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Joshi P, Borde D, Apsingekar P, Pande S, Tandale M, Deodhar A, Jangle S. Pecto-intercostal Fascial Plane Block: A Novel Technique for Analgesia in Patients with Sternal Dehiscence. Ann Card Anaesth 2024; 27:169-174. [PMID: 38607883 PMCID: PMC11095774 DOI: 10.4103/aca.aca_107_23] [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: 07/06/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 04/14/2024] Open
Abstract
ABSTRACT Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.
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Affiliation(s)
- Pooja Joshi
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Deepak Borde
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingekar
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Swati Pande
- Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Mangesh Tandale
- Department of Plastic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
| | - Anand Deodhar
- Department of Cardiovascular and Thoracic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
| | - Sachin Jangle
- Department of Plastic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India
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Neville EK, Stolic S, Wagstaff RA, Neville CC. Pain Management in the Postoperative Period for People With Dementia: An Integrative Review. ANNALS OF SURGERY OPEN 2023; 4:e301. [PMID: 37746623 PMCID: PMC10513124 DOI: 10.1097/as9.0000000000000301] [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: 09/13/2022] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Objective With the increased global prevalence of older people with dementia, more will present for surgery over the coming decades. Therefore, the objective of this study was to synthesize the existing research about how pain in managed for people with dementia in the postoperative period and discuss the implications for clinical practice. Methods For this integrative review, the Cumulative Index to Nursing and Allied Health literature, Medline/Pubmed, ProQuest, ERIC, and Health Source Nursing were searched to identify original empirical research published between 2000 and 2021. Tasks were divided between reviewers to ensure independent study selection, data extraction, and risk of bias assessment. Results Eleven articles were eligible. The evidence is incompletely developed therefore the review focused on pain assessment, the types and amount of pain relief, that people with dementia receive less analgesia than people without dementia and the challenges for effective pain management. Most studies were surgery for hip fracture so there is scope to look at outcomes for other types of surgery. Analgesia was administered but it was noted that even over a 20-year period, people with dementia received less than cognitively intact people. Pain management could have a stronger evidence-base with more psychometric development of pain assessment tools. Challenges are due to the impaired ability of the person with dementia to communicate pain and that clinicians have difficulty understanding pain behavior in people with dementia. Conclusion Adequate pain management for people with dementia in the postoperative period is important for a faster and better recovery.
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Affiliation(s)
- Emily K Neville
- From the Department of General Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
- University of Notre Dame Australia, School of Medicine, Wagga Wagga Rural Clinical School, Wagga Wagga, NSW, Australia
| | - Snezana Stolic
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD, Australia
| | - Ruth A Wagstaff
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Christine C Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
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Riecke J, Zerth SF, Schubert AK, Wiesmann T, Dinges HC, Wulf H, Volberg C. Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data. BMJ Open 2023; 13:e069977. [PMID: 37156592 PMCID: PMC10173966 DOI: 10.1136/bmjopen-2022-069977] [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] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Surgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological risk and resilience factors of postoperative pain and validated the German version of the Surgical Fear Questionnaire (SFQ). SETTING University Hospital of Marburg, Germany. DESIGN Single-centre observational study and cross-sectional validation study. PARTICIPANTS Data for validating the SFQ were obtained from a cross-sectional observational study (N=198, mean age 43.6 years, 58.8% female) with persons undergoing different kinds of elective surgery. A sample of N=196 (mean age 43.0 years, 45.4% female) undergoing elective (orthopaedic) surgery was analysed to investigate somatic and psychological predictors of relevant acute postsurgical pain (APSP). OUTCOME MEASURES Participants completed preoperative and postoperative assessments at postoperative days 1, 2 and 7. Presurgical pain, age, gender, pain expectation, surgical setting, physical status, anaesthesia, surgical fear, pain catastrophising, depression, optimism and self-efficacy were examined as predictors. RESULTS Confirmatory factor analysis confirmed the original two-factor structure of the SFQ. Correlation analyses indicated good convergent and divergent validity. Internal consistency (Cronbach's α) was between 0.85 and 0.89. Blockwise logistic regression analyses for the risk of APSP revealed outpatient setting, higher preoperative pain, younger age, more surgical fear and low dispositional optimism as significant predictors. CONCLUSIONS The German SFQ is a valid, reliable and economical instrument with which the important psychological predictor surgical fear can be assessed. Modifiable factors that increase the risk of postoperative pain were higher pain intensity before surgery and being fearful about negative consequences of the surgery whereas positive expectations seem to buffer against postsurgical pain. TRIAL REGISTRATION NUMBERS DRKS00021764 and DRKS00021766.
