1
|
Tan H, Wang C, Jiang Y, Shi Q, Liang W, Li D. Postoperative effect of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients. BMC Anesthesiol 2023; 23:170. [PMID: 37210488 DOI: 10.1186/s12871-023-02143-8] [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: 10/25/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES To explore the postoperative effects of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients undergoing radical surgery. METHODS 112 female breast cancer patients aged 18-80 years old who underwent radical surgery by the same surgeon were randomly divided into 4 groups, and there were 28 patients in each group. Patients in group A were given 10 µg sufentanil preemptive analgesia combined with perioperative psychological support therapy (PPST), group B had only 10 µg sufentanil preemptive analgesia, group C had only PPST, and group D were under general anesthesia with conventional intubation. Visual analogue scoring (VAS) was used for analgesic evaluation at 2, 12 and 24 h after surgery and compared among the four groups by ANOVA method. RESULTS The awakening time of patients in group A or B was significantly shorter than that in group C or D, and the awakening time in group C was significantly shorter than that in group D. Moreover, patients in group A had the shortest extubation time, while the group D had the longest extubation time. The VAS scores at different time points showed significant difference, and the VAS scores at 12 and 24 h were significantly lower than those at 2 h (P < 0.05). The VAS scores and the changing trend of VAS scores were varied among the four groups (P < 0.05). In addition, we also found that patients in group A had the longest time to use the first pain medication after surgery, while patients in group D had the shortest time. But the adverse reactions among the four groups showed no difference. CONCLUSIONS Sufentanil preemptive analgesia combined with psychological intervention can effectively relieve the postoperative pain of breast cancer patients.
Collapse
Affiliation(s)
- Hong Tan
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Chengqiang Wang
- Department of Epidemiology and Statistics, School of Public Health, Guilin Medical University, Guilin, 541199, Guangxi, China
| | - Yihong Jiang
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Quan Shi
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Wei Liang
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Di Li
- Department of Epidemiology and Statistics, School of Public Health, Guilin Medical University, Guilin, 541199, Guangxi, China.
| |
Collapse
|
2
|
Wagemans MF, Scholten WK, Hollmann MW, Kuipers AH. Epidural anesthesia is no longer the standard of care in abdominal surgery with ERAS. What are the alternatives? Minerva Anestesiol 2020; 86:1079-1088. [DOI: 10.23736/s0375-9393.20.14324-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
3
|
Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New Advances in Acute Postoperative Pain Management. Curr Pain Headache Rep 2018; 22:35. [PMID: 29619627 DOI: 10.1007/s11916-018-0690-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management. RECENT FINDINGS Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery. Multimodal analgesia (MMA) is an essential component of such care. Further, in the wake of serious and persistent concern on the opioid epidemic in the USA, there has been a recent renewal of interest in non-opioid alternatives or adjuncts in controlling postoperative pain, often in the context of MMA. Intravenous (IV) acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), magnesium, ketamine, dexmedetomidine, liposomal bupivacaine, and newer neuraxial and peripheral regional techniques as well as patient-controlled modalities are gaining importance. Gabapentinoids have become popular but recent meta-analytic reviews have cast doubt on their routine use in perioperative settings. Among opioids, sublingual sufentanil, IV oxycodone, and iontophoretic transdermal fentanyl hold promise. Acupuncture and transcutaneous electrical nerve stimulation may be useful as adjuncts in MMA packages. Genetic testing, derivatives of herbal preparations, and an extended role of acute pain services may emerge as potential areas of importance in the future. There are, however, critical gaps in good quality evidence in many of the practice guideline recommendations. In the era of opioid epidemic, several lines of evidence have emerged to support non-opioid-based drugs and approaches along with a few newer opioid formulations for postoperative pain management, although more research is needed to find the right balance of efficacy and safety.
Collapse
Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India.
| | - Daniel Carlyle
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Vijay Kodumudi
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Scardino M, D'Amato T, Martorelli F, Fenocchio G, Simili V, Di Matteo B, Bugada D, Kon E. Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study. J Exp Orthop 2018; 5:8. [PMID: 29557999 PMCID: PMC5861254 DOI: 10.1186/s40634-018-0123-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/08/2018] [Indexed: 02/03/2023] Open
Abstract
Background Currently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA IV opioids do not provide optimal results with fast track rehabilitation protocols. Methods The present is a retrospective study comparing the novel sublingual sufentanil PCA system (SSTS) to our standard of care foreseeing continuous femoral nerve block (cFNB) within a multimodal analgesic in a TKA fast-track protocol. The study evaluated 95 patients on SSTS (SSTS group) and 87 on cFNB (cFNB/control group) and collected data on numeric rating scores for pain from day 1–3 after surgery (T1, T2, T3), both at rest (NRS) and during movement (mNRS), patient’s ability to walk, need for supplementary analgesia (rescue dose), occurrence of adverse effects, length of hospital stay, and usability rating for SSTS by both patients and hospital staff. Results NRS at rest was lower in the cFNB than in the SSTS group for all 3 days after surgery, whereas mNRS scores were lower in the SSTS group at all time points measured. Adverse effects were significantly fewer among patients of the SSTS group (6% patients) than those of the cFNB (74% patients) (p < 0.001). Rescue doses were needed by 5% of SSTS patients vs 60% of cFNB. The fewer adverse events and lower pain scores for the SSTS group were associated to a notably better ability to ambulate, with all patients (100%) of the SSTS group being able to stand and walk for 10 m from T1 on; patients in the cFNB group showed a slower recovery with only 40% being able to stand and walk on T1, 70% on T2 and 85% on T3. All patients of the SSTS group had a length of stay of 4 days (day of surgery plus 3 after) as foreseen by the fast track protocol, in comparison only 36% of cFNB. Lastly, patient and nursing staff judged SSTS easy to use. Conclusion Our experience suggests that SSTS is a valuable strategy for routine postoperative analgesia following TKA in the context of a multimodal analgesic approach within the fast-track setting.
