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Roberts RL, Hanley AW, Garland EL. Mindfulness-Based Interventions for Perioperative Pain Management and Opioid Risk Reduction Following Surgery: A Stepped Care Approach. Am Surg 2024; 90:939-946. [PMID: 35802881 DOI: 10.1177/00031348221114019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness.
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Affiliation(s)
- R Lynae Roberts
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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2
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Reynolds KA, Sommer JL, Roy R, Kornelsen J, Mackenzie CS, El-Gabalawy R. A Qualitative Analysis of the Impact of Preoperative Mindfulness-Based Stress Reduction on Total Knee Arthroplasty Surgical Experiences. Pain Manag Nurs 2024:S1524-9042(24)00144-9. [PMID: 38697887 DOI: 10.1016/j.pmn.2024.04.002] [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: 10/12/2023] [Revised: 04/02/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024]
Abstract
We qualitatively explored the impact of preoperative mindfulness-based stress reduction (MBSR) on total knee arthroplasty (TKA) experiences. Participants (n = 10) who received MBSR prior to TKA participated in semi-structured interviews concerning their experiences with MBSR and its perceived impact on surgery. We analyzed interviews according to reflexive thematic analysis, and coded data into three main themes: 1) Impact of MBSR on surgery experiences; 2) Contributors to change; and 3) Motivations for participation. Participants noted they were able to relax, feel more confident, and cope more effectively during the preoperative period, and that others in their lives noticed positive changes following their participation in MBSR. Participants' openness to mindfulness and health-related beliefs and may have contributed to the positive impacts they experienced from MBSR. Participants described being motivated to participate in MBSR to help them prepare for their surgery and to learn new coping strategies. Participants described a strong level of commitment to the intervention. With further research, integration of MBSR into prehabilitation for TKA may be appropriate.
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Affiliation(s)
- Kristin A Reynolds
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada.
| | - Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada
| | - Rachel Roy
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3A 1R9, Canada
| | - Corey S Mackenzie
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, Manitoba, R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 0Z2, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, R3E 3N4, Canada; CancerCare Manitoba, Manitoba, R3E 0V9, Canada
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3
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Burney E, Bash J, Robinson E, Scull D, Bassale S, Barton C, Chouhan JD. Outcomes of a Standardized Pain Pathway for Transgender Patients Undergoing Vaginoplasty and Vulvoplasty. Urology 2024:S0090-4295(24)00147-X. [PMID: 38467283 DOI: 10.1016/j.urology.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To establish and evaluate a multimodal, opioid-minimizing pathway for gender-affirming vaginoplasty (GAVa) and vulvoplasty (GAVu) in treating postoperative pain. METHODS A standardized pain pathway including opioids, non-opioid analgesics, and patient counseling was implemented at a single academic institution with a center for transgender care. Postoperative pain levels, analgesia methods, and opioid use for 84 GAVa and 64 GAVu patients were prospectively gathered during inpatient postoperative days 2-4 and outpatient follow-up at 2 weeks. Pertinent patient, operative, and medication administration data were extracted from patient charts and outpatient pain was measured with the Brief Pain Inventory short form (BPI-sf). RESULTS On average, GAVa patients used 89.3 MME and GAVu patients used 41.8 MME during inpatient stay. MME decreased daily for both groups. There was no difference in MME between open and robotic GAVa. Forty-nine percent of GAVa patients and 54% of GAVu patients used ketorolac with decreasing daily inpatient use. Postoperative pain levels were similar between GAVa and GAVu patients. Fifty percent of respondents denied postoperative pain in the 24 hours preceding the survey. Forty-four percent of GAVa and of GAVu patients did not use any opioid medications in the outpatient setting, while 81% of GAVa and 83% of GAVu patients used fewer than 20 of 30 prescribed opioid tablets. Ibuprofen and acetaminophen were rated the most effective outpatient analgesics among GAVa and GAVu patients, respectively. CONCLUSION The multimodal pathway demonstrated effective postoperative pain control for GAVa and GAVu patients while minimizing opioid use and has changed institutional prescribing practice.
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Affiliation(s)
- Emily Burney
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jasper Bash
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Eric Robinson
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Dorian Scull
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Chandler Barton
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jyoti D Chouhan
- Department of Urology, Oregon Health & Science University, Portland, OR.
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Benchimol-Elkaim B, Khoury B, Tsimicalis A. Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review. Front Pediatr 2024; 12:1334221. [PMID: 38283632 PMCID: PMC10820709 DOI: 10.3389/fped.2024.1334221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.
