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Park I, Hong S, Kim SY, Hwang JW, Do SH, Na HS. Reduced side effects and improved pain management by continuous ketorolac infusion with patient-controlled fentanyl injection compared with single fentanyl administration in pelviscopic gynecologic surgery: a randomized, double-blind, controlled study. Korean J Anesthesiol 2024; 77:77-84. [PMID: 37312413 PMCID: PMC10834721 DOI: 10.4097/kja.23217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND A combination of opioids and adjunctive drugs can be used for intravenous patient-controlled analgesia (PCA) to minimize opioid-related side effects. We investigated whether two different analgesics administered separately via a dual-chamber PCA have fewer side effects with adequate analgesia than a single fentanyl PCA in gynecologic pelviscopic surgery. METHODS This prospective, double-blind, randomized, and controlled study included 68 patients who underwent pelviscopic gynecological surgery. Patients were allocated to either the dual (ketorolac and fentanyl delivered by a dual-chamber PCA) or the single (fentanyl alone) group. Postoperative nausea and vomiting (PONV) and analgesic quality were compared between the two groups at 2, 6, 12, and 24 h postoperatively. RESULTS The dual group showed a significantly lower incidence of PONV during postoperative 2-6 h (P = 0.011) and 6-12 h (P = 0.009). Finally, only two patients (5.7%) in the dual group and 18 (54.5%) in the single group experienced PONV during the entire postoperative 24 h and could not maintain intravenous PCA (odds ratio: 0.056, 95% CI [0.007, 0.229], P < 0.001). Despite the administration of less fentanyl via intravenous PCA during the postoperative 24 h in the dual group than in the single group (66.0 ± 77.8 vs. 383.6 ± 70.1 μg, P < 0.001), postoperative pain had no significant intergroup difference. CONCLUSIONS Two different analgesics, continuous ketorolac and intermittent fentanyl bolus, administered via dual-chamber intravenous PCA, showed fewer side effects with adequate analgesia than conventional intravenous fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
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Affiliation(s)
- Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seukyoung Hong
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Yeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Barat E, Chenailler C, Gillibert A, Pouplin S, Varin R, Compere V. Impact of Clinical Pharmacist Consultations on Postoperative Pain in Ambulatory Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3967. [PMID: 36900980 PMCID: PMC10001952 DOI: 10.3390/ijerph20053967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Post-operative pain is a common symptom of ambulatory surgery. The objective of this study was to evaluate a pain management protocol integrating a pharmacist consultation. We conducted a quasi-experimental, single center, before-after study. The control group was recruited between 1 March and 31 May 2018 and the intervention group between 1 March and 31 May 2019. Outpatients in the intervention group received a pharmacist consultation, in addition to the usual anesthesiologist and nurse consultations. Pharmacist consultations were conducted in two steps: the first step consisted of general open-ended questions and the second step of a specific and individualized pharmaceutical interview. A total of 125 outpatients were included in each group. There were 17% (95% CI 5 to 27%, p = 0.022) fewer patients with moderate to severe pain in the pharmaceutical intervention group compared with the control group, which corresponded to a decrease in the mean pain level of 0.9/10 (95% CI -1.5/10; -0.3/10; p = 0.002). The multivariate analysis did not reveal any confounding factors, showing that only the pharmaceutical intervention could explain this result. This study demonstrates a positive impact of pharmacist consultations on postoperative pain in ambulatory surgery.
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Affiliation(s)
- Eric Barat
- Department of Pharmacy, CHU Rouen, CEDEX, 76031 Rouen, France
- Department of Pharmacy, Normandie University, UNICAEN, Inserm U1086, 14000 Caen, France
| | | | - André Gillibert
- Department of Biostatistics, CHU Rouen, CEDEX, 76031 Rouen, France
| | - Sophie Pouplin
- Department of Rheumatology, CHU Rouen, CEDEX, 76031 Rouen, France
| | - Remi Varin
- Department of Pharmacy, UNIROUEN, Inserm U1234, CHU Rouen, Normandie University, Rouen, CEDEX, 76031 Rouen, France
| | - Vincent Compere
- Department of Anesthesiology and Critical Care, CHU Rouen, CEDEX, 76031 Rouen, France
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Huang L, Li P, Zhang L, Kang G, Zhou H, Zhao Z. Analgesic comparison between perineural and intravenous dexamethasone for shoulder arthroscopy: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:103. [PMID: 35177116 PMCID: PMC8851776 DOI: 10.1186/s13018-022-02952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy. Methods We have searched PubMed, Embase, Web of science, EBSCO and Cochrane library databases through April 2021 and included randomized controlled trials (RCTs) assessing the effect of perineural and intravenous dexamethasone on interscalene block in patients with shoulder arthroscopy. Results Five RCTs were included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone led to similar block duration (SMD = 0.12; 95% CI − 0.12 to 0.35; P = 0.33), pain scores at 12 h (SMD = − 0.67; 95% CI − 1.48 to 0.15; P = 0.11), pain scores at 24 h (SMD = − 0.33; 95% CI − 0.79 to 0.14; P = 0.17), opioid consumption (SMD = 0.01; 95% CI − 0.18 to 0.19; P = 0.95) and incidence of nausea/vomiting (OR = 0.74; 95% CI 0.38–1.44; P = 0.38). Conclusions Perineural and intravenous dexamethasone demonstrated comparable pain relief after shoulder arthroscopy.
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Affiliation(s)
- Liangku Huang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Peng Li
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Liang Zhang
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Guangming Kang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Haizhen Zhou
- Department of Orthopaedic Oncology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Zandong Zhao
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China.
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Liu C, Cheng L, Du B, Cheng S, Jiang Y, Tan X, Qian K. The analgesic efficacy of pregabalin for shoulder arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26695. [PMID: 34559094 PMCID: PMC8462647 DOI: 10.1097/md.0000000000026695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/19/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model. RESULTS Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = -0.57; 95% CI = -1.04 to -0.09; P = .02) and 12 hours (Std. MD = -0.37; 95% CI = -0.72 to -0.02; P = .04), as well as analgesic consumption (Std. MD = -1.84; 95% CI = -2.24 to -1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = -0.54; 95% CI = -1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53-1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89-1.47; P = .30). CONCLUSIONS Pregabalin may benefit to pain control after shoulder arthroscopy.
