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Carron M, Tamburini E, Linassi F, Pettenuzzo T, Boscolo A, Navalesi P. Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:2100. [PMID: 38610865 PMCID: PMC11012569 DOI: 10.3390/jcm13072100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Background/Objectives: Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity.
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Affiliation(s)
- Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
| | - Enrico Tamburini
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Giustiniani St. 2, 35128 Padova, Italy
| | - Federico Linassi
- Department of Anesthesia and Intensive Care, Ca' Foncello Treviso Regional Hospital, Hospital Sq. 1, 31100 Treviso, Italy
| | - Tommaso Pettenuzzo
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Giustiniani St. 2, 35128 Padova, Italy
| | - Annalisa Boscolo
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
| | - Paolo Navalesi
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Gallucci V. St. 13, 35121 Padova, Italy
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Albarrak AA. Safety of Non-steroidal Anti-inflammatory Drugs as Part of Enhanced Recovery After Laparoscopic Sleeve Gastrectomy-A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:643-652. [PMID: 38097892 DOI: 10.1007/s11695-023-06984-7] [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: 09/06/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery option for managing extreme obesity in most patients. While non-steroidal anti-inflammatory drugs (NSAIDs) promise postoperative pain management after bariatric surgeries, their safety in LSG remains unexplored. In this systematic review, we studied the safety of NSAIDs following LSG reported by six studies involving 588 patients. Our study demonstrated that NSAIDs effectively alleviated the postoperative pain after LSG without major safety concerns. Most reported (>20% incidence) adverse events included postoperative nausea and vomiting (PONV, 21%). For patients undergoing LSG, NSAIDs offer a valuable option for pain management and improved care, potentially reducing opioid consumption. However, additional research is required to optimize NSAID usage and ensure safety, especially concerning renal and gastrointestinal issues.
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Affiliation(s)
- Abdullah A Albarrak
- Surgery Department, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia.
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3
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Vitiello A, Iacovazzo C, Berardi G, Vargas M, Marra A, Buonanno P, Velotti N, Musella M. Propensity score matched analysis of postoperative nausea and pain after one anastomosis gastric bypass (MGB/OAGB) versus sleeve gastrectomy (SG). Updates Surg 2023; 75:1881-1886. [PMID: 37193850 PMCID: PMC10543143 DOI: 10.1007/s13304-023-01536-1] [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: 01/18/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
The aim of our study was to assess and compare postoperative nausea and pain after one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (LSG). Patients undergoing OAGB and LSG at our institution between November 2018 and November 2021 have been prospectively asked to report postoperative nausea and pain on a numeric analogic scale. Medical records were retrospectively reviewed to collect scores of these symptoms at the 6th and 12th postoperative hour. One-way analysis of variance (ANOVA) was used to evaluate effect of type of surgery on postoperative nausea and pain scores. To adjust for baseline differences between cohorts, a propensity score algorithm was used to match LSG patients to MGB/OAGB patients in a 1:1 ratio with a 0.1 tolerance. A total number of 228 (119 SGs and 109 OAGBs) subjects were included in our study. Nausea after OAGB was significantly less severe than after LSG both at the 6th and 12th hour assessment; pain was less strong after OAGB at the 6th hour but not after 12 h. Fifty-three individuals had a rescue administration of metoclopramide after LSG and 34 after OAGB (44.5% vs 31.2%, p = 0.04); additional painkillers were required by 41 patients after LSG and 23 after OAGB (34.5% vs 21.1%, p = 0.04). Early postoperative nausea was significantly less severe after OAGB, while pain was comparable especially at the 12th hour.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Vargas
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Annachiara Marra
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Pasquale Buonanno