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Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Simon Felix Zerth
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | | | - Hanns-Christian Dinges
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | - Christian Volberg
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
- Research Group Medical Ethics, University of Marburg, Marburg, Germany
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Leblanc D, Guichoux A, Sail M, Boré F, Seegers V, Espitalier F. Unresolved early post-operative pain trajectory predicts moderate-to-severe persistent pain after breast cancer surgery-An observational cohort study. Acta Anaesthesiol Scand 2023; 67:448-454. [PMID: 36583306 DOI: 10.1111/aas.14191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/09/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Modelling acute post-operative pain trajectories may improve the prediction of persistent pain after breast cancer surgery (PPBCS). This study aimed to investigate the predictive accuracy of early post-operative pain (EPOP) trajectories in the development of PPBCS. MATERIALS & METHODS This observational study was conducted in a French Comprehensive Cancer Centre and included patients who underwent breast cancer surgery from December 2017 to November 2018. Perioperative and follow-up data were obtained from medical records, and anaesthesia and perioperative charts. EPOP was defined as pain intensity during the first 24 h after surgery, and modelled by a pain trajectory. K-means clustering method was used to identify patient subgroups with similar EPOP trajectories. The prevalence of moderate-to-severe PPBCS (numeric rating scale ≥4) was evaluated until 24 months after surgery. RESULTS A total of 608 patients were included in the study, of which 18% (n = 108) and 9% (n = 52) reported mild and moderate-to-severe PPBCS, respectively. Based on EPOP trajectories, we were able to identify a low (64%, n = 388), resolved (30%, n = 182), and unresolved (6%, n = 38) pain group. Multivariate analysis identified younger age, axillary lymph node dissection, and unresolved EPOP trajectory as independent risk factors for moderate-to-severe PPBCS development. When compared to patients reporting mild PPBCS, moderate-to-severe PPBCS patients experienced significantly more neuropathic pain features, pain-related interference, and delayed opioid cessation. CONCLUSION EPOP trajectories can distinguish between resolved and unresolved acute pain after breast cancer surgery, allowing early identification of patients at risk to develop significant PPBCS.
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Affiliation(s)
- Damien Leblanc
- Department of Anaesthesia and Intensive Care, Angers University Hospital, Angers, France
| | - Arthur Guichoux
- Department of Anaesthesia, Bretagne-Atlantique Hospital, Vannes, France
| | - Marjorie Sail
- Department of Anaesthesia and Pain Medicine, Angers Integrated Oncology Centre, Angers, France
| | - François Boré
- Department of Anaesthesia and Pain Medicine, Angers Integrated Oncology Centre, Angers, France
| | - Valérie Seegers
- Department of Biostatistics, Angers Integrated Oncology Centre, Angers, France
| | - Fabien Espitalier
- Department of Anaesthesia and Intensive Care, Tours University Hospital, Tours, France
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Probert N, Blomberg K, Wretenberg P, Andersson ÅG. Traditional compared to modified method of disinfection before hip fracture surgery - Experiences of nursing personnel. Int J Orthop Trauma Nurs 2023; 49:101002. [PMID: 36801597 DOI: 10.1016/j.ijotn.2023.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND National guidelines in Sweden recommend preoperative full-body disinfection (FBD) with 4% chlorhexidine to prevent surgical-site infection (SSI) after hip fracture surgery, a method causing patients' severe pain. Although, due to little evidence in research, orthopedic clinics in Sweden are wavering in favor of simpler methods such as local disinfection (LD) of the surgical site. PURPOSE The aim of this study was to describe the experiences of nursing personnel regarding the performance of preoperative LD on patients prior to hip fracture surgery after having switched from FBD. METHODS This study has a qualitative design where data were collected via focus-group discussions (FGDs) including in total 12 participants and analysed using content analysis. RESULTS Six categories were identified describing the aim: sparing the patients' physical harm, sparing the patients' psychological distress, involving the patients in the procedure, improving the working environment for personnel, preventing unethical situations and a more adequate utilization of resources. CONCLUSIONS All participants considered LD of the surgical site as a favorable method to FBD, witnessing of an increased wellbeing in patients and the method facilitating a better involvement of patients in the procedure, findings that are supported by other studies promoting person-centered care.