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Affiliation(s)
- Chunhong Liu
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Ling Cheng
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Bo Du
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Shuang Cheng
- Department of Surgery, The TCM Hospital of Kaizhou District, Chongqing, China
| | - Yangming Jiang
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Xiaohong Tan
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Ke Qian
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
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Analgesic effectiveness and safety of celecoxib versus non-opioid active controls after third molar surgery: A meta-analytical evaluation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e1-e9. [PMID: 34192584 DOI: 10.1016/j.jormas.2021.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
The aim of this meta-analysis was to assess the analgesic efficacy and adverse effects of celecoxib compared to non-opioid drugs after third molar surgery. A search in PubMed and Google Scholar was performed to identify clinical trials, and then, the Cochrane Collaboration's toll for assessing risk of bias tool was used to evaluate the quality of all clinical trials. Studies without any high-risk of bias were included in the statistical analysis. The data extraction included the pain intensity measured by the visual analogue scale (VAS), the number of patients using rescue analgesics and adverse effects of gastric (nausea and vomiting), and nervous (dizziness and headache) systems. Data were analyzed using the Review Manager Software 5.3 for Windows and the Risk Reduction Calculator. The visual analog scale, total pain relief, and the number of patients who needed rescue analgesics showed statistical significance. Moreover, celecoxib had a lower frequency of nausea and vomiting compared with ibuprofen. In conclusion, celecoxib was more effective than acetaminophen and ibuprofen for pain control after third molar surgery.
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Huang F, Yang Z, Su Z, Gao X. The analgesic evaluation of gabapentin for arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e25740. [PMID: 34011032 PMCID: PMC8137103 DOI: 10.1097/md.0000000000025740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/07/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of gabapentin for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of gabapentin versus placebo on the postoperative pain intensity of arthroscopy. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials assessing the effect of gabapentin versus placebo on pain control of arthroscopy. This meta-analysis is performed using the random-effect model. RESULTS Five randomized controlled trials are included in the meta-analysis. Overall, compared with control group for arthroscopy, gabapentin remarkably decreases pain scores at 24 hour (standard mean difference [SMD]=-0.68; 95% confidence interval [CI]=-1.15 to -0.02; P = .21), analgesic consumption (SMD = -18.24; 95% CI=-24.61 to -11.88; P < .00001), nausea and vomiting (OR = 0.42; 95% CI = 0.21 to 0.84; P = .01), but has no obvious influence on pain scores at 6 h (SMD = -1.30; 95% CI = -2.92 to 0.31; P = .11) or dizziness (OR = 1.12; 95% CI = 0.56 to 2.24; P = .75). CONCLUSIONS Gabapentin is effective for pain control after arthroscopy.
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Affiliation(s)
- Feiri Huang
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Zhifang Yang
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Zhongliang Su
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Xiaosheng Gao
- Department of Orthopedics, Affiliated Yueqing Hospital,Wenzhou Medical University, Wenzhou, Zhejiang Province, P.R. China
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Guan YJ, Wei L, Liao Q, Fang QW, He N, Han CF, Miao CH, Luo GJ, Wang HB, Cheng H, Guo QL, Cheng ZG. Pain management after ambulatory surgery: a prospective, multicenter, randomized, double-blinded parallel controlled trial comparing nalbuphine and tramadol. BMC Anesthesiol 2020; 20:204. [PMID: 32799814 PMCID: PMC7429784 DOI: 10.1186/s12871-020-01125-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Postoperative pain in ambulatory surgery is a multifactorial issue affecting patient satisfaction, time of discharge, and rehospitalization. This study evaluated the efficacy and safety of nalbuphine for the treatment of postoperative pain after ambulatory surgery, relative to tramadol. Methods This multi-center, randomized, double blind, and controlled study was conducted at 10 centers. In accordance with the inclusion criteria, 492 ambulatory surgery patients were recruited. These patients had moderate to severe pain after ambulatory surgery, with a visual analogue scale (VAS) score > 3 cm. They were randomly divided into an experimental (n = 248) or control (n = 244) group and treated for analgesia with 0.2 mg/kg of nalbuphine or 2 mg/kg of tramadol, respectively. VAS scores, adverse events, and vital signs of the patients were recorded before administration (baseline; T1); and 30 min (T2), 2 h (T3), 4 h (T4), and 6 h (T5) after administration of analgesia. A decrease in pain intensity of more than 25% compared with the baseline was used as an indicator of analgesic efficacy. The experimental and control groups were compared with regard to this indicator of efficacy at each timepoint. Results The VAS scores of the experimental and control groups were statistically comparable at timepoints T1-T4. At T5, the VAS scores of the experimental group were significantly lower than that of the control. The pain intensity was significantly higher in the experimental group compared with the control at T2 and T3. Adverse events and vital signs were similar for the two groups at each timepoint. Conclusions Nalbuphine can provide effective and safe pain relief in patients after ambulatory surgery. Trial registration The registration number is ChiCTR-IOR-16010032, the date of registration was 2016-11-28.
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Affiliation(s)
- Yu-Jiao Guan
- Department of Anesthesiology, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Changsha, Hunan, China
| | - Lai Wei
- Department of Anesthesiology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Qin Liao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qi-Wu Fang
- Department of Anesthesiology, Pain Medicine & Critical Care Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing, China
| | - Nong He
- Department of Anesthesiology, Peking University Shougang Hospital, Beijing, China
| | - Chong-Fang Han
- Department of Anesthesiology, Shanxi Academy of Medical Sciences, Shanxi Dayi Hospital, Shanxi, China
| | - Chang-Hong Miao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gang-Jian Luo
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Han-Bing Wang
- Department of Anesthesiology, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Hao Cheng
- Department of Anesthesiology, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Qu-Lian Guo
- Department of Anesthesiology, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Changsha, Hunan, China.
| | - Zhi-Gang Cheng
- Department of Anesthesiology, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Changsha, Hunan, China.
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Wan R, Li P, Jiang H. The efficacy of celecoxib for pain management of arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17808. [PMID: 31804304 PMCID: PMC6919475 DOI: 10.1097/md.0000000000017808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of celecoxib for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to assess if celecoxib before the surgery decreases postoperative pain intensity of arthroscopy. METHODS We search PubMed, Embase, Web of science, EBSCO, and Cochrane library databases for randomized controlled trials (RCTs) assessing the effect of celecoxib versus placebo on pain control of arthroscopy. RESULTS Five RCTs are included in the meta-analysis. Celecoxib is administered at 200 mg or 400 mg dosage before the surgery. Overall, compared with control group for arthroscopy, preemptive celecoxib has remarkably positive impact on pain scores at 2 to 6 hours (standard mean difference (SMD) = -0.66; 95% confidence interval (CI) = -0.95 to -0.36; P < .0001) and 24 hours after the surgery (SMD = -1.26; 95% CI = -1.83 to -0.70; P < 0.0001), analgesic consumption (SMD = -2.73; 95% CI = -5.17 to -0.28; P = .03), as well as the decrease in adverse events (risk ratio (RR) = 0.56; 95% CI = 0.39 to 0.79; P = .001), but shows no obvious effect on first time for analgesic requirement (SMD = 0.02; 95% CI = -0.22 to 0.26; P = .87), nausea, or vomiting (RR = 0.70; 95% CI = 0.42 to 1.17; P = .18). CONCLUSION Celecoxib administered at 200 mg or 400 mg dosage before the surgery decreases postoperative pain intensity of arthroscopy.