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Affiliation(s)
| | - Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Shriners Hospital for Children, Montreal, QC, Canada
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Guida S, Vitale J, Gianola S, Castellini G, Swinnen E, Beckwée D, Gelfi C, Torretta E, Mangiavini L. Effects of tele-prehabilitation on clinical and muscular recovery in patients awaiting knee replacement: protocol of a randomised controlled trial. BMJ Open 2023; 13:e073163. [PMID: 37793919 PMCID: PMC10551960 DOI: 10.1136/bmjopen-2023-073163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The increasing prevalence of knee osteoarthritis and total knee arthroplasty (TKA) impose a significant socioeconomic burden in developed and developing countries. Prehabilitation (rehabilitation in the weeks immediately before surgery) may be crucial to prepare patients for surgery improving outcomes and reducing assistance costs. Moreover, considering the progress of telemedicine, candidates for TKA could potentially benefit from a tele-prehabilitation programme. We aim to evaluate the effects of a home-based tele-prehabilitation program for patients waiting for total knee replacement. METHODS AND ANALYSIS Forty-eight male patients, aged 65-80, on a waiting list for TKA will be recruited and randomly assigned to the tele-prehabilitation intervention or control groups. Both groups will undergo the same 6-week exercise program (five sessions/week) and the same educational session (one per week). The tele-prehabilitation group will perform asynchronous sessions using a tablet, two accelerometers and a balance board (Khymeia, Padova, Italy), while the control group will use a booklet. The Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire, at the end of the prehabilitation, will be the primary outcome. Secondary outcomes will include self-reported outcomes, performance tests and change in expressions of blood and muscle biomarkers. Ten healthy subjects, aged 18-30, will be also recruited for muscle and blood samples collection. They will not undergo any intervention and their data will be used as benchmarks for the intervention and control groups' analyses. ETHICS AND DISSEMINATION This randomised controlled trial will be conducted in accordance with the ethical principles of the Declaration of Helsinki. This study has been approved by the Ethics Committee of Vita-Salute San Raffaele University (Milan, Italy. No. 50/INT/2022). The research results will be published in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05668312.
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Affiliation(s)
- Stefania Guida
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacopo Vitale
- Spine Center, Schulthess Klinik, Zurich, Switzerland
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Eva Swinnen
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Deparment, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - Cecilia Gelfi
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Enrica Torretta
- Laboratory of Proteomics and Lipidomics, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Eubanks JE, Carlesso C, Sundaram M, Bejarano G, Smeets RJEM, Skolasky R, Vanushkina M, Turner R, Schneider MJ. Prehabilitation for spine surgery: A scoping review. PM R 2023; 15:1335-1350. [PMID: 36730164 DOI: 10.1002/pmrj.12956] [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: 04/19/2022] [Revised: 12/27/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full-text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n = 6, 26%), exercise (n = 6, 26%), cognitive behavioral therapy (n = 3, 13%), pain neuroscience education (n = 3, 13%), health behavior counseling (n = 3, 13%), and mindfulness (n = 2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self-efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.
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Affiliation(s)
- James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Cristiane Carlesso
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Meenakshi Sundaram
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Geronimo Bejarano
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University and CIR Revalidatie, Eindhoven, The Netherlands
- Pain in Motion International Research Group (PiM), Eindhoven, The Netherlands
| | - Richard Skolasky
- Orthopaedic Surgery and Physical Medicine & Rehabilitation, Spine Outcomes Research Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Vanushkina
- Interventional Spine and Musculoskeletal Physiatry, UCHealth Medical Group, Colorado Springs, Colorado, USA
| | - Rose Turner
- Liaison Services and Instruction, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Krane NA, Simmons JK, Sykes KJ, Kriet JD, Humphrey CD. Guided Mindfulness Meditation for Pain Control After Septorhinoplasty: A Randomized-Controlled Pilot Study. Facial Plast Surg Aesthet Med 2021; 24:111-116. [PMID: 34861125 DOI: 10.1089/fpsam.2021.0184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mindfulness meditation has been shown to alleviate pain and may be an appealing adjunctive pain management option. Objective: To compare measures of pain, mindfulness, and opioid usage, and collect evaluative feedback among patients undergoing septorhinoplasty with and without guided meditation. Methods: Patients undergoing septorhinoplasty were randomized to online-guided meditation postoperative days 0-3 versus standard care; all received the same pain medications. Primary outcome measures included pain intensity, opioid consumption, mindfulness scores, and evaluative feedback. Results: Twenty-one patients received guided meditation and 24 received standard care. No significant difference in opioid consumption or pain scores was seen with the exception of higher opioid use in patients with intranasal splints in the standard care group. Twenty out of 21 patients provided evaluative feedback; all recommended mindfulness meditation to friends undergoing nasal surgery, 90% reported it was beneficial, 85% believed it eased pain/discomfort, and 80% believed it aided with sleep. Conclusion: Although no objective difference was found in opioid consumption or pain scores, most patients reported that guided mindfulness meditation was beneficial to their recovery following septorhinoplasty.