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Affiliation(s)
- Noelle Probert
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE70182, Örebro, Sweden; Department of Radiology and Centre for Clinical Research, Region Värmland, SE 65182, Karlstad, Sweden.
| | - Karin Blomberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- Department of Orthopedics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa G Andersson
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Rubio G, Ibekwe SO, Anton J, Tolpin D. Pro: Regional Anesthesia for Cardiac Surgery With Sternotomy. J Cardiothorac Vasc Anesth 2023; 37:1042-1045. [PMID: 36775746 DOI: 10.1053/j.jvca.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Gabriel Rubio
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute, Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX.
| | - Stephanie Opusunju Ibekwe
- Division of Cardiovascular Anesthesiology at Ben Taub Hospital, Baylor College of Medicine, Houston, TX
| | - James Anton
- Baylor College of Medicine Department of Anesthesiology, Texas Heart Institute, Houston, TX
| | - Daniel Tolpin
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute, Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX
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Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS ®) Programs. J Clin Med 2023; 12:jcm12020631. [PMID: 36675560 PMCID: PMC9861533 DOI: 10.3390/jcm12020631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as "surgical pharmacy" by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists' work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.
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Rachidi F, Wagner R, Fieseler H, Kaiser M, Müller H, Podpečan O, Mielenz N, Gottschalk J, Einspanier A, Möbius G, Baumgartner W, Starke A. Effect of a targeted pain management protocol for the treatment of dermatitis interdigitalis contagiosa in Merino meat sheep in a tilt squeeze chute. FRONTIERS IN ANIMAL SCIENCE 2022. [DOI: 10.3389/fanim.2022.1021039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IntroductionThe effect of a targeted pain management protocol consisting of sedation and local anesthesia on the stress response to treatment of dermatitis interdigitalis contagiosa (DINCO) was assessed in sheep placed in dorsal recumbency.MethodsBlood cortisol concentrations were measured once a day (Day -3 to 2) and additionally on day 0, six times during the claw treatment (stress model). Twelve healthy sheep (control group; HEALTHY) and 36 sheep with DINCO, randomly allocated to one of three treatment groups, underwent the stress model with or without pain control: the XYLA-IVRA sheep were sedated with 2% xylazine hydrochloride (XYLA) and received retrograde intravenous regional anesthesia (IVRA); the IVRA sheep underwent IVRA and received a placebo instead of sedation; the PLACEBO sheep received placebos for sedation and IVRA. The HEALTHY sheep underwent sham claw treatment and received placebos.Results and discussionThe cortisol concentrations were higher in sheep restrained in dorsal recumbency compared with the cortisol concentrations measured four hours later in standing sheep (HEALTHY 37.2 ± 3.3 ng/ml vs. 18.5 ± 3.3 ng/ml; DISEASED 34.0 ± 1.9 ng/ml vs. 17.6 ± 1.9 ng/ml; p < 0.001). The stress response of XYLA-IVRA (area under the curve; AUC = 34.9 ± 2.6 ng/ml) was reduced compared with the stress response of PLACEBO (AUC = 48.0 ± 2.6 ng/ml, p < 0.01) and HEALTHY sheep (AUC = 46.6 ± 2.5 ng/ml; p = 0.01). While cortisol concentration of XYLA-IVRA and HEALTHY sheep did not increase one day after the stress model (Day 1) compared with the day of the stress model (Day 0), both PLACEBO (47.4 ± 3.3 vs. 35.6 ± 3.1 ng/ml, p = 0.02) and IVRA sheep (39.1 ± 2.8 vs. 28.6 ± 3.1 ng/ml, p = 0.01) had higher cortisol concentrations. The results confirm that fixation in dorsal recumbency in a tilt squeeze chute was a major stressor in sheep. The differences in the cortisol concentration of the PLACEBO sheep versus the XYLA-IVRA sheep during and after the stress model illustrate the effect and necessity of pain management protocols in practice.