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Affiliation(s)
| | - Pin Li
- Department of Orthopaedics
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, China
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Crain N, Aboulian A. Unplanned Returns to Care within Seven Days after Anorectal Surgery: Can they be Avoided? Am Surg 2019. [DOI: 10.1177/000313481908500139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
With rates up to 50 per cent, unanticipated returns after anorectal surgery remain a major issue. A retrospective analysis was performed on 5929 anorectal operations from January 2011 to December 2015 across 14 Kaiser Permanente Southern California medical centers. Data were gathered on the cause, frequency and timing of unplanned returns to the ED and urgent care. Of all patients, 246 (4%) returned with a nonavoidable diagnosis and 243 (4%) returned with one of four avoidable diagnoses: pain, constipation, urinary retention, and nausea/vomiting. Seventy four per cent of avoidable diagnoses returns occurred within the first four postoperative days, with 48 per cent between days 2 and 4. In patients older than 50 years of age, males showed higher urinary retention (P = 0.001), whereas females had higher constipation (P < 0.001). Contrarily, pain was higher for both males (P = 0.02) and females (P < 0.001) less than 50 years old. In a separate subanalysis on anesthesia type, both constipation (P = 0.03) and urinary retention (P = 0.01) showed double the return rate in the general versus local/monitored anesthesia care group, whereas pain (P = 0.15) and nausea/vomiting (P = 0.20) showed no differences. Half of returns fall into a category that is potentially avoidable with preemptive interventions.
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Affiliation(s)
- Nikhil Crain
- From Kaiser Permanente, Woodland Hills, California
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Edwards MC, Sorokin E, Brzezienski M, Nahai FR, Scranton R, Wall H, Wall S, Finical S, Smith K. Impact of liposome bupivacaine on the adequacy of pain management and patient experiences following aesthetic surgery: Results from an observational study. Plast Surg (Oakv) 2015; 23:15-20. [PMID: 25821767 DOI: 10.4172/plastic-surgery.1000904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite the efficacy of opioid analgesics for postsurgical pain, they are associated with side effects that may complicate recovery. Liposome bupivacaine is a prolonged-release formulation of bupivacaine approved for intraoperative administration at the surgical site for postsurgical analgesia. OBJECTIVES To evaluate the effect of a single intraoperative administration of liposome bupivacaine on postsurgical pain, opioid use and opioid-related side effects in subjects undergoing breast surgery and/or abdominoplasty. METHODS In the present phase IV, multicentre, prospective observational study, subjects received a single intraoperative administration (266 mg) of liposome bupivacaine. Rescue analgesia was available to all subjects as needed. Outcome measures, assessed through postoperative day 3, included postsurgical pain intensity (11-point numerical rating scale), opioid consumption and overall benefit of analgesic score. Results were evaluated comparing investigators' previous experience with similar surgeries. RESULTS Forty-nine subjects entered the study: 34 underwent breast surgery only and 15 underwent abdominoplasty with or without breast surgery (six underwent breast surgery in addition to abdominoplasty). Mean numerical rating scale pain scores remained ≤4.3 from discharge through postoperative day 3. Median daily oral opioid consumption was approximately 1.0 tablet postoperatively on the day of surgery and was approximately 2.0 tablets by postoperative day 3. Mean overall benefit of analgesic score ranged between 2.8 and 4.9 throughout the study. CONCLUSION In this particular subject population, liposome bupivacaine was associated with low pain intensity scores and reduced opioid consumption compared with the investigators' previous experiences. Subjects' satisfaction with postsurgical analgesia was high, with a low burden of opioid-related side effects.
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Affiliation(s)
| | - Evan Sorokin
- Delaware Valley Plastic Surgery, Cherry Hill, New Jersey
| | | | | | | | - Holly Wall
- The Wall Center for Plastic Surgery, Shreveport, Louisiana
| | - Simeon Wall
- The Wall Center for Plastic Surgery, Shreveport, Louisiana
| | | | - Kevin Smith
- Charlotte Plastic Surgery, Charlotte, North Carolina, USA
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Edwards MC, Sorokin E, Brzezienski M, Nahai FR, Scranton R, Wall H, Wall S, Finical S, Smith K. Impact of liposome bupivacaine on the adequacy of pain management and patient experiences following aesthetic surgery: Results from an observational study. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Despite the efficacy of opioid analgesics for postsurgical pain, they are associated with side effects that may complicate recovery. Liposome bupivacaine is a prolonged-release formulation of bupivacaine approved for intraoperative administration at the surgical site for postsurgical analgesia. Objectives To evaluate the effect of a single intraoperative administration of liposome bupivacaine on postsurgical pain, opioid use and opioid-related side effects in subjects undergoing breast surgery and/or abdominoplasty. Methods In the present phase IV, multicentre, prospective observational study, subjects received a single intraoperative administration (266 mg) of liposome bupivacaine. Rescue analgesia was available to all subjects as needed. Outcome measures, assessed through postoperative day 3, included postsurgical pain intensity (11-point numerical rating scale), opioid consumption and overall benefit of analgesic score. Results were evaluated comparing investigators' previous experience with similar surgeries. Results Forty-nine subjects entered the study: 34 underwent breast surgery only and 15 underwent abdominoplasty with or without breast surgery (six underwent breast surgery in addition to abdominoplasty). Mean numerical rating scale pain scores remained ≤4.3 from discharge through postoperative day 3. Median daily oral opioid consumption was approximately 1.0 tablet postoperatively on the day of surgery and was approximately 2.0 tablets by postoperative day 3. Mean overall benefit of analgesic score ranged between 2.8 and 4.9 throughout the study. Conclusion In this particular subject population, liposome bupivacaine was associated with low pain intensity scores and reduced opioid consumption compared with the investigators' previous experiences. Subjects' satisfaction with postsurgical analgesia was high, with a low burden of opioid-related side effects.