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
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4
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Alshehri AA. Comparative Evaluation of Postoperative Pain Scores and Opioid Consumption in Septorhinoplasty After Administration of Single-Dose Preemptive Paracetamol and Ibuprofen: A Randomized Controlled Trial. Int Arch Otorhinolaryngol 2023; 27:e471-e477. [PMID: 37564463 PMCID: PMC10411065 DOI: 10.1055/s-0042-1749386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/17/2022] [Indexed: 08/12/2023] Open
Abstract
Introduction Septorhinoplasty operates on the nose's bone and cartilage and is ensued by severe postoperative pain. Objective The objective of this study is to evaluate the effects of preoperative administration of intravenous (IV) paracetamol and ibuprofen on postoperative pain scores in patients undergoing septorhinoplasty. Methods A total of 150 patients undergoing septorhinoplasty were randomly assigned into 3 groups with 50 patients in each group. The control group (group A) was administered 100 ml saline solution; the paracetamol group (group B) was administered 1,000 mg of IV paracetamol in 100 ml of saline solution; and the ibuprofen group (group C) was administered 800 mg of IV ibuprofen in 100 ml of saline solution before surgery. Opioid analgesics were employed to achieve postoperative analgesia. Postoperative pain was evaluated using the visual analogue scale (VAS). Postoperative opioid consumption and adverse effects were also recorded for each patient. Results In comparison with group A, the score in the VAS of groups B and C was statistically lower in all the time intervals ( p < 0.05). In the 1 st and 6 th hours postoperatively, group C's score in the VAS in was lower than that of group B ( p < 0.05). In the control group, total opioid consumption was highest in all time intervals ( p < 0.05). In group C, total opioid consumption was significantly lower than in group B in the 0 to 6 and 6 to 12 hours intervals. ( p < 0.05). Conclusion The single-dose preemptive administration of ibuprofen has a more profound postoperative analgesic effect than paracetamol in the first 6 hours after septorhinoplasty. After the first 6 hours postsurgery, there is no difference between ibuprofen and paracetamol in terms of analgesic effect.
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Affiliation(s)
- Ali Abdullah Alshehri
- ORL&HNs and Facial Plastic Surgery, College of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
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5
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Hirano Y, Konishi T, Kaneko H, Itoh H, Matsuda S, Kawakubo H, Uda K, Matsui H, Fushimi K, Daiko H, Itano O, Yasunaga H, Kitagawa Y. Early postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after oesophagectomy. Br J Surg 2023; 110:260-266. [PMID: 36433812 DOI: 10.1093/bjs/znac399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/10/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous studies have suggested that postoperative non-steroidal anti-inflammatory drug (NSAID) use may increase the risk of anastomotic leakage after colorectal surgery. However, the association between NSAIDs and anastomotic leakage after oesophagectomy is unclear. The aim of this retrospective study was to assess the effect of early postoperative NSAID use on anastomotic leakage after oesophagectomy. METHODS The Data of patients who underwent oesophagectomy for cancer between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the association between NSAID use in the early postoperative period (defined as the day of and the day after surgery) and short-term outcomes, adjusting for potential confounders. The primary outcome was anastomotic leakage. The secondary outcomes were acute kidney injury, gastrointestinal bleeding, and mortality. RESULTS Among 39 418 eligible patients, early postoperative NSAIDs were used by 16 211 individuals (41 per cent). Anastomotic leakage occurred in 5729 patients (15 per cent). In stabilized IPTW analyses, NSAIDs were not associated with anastomotic leakage (odds ratio 1.04, 95 per cent c.i. 0.97 to 1.10). The proportions of acute kidney injury and gastrointestinal bleeding, as well as 30-day mortality and in-hospital mortality, did not differ according to NSAID use. Propensity score matching and instrumental variable analyses demonstrated similar results. CONCLUSION Early postoperative NSAID use was not associated with anastomotic leakage or other complications in patients who underwent oesophagectomy.