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Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies. Plast Reconstr Surg Glob Open 2022; 10:e4310. [PMID: 35572190 PMCID: PMC9094416 DOI: 10.1097/gox.0000000000004310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/13/2022]
Abstract
Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods A review study based on multimodal analgesia was conducted. Results We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.
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Weyh AM, Pucci R, Busby E, Kansal L, Joy R, Bunnell A, Valentini V, Dyalram D, Pattatheyill A, Figari M, Boccalatte L, Larrañaga J, Cassoni A, Fernandes R. Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study. Int J Oral Maxillofac Surg 2022; 51:1412-1419. [PMID: 35599083 DOI: 10.1016/j.ijom.2022.04.016] [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: 10/05/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.
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Affiliation(s)
- A M Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - E Busby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - L Kansal
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - R Joy
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - V Valentini
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - D Dyalram
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD, USA.
| | - A Pattatheyill
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, India.
| | - M Figari
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - L Boccalatte
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - J Larrañaga
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Cassoni
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Chorath K, Hobday S, Suresh NV, Go B, Moreira A, Rajasekaran K. Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature. World J Otorhinolaryngol Head Neck Surg 2022; 8:96-106. [PMID: 35782396 PMCID: PMC9242417 DOI: 10.1002/wjo2.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/07/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Enhanced recovery after surgery (ERAS) protocols are patient‐centered, evidence‐based pathways designed to reduce complications, promote recovery, and improve outcomes following surgery. These protocols have been successfully applied for the management of head and neck cancer, but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology. Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations. Methods A systematic literature review was conducted using MEDLINE, EMBASE, SCOPUS, and gray literature. We identified studies that evaluated ERAS protocols among patients undergoing otologic, laryngeal, nasal/sinus, pediatric, and general otolaryngology operations. We assessed the outcomes and ERAS components across protocols as well as the study design and limitations. Results A total of eight studies fulfilled the inclusion criteria and were included in the analysis. Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy, functional endoscopic sinus surgery, tympanoplasty and mastoidectomy, and septoplasty. A reduction in postoperative length of stay and hospital costs was reported in two and three studies, respectively. Comparative studies between ERAS and control groups showed persistent improvement in pre‐ and postoperative anxiety and pain levels, without an increase in postoperative complications and readmission rates. Conclusions A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology. These clinical pathways appear promising for these procedures as they may reduce length of stay, decrease costs, and improve pain and anxiety postoperatively. Enhanced recovery after surgery (ERAS) protocols in outpatient otolaryngology operations are effective in significantly decreasing hospital length of stay, hospital costs, and postoperative pain/anxiety. The most common components among ERAS protocols were postoperative analgesia regimen, postoperative nutrition, fluid management, and preoperative education/counseling.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Sara Hobday
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Neeraj V. Suresh
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Beatrice Go
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Alvaro Moreira
- Department of Pediatrics University of Texas Health‐San Antonio San Antonio Texas USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
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Rafiei M, Afsahi M, Karbalaeikhani A, Kheradmand B, Hazrati E. Lidocaine Plus Morphine Versus Lidocaine Plus Paracetamol for Bier Block: A Double-Blind Randomized Controlled Trial. J Perianesth Nurs 2022; 37:380-385. [DOI: 10.1016/j.jopan.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