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Affiliation(s)
| | - Evan Sorokin
- Delaware Valley Plastic Surgery, Cherry Hill, New Jersey
| | | | | | | | - Holly Wall
- The Wall Center for Plastic Surgery, Shreveport, Louisiana
| | - Simeon Wall
- The Wall Center for Plastic Surgery, Shreveport, Louisiana
| | | | - Kevin Smith
- Charlotte Plastic Surgery, Charlotte, North Carolina, USA
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Preemptive analgesia with bupivacaine in reduction mammaplasty: a prospective, randomized, double-blind, placebo-controlled trial. Plast Reconstr Surg 2014; 134:581-586. [PMID: 24945948 DOI: 10.1097/prs.0000000000000522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preincisional analgesia is an antinociceptive treatment that prevents altered central excitability from high-intensity noxious stimuli. To determine the analgesic efficacy of preoperative infiltration with bupivacaine for reduction mammaplasty, a randomized, double-blind, placebo-controlled trial was designed. METHODS Women with mammary hypertrophy were allocated randomly to one of two study groups. Patients in group I received preincision infiltration with bupivacaine into each breast after general anesthesia. Group II patients received similar injections of saline injection alone after general anesthesia. RESULTS Visual analogue pain score, verbal pain score, and short-form McGill Pain Questionnaire scores were higher in group II patients until 22 hours after surgery (p < 0.008). Patients in the saline group had higher intravenous meperidine consumption for 22 hours postoperatively and solicited opioids before the patients in the bupivacaine group (p < 0.001). The difference between groups was statistically significant. CONCLUSION Preincisional infiltration with bupivacaine results in reduced pain and lower postoperative opioid requirements in the early postoperative phase of pain following breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Dionigi G, Bacuzzi A, Rovera F, Boni L, Piantanida E, Tanda ML, Castano P, Annoni M, Bartalena L, Dionigi R. Shortening hospital stay for thyroid surgery. Expert Rev Med Devices 2014; 5:85-96. [DOI: 10.1586/17434440.5.1.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mardani-Kivi M, Karimi Mobarakeh M, Haghighi M, Naderi-Nabi B, Sedighi-Nejad A, Hashemi-Motlagh K, Saheb-Ekhtiari K. Celecoxib as a pre-emptive analgesia after arthroscopic knee surgery; a triple-blinded randomized controlled trial. Arch Orthop Trauma Surg 2013; 133:1561-6. [PMID: 24043481 DOI: 10.1007/s00402-013-1852-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pre-emptive analgesia not only controls pain but also may result in the reduction of opioid consumption and related side effects following orthopedic surgeries. The purpose of the present study was to examine the therapeutic effects of celecoxib in reducing pain following the arthroscopic knee surgeries: anterior cruciate ligament (ACL) reconstruction and partial meniscectomy. MATERIALS AND METHODS In this triple-blinded, randomized, placebo-controlled clinical trial, celecoxib 400 mg and identical placebo were administered, 2 h prior to operation, to 130 patient candidates for undergoing knee arthroscopic surgery of either isolated meniscectomy or ACL reconstruction. Pain intensity, 24 h opioid consumption and the related side effects were measured at 6 and 24 h post operation. RESULTS The patients in both groups were similar with regards to demographic characteristics such as age, gender and body mass index. The results of the study indicated that the pain intensity and opioid consumption were lower in both subgroups (meniscectomy and ACL-R) in celecoxib group at 6 and 24 h post operation (P < 0.0001). The side effects of analgesics such as nausea and vomiting, sedation, and dizziness were not significantly different between the two groups (P > 0.05). CONCLUSION It seems that celecoxib as a pre-emptive analgesia agent is effective in decreasing acute postoperative pain and 24 h opioid consumption in patients undergoing arthroscopic knee surgery.
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Jadlowiec CC, Cohen JL. Postoperative management. SEMINARS IN COLON AND RECTAL SURGERY 2013. [DOI: 10.1053/j.scrs.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lemarie M, Compère V, Fourdrinier V, Lignot S, Legrand L, Marguerite C, Devellenne C, Wood G, Dujardin F, Dureuil B. [Evaluation of the impact of prescription analgesic during the anaesthesia consultation on the incidence of postoperative pain at home in ambulatory orthopaedic surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2011; 30:883-7. [PMID: 22054715 DOI: 10.1016/j.annfar.2011.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 05/26/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Postoperative pain at home in ambulatory surgery is a major problem. To improve its management, the French society of anaesthesia emphasizes the importance of writing prescriptions for analgesic during the preanaesthetic consultation. The objective of this study was to assess the impact of this prescription on the incidence of postoperative pain at home in ambulatory orthopaedic surgery. PATIENT AND METHODS We conducted a prospective evaluation in the ambulatory surgery unit of Rouen University Hospital. We were able to identify two periods of 1 year with implementation of a systematic prescription of analgesics during the postoperative period (P1) or during the preanaesthetic consultation (P2). The evaluation of this measurement was made by a telephone survey conducted the day after surgery. The main parameter was the incidence of postoperative pain at home defined by the occurrence of a pain greater to 3/10 on a numerical scale (FR). Secondary parameters were demographic and anaesthetic data, the incidence of moderate pain (FR ≤ 3), treatment adherence and patient satisfaction. RESULTS We included 638 patients and 531 were analysed: 28% of patients had an EN greater than 3 the day following surgery. There is no difference between the two periods (30% for P1 versus 27% for P2). The analysis of subgroups showed that in the general anaesthesia group, 30% of patients had an EN greater than 3 for P1 versus 18% for P2 (P<0.01). Furthermore, 55% of patients expressed moderate pain (FR ≤ 3) for P1 versus 22% for P2 (P<0.01). Moreover, 89% of patients reported having an adequate analgesic treatment. The overall observance was 64%, 53% for P1 versus 75% for P2 (P<0.01). DISCUSSION The systematic prescription of analgesics during the preanaesthetic consultation does not decrease the intensity of moderate to severe pain. On the other hand, this procedure seems to be positive for the people who underwent a general anaesthesia.