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Affiliation(s)
- Yuki Hirano
- Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuaki Uda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Osamu Itano
- Department of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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6
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Abiri A, Patel TR, Nguyen E, Birkenbeuel JL, Tajudeen BA, Choby G, Wang EW, Schlosser RJ, Palmer JN, Adappa ND, Kuan EC. Postoperative protocols following endoscopic skull base surgery: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2023; 13:42-71. [PMID: 35678720 DOI: 10.1002/alr.23041] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence-based guidance. METHODS The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated. RESULTS A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction. CONCLUSION The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high-quality studies are needed in order to devise optimal postoperative ESBS protocols.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Tirth R Patel
- Department of Otolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Emily Nguyen
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Bobby A Tajudeen
- Department of Otolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Garret Choby
- Department of Otolaryngology, Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric W Wang
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rodney J Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James N Palmer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
- Department of Neurological Surgery, University of California Irvine, Orange, California, USA
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7
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Ketamine as a component of multimodal analgesia for pain management in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials. Ann Med Surg (Lond) 2022; 78:103783. [PMID: 35600177 PMCID: PMC9121244 DOI: 10.1016/j.amsu.2022.103783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Anaesthesia in morbidly obese people is challenging with a high dose of opioid consumption. This systematic review and meta-analysis of randomised controlled trials (RCTs) summaries evidence comparing ketamine to placebo for pain management after bariatric surgery. Methods We used PRISMA 2020 and AMSTAR 2 guidelines to conduct this study. The random-effects model was adopted using Review Manager Version 5.3 for pooled estimates. Results Seven RCTs published between 2009 and 2021 were eligible, including a total of 412 patients (202 patients in the ketamine group and 210 patients in the control group). In the ketamine group total opioid consumption during the first 24 h postoperatively was reduced (mean difference, MD = −5.89; 95% CI [-10.39, −1.38], p = 0.01), lower pain score at 4 h (MD = −0.81; 95% CI [-1.52, −0.10], p = 0.03), pain score at 8 h (MD = −1.00; 95% CI [-1.21, −0.79], p < 0.01), and shorter hospital stay (MD = −0.10; 95% CI [-0.20, −0.01], p = 0.03). There was no significant difference between the two groups regarding duration of anaesthesia (MD = −3.42; 95% CI [-8.62, 1.82], p = 0.20), or sedation score (MD = −0.02; 95% CI [-0.21, 0.17], p = 0.84). As concern the postoperative complications, risks of postoperative nausea and vomiting(OR = 0.75; 95% CI [0.27, 2.04], p = 0.56), hallucinations (OR = 5.47; 95% CI [0.26, 117.23], p = 0.28), dizziness (OR = 1.05; 95% CI [0.14, 7.78], p = 0.96), and euphoria (OR = 5.77; 95% CI [0.65, 51.52], p = 0.12) were not different between the two groups either. Conclusion Ketamine could be an effective and safe technique for pain management following bariatric surgery. It reduces opioid consumption, postoperative pain, and hospital stay. RegistrationThis review was registered in PROSPERO (CRD42022296484). This study comparing ketamine infusion or bolus with placebo when used with morphine, paracetamol or tramadol for pain management following bariatric surgery demonstrated that: Ketamine was associated with lower opioid consumption during the 24 h postoperatively. Ketamine decreased VAS scores at H4 and H8, and shorten the hospital stay. Ketamine ensure a similar duration of anaesthesia, postoperative sedation scores, PONV, and postoperative complications rate (hallucinations, headache, euphoria and dizziness).
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8
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Kuan EC, Birkenbeuel JL, Kovacs AJ, Abiri A, Goshtasbi K, Lehrich BM, Golshani K, Chen JW, Cadena G, Hsu FPK. Patterns of Opioid Usage and Predictors of Utilization Following Endoscopic Skull Base Surgery. Laryngoscope 2022; 132:1939-1945. [PMID: 35543275 DOI: 10.1002/lary.30164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/02/2022] [Accepted: 04/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pain control is an important topic that has not been extensively studied in patients undergoing endoscopic skull base surgery (ESBS). The purpose of this study is to identify opioid requirements after ESBS and the risk factors predictive of increased use. METHODS This study was a retrospective review of all patients undergoing ESBS at a tertiary academic skull base surgery program between July 2018 and August 2020. The primary outcome variable was total morphine equivalent dose (MED) requirements after surgery, calculated as the sum of all morphine milligram equivalents over a 24-h period, and summated across the duration of each participant's hospital course. RESULTS 94 patients were included in this review. Average daily MED requirements were 14.00 ± 6.79 mg. Average total MED requirements were 83.78 ± 92.99 mg during hospitalization. Average length of stay (LOS) was 5.71 ± 4.42 days, with 22 (23.4%) patients not requiring opioid use upon discharge. On multivariate analysis, female sex (β = 49.62; 95% CI [13.53, 85.71], p = 0.008), nasoseptal flap (NSF) reconstruction (β = 49.56; 95% CI [13.51, 85.61], p = 0.008) and LOS (β = 4.02; 95% CI [0.001, 8.04], p = 0.050) were independently associated with higher total MED requirements. CONCLUSIONS We report average total MED requirements of 83.78 mg after ESBS, with female sex, intraoperative use of an NSF, and increased LOS as predictors of higher MED use. This data indicates a subset of patients who may benefit from more aggressive pain control strategies upfront, including consideration of non-opioid, multimodal pain regimens. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A.,Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Alexander J Kovacs
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, U.S.A
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Jefferson W Chen
- Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Gilbert Cadena
- Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A
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9
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Oncel G, Yilmaz A, Sabirli R, Cimen YK, Ozen M, Seyit M, Turkcuer I, Cimen U. Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial. Turk J Emerg Med 2021; 21:177-183. [PMID: 34849429 PMCID: PMC8593431 DOI: 10.4103/2452-2473.329629] [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: 05/31/2021] [Revised: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE: Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis. METHODS: This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min. RESULTS: One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350). CONCLUSION: Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.