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Affiliation(s)
- Natalie A Krane
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - J Kai Simmons
- Department of Otolaryngology - Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kevin J Sykes
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - J David Kriet
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Clinton D Humphrey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head & Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Reynolds A, Hamidian Jahromi A. Improving Postoperative Care Through Mindfulness-Based Cognitive Therapy and Isometric Exercise Interventions: A Systematic Review (Preprint). JMIR Perioper Med 2021; 5:e34651. [PMID: 35687415 PMCID: PMC9233259 DOI: 10.2196/34651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mindfulness-based cognitive therapy and isometric exercise training (IET) interventions are relatively new approaches to maintain physical functioning, alleviate pain, prevent joint stiffness and muscular atrophy, and positively influence other postoperative care outcomes. Objective The aim of this review was to identify the impacts of mindfulness-based interventions (MBIs) and IET and, more specifically, their combination, which have not previously been assessed to our knowledge. Methods Studies were identified by searching the PubMed and Cochrane databases within the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm format and using relevant keyword combinations, which resulted in 39 studies meeting the inclusion criteria. Results In general, MBI was shown to positively impact both pain relief and physical functioning, while IET positively impacted physical functioning. Numerous other benefits, including improved quality of life and decreased postoperative opioid use, were also described from both interventions; however, further research is needed to confirm these findings as well as to determine other possible benefits. No studies were found that combined MBI and IET. Conclusions Despite many positive results from each individual intervention, there is a lack of information about how the combination of MBI and IET might impact postoperative care. The combination of these two interventions might prove to be more effective than each individual intervention alone, and the findings from this review show that they could even be complementary. Going forward, research should be expanded to study the possible benefits of the combination of MBI and IET in postoperative care routines as well as other possible combinations.
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Affiliation(s)
- Allie Reynolds
- Biological Sciences Division, University of Chicago Medicine, Chicago, IL, United States
| | - Alireza Hamidian Jahromi
- Department of Plastic and Reconstructive Surgery, Temple University Medical Center, Philadelphia, PA, United States
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Caring for the opioid-dependent patient. SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mallama CA, Greene C, Alexandridis AA, McAninch J, Dal Pan G, Meyer T. Patient-reported opioid analgesic use after discharge from surgical procedures: a systematic review. PAIN MEDICINE 2021; 23:29-44. [PMID: 34347101 DOI: 10.1093/pm/pnab244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use post-surgery. METHODS We searched Pubmed (February 2019), Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized use, and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale. RESULTS Ninety-six studies met eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5 mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as < 5 tablets. In studies that examined excess tablets, 25%-98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50%-70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies due to heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria. CONCLUSION Self-reported post-surgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
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Affiliation(s)
- Celeste A Mallama
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Christina Greene
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Apostolos A Alexandridis
- Office of Science, Center for Tobacco Products, United States Food and Drug Administration, Silver Spring MD, USA. The work presented here was conducted while an ORISE fellow with the Center for Drug Evaluation and Research
| | - Jana McAninch
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Gerald Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Tamra Meyer
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
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11
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Does fear impede the success of spinal surgery in patients with chronic Back pain? Potential prognosticative factors in spinal surgery failure. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Scoville JP, Joyce E, Hunsaker J, Reese J, Wilde H, Arain A, Bollo RL, Rolston JD. Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:6-13. [PMID: 33733680 DOI: 10.1093/ons/opab040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/25/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.
