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Wahlstrom D, Toscano C, Havard D. Enhanced recovery after orthognathic surgery: a retrospective comparison study of 56 patients. Br J Oral Maxillofac Surg 2023; 61:171-175. [PMID: 36781310 DOI: 10.1016/j.bjoms.2023.01.001] [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: 04/20/2022] [Revised: 10/22/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have been demonstrated to expedite recovery and decrease hospital stay from multiple surgical specialties. This study sought to determine how an ERAS protocol would improve patient outcomes with regards to inpatient postoperative nausea, vomiting, and pain scores following orthognathic surgeries. This was a retrospective study comparing patients who underwent orthognathic surgery with and without an ERAS protocol. The primary measurables included opioid consumption, antiemetic medical consumption, nausea and vomiting incidences, and pain scores between the two groups during their hospital stays. A total of 56 patients were retrospectively analysed comparing ERAS protocol to non-ERAS protocol. The maximum pain score of the ERAS group was 5.50 out of 10 compared to the control group of 7.50 out of 10 (p<0.001). Morphine equivalent consumption during their time in the ward was statistically significant (51.4 mg control versus 9.4 mg ERAS group). ERAS protocol is safe and effective for decreasing postoperative pain and nausea. The ERAS protocol is not only applicable for orthognathic surgery but should be highly considered for other maxillofacial surgeries.
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Affiliation(s)
- Devin Wahlstrom
- DMD, MAJ, USA, Brooke Army Medical Center, San Antonio, Texas, USA.
| | - Corey Toscano
- DMD, CAPT, USAF, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Drew Havard
- DMD, CDR, USN, Naval Medical Research Unit, San Antonio, Texas, USA
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George S, Johns M. Review of nonopioid multimodal analgesia for surgical and trauma patients. Am J Health Syst Pharm 2020; 77:2052-2063. [DOI: 10.1093/ajhp/zxaa301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractPurposePain is a frequent finding in surgical and trauma patients, and effective pain control remains a common challenge in the hospital setting. Opioids have traditionally been the foundation of pain management; however, these agents are associated with various adverse effects and risks of dependence and diversion.SummaryIn response to the rising national opioid epidemic and the various risks associated with opioid use, multimodal pain management through use of nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, α 2 agonists, N-methyl-d-aspartate (NMDA) receptor antagonists, skeletal muscle relaxants, sodium channel blockers, and local anesthetics has gained popularity recently. Multimodal analgesia has synergistic therapeutic effects and can decrease adverse effects by enabling use of lower doses of each agent in the multimodal regimen. This review discusses properties of the various nonopioid analgesics and encourages pharmacists to play an active role in the selection, initiation, and dose-titration of multimodal analgesia. The choice of nonopioid agents should be based on patient comorbidities, hemodynamic stability, and the agents’ respective adverse effect profiles. A multidisciplinary plan for management of pain should be formulated during transitions of care and is an area of opportunity for pharmacists to improve patient care.ConclusionMultimodal analgesia effectively treats pain while decreasing adverse effects. There is mounting evidence to support use of this strategy to decrease opioid use. As medication experts, pharmacists can play a key role in the selection, initiation, and dose-titration of analgesic agents based on patient-specific factors.