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Abu Khudair H, Ramadan M, Obaid A, Yousef O, Sammour R. Prevalence of chronic postsurgical pain among cancer patients: A cross-sectional study. Anesth Essays Res 2022; 16:71-79. [PMID: 36249138 PMCID: PMC9558672 DOI: 10.4103/aer.aer_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Cancer patients accept surgeries as part of their treatment. They may not be aware of the possibility of surgical pain persisting long after the surgery. Understanding chronic postsurgical pain is essential for effective pain management. Aims: We aimed to assess the prevalence of chronic postsurgical pain in cancer patients and the associated symptom burden. Settings and Design: This study was carried out at a tertiary cancer center. It was a cross-sectional study. Materials and Methods: Participants who underwent surgeries were asked to provide feedback on the MD Anderson Symptom Inventory at 3 months. Statistical Analysis Used: Descriptive statistics were used. Statistical tests included Kruskal–Wallis test, Chi-square test, Fisher's exact test, and Spearman's correlation. Logistic regression was used to assess the influence of variables on the presence or absence of chronic postsurgical pain. Results: Nine hundred and eighteen participants completed the study. Ninety-two percent (n = 840) were asymptomatic. Eight percent (n = 78) had postsurgical pain. Chronic postsurgical pain was influenced by the type of surgery (P = 0.01), specifically orthopedic and thoracic surgeries. Patients who receive epidurals are three times less likely to continue to have pain at 3 months. Conclusions: The prevalence of chronic postsurgical pain at 3 months in this study is lower than the rates in the literature. It is still associated with symptom burden that interferes with daily life. The risk of developing chronic postsurgical pain increases with thoracic and orthopedic surgeries. The risk may be lowered with epidural analgesia.
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The effect of opioid-free anesthesia protocol on the early quality of recovery after major surgery (SOFA trial): study protocol for a prospective, monocentric, randomized, single-blinded trial. Trials 2021; 22:855. [PMID: 34838109 PMCID: PMC8627013 DOI: 10.1186/s13063-021-05829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/13/2021] [Indexed: 01/20/2023] Open
Abstract
Background Since the 2000s, opioid-free anesthesia (OFA) protocols have been spreading worldwide in anesthesia daily practice. These protocols avoid using opioid drugs during anesthesia to prevent short- and long-term opioid side effects while ensuring adequate analgesic control and optimizing postoperative recovery. Proofs of the effect of OFA protocol on optimizing postoperative recovery are still scarce. The study aims to compare the effects of an OFA protocol versus standard anesthesia protocol on the early quality of postoperative recovery (QoR) from major surgeries. Methods The SOFA trial is a prospective, randomized, parallel, single-blind, monocentric study. Patients (n = 140) scheduled for major plastic, visceral, urologic, gynecologic, or ear, nose, and throat (ENT) surgeries will be allocated to one of the two groups. The study group (OFA group) will receive a combination of clonidine, magnesium sulfate, ketamine, and lidocaine. The control group will receive a standard anesthesia protocol based on opioid use. Both groups will receive others standard practices for general anesthesia and perioperative care. The primary outcome measure is the QoR-15 value assessed at 24 h after surgery. Postoperative data such as pain intensity, the incidence of postoperative complication, and opioid consumption will be recorded. We will also collect adverse events that may be related to the anesthetic protocol. Three months after surgery, the incidence of chronic pain and the quality of life will be evaluated by phone interview. Discussion This will be the first study powered to evaluate the effect of OFA versus a standard anesthesia protocol using opioids on global postoperative recovery after a wide range of major surgeries. The SOFA trial will also provide findings concerning the OFA impact on chronic pain incidence and long-term patient quality of life. Trial registration ClinicalTrials.gov NCT04797312. Registered on 15 March 2021