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Affiliation(s)
- Gizem Oncel
- Servergazi State Hospital, Emergency Service, Denizli, Turkey
| | - Atakan Yilmaz
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Ramazan Sabirli
- Department of Emergency Medicine, Medical Faculty, Kafkas University, Kars, Turkey
| | - Yesim Kinaci Cimen
- Department of Family Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Mert Ozen
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Murat Seyit
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Ibrahim Turkcuer
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Uzeyir Cimen
- Servergazi State Hospital, Emergency Service, Denizli, Turkey
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10
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Ferguson MC, Schumann R, Gallagher S, McNicol ED. Single-dose intravenous ibuprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2021; 9:CD013264. [PMID: 34499349 PMCID: PMC8428326 DOI: 10.1002/14651858.cd013264.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Postoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs) reduces patient opioid requirements and, in turn, may reduce the incidence and severity of opioid-induced adverse events (AEs). OBJECTIVES To assess the analgesic efficacy and adverse effects of single-dose intravenous (IV) ibuprofen, compared with placebo or an active comparator, for moderate-to-severe postoperative pain in adults. SEARCH METHODS We searched the following databases without language restrictions: CENTRAL, MEDLINE, Embase and LILACS on 10 June 2021. We checked clinical trials registers and reference lists of retrieved articles for additional studies. SELECTION CRITERIA We included randomized trials that compared a single postoperative dose of intravenous (IV) ibuprofen with placebo or another active treatment, for treating acute postoperative pain in adults following any surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently considered trials for review inclusion, assessed risk of bias, and extracted data. Our primary outcome was the number of participants in each arm achieving at least 50% pain relief over a 4- and 6-hour period. Our secondary outcomes were time to, and number of participants using rescue medication; withdrawals due to lack of efficacy, adverse events (AEs), and for any other cause; and number of participants reporting or experiencing any AE, serious AEs (SAEs), and specific NSAID-related or opioid-related AEs. We were not able to carry out any planned meta-analysis. We assessed the certainty of the evidence using GRADE. MAIN RESULTS Only one study met our inclusion criteria, involving 201 total participants, mostly female (mean age 42 years), undergoing primary, unilateral, distal, first metatarsal bunionectomy (with osteotomy and internal fixation). Ibuprofen 300 mg, placebo or acetaminophen 1000 mg was administered intravenously to participants reporting moderate pain intensity the day after surgery. Since we identified only one study for inclusion, we did not perform any quantitative analyses. The study was at low risk of bias for most domains. We downgraded the certainty of the evidence due to serious study limitations, indirectness and imprecision. Ibuprofen versus placebo Findings of the single study found that at both the 4-hour and 6-hour assessment period, the proportion of participants with at least 50% pain relief was 32% (24/76) for those assigned to ibuprofen and 22% (11/50) for those assigned to placebo. These findings produced a risk ratio (RR) of 1.44 (95% confidence interval (CI) 0.77 to 2.66 versus placebo for at least 50% of maximum pain relief over the 4-hour and 6-hour period (very low-certainty evidence). Median time to rescue medication was 101 minutes for ibuprofen and 71 minutes for placebo (1 study, 126 participants; very low-certainty evidence). The number of participants using rescue medication was not reported within the included study. During the study (1 study, 126 participants), 58/76 (76%) of participants assigned to ibuprofen and 39/50 (78%) assigned to placebo reported or experienced any adverse event (AE), (RR 0.98, 95% CI 0.81 to 1.19; low-certainty evidence). No serious AEs (SAEs) were experienced (1 study, 126 participants; very low-certainty evidence). Ibuprofen versus active comparators Ibuprofen (300 mg) was similar to the active comparator, IV acetaminophen (1000 mg) at 4 hours and 6 hours (1 study, 126 participants). For those assigned to active control (acetaminophen), the proportion of participants with at least 50% pain relief was 35% (26/75) at 4 hours and 31% (23/75) at 6 hours. At 4 hours, these findings produced a RR of 0.91 (95% CI 0.58 to 1.43; very low-certainty evidence) versus active comparator (acetaminophen). At 6 hours, these findings produced a RR of 1.03 (95% CI 0.64 to 1.66; very low-certainty evidence) versus active comparator (acetaminophen). Median time to rescue medication was 101 minutes for ibuprofen and 125 minutes for the active comparator, acetaminophen (1 study, 151 participants; very low-certainty evidence). The number of participants using rescue medication was not reported within the included study. During the study, 8/76 (76%) of participants assigned to ibuprofen and 45/75 (60%) assigned to active control (acetaminophen) reported or experienced any AE, (RR 1.27, 95% CI 1.02 to 1.59; very low-certainty evidence). No SAEs were experienced (1 study, 151 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to support or refute the suggestion that IV ibuprofen is effective and safe for acute postoperative pain in adults.