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Affiliation(s)
- Stephy George
- Department of Pharmacy, Texas Health Harris Methodist Hospital, Fort Worth, TX
| | - Meagan Johns
- Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX
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Jahr JS, Searle S, McCallum S, Mack R, Minger K, Freyer A, Du W, Hobson S. Platelet Function: Meloxicam Intravenous in Whole Blood Samples From Healthy Volunteers. Clin Pharmacol Drug Dev 2020; 9:841-848. [PMID: 31961516 PMCID: PMC7587000 DOI: 10.1002/cpdd.772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
Nonsteroidal anti‐inflammatory drugs (NSAIDs) are effective treatments for pain but may induce bleeding events due to platelet dysfunction associated with inhibition of cyclooxygenase (COX)‐1 impairing thromboxane production. An intravenous nanocrystal formulation of meloxicam, a COX‐2 preferential nonsteroidal anti‐inflammatory drug, is under development for the treatment of moderate to severe pain. This single‐center ex vivo study evaluated the effect of meloxicam intravenous and ketorolac on platelet function in whole blood samples from healthy volunteers. Each whole blood sample was aliquoted to allow analysis using a platelet function analyzer under negative control (untreated), positive control (2 therapeutic ketorolac concentrations), and meloxicam intravenous (1 therapeutic, 3 supratherapeutic concentrations) using both collagen with epinephrine and collagen with adenosine diphosphate reagent cartridges. The platelet function analyzer determines closure time by simulating platelet adhesion and aggregation following vascular injury. The final analysis set included data from 8 subjects. The collagen with adenosine diphosphate analysis (sensitive to thrombocytopathies) showed no significant differences in closure time for meloxicam‐ or ketorolac‐treated samples and untreated control. The collagen with epinephrine analysis (sensitive to aspirin‐induced platelet abnormalities) produced no significant difference in closure time between any meloxicam concentration and untreated control. Ketorolac was associated with significantly longer closure times vs untreated control at both the 2.5‐ and 5‐µg/mL concentrations (P = .003 and .0257, respectively) and vs meloxicam at several concentrations. Similar results were observed when all analyzed samples were included. Meloxicam intravenous had no significant effect on closure times at therapeutic or supratherapeutic concentrations in this ex vivo study.
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Affiliation(s)
- Jonathan S Jahr
- David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center/UCLA Health, Los Angeles, California, USA
| | | | - Stewart McCallum
- Baudax Bio (formerly Recro Pharma, Inc.), Malvern, Pennsylvania, USA
| | - Randall Mack
- Baudax Bio (formerly Recro Pharma, Inc.), Malvern, Pennsylvania, USA
| | - Kim Minger
- Baudax Bio (formerly Recro Pharma, Inc.), Malvern, Pennsylvania, USA
| | - Alex Freyer
- Baudax Bio (formerly Recro Pharma, Inc.), Malvern, Pennsylvania, USA
| | - Wei Du
- Clinical Statistics Consulting, Blue Bell, Pennsylvania, USA
| | - Sue Hobson
- Baudax Bio (formerly Recro Pharma, Inc.), Malvern, Pennsylvania, USA
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Davidson JC, Rahim S, Hanks SE, Patel IJ, Tam AL, Walker TG, Weinberg I, Wilkins LR, Sarode R. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions-Part I: Review of Anticoagulation Agents and Clinical Considerations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 2019; 30:1155-1167. [PMID: 31229332 DOI: 10.1016/j.jvir.2019.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jon C Davidson
- Department of Interventional Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shiraz Rahim
- Department of Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sue E Hanks
- Department of Radiology, University of Southern California, Los Angeles, California
| | | | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas.
| | - T Gregory Walker
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ido Weinberg
- Cardiology Division, Vascular Medicine Section, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Luke R Wilkins
- Division of Vascular and Interventional Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Ravi Sarode
- Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern Medical Center, Dallas, Texas
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Gill A, Farwell DG, Moore MG. Nutrition and Perioperative Care for the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:411-420. [DOI: 10.1016/j.coms.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wiles KS, Banerjee A. Acute kidney injury in pregnancy and the use of non-steroidal anti-inflammatory drugs. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/tog.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Kate S Wiles
- Department of Women's Health; Guy's and St. Thomas' NHS Foundation Trust; Westminster Bridge Road London SE1 7EH UK
| | - Anita Banerjee
- Department of Women's Health; Guy's and St. Thomas' NHS Foundation Trust; Westminster Bridge Road London SE1 7EH UK