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Ruel M, Boussat B, Boudissa M, Garnier V, Bioteau C, Tonetti J, Pailhe R, Gavazzi G, Drevet S. Management of preoperative pain in elderly patients with moderate to severe cognitive deficits and hip fracture: a retrospective, monocentric study in an orthogeriatric unit. BMC Geriatr 2021; 21:575. [PMID: 34666691 PMCID: PMC8524930 DOI: 10.1186/s12877-021-02500-7] [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: 02/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Patients with cognitive deficits are 3 times more likely to suffer a hip fracture than geriatric patients of the same age group without cognitive deficits. The persistence of perioperative pain following hip fracture is a risk factor for the occurrence of delirium, poor functional prognosis, and the development of secondary chronic pain. Patients with cognitive deficits receive 20 to 60% less analgesics than those without cognitive deficits. Our retrospective descriptive monocentric study was performed in an orthogeriatric unit on a cohort of elderly patients hospitalized for hip fracture. The aim of the study was to compare the quantity of strong opioids delivered in a morphine sulfate equivalent daily during the preoperative period after a hip fracture between cognitively intact patients and those with cognitive deficits. Results Our total population of 69 patients had a median age of 90 years old, and 46% of these patients had moderate or severe cognitive deficits. During the preoperative period, the same quantity of strong opioids was administered to both groups of patients (13.1 mg/d versus 10.8 mg/d (p = 0.38)). Patients with moderate to severe cognitive deficits more often experienced delirium during their hospitalization (p < 0.01) and received more psychotropic drugs in the first 3 postoperative days (p = 0.025). Conclusions We reported that with standardized pain management in an orthogeriatric unit, patients aged 75 years and older received the same daily average quantity of strong opioids during the preoperative period regardless of the presence of cognitive deficits.
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Affiliation(s)
- Mathilde Ruel
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France.
| | - Bastien Boussat
- Public Health Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Mehdi Boudissa
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Virginie Garnier
- Geriatric Department, University Hospital Grenoble Alpes, Grenoble, France
| | | | - Jérôme Tonetti
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Régis Pailhe
- Orthopaedic and Traumatology Surgery Department, University Hospital Grenoble Alpes, Grenoble, France
| | - Gaëtan Gavazzi
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
| | - Sabine Drevet
- Orthogeriatric Unit, University Hospital Grenoble Alpes, Grenoble, France
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Tirrell AR, Abu El Hawa AA, Bekeny JC, Fan KL, Del Corral G. Minimizing opioid consumption by eliminating patient-controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol. Andrology 2021; 10:232-240. [PMID: 34392611 DOI: 10.1111/andr.13095] [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: 05/23/2021] [Revised: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genital-based gender affirmation surgery is a physically demanding procedure requiring extensive postoperative pain management. However, perioperative opioid use for these procedures is relatively understudied. OBJECTIVES This study analyzes whether intravenous patient-controlled analgesia (PCA) enhances pain control after penile inversion vaginoplasty (PIV) in the setting of enhanced recovery after surgery (ERAS) protocols, and whether non-PCA (NCA)-based regimens could reduce postoperative opioid use. METHODS All patients undergoing PIV with ERAS protocols by a single provider from December 2018 to November 2020 were retrospectively reviewed. Patient demographics, comorbid conditions, pain scores, length of stay (LOS), and opioid usage during their hospitalization were collected. Postoperative opioid use and pain scores were compared between PCA and NCA patient cohorts. RESULTS A total of 61 patients were included. 30 patients received intravenous PCA postoperatively, and 31 patients used NCA-based narcotic pain control. All patients underwent ERAS protocol perioperatively. Average patient age was 34.5 years (SD 11.9) in the PCA cohort and 37.6 years (SD 11.9) in the NCA cohort (p = 0.242). Average total postoperative opioid use during hospital stay was reduced by 53.7% in the NCA cohort, with an average use of 501.6 morphine milligram equivalents (MME) (SD 410.3) among PCA patients and an average use of 232.0 MME (SD 216.5) among NCA patients (p = 0.003). Daily average pain scores for postoperative days 1 to 6 did not differ between the PCA and NCA patient groups (p > 0.05). Average hospital LOS was shorter among NCA patients, 6.2 days (SD 1.0) versus 7.3 days (SD 1.4), respectively, (p < 0.001). DISCUSSION In combination with an ERAS non-narcotic pain control protocol, it may be possible to reduce opioid use by more than 50% and shorten length of postoperative hospital stay among patients by implementing NCA pain management protocols. CONCLUSION Minimizing postoperative opioid consumption after PIV will benefit patients and their sustained well-being.