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Affiliation(s)
- McKenzie C Ferguson
- Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Roman Schumann
- Department of Anesthesia, Critical Care and Pain Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Sean Gallagher
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ewan D McNicol
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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11
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Hung KC, Chang YJ, Chen IW, Chang YP, Chiu SF, Sun CK. Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies. Surg Obes Relat Dis 2021; 18:135-147. [PMID: 34565683 DOI: 10.1016/j.soard.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of intravenous lidocaine in adults undergoing laparoscopic bariatric surgeries (LBS) remains unclear. OBJECTIVES This study aimed at investigating the effect of intravenous lidocaine on postoperative opioid consumption and recovery following LBS. SETTING Meta-analysis. METHODS We searched databases including MEDLINE, Embase, Google Scholar, and the Cochrane Library for randomized controlled trials that evaluated the use of intravenous lidocaine compared to placebo only prior to May 2021. The primary outcome was 24-hour postoperative opioid consumption, while secondary outcomes included pain score, quality of recovery (QOR)-40 score, length of hospital stay (LOS), and postoperative nausea/vomiting (PONV). RESULTS Seven trials (496 participants) were included. Intraoperative intravenous lidocaine significantly reduced 24-hour equivalent morphine consumption (mean difference [MD]: -11.97 mg; 95% confidence interval [CI]: -23.12 to -.83), pain score at 1 to 3 hours (MD: -.77; 95% CI: -1.5 to -.04), and LOS (MD: -8.93 hr; 95% CI: -13.41 to -4.44) without positive impact on 24-hour pain score and PONV. There was also an increase in time to first opioid requirement (MD: 20.23 min; 95% CI: 11.76-28.7) and QOR-40 score (MD: 24.38; 95% CI: 5.57-43.18). However, sensitivity analysis demonstrated evidence supporting the beneficial effect of lidocaine only for time to first opioid requirement and QOR-40. The associations of intraoperative intravenous lidocaine with reductions in morphine consumption, pain score at 1 to 3 hours, and LOS after LBS were also weak. CONCLUSION Intraoperative intravenous lidocaine during LBS prolonged time to first opioid requirement and improved quality of recovery postoperatively without 24-hour pain or nausea/vomiting benefits. Due to the small number of trials, larger studies are warranted to verify our findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; General Education Center, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan city, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Fu Chiu
- Department of Oral and Maxillofacial Surgery, Chi Mei Hospital, Liouying, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan; College of Medicine, I-Shou University, Kaohsiung City, Taiwan.
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12
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Franco-de la Torre L, Figueroa-Fernández NP, Franco-González DL, Alonso-Castro ÁJ, Rivera-Luna F, Isiordia-Espinoza MA. A Meta-Analysis of the Analgesic Efficacy of Single-Doses of Ibuprofen Compared to Traditional Non-Opioid Analgesics Following Third Molar Surgery. Pharmaceuticals (Basel) 2021; 14:ph14040360. [PMID: 33919715 PMCID: PMC8070746 DOI: 10.3390/ph14040360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 01/10/2023] Open
Abstract
The purpose of this systematic review was to determine the analgesic efficacy and adverse effects of ibuprofen in comparison with other traditional non-opioid analgesics after third molar surgery. A total of 17 full texts were identified in PubMed and assessed using the Cochrane Collaboration’s risk of bias tool by two independent researchers. The sum of pain intensity differences, total pain relief, the overall evaluation, the number of patients requiring rescue analgesics, and adverse effects were collected. Data were analyzed using the Review Manager Software 5.3. for Windows. A total of 15 articles met the criteria. The qualitative and quantitative analysis showed that ibuprofen is more effective to relieve post-operative dental pain than acetaminophen, meclofenamate, aceclofenac, bromfenac, and aspirin. Moreover, ibuprofen and traditional non-steroidal anti-inflammatory drugs have a similar safety profile. In conclusion, ibuprofen 400 mg appears to have good analgesic efficacy and a safety profile similar to other traditional non-steroidal anti-inflammatory drugs after third molar surgery.
