orthopedic surgery was obtained from PAIN OUT (1985 qualified patients of 2244). A more recent validation dataset obeying the same conditions was obtained from the Chinese Anesthesia Shared-database Platform (1004 qualified patients of 1032). Outcomes were assessed using the International Pain Outcomes Questionnaire (IPO-Q), which comprises key patient-level outcomes of perioperative pain management, including pain experience and perceptions of care. Using principal component analysis and regression models, a composite score was inferred to integrate pain experience. The discrimination of the composite score for dissatisfaction and desire for more pain treatment was compared with that of the worst pain score. RESULTS A composite score was developed from the 12 items of the IPO-Q regarding pain experience. The weight for calculating the composite score was worst pain 11, least pain 17, time spent in severe pain 11, interference with activity in bed 9, interference with breathing deeply or coughing 10, interference with sleep 9, anxiety 12, helplessness 12, nausea 0, drowsiness 2, itch 5, and dizziness 2. In external validation, the composite score indicated superior discrimination to the worst pain in predicting dissatisfaction (P<0.001) and desire for more pain treatment (P<0.001). CONCLUSIONS This study introduced a methodology to integrate outcomes regarding perioperative pain experience into a composite score, which was based on the weight of each item.
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Affiliation(s)
- B Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Y Liu
- Anesthesia and Operation Center, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Wu
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - W Mi
- Anesthesia and Operation Center, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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14
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Polanco-García M, Granero R, Gallart L, García-Lopez J, Montes A. Finding the vulnerable postoperative population: A two-step cluster analysis of the PAIN-OUT registry. Eur J Pain 2022; 26:1732-1745. [PMID: 35762292 DOI: 10.1002/ejp.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Identifying predictors of poor postoperative outcomes is crucial for planning personalized pain treatments. The aim of this study was to examine pain outcomes using cluster analysis in N=2,678 patients from the PAIN-OUT registry at first postoperative day. METHODS Indicator variables of the clustering analysis assessed multiple domains, such as clinical and surgical conditions, analgesic-anesthetic variables, desire for more pain treatment and outcome variables of the International Pain Outcome Questionnaire (IPO) summarized as factor scores. RESULTS Two-step cluster identified the three-cluster solution as the optimal. Two empirical groups (C1 and C2) included patients with good postoperative outcomes discriminated by peripheral nerve block use, while the other cluster (C3) grouped patients with the worst outcomes, where all patients desired more pain treatment. C3 comprised about 20% of the participants, mostly lower limb, abdominal and spine procedures. The best predictors of belonging to C3 included younger age, being male, preoperative opioid use, bone and fracture reduction procedures, institution, number of comorbidities and morphine equivalents in the recovery room. CONCLUSIONS IPO factor scores can be used to select pain outcomes phenotypes in large clinical databases. Most of the predictors were present before the recovery period so perioperative planning should focus in the preoperative and intraoperative periods.
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Affiliation(s)
- Mauricio Polanco-García
- Department of Anesthesiology, Consorci Sanitari Integral, Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Spain.,Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona, Spain
| | - Lluís Gallart
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
| | - Jaume García-Lopez
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
| | - Antonio Montes
- Department of Anesthesiology, Hospital del Mar. IMIM (Hospital del Mar Medical Research Institute). Universitat Autònoma de Barcelona, Spain
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15
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Hohmann E, Glatt V, Tetsworth K, Bak K, Beitzel K, Bøe B, Calvo E, Di Giacomo G, Favard L, Franceschi F, Funk L, Glanzmann M, Imhoff A, Lädermann A, Levy O, Ludvigsen T, Milano G, Moroder P, Rosso C, Siebenlist S, Abrams J, Arciero R, Athwal G, Burks R, Gillespie R, Kibler B, Levine W, Mazzocca A, Millett P, Ryu R, Safran M, Sanchez-Sotelo J, Savoie FB, Sethi P, Shea K, Verma N, Warner JJ, Weber S, Wolf B. Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons. Arthroscopy 2022; 38:1051-1065. [PMID: 34655764 DOI: 10.1016/j.arthro.2021.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American with European shoulder surgeon preferences. METHODS Nineteen surgeons from North America (North American panel [NAP]) and 18 surgeons from Europe (European panel [EP]) agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤60% for an item, the results were carried forward into round 4. For round 4, the panel members outside consensus (>60%, <80%) were contacted and asked to review their response. The level of agreement and consensus was defined as 80%. RESULTS There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the workup; magnetic resonance imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of nonoperative treatment for a minimum of 6 months. The NAP was likely to routinely prescribe nonsteroidal anti-inflammatory drugs (NAP 89%; EP 35%) and consider steroids for impingement (NAP 89%; EP 65%). CONCLUSIONS Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of no-operative treatment for a minimum of 6 months. The panel also agreed that subacromial decompression is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to nonsurgical measures. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Erik Hohmann
- Department of Orthopaedic Surgery and Sportsmedicine, Valiant Clinic/Houston Methodist, Dubai, United Arab Emirates.