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Affiliation(s)
- M Lemarie
- Département d'anesthésie-réanimation, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
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Older CG, Carr EC, Layzell M. Making sense of patients’ use of analgesics following day case surgery. J Adv Nurs 2010; 66:511-21. [DOI: 10.1111/j.1365-2648.2009.05222.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Riff DS, Duckor S, Gottlieb I, Diamond E, Soulier S, Raymond G, Boesing SE. Diclofenac potassium liquid-filled soft gelatin capsules in the management of patients with postbunionectomy pain: a Phase III, multicenter, randomized, double-blind, placebo-controlled study conducted over 5 days. Clin Ther 2010; 31:2072-85. [PMID: 19922878 DOI: 10.1016/j.clinthera.2009.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2009] [Indexed: 01/29/2023]
Abstract
BACKGROUND Diclofenac potassium liquid-filled soft gelatin capsule (DPSGC) is a rapidly absorbed formulation of diclofenac potassium developed for the treatment of mild to moderate acute pain. OBJECTIVE The present study was conducted to assess the efficacy and safety profile of DPSGC 25 mg in patients with pain after first-metatarsal bunionectomy. METHODS This was a Phase III, multicenter, randomized, double-blind, parallel-group, placebo-controlled study conducted over 5 days. Patients experiencing the requisite level of pain (score > or = 4 on an 11-point numeric pain rating scale [NPRS] from 0 = no pain to 10 = worst possible pain) on the day after bunionectomy were randomized to receive DPSGC 25 mg or matching placebo. A second dose was given when patients requested additional medication for pain. Subsequent doses were given every 6 hours over a 48-hour inpatient multiple-dose period and continued over an additional 48-hour outpatient multiple-dose period. Opioid rescue medication was available as needed after the second dose of study medication. The primary efficacy end point was the mean NPRS score over the 48-hour inpatient multiple-dose period. Additional measures included NPRS scores at predefined times over 48 hours, the summed pain intensity difference over 48 hours (SPID48), the time-weighted sum of pain relief scores over the first 8 hours, the mean dosing interval (the time from dosing to the time rescue medication or the next dose of study medication was administered, whichever was less), the proportion of patients requiring rescue medication, and the onset of perceptible and meaningful pain relief (2-stopwatch method). Tolerability was assessed based on physician monitoring and patient reporting of adverse events (AEs) and the results of standard laboratory tests. RESULTS Of 201 randomized patients (102 DPSGC 25 mg, 99 placebo; 86.6% female; 58.2% white; mean [SD] age, 45.2 [11.5] years; weight range, 49.4-108.0 kg), 198 completed the study. Mean baseline NPRS scores did not differ significantly between the DPSGC and placebo groups (6.9 and 7.3, respectively). DPSGC was associated with significant improvements compared with placebo in mean NPRS score over 48 hours (2.5 vs 5.6, respectively; P < 0.001), mean SPID48 (210.0 vs 90.3; P < 0.001), and overall mean dosing interval (331.5 vs 263.9 min; P < 0.001). Significant differences in NPRS scores between DPSGC 25 mg and placebo were noted at all time points from baseline through 48 hours (P < 0.001). The proportion of patients requiring rescue medication was significantly lower in the DPSGC group compared with the placebo group (39.2% vs 87.9% on day 1; 21.6% vs 64.6% on day 2; both, P < 0.001). Patients receiving DPSGC had a significantly faster onset of meaningful pain relief compared with those receiving placebo (P = 0.008). The most commonly reported AEs were nausea (7.8% vs 18.2%), headache (5.9% vs 9.1%), vomiting (3.9% vs 9.1%), and constipation (3.9% vs 2.0%). The overall incidence of AEs occurring in > or = 2% of patients was significantly lower in the DPSGC group than in the placebo group (20.6% vs 44.4%; P < 0.05); no patient receiving DPSGC had a serious AE. CONCLUSIONS DPSGC 25 mg taken every 6 hours was effective in reducing postbunionectomy pain in the patients studied. DPSGC was well tolerated, suggesting that it may be a practicable option for the treatment of mild to moderate acute pain. ClinicalTrials. gov identifier: NCT00366444.
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Affiliation(s)
- Dennis S Riff
- Advanced Clinical Research Institute, Anaheim, California 92801, USA.
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Asensio-Samper JM, De Andrés-Ibáñez J, Fabregat Cid G, Villanueva Pérez V, Alarcón L. Ultrasound-guided transversus abdominis plane block for spinal infusion and neurostimulation implantation in two patients with chronic pain. Pain Pract 2010; 10:158-62. [PMID: 20070554 DOI: 10.1111/j.1533-2500.2009.00336.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This case report describes an ultrasound approach to the transversus abdominis plane (TAP) local anesthetic block. This block induces sensory blockade in the lower half of the abdomen where the pulse generator or the infusion pump is to be housed in a subcutaneous pocket, and therefore provides an alternate to general anesthesia or administration of high-dose local anesthetics. CASE REPORT We report two cases of neuromodulation procedures-implantation of an internal morphine pump for severe somatic pain refractory to other therapies and placement of a double-stimulator generator for dorsal column stimulation in a patient diagnosed with postoperative failed-back syndrome. We successfully used ultrasound-guided TAP block to achieve ipsilateral sensory block of dermatomes T9-L1 in the context of a monitored anesthesia care multimodal approach. CONCLUSION TAP block can be a potentially useful substitute to general anesthesia or local anesthesia for the pocket formation in neuromodulation techniques, and it provides adequate anesthesia of the abdominal wall. This block is potentially an important addition to the monitored anesthesia care protocol.
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Affiliation(s)
- J M Asensio-Samper
- Anesthesia, Critical Care and Multidisciplinary Unit for Pain Management, Valencia University General Hospital, 46014 Valencia, Spain.
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Moodie JE, Brown CR, Bisley EJ, Weber HU, Bynum L. The Safety and Analgesic Efficacy of Intranasal Ketorolac in Patients with Postoperative Pain. Anesth Analg 2008; 107:2025-31. [DOI: 10.1213/ane.0b013e318188b736] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Successful postoperative pain management after arthroscopic shoulder surgery allows patients to go home earlier, decreases the potential for hospital readmission, and facilitates rehabilitation. Optimal pain control considers the physiological and psychological states of the patient, the resulting alterations due to the surgery, and the technical and economic resources available during recovery. A comprehensive approach to pain control should include preoperative, intraoperative, and postoperative efforts. Efforts at postoperative pain reduction should begin preoperatively with the establishment of an excellent patient/physician relationship. Preoperative analgesia should be administered. Intraoperative efforts should include the administration of anesthetic medication intra-articularly. Postoperative management should include sleep medication, continuous cold-flow therapy, oral analgesics, and, if necessary, the use of narcotics.
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Current concepts in pain management: pharmacologic options for the pediatric, geriatric, hepatic and renal failure patient. Clin Podiatr Med Surg 2008; 25:381-407; vi. [PMID: 18486851 DOI: 10.1016/j.cpm.2008.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article provides a review for current practice. Strict guidelines are not available on some topics, and they may never be drafted because pain is such a unique individual experience. It is recommended to coordinate care with other medical specialties when patients present with organ dysfunctions or are at the extremes of age. More data are required in the field of pain management, particularly with regard to renal and hepatic dysfunction. In turn, these data serve as a foundation for physicians making practice decisions based on current evidence. Until this is achieved, clinicians must rely on anecdotal evidence and the experiences of others to treat a complex issue: pain.