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Affiliation(s)
- Jonathan P Scoville
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - Joshua Hunsaker
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jared Reese
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Herschel Wilde
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amir Arain
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert L Bollo
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA
| | - John D Rolston
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, Utah, USA
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Zhang LK, Li Q, Quan RF, Liu JS. Is preemptive analgesia a good choice for postoperative pain relief in lumbar spine surgeries?: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e25319. [PMID: 33787624 PMCID: PMC8021355 DOI: 10.1097/md.0000000000025319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lumbar spine surgery is associated with moderate-to-severe postoperative pain. Adequate pain management during the postoperative period facilitates rehabilitation. Recently, preemptive analgesia has been considered among the important analgesic methods for reducing postoperative pain. However, its efficacy in postoperative pain relief after lumbar spine surgery remains unclear. This study aimed to evaluate the effects of preemptive analgesia on lumbar spine surgery. METHODS We searched for randomized controlled trials in PubMed (1996 to May 2020), Embase (1980 to May 2020), and Cochrane Library (CENTRAL, May 2020). We included seven studies that evaluated the preemptive analgesic efficacy in lumbar spine surgeries. RESULTS Seven studies, including 509 patients, met the inclusion criteria. Pooled data revealed that preemptive analgesia is effective for lumbar spine surgeries with respect to the visual analog scale score (P < .05), total morphine equivalent consumption (P < .05), and length of stay (P < .05), without increasing complications (P = .73). CONCLUSIONS Our findings indicate that preemptive analgesia is safe and effective for lumbar spine surgery.
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Affiliation(s)
- Lu-kai Zhang
- Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qiang Li
- Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ren-Fu Quan
- Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jun-Sheng Liu
- Department of Orthopedics, Xiaoshan Traditional Chinese Medical Hospital
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
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Current Prehabilitation Programs Do Not Improve the Postoperative Outcomes of Patients Scheduled for Lumbar Spine Surgery: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:103-114. [PMID: 33356804 DOI: 10.2519/jospt.2021.9748] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the effectiveness of prehabilitation in patients with degenerative disorders of the lumbar spine who are scheduled for spine surgery. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH Seven electronic databases were systematically searched for randomized controlled trials or propensity-matched cohorts. STUDY SELECTION CRITERIA Studies that measured the effect of prehabilitation interventions (ie, exercise therapy and cognitive behavioral therapy [CBT]) on physical functioning, pain, complications, adverse events related to prehabilitation, health-related quality of life, psychological outcomes, length of hospital stay, use of analgesics, and return to work were included. DATA SYNTHESIS Data were extracted at baseline (preoperatively) and at short-term (6 weeks or less), medium-term (greater than 6 weeks and up to 6 months), and long-term (greater than 6 months) follow-ups. Pooled effects were analyzed as mean differences and 95% confidence intervals (CIs). Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Cognitive behavioral therapy interventions were no more effective than usual care for all outcomes. Pooled effect sizes were -2.0 (95% CI: -4.4, 0.4) for physical functioning, -1.9 (95% CI: -5.2, 1.4) for back pain, and -0.4 (95% CI: -4.1, 0.4) for leg pain. Certainty of evidence for CBT ranged from very low to low. Only 1 study focused on exercise therapy and found a positive effect on short-term outcomes. CONCLUSION There was very low-certainty to low-certainty evidence of no additional effect of CBT interventions on outcomes in patients scheduled for lumbar surgery. Existing evidence was too limited to draw conclusions about the effects of exercise therapy. J Orthop Sports Phys Ther 2021;51(3):103-114. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9748.
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15
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Giusti EM, Lacerenza M, Manzoni GM, Castelnuovo G. Psychological and psychosocial predictors of chronic postsurgical pain: a systematic review and meta-analysis. Pain 2021; 162:10-30. [PMID: 32694386 DOI: 10.1097/j.pain.0000000000001999] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Knowledge about psychological and psychosocial predictors of chronic postsurgical pain is important to identify patients at risk for poor outcomes. The objective of this systematic review with meta-analysis was to assess the effect of such predictors. A comprehensive search of the available literature on this topic was performed using the electronic databases PubMed, Scopus, Embase, and PsycInfo. Estimates of the effect of each predictor were extracted, and both a narrative synthesis and a quantitative synthesis of these estimates were performed. Multiple imputation was used to take into account the effect of nonsignificant estimates in case they were not reported by original studies. From a sample of 8322 records, 83 articles were included in the narrative synthesis and 41 studies were used to perform the meta-analyses. The narrative synthesis showed that evidence about the effect of psychological predictors is heterogeneous, with few expected predictors, such as optimism, state anxiety and psychological distress, consistently associated with chronic postsurgical pain. By contrast, the meta-analyses showed that state anxiety, trait anxiety, mental health, depression, catastrophizing and, to a lesser extent, kinesiophobia and self-efficacy have a weak but significant association with chronic postsurgical pain. In conclusion, this study showed that psychological predictors have a significant association with chronic postsurgical pain and that state anxiety is the most explicative one.