| | - Vaida Glatt
- University of Texas Health Science Centre, San Antonio, Texas, U.S.A
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Orthopaedic Research Centre of Australia, Sydney, Australia
| | | | - Klaus Bak
- Adeas Hospitals Skodsborg&Parken, Copenhagen, Denmark.
| | | | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Universidad Autonoma, Madrid, Spain.
| | | | - Luc Favard
- Tours University Hospital, University of Tours, France.
| | | | - Lennard Funk
- Upper Limb Unit, Wrightington Hospital, Wrightington, UK.
| | | | - Andreas Imhoff
- Department of Orthopaedic Sports Medicine, Technical University Munich, Germany.
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, Berkshire, United Kingdom; The Israeli Shoulder Institute, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel.
| | - Tom Ludvigsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway.
| | - Giuseppe Milano
- Unit of Orthopaedics and Traumatology, University of Brescia, Italy.
| | - Philipp Moroder
- Department of Shoulder and Elbow Surgery, Centrum for Muskuloskeletale Chirurgie, Charite Universitätsmedizin Berlin, Germany.
| | | | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University Munich, Germany.
| | - Jeffrey Abrams
- Princeton Orthopeadic Associates Princeton, New Jersey , USA.
| | - Robert Arciero
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | - George Athwal
- Roth/McFarlane Hand&Upper limb Centre, St Joseph's Health Care, London, Ontario, Canada.
| | | | - Robert Gillespie
- Department of Orthopaedics Case Western Reserve University, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA.
| | - Ben Kibler
- Lexington Orthopaedic Clinic, Sports Medicine Center Lexington, Kentucky, USA.
| | - William Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center New York, NY, USA.
| | - Augustus Mazzocca
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | | | - Richard Ryu
- The Ryu Hurvitz Orthopaedic Clinic, Santa Barbara, California, USA.
| | - Marc Safran
- Department of Orthopaedic Surgery, Stanford University Stanford, CA, USA.
| | | | - Felix Buddy Savoie
- Department of Orthopaedic Surgery, Tulane University New Orleans, LA, USA.
| | - Paul Sethi
- The ONS Sports and Shoulder Service, Greenwich, CT, USA.
| | - Kevin Shea
- Department of Orthopaedic Surgery, UCONN Health, Farmington, CT, USA.
| | - Nikhil Verma
- Midwest Orthopaedics at Rush University, Chicago, IL, USA.
| | - Jon Jp Warner
- Massachusetts General Hospital, The Boston Shoulder Institute Boston, MA USA.
| | | | - Brian Wolf
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA USA.
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Macintyre PE, Quinlan J, Levy N, Lobo DN. Current Issues in the Use of Opioids for the Management of Postoperative Pain: A Review. JAMA Surg 2022; 157:158-166. [PMID: 34878527 DOI: 10.1001/jamasurg.2021.6210] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Uncontrolled and indiscriminate prescribing of opioids has led to an opioid crisis that started in North America and spread throughout high-income countries. The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, focusing on drivers that led to escalation of use, patient harms, the move away from using self-reported pain scores alone to assess adequacy of analgesia, concerns about the routine use of controlled-release opioids for the management of acute pain, opioid-free anesthesia and analgesia, and prescription of opioids on discharge from hospital. Observations The origins of the opioid crisis are multifactorial and may include good intentions to keep patients pain free in the postoperative period. Assessment of patient function may be better than unidimensional numerical pain scores to help guide postoperative analgesia. Immediate-release opioids can be titrated more easily to match analgesic requirements. There is currently no good evidence to show that opioid-free anesthesia and analgesia affects opioid prescribing practices or the risk of persistent postoperative opioid use. Attention should be paid to discharge opioid prescribing as repeat and refill prescriptions are risk-factors for persistent postoperative opioid use. Opioid stewardship is paramount, and many governments are passing legislation, while statutory bodies and professional societies are providing advice and guidance to help mitigate the harm caused by opioids. Conclusions and Relevance Opioids remain a crucial part of many patients' journey from surgery to full recovery. The last few decades have shown that unfettered opioid use puts patients and societies at risk, so caution is needed to mitigate those dangers. Opioid stewardship provides a multilayered structure to allow continued safe use of opioids as part of broad pain management strategies for those patients who benefit from them most.