Collapse
Affiliation(s)
- Marco Scardino
- Department of Anesthesia, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy
| | - Tiziana D'Amato
- Department of Anesthesia, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy
| | - Federica Martorelli
- Department of Anesthesia, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy
| | - Giorgia Fenocchio
- Department of Anesthesia, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy
| | - Vincenzo Simili
- Department of Anesthesia, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy
| | - Berardo Di Matteo
- Center for functional and biologic reconstruction of the Knee, Humanitas Clinical and Research Institute, Via Manzoni 113, 20089, Rozzano, Italy.
| | - Dario Bugada
- Department of Medicine and Surgery, Parma University, Parma, Italy.,Department of Anesthesia, ICU and Pain Medicine, Parma University Hospital, Parma, Italy
| | - Elizaveta Kon
- Center for functional and biologic reconstruction of the Knee, Humanitas Clinical and Research Institute, Via Manzoni 113, 20089, Rozzano, Italy
| |
Collapse
|
5
|
Bantel C, Laycock HC. Between evidence and commerce - the case of sufentanil sublingual tablet systems. Anaesthesia 2017; 73:143-147. [PMID: 29219168 PMCID: PMC5814728 DOI: 10.1111/anae.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C Bantel
- Pain Medicine and Anaesthesia, Klinikum Oldenburg AöR, Oldenburg, Germany.,Imperial College London, London, UK
| | | |
Collapse
|
6
|
Wirz S, Conrad S, Shtrichman R, Schimo K, Hoffmann E. Clinical Evaluation of a Novel Technology for Oral Patient-Controlled Analgesia, the PCoA® Acute Device, for Hospitalized Patients with Postoperative Pain, in Pilot Feasibility Study. Pain Res Manag 2017; 2017:7962135. [PMID: 29093632 PMCID: PMC5637857 DOI: 10.1155/2017/7962135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 08/10/2017] [Indexed: 12/05/2022]
Abstract
Background Acute postoperative pain delays recovery and increases morbidity and mortality. Traditional administration of postoperative analgesics by nurses is often inefficient. The present study evaluated the safety, efficacy, and usability of a novel, patient-controlled analgesic dispenser, the PCoA Acute. Methods A controlled pilot study was conducted at three medical centers. Patients scheduled for elective surgery were enrolled into two groups, both taking oral analgesics: a control group (n = 43), opioids dispensed by nurses, and a test group (n = 27), opioids dispensed via the PCoA Acute. Pill intake data were recorded. Pain ratings at rest and during movement were surveyed. Results No severe adverse events were recorded. Average pill intake time was reduced from 8 : 58 minutes in the control group to 1 : 17 minutes in the test group (P value < 0.05). The test group took 67% more pills than the control group, indicating enhanced compliance. Pain scores were significantly lower for patients in the test group (P value < 0.05). Over 90% of PCoA Acute users were satisfied with its use. Conclusions The study confirmed that PCoA Acute is safe and effective. It is well accepted by patients and medical staff. Its use can optimize pain medication administration.
Collapse
Affiliation(s)
- Stefan Wirz
- Department of Anesthesia, Intensive Medicine, Pain Medicine/Palliative Medicine, Center for Pain Medicine, CURA Hospital GFO, Bad Honnef, Germany
| | - Stefan Conrad
- DosentRx Ltd., 2 Hahar St., Har Tuv Industrial Zone A, 9980101 Har Tuv, Israel
| | - Ronit Shtrichman
- DosentRx Ltd., 2 Hahar St., Har Tuv Industrial Zone A, 9980101 Har Tuv, Israel
| | - Kai Schimo
- DosentRx Ltd., 2 Hahar St., Har Tuv Industrial Zone A, 9980101 Har Tuv, Israel
| | - Eva Hoffmann
- Department of Anesthesia, Interdisciplinary Intensive Care, Emergency Medicine and Pain Medicine, EvK-Protestant Hospital Herne, Herne, Germany
| |
Collapse
|