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Affiliation(s)
- Abigail R Tirrell
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Areeg A Abu El Hawa
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jenna C Bekeny
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Gabriel Del Corral
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Khurana J, Fairey AS, Jacobsen NE, Ip VH. Liposomal bupivacaine for open urological surgery: Friend or foe? Urol Oncol 2021; 39:306-307. [PMID: 33610445 DOI: 10.1016/j.urolonc.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Jaasmit Khurana
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Adrian S Fairey
- Division of Urology, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Niels-Erik Jacobsen
- Division of Urology, Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Vivian Hy Ip
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
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Patel AA, Walker CT, Prendergast V, Radosevich JJ, Grimm D, Godzik J, Whiting AC, Kakarla UK, Mirzadeh Z, Uribe JS, Turner JD. Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events. Neurosurgery 2021; 87:592-601. [PMID: 32357244 DOI: 10.1093/neuros/nyaa111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/10/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion. OBJECTIVE To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices. METHODS A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients were divided into cohorts on the basis of postoperative treatment with PCA or NCA. Postoperative pain scores, length of stay, and total opioid consumption data were collected. Patients were stratified according to preoperative opioid consumption as opioid naive (0 morphine milligram equivalents [MME] daily), low consumption (1-60 MME), high consumption (61-90 MME), or very high consumption (>90 MME). RESULTS A total of 240 patients were identified, including 62 in the PCA group and 178 in the NCA group. PCA patients had higher mean preoperative opioid consumption than NCA patients (49.2 vs 24.3 MME, P = .009). PCA patients had higher mean opioid consumption in the first 72 h in all 4 of the preoperative opioid consumption subcategories. Pain control and adverse event rates were similar between PCA and NCA in the low to high preoperative opioid consumption groups. CONCLUSION Postoperative PCA is associated with significantly more opioid consumption in the first 72 h after surgery and equal or worse postoperative pain scores compared with NCA after lumbar spinal fusion surgery.
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Affiliation(s)
- Arpan A Patel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Virginia Prendergast
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - John J Radosevich
- Department of Pharmacy, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Doneen Grimm
- Department of Pharmacy, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Alexander C Whiting
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Khera T, Murugappan KR, Leibowitz A, Bareli N, Shankar P, Gilleland S, Wilson K, Oren-Grinberg A, Novack V, Venkatachalam S, Rangasamy V, Subramaniam B. Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial. J Cardiothorac Vasc Anesth 2020; 35:896-903. [PMID: 32798172 DOI: 10.1053/j.jvca.2020.07.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore the effect of pecto-intercostal fascial plane block (PIFB) on postoperative opioid requirements, pain scores, lengths of intensive care unit and hospital stays and incidence of postoperative delirium in cardiac surgical patients. DESIGN Single- center, prospective, randomized (1:1), quadruple- blinded, placebo-controlled trial. SETTING Single center, tertiary- care center. PARTICIPANTS The study comprised 80 adult cardiac surgical patients (age >18 y) requiring median sternotomy. INTERVENTION Patients were randomly assigned to receive ultrasound-guided PIFB, with either 0.25% bupivacaine or placebo, on postoperative days 0 and 1. MEASUREMENTS AND MAIN RESULTS Of the 80 patients randomized, the mean age was 65.78 ± 8.73 in the bupivacaine group and 65.70 ± 9.86 in the placebo group (p = 0.573). Patients receiving PIFB with 0.25% bupivacaine showed a statistically significant reduction in visual analog scale scores (4.8 ± 2.7 v 5.1 ± 2.6; p < 0.001), but the 48-hour cumulative opioid requirement computed as morphine milligram equivalents was similar (40.8 ± 22.4 mg v 49.1 ± 26.9 mg; p = 0.14). There was no difference in the incidence of postoperative delirium between the groups evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40 [7.5%] v 5/40 [12.5%] placebo; p = 0.45). CONCLUSION Patients who received PIFB with bupivacaine showed a decline in cumulative opioid consumption postoperatively, but this difference between the groups was not statistically significant. Low incidence of complications and improvement in visual analog scale pain scores suggested that the PIFB can be performed safely in this population and warrants additional studies with a larger sample size.