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Affiliation(s)
- Pamela E Macintyre
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and Discipline of Acute Care Medicine, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Quinlan
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nicholas Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, United Kingdom
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
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How orthopedic surgeons view open label placebo pills: Ethical and effective, but opposed to personal use. J Psychosom Res 2021; 151:110638. [PMID: 34644614 PMCID: PMC8633179 DOI: 10.1016/j.jpsychores.2021.110638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/28/2021] [Accepted: 10/02/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine attitudes of Open Label Placebos (OLP) among a national sample of US orthopedic surgeons. METHODS Orthopedic surgeons across the US were invited to participate in a brief online cross-sectional survey; n = 687 participated. The survey included a short vignette of a surgeon using adjunctive OLPs in addition to opioids for postoperative pain management. Participants indicated how ethical and effective they thought OLPs would be in this context, and whether they would personally consider using OLPs. RESULTS Nearly three-quarters (73.9%) of the surgeons considered OLPs ethical. In total, 55.4% and 48.8% of participants said that OLPs would "probably" or "definitely" be effective for Vicodin reduction and pain relief, respectively. However, only 19.2% of participants indicated they were personally willing to consider OLPs, and 59.6% were unwilling to do so. CONCLUSIONS Generally, orthopedic surgeons perceive OLPs as both ethical and effective, but would not consider using them in their practice. Further research is needed to identify clinician barriers to OLP use.
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18
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Lee L, Fiore JF. NSAIDs and anastomotic leak: What's the evidence? SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Torabikhah M, Yousefi H, Ansari AHM, Musarezaie A. The Effect of Reducing the Fasting Time on Postoperative Pain in Orthopaedic Patients: A Randomized Controlled Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:310-315. [PMID: 34422610 PMCID: PMC8344633 DOI: 10.4103/ijnmr.ijnmr_291_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/06/2020] [Accepted: 02/08/2021] [Indexed: 11/04/2022]
Abstract
Background Patients undergoing orthopedics surgery experience the most severe postoperative pain. The fasting time is a factor that affects this complication. The aim of this study was to investigate the impact of fasting time reduction by using oral carbohydrate on postoperative pain and analgesic consumption in orthopedic patients. Materials and Methods This randomized control trial was conducted between November 2017 and December 2018. Sixty-four patients were randomly assigned into the intervention (which consumed 200 mL of the 12.50% carbohydrate, 2 h before the surgery) and the control group (which was fasted from midnight). Postoperative pain was measured by visual analog scale; the amount of the consumed analgesics was also recorded. The data were analyzed by using Chi-square and t-test. Results The mean (SD) of the pain scores in the control group immediately and 2, 4, 6, 12 and 24 h after consciousness were 7.19 (2.64), 6.69 (2.17), 6.31 (2.05), 6.16 (2.08), 6.06 (2.24), and 5.38 (1.86), respectively. These scores for the intervention group were 7.44 (1.48), 6.31 (1.25), 5.72 (1.17), 5.59 (1.43), 5.25 (1.13), and 4.97 (1.57). The mean of the pain scores between two groups was not different (p > 0.05). The amount of the consumed morphine (t 61= -2.10, p = 0.039), pethidine (t 62= -2.25, p = 0.028), and diclofenac (t 62= -2.51, p = 0.015) were significantly different between the two groups. Conclusions The pain intensity in the patients with shortened fasting time was lower, but it was not statistically significant. Moreover, reducing fasting time by using carbohydrate significantly reduced the use of analgesics.