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Winkler SH, Barta S, Kehl V, Schröter C, Wagner F, Grifka J, Springorum HR, Craiovan B. Perioperative blood loss and gastrointestinal tolerability of etoricoxib and diclofenac in total hip arthroplasty (ETO-DIC study): a single-center, prospective double-blinded randomized controlled trial. Curr Med Res Opin 2016; 32:37-47. [PMID: 26414653 DOI: 10.1185/03007995.2015.1100987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Non-selective NSAIDs can cause serious gastrointestinal side-effects. Selective COX-2 blockers are a reasonable alternative for pain treatment. They do not seem to affect platelet function and consequently cause a lower perioperative blood loss than non-selective NSAIDs. This study compared etoricoxib and diclofenac during a perioperative (9 days) period after THA to investigate total blood loss and gastrointestinal tolerability. The hypothesis was that etoricoxib is superior to diclofenac. METHODS A total of 100 patients (50 in each group) were included in this trial. Etoricoxib (90 mg) was administered once and diclofenac sodium (75 mg) twice daily for 9 days. Total blood loss during and after primary cementless THA was detected. The rate of adverse events (AEs) and serious adverse events (SAEs) was analyzed to detect gastrointestinal tolerability. RESULTS The mean total blood loss (calculated) was 1548 ± SD 468 ml in the etoricoxib (ETO) group and 1649 (SD 547) ml in the diclofenac (DIC) group. The mean duration of THA was 81 min (SD 29) in the DIC and 75 min (SD 30) in the ETO group. Hence, the mean calculated total blood loss was 101 ml higher in the DIC group. This difference was not statistically significant (p = 0.334). Fifty-six patients (28 in each group) received a cell saver retransfusion, but only one patient (ETO group) needed an additional red blood cell transfusion. The hidden blood loss was 1067 ml (SD 603) in the DIC group and 999 ml (SD 378) in the ETO group. The gastrointestinal tolerability (number of adverse and serious adverse events) was not significantly different between groups. CONCLUSION There was no statistically significant difference in perioperative blood loss after primary THA under etoricoxib (90 mg) compared to diclofenac (75 mg). Furthermore, no gastrointestinal superiority of etoricoxib could be detected during a short period of 9 days.
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Affiliation(s)
- Sebastian H Winkler
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Sabine Barta
- b b Münchner Studienzentrum, Klinikum rechts der Isar der Technischen Universität München , Munich , Germany
| | - Victoria Kehl
- c c Institute for Medical Statistics and Epidemiology, Technische Universität , Munich , Germany
| | - Christoph Schröter
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Ferdinand Wagner
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Joachim Grifka
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Hans Robert Springorum
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
| | - Benjamin Craiovan
- a a Department of Orthopedic Surgery , Regensburg University Medical Center , Bad Abbach , Germany
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Brallier JW, Deiner S. The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy. Drugs Aging 2015; 32:601-9. [DOI: 10.1007/s40266-015-0278-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kast RE, Karpel-Massler G, Halatsch ME. CUSP9* treatment protocol for recurrent glioblastoma: aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, ritonavir, sertraline augmenting continuous low dose temozolomide. Oncotarget 2015; 5:8052-82. [PMID: 25211298 PMCID: PMC4226667 DOI: 10.18632/oncotarget.2408] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
CUSP9 treatment protocol for recurrent glioblastoma was published one year ago. We now present a slight modification, designated CUSP9*. CUSP9* drugs--aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, sertraline, ritonavir, are all widely approved by regulatory authorities, marketed for non-cancer indications. Each drug inhibits one or more important growth-enhancing pathways used by glioblastoma. By blocking survival paths, the aim is to render temozolomide, the current standard cytotoxic drug used in primary glioblastoma treatment, more effective. Although esthetically unpleasing to use so many drugs at once, the closely similar drugs of the original CUSP9 used together have been well-tolerated when given on a compassionate-use basis in the cases that have come to our attention so far. We expect similarly good tolerability for CUSP9*. The combined action of this suite of drugs blocks signaling at, or the activity of, AKT phosphorylation, aldehyde dehydrogenase, angiotensin converting enzyme, carbonic anhydrase -2,- 9, -12, cyclooxygenase-1 and -2, cathepsin B, Hedgehog, interleukin-6, 5-lipoxygenase, matrix metalloproteinase -2 and -9, mammalian target of rapamycin, neurokinin-1, p-gp efflux pump, thioredoxin reductase, tissue factor, 20 kDa translationally controlled tumor protein, and vascular endothelial growth factor. We believe that given the current prognosis after a glioblastoma has recurred, a trial of CUSP9* is warranted.
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Affiliation(s)
| | - Georg Karpel-Massler
- University of Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, Ulm, Germany
| | - Marc-Eric Halatsch
- University of Ulm, Department of Neurosurgery, Albert-Einstein-Allee 23, Ulm, Germany
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