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Abstract
Surgery is a circumstance in which we know that we will cause pain. Although most of our perioperative pain management interventions are symptomatic, several strategies can reduce and even prevent pain in the perioperative setting. Because the physiologic mechanisms of postoperative pain are understood, it is possible to interrupt these mechanisms before the patient actually becomes symptomatic. This article reviews the literature and presents these strategies with the hope of implementation of the readers.
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Affiliation(s)
- Robert Hallivis
- Podiatric Surgery Section, Department of Orthopedics, INOVA Fairfax Hospital, Falls Church, VA 20042, USA
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Malaise O, Bruyere O, Reginster JY. Intravenous paracetamol: a review of efficacy and safety in therapeutic use. FUTURE NEUROLOGY 2007. [DOI: 10.2217/14796708.2.6.673] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Paracetamol is well established as a leading nonprescription antipyretic analgesic drug and is available in oral, rectal or intravenous forms. However, except for oral paracetamol, there is a marked discrepancy between the extent to which paracetamol is used and the available evidence for an analgesic effect in postoperative pain. This review mainly focuses on intravenous paracetamol. Its efficacy and safety are analyzed, as well as its use in therapeutics, alone or in combination. The morphine-sparing, additive and antihyperalgesia effects of intravenous paracetamol are also reviewed. The analyses are divided into several sections, comparing the efficacy of intravenous paracetamol with placebo, other forms of paracetamol or analgesic agents and analyzing its efficacy in multimodal therapy combined with NSAIDs or a morphinic agent.
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Affiliation(s)
- Olivier Malaise
- University of Liège, Department of Public Health, Epidemiology & Health Economics, CHU Sart-Tilman, Bât B23, 4000 Liège, Belgium
| | - Olivier Bruyere
- University of Liège, Department of Public Health, Epidemiology & Health Economics, CHU Sart-Tilman, Bât B23, 4000 Liège, Belgium
| | - Jean-Yves Reginster
- University of Liège, Department of Public Health, Epidemiology & Health Economics, CHU Sart-Tilman, Bât B23, 4000 Liège, Belgium
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Avidan A, Drenger B, Ginosar Y. Peripheral nerve block for ambulatory surgery and postoperative analgesia. Curr Opin Anaesthesiol 2007; 16:567-73. [PMID: 17021512 DOI: 10.1097/00001503-200312000-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW With this article we intend to increase the awareness of the efficiency and efficacy of peripheral nerve block as a treatment option for outpatient surgical anesthesia and postoperative home-based analgesia. RECENT FINDINGS Current investigations have demonstrated that peripheral nerve block is associated with a superior outcome (reduced pain, nausea and vomiting) and more efficient patient turnover than general anesthesia. Continuous peripheral nerve block and patient controlled peripheral nerve block lead to further improvement in postoperative analgesia and patient satisfaction. SUMMARY The recent advances and techniques described indicate that peripheral nerve block is both a valid and frequently a preferred option for ambulatory surgery.
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Affiliation(s)
- Alexander Avidan
- Department of Anesthesiology and Critical Care Medicine, Hebrew University Hadassah Medical School, Hadassah University Hospital, Jerusalem, Israel.
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Newcomb W, Lincourt A, Hope W, Schmelzer T, Sing R, Kercher K, Heniford BT. Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery. Am Surg 2007. [DOI: 10.1177/000313480707300615] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and prein cision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.
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Affiliation(s)
- William Newcomb
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Amy Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - William Hope
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas Schmelzer
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Ronald Sing
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kent Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Abstract
AIM To explore and reveal patients' perceptions of discharge arrangements and recovery following day surgery. INTRODUCTION Contemporary day surgery is increasingly being used to carry out elective surgical procedures enabling patients to be discharged on the same day. The Department of Health and government modernization programmes in the UK have encouraged this rapid growth. Preparation for discharge is important because patients require knowledge and understanding about self-management and access to primary health care services if required. METHODS Using a phenomenological approach, data were collected by unstructured interviews from 30 patients undergoing gynaecology, urology and general surgery procedures. RESULTS Deficits in patient preparation for discharge including the timing of information giving postprocedure for all groups were highlighted. The gynaecology patients pointed to a specific lack of verbal information about resuming sexual activity following procedures. Some general surgery and urology patients alluded to finding it stressful coping with threats to body image through 'skin discoloration', 'swelling' or 'bruising', because they did not know what to do. A number of urology patients talked about the challenges posed by difficulty with voiding, dysuria and haematuria. RELEVANCE TO CLINICAL PRACTICE The results and problems identified have applicability for the development of discharge planning services and patient education in a day surgery context. It is suggested that the use of evidenced-based and innovative interventions among health professionals might improve patient outcomes.
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Affiliation(s)
- Jo Gilmartin
- School of Healthcare Studies, Baines Wing, University of Leeds, Leeds, UK.
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Abstract
PURPOSE OF REVIEW To summarize and examine the updated published results on the outcome measures that can be used to assess the quality of ambulatory surgery and anesthesia. RECENT FINDINGS Major morbidity and mortality following ambulatory surgery is exceedingly low. Cancellations and delays may have a negative impact on the patients, healthcare personnel and the organizations. Minor cardiovascular adverse events are the most common intraoperatively and are associated with preexisting cardiovascular diseases and elderly patients. Respiratory events postoperatively are associated with obesity, smoking and asthma. Also, pain is a common cause for longer postoperative stay, unanticipated admission and readmission. Postoperative nausea and vomiting occurs in 30% of patients and strongly affects patient satisfaction. Furthermore, prolonged stays are mainly caused by surgical factors, or minor symptoms like pain or nausea. Surgical factors are also the main causes of unanticipated hospital admission. The type of surgery and the 24 h postoperative symptoms may affect the degree of return to daily living function. Also, patient satisfaction affects the outcome of healthcare and the use of healthcare services. SUMMARY Ambulatory surgery, as currently practiced, provides quality care that is cost-effective. Minor adverse events such as pain and postoperative nausea and vomiting are still common, and improvement could be targeted in these areas.
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Affiliation(s)
- Ilia Shnaider
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Iverson RE, Lynch DJ. Practice Advisory on Pain Management and Prevention of Postoperative Nausea and Vomiting. Plast Reconstr Surg 2006; 118:1060-1069. [PMID: 16980870 DOI: 10.1097/01.prs.0000232390.14109.f5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
AIM This paper reports a study examining the effects of preoperative nursing intervention for pain on abdominal surgery preoperative anxiety and attitude to pain, and postoperative pain. METHOD In a randomized controlled study conducted between January and August 2001, patients undergoing abdominal surgery in a medical center in southern Taiwan were randomly assigned to an experimental (n = 32) or control group (n = 30). The experimental group received routine care and preoperative nursing intervention for pain, while the control group received routine care only. A structured questionnaire including an anxiety scale, pain attitude scale, and Brief Pain Inventory was used to assess the results. RESULTS Participants in the experimental group experienced a significant decrease in preoperative anxiety and a significant improvement in preoperative pain attitude. They also had statistically significantly lower postoperative pain intensity for 4 hours after surgery and lower highest pain intensity within the first 24 hours after surgery. Perceived pain interference during position changes, deep breathing/coughing, and moments of emotion in the experimental group was statistically significantly lower than that of the control group in the same situations. The experimental group also started out-of-bed activities 1.5 days earlier. CONCLUSION Preoperative nursing intervention for pain has positive effects for patients undergoing abdominal surgery. The intervention used in this study could serve as a guide for nurses to improve the pain care of these patients.