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Affiliation(s)
- Mohsen Torabikhah
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hojatollah Yousefi
- Nursing and Midwifery Care Research Center, Adult Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Amir Musarezaie
- Nursing and Midwifery Care Research Center, Adult Nursing Department, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Stopar-Pintaric T, Blajic I, Visic U, Znider M, Plesnicar A, Vlassakov K, Lucovnik M. Posteromedial quadratus lumborum block versus wound infiltration after caesarean section: A randomised, double-blind, controlled study. Eur J Anaesthesiol 2021; 38:S138-S144. [PMID: 33988528 DOI: 10.1097/eja.0000000000001531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reducing pain and minimising the use of opioids after caesarean section are crucial to enhancing maternal recovery and promoting mother-newborn interaction. Various techniques have been implemented to improve analgesia. We compared the analgesic efficacy of posteromedial quadratus lumborum block with that of wound infiltration following elective caesarean section. OBJECTIVE We hypothesised that within a multimodal analgesia approach, posteromedial quadratus lumborum block would, due to its potential to relieve visceral pain, result in a 15% reduction in 24-h postoperative opioid consumption compared with wound infiltration. DESIGN A double-blind, randomised, placebo-controlled clinical study. SETTING A single-centre study between August 2019 and May 2020. PATIENTS One hundred and sixteen women were randomly allocated into two groups. In the quadratus lumborum group, 20 ml 0.9% saline was injected into the surgical wound followed by bilateral posteromedial quadratus lumborum block using 20 ml 0.25% levobupivacaine per side. In the wound infiltration group, 20 ml of 0.25% levobupivacaine was injected into the surgical wound followed by a bilateral posteromedial quadratus lumborum injection with 20 ml 0.9% saline per side. MAIN OUTCOME MEASURES The primary outcome was opioid (piritramide) consumption at 24 h. Secondary outcomes were piritramide consumption at 48 h, time-to-first analgesic request, pain scores at rest and with movement, surgery-to-first-ambulation time, surgery-to-breastfeeding time, sedation, pruritus and complications. RESULTS Piritramide consumption in 24 h was significantly lower with posteromedial quadratus lumborum block (1.5 ± 1.8 mg) than with wound infiltration (2.2 ± 1.7 mg) (P = 0.04), mean difference of -0.7 mg, (95% CI -1.3 to -0.03). In those who required piritramide, time-to-first analgesic request was significantly longer with posteromedial quadratus lumborum block 11 [7 to 14] h, than with wound infiltration 7 [5 to 11] h (P = 0.02). Pain scores were low, with no differences recorded at rest and with movement. There were no differences in time-to-ambulation and time-to-breastfeed between the groups. CONCLUSION As a component of multimodal post-caesarean section analgesia, posteromedial quadratus lumborum block was associated with lower 24-h opioid consumption compared with wound infiltration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04000308.
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Affiliation(s)
- Tatjana Stopar-Pintaric
- From the Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana (TSP, IB), the Institute of Anatomy, Faculty of Medicine, University of Ljubljana (TSP), the Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana (UV, ML), the Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia (MZ, AP, ML), the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA (KV)
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Tomaszek L, Ozga D. Predictors of maximal postoperative pain at rest in adult patients undergoing elective surgery - A multicenter observational study. Nurs Health Sci 2021; 23:754-762. [PMID: 33993604 DOI: 10.1111/nhs.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023]
Abstract
The aim of this prospective cohort study was to assess the maximum intensity of postoperative pain at rest in 620 adults after an elective surgery as well as to determine demographic and clinical predictors of pain. The Hospital Anxiety and Depression Scale was used to evaluate the preoperative mental condition of the patient. Preoperative and postoperative pain were assessed at rest based on the Numeric Rating Scale (range: 0-10). The total median maximum intensity of pain was 3 (interquartile range: 1-5). The linear regression model for the maximum intensity of postoperative pain was statistically significant and very well fitted - the coefficient of determination was 62%. Preoperative anxiety, pain, cancer, a medical history of thyroid (vs abdominal) surgery, and an operation resulting in major (vs moderate) tissue injury have a positive impact on the maximum intensity of postoperative pain. Eye surgery and lower limb operations gave lower scores than abdominal surgery. The early identification of these predictors in patients at risk for postoperative pain will help in preparing an individual pain management plan.