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Affiliation(s)
- Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (D.L.F.-G.)
| | - Norma Patricia Figueroa-Fernández
- Departamento de Cirugía Oral y Maxilofacial, Facultad de Odontología, Universidad Autónoma de Baja California, Campus Mexicali 21040, Mexico; (N.P.F.-F.); (F.R.-L.)
| | - Diana Laura Franco-González
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (D.L.F.-G.)
| | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato 36250, Mexico;
| | - Federico Rivera-Luna
- Departamento de Cirugía Oral y Maxilofacial, Facultad de Odontología, Universidad Autónoma de Baja California, Campus Mexicali 21040, Mexico; (N.P.F.-F.); (F.R.-L.)
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (D.L.F.-G.)
- Correspondence: ; Tel.: +52-378-119-5786
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13
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Tompkins DM, DiPasquale A, Segovia M, Cohn SM. Review of Intravenous Acetaminophen for Analgesia in the Postoperative Setting. Am Surg 2021; 87:1809-1822. [PMID: 33522265 DOI: 10.1177/0003134821989056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acetaminophen is a non-opioid analgesic commonly utilized for pain control after several types of surgical procedures. METHODS This scoping primary literature review provides recommendations for intravenous (IV) acetaminophen use based on type of surgery. RESULTS Intravenous acetaminophen has been widely studied for postoperative pain control and has been compared to other agents such as NSAIDs, opioids, oral/rectal acetaminophen, and placebo. Some of the procedures studied include abdominal, gynecologic, orthopedic, neurosurgical, cardiac, renal, and genitourinary surgeries. Results of these studies have been conflicting and largely have not shown consistent clinical benefit. CONCLUSION Overall, findings from this review did not support the notion that IV acetaminophen has significant efficacy for postoperative analgesia. Given the limited clinical benefit of IV acetaminophen, especially when compared to the oral or rectal formulations, use is generally not justifiable.
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Affiliation(s)
- Danielle M Tompkins
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.,Department of Pharmacy, 3673Hackensack University Medical Center, Hackensack, NJ, USA
| | - Arielle DiPasquale
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Michelle Segovia
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Stephen M Cohn
- Department of Surgery, 3673Hackensack University Medical Center, Hackensack, NJ, USA
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14
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Boloori A, Arnetz BB, Viens F, Maiti T, Arnetz JE. Misalignment of Stakeholder Incentives in the Opioid Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7535. [PMID: 33081276 PMCID: PMC7589670 DOI: 10.3390/ijerph17207535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients' non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.