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Affiliation(s)
- Tanvi Khera
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kadhiresan R Murugappan
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Akiva Leibowitz
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Noa Bareli
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Puja Shankar
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Scott Gilleland
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Katerina Wilson
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Achikam Oren-Grinberg
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Victor Novack
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Senthilnathan Venkatachalam
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Valluvan Rangasamy
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Balachundhar Subramaniam
- Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
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Moyano J, Rodríguez P, Fierro CL. Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n2.75649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.
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Wang XQ, Duan PB, Zheng M, Xu Q, Yang LH, Wang AQ. Perioperative auricular acupuncture technique via intradermal needling buried for postoperative movement-evoked pain after open radical gastrectomy: Study protocol for a pilot randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Predictive value of the surgical pleth index for the hemodynamic responses to trachea intubation and skin incision. J Clin Monit Comput 2019; 34:1303-1309. [PMID: 31808060 DOI: 10.1007/s10877-019-00425-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
Surgical pleth index (SPI) has been widely investigated in assessing the nociceptive level. The aim of this study was to investigate the relationship between SPI level and patient responses to trachea intubation and skin incision. A total of 40 patients undergoing open abdominal general surgery were recruited for analyses. The patients were monitored with electrocardiogram, non-invasive blood pressure, SpO2, invasive blood pressure and SPI before anesthesia induction. Anesthesia was induced with midazolam, propofol, sufentanil and rocuronium and maintained with sufentanil and sevoflurane. Blood pressure, heart rate and SPI were recorded for analyses during the peri-intubation and peri-incision periods. A receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive value of blood pressure, heart rate (HR) and SPI for hemodynamic responses for trachea intubation and skin incision. SPI had a similar changing trend to systolic blood pressure (SBP) and diastolic blood pressure (DBP). The SPI level was linearly correlated with SBP, DBP and HR. SPI increased significantly after intubation and incision in patients with positive but not negative responses to intubation and incision. The ROC analysis showed that only SBP level is predictive of intubation responses. These data suggested that SPI elevated under the noxious stimulation by intubation and incision, but it was not predictive of the hemodynamic responses to intubation and incision.
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Gaignard E, Bergeat D, Courtin-Tanguy L, Rayar M, Merdrignac A, Robin F, Boudjema K, Beloeil H, Meunier B, Sulpice L. Is systematic nasogastric decompression after pancreaticoduodenectomy really necessary? Langenbecks Arch Surg 2018; 403:573-580. [DOI: 10.1007/s00423-018-1688-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/06/2018] [Indexed: 12/18/2022]
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Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New Advances in Acute Postoperative Pain Management. Curr Pain Headache Rep 2018; 22:35. [PMID: 29619627 DOI: 10.1007/s11916-018-0690-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management. RECENT FINDINGS Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, ketamine, dexmedetomidine, liposomal bupivacaine, and newer neuraxial and peripheral regional techniques as well as patient-controlled modalities are gaining importance. Gabapentinoids have become popular but recent meta-analytic reviews have cast doubt on their routine use in perioperative settings. Among opioids, sublingual sufentanil, IV oxycodone, and iontophoretic transdermal fentanyl hold promise. Acupuncture and transcutaneous electrical nerve stimulation may be useful as adjuncts in MMA packages. Genetic testing, derivatives of herbal preparations, and an extended role of acute pain services may emerge as potential areas of importance in the future. There are, however, critical gaps in good quality evidence in many of the practice guideline recommendations. In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.
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Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Daniel Carlyle
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Vijay Kodumudi
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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