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Affiliation(s)
- Lucyna Tomaszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.,Pediatric Division, Institute for Tuberculosis and Lung Diseases, Rabka-Zdroj, Poland
| | - Dorota Ozga
- Institute of Health Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Xu X, Liu H, Zhang Y, Xue E, Yu H, Hu Y. The use of 2-octyl cyanoacrylate as an adjuvant to wound closure in total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:663-668. [PMID: 33386442 DOI: 10.1007/s00402-020-03674-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The efficacy of the use of 2-octyl cyanoacrylate (OCA) as an adjuvant to wound closure in preventing wound complications after total knee arthroplasty (TKA) is rarely reported. This study was aimed to determine whether the use of OCA as a supplement to conventional wound closure reduces the incidence of wound complications following TKA. PATIENTS AND METHODS This retrospective study reviewed 1106 consecutive patients who underwent TKA for symptomatic end-stage osteoarthritis (OA) between 2012 and 2017. The first 562 patients who did not receive OCA were grouped into the Control group, and the subsequent 544 patients who received OCA as an adjuvant to wound closure were grouped into the OCA group. All patients were followed up for at least 2 years. The main outcome was the development of operative site complications, including aseptic and infectious complications. Aseptic wound complications were wound leakage, hematoma, wound dehiscence and delayed wound healing, and infectious complication was mainly referred to the superficial infection. RESULTS No significant difference with regard to hematoma was observed between groups (3.0% vs. 3.7%, P = 0.617, φ = - 0.02). The incidences were significantly higher in the Control group versus the OCA group in regard to wound leakage (9.4% vs. 2.0%, P = 0.000, φ = 0.16), wound dehiscence (5.7% vs. 1.3%, P = 0.000, φ = 0.12), delayed wound healing (4.4% vs. 1.5%, P = 0.004, φ = 0.09) and superficial infection (2.0% vs. 0.4%, P = 0.022, φ = 0.07). No serious adverse events (AEs) occurred. CONCLUSIONS The present study showed that the addition of OCA reduced the incidence of wound leakage, wound dehiscence, delayed wound healing and superficial infection after TKA compared to conventional wound closure. Based on the outcomes above, we decide to use OCA routinely for wound closure after TKA. LEVEL OF EVIDENCE III, retrospective, cohort study.
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Affiliation(s)
- Xinxian Xu
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haixiao Liu
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu Zhang
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Enxing Xue
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huachen Yu
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuezheng Hu
- The Osteopathy Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Confirmatory factor analysis of the International Pain Outcome questionnaire in surgery. Pain Rep 2021; 6:e903. [PMID: 33693302 PMCID: PMC7939228 DOI: 10.1097/pr9.0000000000000903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. The reliability and validity of International Pain Outcome questionnaire Spanish adaptation is confirmed in a large heterogeneous sample. Factor scores can be used as a global outcome analysis tool. Background: Choosing perioperative suitable treatments requires reliable and valid outcome measurements. The International Pain Outcome (IPO) questionnaire has been widely used for quality improvement and research purposes within the PAIN-OUT network that has collected more than 550,000 data sets of postoperative patients in 200 hospitals worldwide. Our aim is to confirm psychometric properties of the Spanish version of the IPO questionnaire and its invariance by pain predictors. Method: Sample included 4014 participants within a large age range, who underwent different surgical procedures. Confirmatory factor analysis (CFA) assessed internal structure, considering invariance by sex, age, procedure, smoking, obesity, affective disorder, and chronic pain. Incremental predictive validity of factor scores on question would have liked more pain treatment and opioid requirement was also estimated with logistic binary regression. Results: Confirmatory factor analysis verified original structure in 3 factors measuring pain intensity and interference (F1), adverse effects (F2), and perceptions of care (F3), with good internal consistency. Multigroup CFA analysis confirmed invariance by assessed pain predictors. Good incremental predictive capacity to identify would have liked more pain treatment was achieved. Conclusion: Our study confirms the factor structure, supports reliability, and adds some evidence of convergent validity of the Spanish adaptation of the IPO questionnaire. The sum of scores in its main factors serves a global outcome analysis tool. Low scores in F1 and F2 with high scores in F3 would indicate optimal quality of care.