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Affiliation(s)
- Alireza Boloori
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Bengt B. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Frederi Viens
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Taps Maiti
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Judith E. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
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15
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Baboli KM, Liu H, Poggio JL. Opioid-free postoperative analgesia: Is it feasible? Curr Probl Surg 2020; 57:100794. [DOI: 10.1016/j.cpsurg.2020.100794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/28/2022]
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16
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Wu S, Ahmad Z, Li JS, Chang MW. Fabrication of flexible composite drug films via foldable linkages using electrohydrodynamic printing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 108:110393. [DOI: 10.1016/j.msec.2019.110393] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022]
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17
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American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions. Pain Manag Nurs 2020; 21:7-25. [DOI: 10.1016/j.pmn.2019.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 01/12/2023]
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18
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Zhao H, Yang S, Wang H, Zhang H, An Y. Non-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis. J Crit Care 2019; 54:136-144. [PMID: 31446231 DOI: 10.1016/j.jcrc.2019.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify the impact of non-opioid analgesics as adjuvants to opioid on opioid consumption and its side effects, as well as the analgesic effectiveness in adult patients in the ICU. METHODS Only randomized clinical trials using non-opioid analgesics for analgesia in the ICU were included. Pooled analyses with 95% CI were determined. RESULTS Twelve studies (mainly surgical and Guillain-Barre syndrome patients) were included. Non-opioid analgesics as adjuvants to opioid were associated with a significant reduction in the consumption of opioids when compared with opioid use alone at Day 1 (MD -15.40; 95% CI -22.41 to -8.39; P < .001) and Day 2 (MD -22.93; 95% CI -27.70 to -18.16; P < .001). Non-opioid analgesics as adjuvants to opioid were associated with a significantly lower incidence of nausea and vomiting when compared with opioid use alone (RR 0.46; 95% CI 0.30 to 0.68; P < .001). Non-opioid analgesics as adjuvants to opioid significantly decreased the pain score at Day 1 (MD -0.68; 95% CI -1.28 to -0.08; P = .03) and Day 2 (MD -1.36; 95% CI -2.47 to -0.24; P = .02). CONCLUSIONS Non-opioid analgesics as adjuvants to opioid reduced the consumption and the side effects of opioids in adult surgical and Guillain-Barre syndrome patients in the ICU. TRIAL REVIEW REGISTRATION PROSPERO international prospective register of systematic reviews on January 23, 2017, registration number CRD42017055768.
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Affiliation(s)
- Huiying Zhao
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
| | - Shuguang Yang
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Huixia Wang
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Hua Zhang
- Epidemiology Center, Peking University Third Hospital, Beijing, China
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
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AlRuthia Y, Alghadeer S, Balkhi B, Almalag HM, Alsobayel H, Alodaibi F, Alayoubi F, Alkhamali AS, Alshuwairikh S, Alqahtani FN, Alsanawi H. Efficacy of acetaminophen versus ibuprofen for the management of rotator cuff-related shoulder pain: Randomized open-label study. Saudi Pharm J 2019; 27:882-888. [PMID: 31516331 PMCID: PMC6734016 DOI: 10.1016/j.jsps.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/08/2019] [Indexed: 12/11/2022] Open
Abstract
Background Shoulder pain related to the rotator cuff (RC) is one of the most common and bothersome musculoskeletal complaints. Pharmacologic treatment most often includes acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. However, data allowing comparison of the efficacy of these two drugs are very limited. We compared the therapeutic outcomes of acetaminophen and ibuprofen in the management of RC-related pain. Methods This was an open-label, two-center, active-control, prospective randomized clinical trial. Participants were assigned randomly to acetaminophen or ibuprofen treatment groups. The acetaminophen dose was 500 mg every 6–8 h, and it was 400–800 mg every 6–8 h for ibuprofen. The impact of the treatment was measured by Shoulder Pain and Disability Index (SPADI), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires at baseline and after 6 weeks of therapy. Results Thirty-three patients completed the study; 20 treated with ibuprofen and 13 with acetaminophen. Patients in both groups were comparable at baseline with regard to SPADI, Quick-DASH, and WHOQOL-BREF scores. After 6 weeks of treatment, patients receiving ibuprofen, but not acetaminophen, reported an improvement in pain severity and functional activity (as measured by SPADI and Quick-DASH). Patients taking acetaminophen, but not ibuprofen, reported improvement in the physical and environmental domains of WHOQOL-BREF scores. Conclusions Ibuprofen and acetaminophen provide benefits to patients suffering from RC-related pain. However, the type of improvement perceived by patients differed between these two medications.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacy Education Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Corresponding author at: P.O. Box 2454, Riyadh 11451, Saudi Arabia.
| | - Sultan Alghadeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya M. Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hana Alsobayel
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Faris Alodaibi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Fakhr Alayoubi
- Department of Pharmaceutical Care, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Amal S. Alkhamali
- Department of Pharmaceutical Care, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | | | - Hisham Alsanawi
- Department of Orthopedics Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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De Oliveira GS. Optimal analgesic regimen for bariatric surgery: No opioid is rarely the option…. J Clin Anesth 2018; 51:123-124. [PMID: 30142488 DOI: 10.1016/j.jclinane.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Gildasio S De Oliveira
- School of Medicine, Brown University, Providence, USA; Department of Anesthesiology, Rhode Island Hospital, Providence, RI, USA; Department of Surgery, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Health Services Research, School of Public Health, Providence, RI, USA.
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