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Affiliation(s)
- Li-Ying Lin
- Department of Nursing, Veterans General Hospital, Kaohsiung City, Taiwan
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Joshi GP, Ogunnaike BO. Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain. ACTA ACUST UNITED AC 2005; 23:21-36. [PMID: 15763409 DOI: 10.1016/j.atc.2004.11.013] [Citation(s) in RCA: 294] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Inadequately controlled pain has undesirable physiologic and psychologic consequences such as increased postoperative morbidity, delayed recovery, a delayed return to normal daily living, and reduced patient satisfaction. Importantly, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. This article reviews the physiologic and psychologic consequences of inadequately treated pain, with an emphasis on chronic persistent postoperative pain.
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Affiliation(s)
- Girish P Joshi
- Perioperative Medicine and Ambulatory Anesthesia, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
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Watt-Watson J, Chung F, Chan VWS, McGillion M. Pain management following discharge after ambulatory same-day surgery. J Nurs Manag 2004; 12:153-61. [PMID: 15089952 DOI: 10.1111/j.1365-2834.2004.00470.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM AND BACKGROUND Same-day surgeries are becoming routine for many surgical procedures. However, the degree to which patients need help with pain management at home following laparoscopic cholecystectomy (LC), shoulder, or hand ambulatory day surgery has received minimal examination. This study examined pain and related interference, analgesic use and adverse events, complications and resources utilized, and adequacy of postdischarge information at four time periods. METHODS Data were collected from 180 patients by telephone interviews at 24, 48 and 72 hours, and 7 days after discharge. Patients (n = 78 hand, 48 shoulder, 54 LC surgery) were on average 41 years old. RESULTS For all patients, worst 24-hour pain was reported as moderate to severe at all time periods. Using repeated measures anova demonstrated that shoulder patients had significantly more pain and overall pain-related interference, particularly in sleep and work, from 24 hours to day 7 than did hand or LC patients. The main analgesic taken was acetaminophen (paracetamol) with codeine 30 mg; 50% took no analgesia from 72 hours. About 20% experienced analgesic adverse events within 72 hours, mainly constipation and nausea. Only </=6% used non-pharmacological strategies. Bleeding (4%) and sore throat (11%) at 24-48 hours were identified as complications; six patients (4%) called their physician. Most patients received no information about analgesic use with inadequate pain relief and/or adverse events. CONCLUSIONS Despite the considerable pain reported across all time periods, analgesic use and other interventions were minimal. Adverse events, which were problematic for some, may explain why patients stopped analgesics despite pain. These data support further research on more effective pain interventions and related education for day-surgery patients after discharge.
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Affiliation(s)
- Judy Watt-Watson
- Faculty of Nursing, and Centre for the Study of Pain, University of Toronto, Ontario, Canada.
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Abstract
BACKGROUND Despite technological advancements in anaesthesia and analgesia, reported pain levels after day surgery remains high. Whilst it is unrealistic to expect no pain, the level that constitutes 'acceptable' pain remains unclear because of inconsistencies in reporting. These inconsistencies have resulted from different interpretations of what pain is and the use of different measurement tools. AIM The aim of this paper is to report a study investigating any disparity in reported levels of pain following day surgery, within different specialties and in relation to specific operative procedures. METHOD Nursing and health care papers published since 1983 were sought using the keywords: postoperative pain, postoperative complications, pain after day surgery, day surgery, ambulatory surgery, nursing, operation types, operative procedures, surgical procedures, descriptors of pain, pain intensity, verbal descriptor scale, numerical rating scale, visual analogue scale, validity, reliability, design, sample size, data collection methods and their various combinations. Databases searched were Medline, CINAHL, Nursing Collection, Embase, Healthstar, BMJ and several on-line Internet journals, specifically Ambulatory Surgery. The search was restricted to publications in the English language. Findings. Twenty-four papers were identified. Inconsistencies in the reported intensity of pain are highlighted, in relation to different operative procedures and specialties. Data in the papers are based on different descriptors, measurement tools and data collection methods. In many cases, sample size, and validity and reliability can also be questioned. CONCLUSIONS There is a disparity in reported levels of pain after day surgery. It is important that a unified day surgery pain measurement strategy is established, so that patients can be informed about the intensity of pain that they are likely to experience following specific procedures.
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Affiliation(s)
- Anne Marie Coll
- Research Unit, School of Care Sciences, University of Glamorgan, Pontypridd, Mid Glamorgan, UK.
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Fletcher D. [Improvement in analgesia for ambulatory surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:689-90. [PMID: 14522386 DOI: 10.1016/s0750-7658(03)00180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Carbonell AM, Harold KL, Mahmutovic AJ, Hassan R, Matthews BD, Kercher KW, Sing RF, Heniford BT. Local Injection for the Treatment of Suture Site Pain after Laparoscopic Ventral Hernia Repair. Am Surg 2003. [DOI: 10.1177/000313480306900810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transabdominal sutures (TAS) used for mesh fixation in laparoscopic ventral hernia repair (LVHR) are an occasional source of prolonged postoperative pain. We sought to analyze the incidence of TAS site pain and the efficacy of local treatment methods. A retrospective review of patients who underwent LVHR from January 1999 to August 2002 was performed to identify patients experiencing suture site pain. Patients were considered candidates for injection therapy if their discomfort lasted 10 days postoperatively. Patient demographics, hernia size, mesh size, and subjective pain intensity were recorded. Treatment consisted of injection circumferentially around the suture site with 0.25 per cent bupivacaine with one to 200,000 epinephrine and 1 per cent lidocaine at the level of the abdominal musculature. Statistical ( P < 0.05) significance was determined by chi-square, logistic regression, and analysis of variance. One hundred three patients (42 men and 61 women) with a mean age of 53 years (range 26–78) and weight of 99.8 kg (range 61–239) underwent LVHR. Mean hernia size was 192 cm2 (range 12–450) and mean size of mesh placed measured 534 cm2 (range 100–1200). Twenty-four patients (23%) complained of prolonged discomfort at a transabdominal suture site and were injected postoperatively in the office as described. Of these 58 per cent were female and 42 per cent were male. Logistic regression demonstrated increasing mesh size was the only factor ( P < 0.01) that correlated with the need for injection. Twenty-two of 24 patients (92%) undergoing injection therapy had complete relief of their symptoms. Twenty patients required a single injection and two patients required two injections to treat their TAS site pain. After local injection failure two patients were referred to an anesthesia pain service; one underwent intercostal nerve block with complete resolution of pain, while the other is currently in treatment. There were no complications. Suture site pain was present after LVHR in 23 per cent of our patients. Increasing mesh size is associated with a greater chance of suture site pain. It appears to be effectively treated postoperatively with the injection of a local anesthetic at the TAS site. The mechanisms by which short-duration anesthetics relieve chronic pain are not fully understood.