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Baca Q, Marti F, Poblete B, Gaudilliere B, Aghaeepour N, Angst MS. Predicting Acute Pain After Surgery: A Multivariate Analysis. Ann Surg 2021; 273:289-298. [PMID: 31188202 PMCID: PMC8130578 DOI: 10.1097/sla.0000000000003400] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify perioperative practice patterns that predictably impact postoperative pain. BACKGROUND Despite significant advances in perioperative medicine, a significant portion of patients still experience severe pain after major surgery. Postoperative pain is associated with serious adverse outcomes that are costly to patients and society. METHODS The presented analysis took advantage of a unique observational data set providing unprecedented detailed pharmacological information. The data were collected by PAIN OUT, a multinational registry project established by the European Commission to improve postoperative pain outcomes. A multivariate approach was used to derive and validate a model predictive of pain on postoperative day 1 (POD1) in 1008 patients undergoing back surgery. RESULTS The predictive and validated model was highly significant (P = 8.9E-15) and identified modifiable practice patterns. Importantly, the number of nonopioid analgesic drug classes administered during surgery predicted decreased pain on POD1. At least 2 different nonopioid analgesic drug classes (cyclooxygenase inhibitors, acetaminophen, nefopam, or metamizol) were required to provide meaningful pain relief (>30%). However, only a quarter of patients received at least 2 nonanalgesic drug classes during surgery. In addition, the use of very short-acting opioids predicted increased pain on POD1, suggesting room for improvement in the perioperative management of these patients. Although the model was highly significant, it only accounted for a relatively small fraction of the observed variance. CONCLUSION The presented analysis offers detailed insight into current practice patterns and reveals modifications that can be implemented in today's clinical practice. Our results also suggest that parameters other than those currently studied are relevant for postoperative pain including biological and psychological variables.
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Affiliation(s)
- Quentin Baca
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Florian Marti
- Department of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital, Solothurn
| | - Beate Poblete
- Clinic for Anesthesia, Rescue Medicine and Pain Therapy, Kantonsspital, Luzern, Switzerland
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Rep 2020; 5:e831. [PMID: 32766467 PMCID: PMC7390596 DOI: 10.1097/pr9.0000000000000831] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 01/01/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. Eight risk factors were identified in a large international database. Patients with 3 or more risk factors are at higher risk for poor pain outcome. Background: The aim of this study was to determine simple risk factors for severe pain intensity (≥7 points on a numeric rating scale [NRS]), to analyse their relation to other patient-reported outcome measures and to develop a simple prediction model. Methods: We used data from 50,005 patients from the PAIN-OUT project. Within a first data set (n = 33,667), relevant risk factors were identified by logistic binary regression analysis, assessed for additional patient-reported outcome measures beyond pain intensity and summed up for developing a simple risk score. Finally, sum of factors was plotted against postoperative pain outcomes within a validation data set (n = 16,338). Results: Odds ratios (OR) for the following risk factors were identified: younger age (<54 years, OR: 1.277), preoperative chronic pain at the site of surgery (OR: 1.195), female sex (OR: 1.433), duration of surgery (>90 minutes, OR: 1.308), preoperative opioid intake (OR: 1.250), feeling anxious (OR: 1.239) and feeling helpless due to pain (OR: 1.198), and the country of the recruiting centre (OR: 1.919). Patients with ≥3 risk factors had more severe pain intensity scores, spent a longer time in severe pain, and wished to have received more pain treatment (P < 0.001). A simple risk score was created with 4 risk factors showing a moderate prediction level. Conclusions: Patients with ≥3 risk factors are at higher risk for poor postoperative acute pain outcome after surgery. Future studies using this score might show that preventive strategies might decrease pain intensity, pain-related postoperative dysfunction, and the development of chronic pain.