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Affiliation(s)
- Emanuele M Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Ospedale San Giuseppe, Verbania, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Marco Lacerenza
- Neurology Service, and Pain Center, Humanitas San Pio X Clinic, Milan, Italy
| | | | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Ospedale San Giuseppe, Verbania, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
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16
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Darnall BD, Ziadni MS, Krishnamurthy P, Flood P, Heathcote LC, Mackey IG, Taub CJ, Wheeler A. "My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial. PAIN MEDICINE 2020; 20:2228-2237. [PMID: 31087093 PMCID: PMC6830264 DOI: 10.1093/pm/pnz094] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery. Design and Setting A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention (“My Surgical Success” [MSS]) with digital general health education (HE). Participants A convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N = 36 MSS, N = 32 HE). Main Outcomes The primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use. Results The attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60–80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12–3.10, P = 0.016). Conclusions Fifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Maisa S Ziadni
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Parthasarathy Krishnamurthy
- Department of Marketing and Entrepreneurship, CT Bauer College of Business, University of Houston, Houston, Texas
| | - Pamela Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ian G Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Chloe Jean Taub
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Amanda Wheeler
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Karhade AV, Cha TD, Fogel HA, Hershman SH, Tobert DG, Schoenfeld AJ, Bono CM, Schwab JH. Predicting prolonged opioid prescriptions in opioid-naïve lumbar spine surgery patients. Spine J 2020; 20:888-895. [PMID: 31901553 DOI: 10.1016/j.spinee.2019.12.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/14/2019] [Accepted: 12/30/2019] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Preoperative determination of the potential for postoperative opioid dependence in previously naïve patients undergoing elective spine surgery may facilitate targeted interventions. OBJECTIVE The purpose of this study was to develop supervised machine learning algorithms for preoperative prediction of prolonged opioid prescription use in opioid-naïve patients following lumbar spine surgery. DESIGN Retrospective review of clinical registry data. Variables considered for prediction included demographics, insurance status, preoperative medications, surgical factors, laboratory values, comorbidities, and neighborhood characteristics. Five supervised machine learning algorithms were developed and assessed by discrimination, calibration, Brier score, and decision curve analysis. SETTING One healthcare entity (two academic medical centers, three community hospitals), 2000 to 2018. PARTICIPANTS Opioid-naïve patients undergoing decompression and/or fusion for lumbar disk herniation, stenosis, and spondylolisthesis. MAIN OUTCOME Sustained prescription opioid use exceeding 90 days after surgery. RESULTS Overall, of 8,435 patients included, 359 (4.3%) were found to have prolonged postoperative opioid prescriptions. The elastic-net penalized logistic regression achieved the best performance in the independent testing set not used for algorithm development with c-statistic=0.70, calibration intercept=0.06, calibration slope=1.02, and Brier score=0.039. The five most important factors for prolonged opioid prescriptions were use of instrumented spinal fusion, preoperative benzodiazepine use, preoperative antidepressant use, preoperative gabapentin use, and uninsured status. Individual patient-level explanations were provided for the algorithm predictions and the algorithms were incorporated into an open access digital application available here: https://sorg-apps.shinyapps.io/lumbaropioidnaive/. CONCLUSION AND RELEVANCE The clinician decision aid developed in this study may be helpful to preoperatively risk-stratify opioid-naïve patients undergoing lumbar spine surgery. The tool demonstrates moderate discriminative capacity for identifying those at greatest risk of prolonged prescription opioid use. External validation is required to further support the potential utility of this tool in practice.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas D Cha
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harold A Fogel
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart H Hershman
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel G Tobert
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher M Bono
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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18
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Staartjes VE, de Wispelaere MP, Schröder ML. Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol. Neurosurg Focus 2020; 46:E7. [PMID: 30933924 DOI: 10.3171/2019.1.focus18646] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVEEnhanced recovery after surgery (ERAS) has led to a paradigm shift in various surgical specialties. Its application can result in substantial benefits in perioperative healthcare utilization through preoperative physical and mental patient optimization and modulation of the recovery process. Still, ERAS remains relatively new to spine surgery. The authors report their 5-year experience, focusing on ERAS application to a broad population of patients with degenerative spine conditions undergoing elective surgical procedures, including anterior lumbar interbody fusion (ALIF).METHODSA multimodal ERAS protocol was applied between November 2013 and October 2018. The authors analyze hospital stay, perioperative outcomes, readmissions, and adverse events obtained from a prospective institutional registry. Elective tubular microdiscectomy and mini-open decompression as well as minimally invasive (MI) anterior or posterior fusion cases were included. Their institutional ERAS protocol contains 22 pre-, intra-, and postoperative elements, including preoperative patient counseling, MI techniques, early mobilization and oral intake, minimal postoperative restrictions, and regular audits.RESULTSA total of 2592 consecutive patients were included, with 199 (8%) undergoing fusion. The mean hospital stay was 1.1 ± 1.2 days, with 20 (0.8%) 30-day and 36 (1.4%) 60-day readmissions. Ninety-four percent of patients were discharged after a maximum 1-night hospital stay. Over the 5-year period, a clear trend toward a higher proportion of patients discharged home after a 1-night stay was observed (p < 0.001), with a concomitant decrease in adverse events in the overall cohort (p = 0.025) and without increase in readmissions. For fusion procedures, the rate of 1-night hospital stays increased from 26% to 85% (p < 0.001). Similarly, the average length of hospital stay decreased steadily from 2.4 ± 1.2 days to 1.5 ± 0.3 days (p < 0.001), with a notable concomitant decrease in variance, resulting in an estimated reduction in nursing costs of 46.8%.CONCLUSIONSApplication of an ERAS protocol over 5 years to a diverse population of patients undergoing surgical procedures, including ALIF, for treatment of degenerative spine conditions was safe and effective, without increase in readmissions. The data from this large case series stress the importance of the multidisciplinary, iterative improvement process to overcome the learning curve associated with ERAS implementation, and the importance of a dedicated perioperative care team. Prospective trials are needed to evaluate spinal ERAS on a higher level of evidence.
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Affiliation(s)
- Victor E Staartjes
- Departments of1Neurosurgery and.,2Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Chavez JL, Porucznik CA, Gren LH, Guan J, Joyce E, Brodke DS, Dailey AT, Mahan MA, Hood RS, Lawrence BD, Spiker WR, Spina NT, Bisson EF. The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Outcomes in Lumbar Spine Degenerative Disease: 3-Month and 12-Month Results of a Pilot Study. World Neurosurg 2020; 139:e230-e236. [PMID: 32278820 DOI: 10.1016/j.wneu.2020.03.186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We previously reported inpatient and 30-day postoperative patient-reported outcomes (PROs) of a controlled, noncrossover pilot study using preoperative mindfulness-based stress reduction (MBSR) training for lumbar spine surgery. Our goal here was to assess 3-month and 12-month postoperative PROs of preoperative MBSR in lumbar spine surgery for degenerative disease. METHODS Intervention group participants were prospectively enrolled in a preoperative online MBSR course. A comparison standard care only group was one-to-one matched retrospectively by age, sex, surgery type, and prescription opioid use. Three-month and 12-month postoperative PROs for pain, disability, quality of life, and opioid use were compared within and between groups. Regression models were used to assess whether MBSR use predicted outcomes. RESULTS Twenty-four participants were included in each group. At 3 months, follow-up was 87.5% and 95.8% in the comparison and intervention groups, respectively. In the intervention group, mean Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was significantly higher, whereas mean Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) and Oswestry Disability Index were significantly lower. The change from baseline in mean PROMIS-PF and PROMIS-PI was significantly greater than in the comparison group. At 12 months, follow-up was 58.3% and 83.3% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PI was significantly lower and change in mean PROMIS-PI from baseline was significantly greater. MBSR use was a significant predictor of change in PROMIS-PF at 3 months and in PROMIS-PI at 12 months. No adverse events were reported. CONCLUSIONS Three-month and 12-month results suggest that preoperative MBSR may have pain control benefits in lumbar spine surgery.
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Affiliation(s)
- Juneyoung L Chavez
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Evan Joyce
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Darrel S Brodke
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Robert S Hood
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Brandon D Lawrence
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - William R Spiker
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Nicholas T Spina
- Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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20
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Doan LV, Blitz J. Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders. CURRENT ANESTHESIOLOGY REPORTS 2020; 10:28-34. [PMID: 32435161 PMCID: PMC7222996 DOI: 10.1007/s40140-020-00367-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose of Review This review summarizes selected recent evidence on issues important for preoperative pain evaluation. Recent Findings Opioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied. Summary Preoperative pain and psychological factors can affect postoperative pain outcomes. More work is needed in the future to develop practical interventions in the preoperative period to address these factors.
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Affiliation(s)
- Lisa V Doan
- 1Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY USA
| | - Jeanna Blitz
- 2Department of Anesthesiology, Duke University School of Medicine, Durham, NC USA
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