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Affiliation(s)
- Alfredo M. Carbonell
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kristi L. Harold
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Aida J. Mahmutovic
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Reem Hassan
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Brent D. Matthews
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kent W. Kercher
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Ronald F. Sing
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- From the Carolinas Laparoscopic and Advanced Surgery Program, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Abstract
Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the treatment of acute pain.Non-pharmacological methods for the management of postoperative pain include acupuncture, electromagnetic millimetre waves, hypnosis and the use of music during surgery. However, further research of these techniques is warranted to elucidate their effectiveness in this indication. Pain is a multifactorial experience, not just a sensation. Emotion, perception and past experience all affect an individual's response to noxious stimuli. Improved postoperative pain control through innovation and creativity may improve compliance, ease of delivery, reduce length of hospital stay and improve patient satisfaction. Patient education, early diagnosis of symptoms and aggressive treatment of pain using an integrative approach, combining pharmacotherapy as well as complementary technique, should serve us well in dealing with this complex problem.
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Affiliation(s)
- Allan B Shang
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Macario A, Lipman AG. Ketorolac in the Era of Cyclo-Oxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Efficacy, Side Effects, and Regulatory Issues. PAIN MEDICINE 2001; 2:336-51. [PMID: 15102238 DOI: 10.1046/j.1526-4637.2001.01043.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The recent introduction of oral COX-2 selective NSAIDs with potential for perioperative use, and the ongoing development of intravenous formulations, stimulated a systemic review of efficacy, side effects, and regulatory issues related to ketorolac for management of postoperative analgesia. DESIGN To examine the opioid dose sparing effect of ketorolac, we compiled published, randomized controlled trials of ketorolac versus placebo, with opioids given for breakthrough pain, published in English-language journals from 1986-2001. Odds ratios were computed to assess whether the use of ketorolac reduced the incidence of opioid side effects or improved the quality of analgesia. RESULTS Depending on the type of surgery, ketorolac reduced opioid dose by a mean of 36% (range 0% to 73%). Seventy percent of patients in control groups experienced moderate-severe pain 1 hour postoperatively, while 36% of the control patients had moderate to severe pain 24 hours postoperatively. Analgesia was improved in patients receiving ketorolac in combination with opioids. However, we did not find a concomitant reduction in opioid side effects (e.g., nausea, vomiting). This may be due to studies having inadequate (to small) sample sizes to detect differences in the incidence of opioid related side effects. The risk for adverse events with ketorolac increases with high doses, with prolonged therapy (>5 days), or invulnerable patients (e.g. the elderly). The incidence of serious adverse events has declined since dosage guidelines were revised. CONCLUSIONS Ketorolac should be administered at the lowest dose necessary. Analgesics that provide effective analgesia with minimal adverse effects are needed.
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Affiliation(s)
- A Macario
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305-5640, USA.
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Lee KF, Ray JB, Dunn GP. Chronic pain management and the surgeon: barriers and opportunities. J Am Coll Surg 2001; 193:689-701; discussion 701-2. [PMID: 11768686 DOI: 10.1016/s1072-7515(01)01091-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- K F Lee
- Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA
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Abstract
Effective postoperative analgesia is a fundamental goal of patient management in the ambulatory surgery setting. There is a physiologic, psychological, and economic cost to unrelieved pain in the postoperative patient. Understanding (1) the individual experience of pain, (2) common barriers to effective pain management, (3) the concept of balanced analgesia, (4) the types and modes of action of various analgesics available to the ambulatory population, and (5) the importance of thorough and organized means of pain assessment will help the perianesthesia nurse optimize analgesia for the postoperative patient. Severe postoperative pain continues to be a problem in ambulatory patients once they are discharged to the home environment. This article looks at fundamental concepts in pain management and integrates these ideas into a comprehensive strategy for the management of postoperative pain in the ambulatory patient.
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Affiliation(s)
- B M Moline
- Acute Pain Clinical Nurse Specialist at the Poudre Valley Hospital, Fort Collins, CO 80524, USA
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Abstract
BACKGROUND In the last decade, there has been heightened awareness that pain management needs to be a priority for all health care settings and clinicians. The article will overview practice guidelines and new technology, and assess their impact on pain relief in inpatient and outpatient surgeries from a patient's perspective. METHODS Literature was retrieved by searches from 1996 to 2000 Medline and CINAHL (nursing database), using keywords "postoperative pain," "postsurgical pain," "patient outcomes," "pain outcomes," "survey," "questionnaire," and "practice guidelines." RESULTS Overall, current practice standards have had minimal impact on decreasing patients' reports of pain. The incidence of moderate to severe pain with cardiac, abdominal, and orthopedic inpatient procedures has been reported as high as 25% to 50%, and incidence of moderate pain after ambulatory procedures is 25% or higher. CONCLUSIONS Despite the advances, the incidence of pain remains high. Yet the future is promising, with new standards from the Joint Commission on Accreditation of Health care Organizations paving the way for reduction of institutional barriers and improved implementation of guidelines.
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Affiliation(s)
- N Huang
- University of Illinois College of Pharmacy, M/C 886, 833 S. Wood St., Rm. 164, Chicago, IL 60612-7230, USA
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Affiliation(s)
- N Rawal
- Department of Anaesthesiology and Intensive Care, Orebro Medical Centre Hospital, S-701 85 Orebro, Sweden
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Martín López MA, Fortuny GO, Riera FO, Grau LH, Maeso MP. Effectiveness of a clinical guide for the treatment of postoperative pain in a major ambulatory surgery unit. AMBULATORY SURGERY 2001; 9:33-35. [PMID: 11179712 DOI: 10.1016/s0966-6532(00)00075-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.
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Affiliation(s)
- M A. Martín López
- Department of Anaesthetics, Consorci Sanitari de Mataró, C. Cirera s/n, 08304 Mataró, Barcelona, Spain
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