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Lovecchio F, Premkumar A, Uppstrom T, Stepan J, Ammerman B, McCarthy M, Stein BS, Pearle A, Taylor S, Kumar K, Albert T, Hannafin J. Opioid Consumption After Arthroscopic Meniscal Procedures and Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120913549. [PMID: 32426402 PMCID: PMC7219018 DOI: 10.1177/2325967120913549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Procedure-specific opioid-prescribing guidelines have the potential to decrease the number of unused pills in the home without compromising patient satisfaction. However, there is a paucity of data on the minimum necessary quantity to prescribe for outpatient orthopaedic surgeries. Purpose: To prospectively record daily opioid use and pain levels after arthroscopic meniscal procedures and anterior cruciate ligament reconstruction (ACLR) at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 95 adult patients who underwent primary arthroscopic knee surgery (meniscectomy, repair, or ACLR) were enrolled. Patients with a history of opioid dependence were ineligible. Daily opioid consumption and Numeric Rating Scale pain scores were collected through an automated text-messaging platform starting on postoperative day 1 (POD1). At 6 weeks or at patient-reported cessation of opioid use, final survey questions were asked. Patients who failed to complete data collection were excluded. Opioid use was converted into “pills” (oxycodone 5-mg equivalents) to facilitate comparisons and clinical applications. Factors associated with high and low opioid use were compared. Results: Of the 95 patients enrolled, 71 (74.7%) were included in the final analysis. Of these, 40 (56.3%) underwent meniscal surgery and 31 (43.7%) underwent ACLR. After outpatient arthroscopic meniscectomy or repair, the total median postdischarge opioid use was 0.3 pills (oxycodone 5-mg equivalents), with 75% of patients consuming 3.3 or fewer pills (range, 0-19 pills). For ACLR, the median postdischarge consumption was 7 pills (75th percentile, 23.3 pills; range, 0-41 pills). Almost one-third of patients (32.3%) took no opioids after surgery (3 ACLR, 20 meniscus). All meniscus patients and 71% of ACLR patients ceased opioid consumption by postoperative day 7. Conclusion: Opioids may not be necessary in all patients, particularly after meniscal surgery and in comparison with ACLR. For patients requesting opioids for pain relief, reasonable prescription quantities are 5 oxycodone 5-mg pills after arthroscopic meniscal procedures and 20 5-mg pills after ACLR. Slowing the current opioid epidemic and preventing future crises is dependent on refining prescribing habits. Clinicians should strongly consider patient education regarding expected pain as well as pain management strategies.
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Affiliation(s)
- Francis Lovecchio
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Ajay Premkumar
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Tyler Uppstrom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Jeffrey Stepan
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Brittany Ammerman
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Moira McCarthy
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Beth Shubin Stein
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Samuel Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Kanuypria Kumar
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, USA
| | - Todd Albert
- Spine Service, Hospital for Special Surgery, New York, New York, USA
| | - Jo Hannafin
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Fiore JF, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, Figueiredo AG, Valanci S, Marquez-GdeV JA, Schulz M, Moldoveanu D, Nguyen-Powanda P, Best G, Banks A, Landry T, Pecorelli N, Baldini G, Feldman LS. Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia. Br J Anaesth 2019; 123:627-636. [DOI: 10.1016/j.bja.2019.08.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/21/2019] [Accepted: 08/10/2019] [Indexed: 01/28/2023] Open
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Meissner W, Zaslansky R. A survey of postoperative pain treatments and unmet needs. Best Pract Res Clin Anaesthesiol 2019; 33:269-286. [PMID: 31785713 DOI: 10.1016/j.bpa.2019.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
More than 300 million patients undergo surgery worldwide each year. Pain associated with these procedures is associated with short- and long-term negative sequelae for patients, healthcare providers, and healthcare systems. The following chapter is a review of the reality of postoperative pain management in everyday clinical routine based on survey- and registry-derived data with a focus on care in adults. Between 30% and up to 80% of patients report moderate to severe pain in the days after surgery. Structures, processes, and outcomes vary widely between hospitals and indicate gaps between evidence-based findings and practice. Pain assessment is not effectively implemented in many hospitals and should consider cultural differences. Few data exist on the situation of pain management in low- and middle-income countries, indicating lack of resources and available medication in many of these areas. Certain types of surgery as well as demographic and clinical factors are associated with increased risk of severe postoperative pain.
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Affiliation(s)
- Winfried Meissner
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany.
| | - Ruth Zaslansky
- Dept of Anesthesiology and Intensive Care, Jena University Hospital, Am Klinikum 1, 07740 Jena, Germany
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The importance of appropriate control groups in perioperative analgesic studies: One size does not fit all. J Clin Anesth 2018; 48:91-92. [PMID: 29803193 DOI: 10.1016/j.jclinane.2018.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/24/2022]
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