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Blonk KM, Davenport A, Morgan B, Muckler VC. Administration of Oral Acetaminophen to Reduce Costs for the Hysterectomy Patient at a Community Hospital. J Perianesth Nurs 2019; 34:143-150. [DOI: 10.1016/j.jopan.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 10/28/2022]
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Stammschulte T, Brune K, Brack A, Augenstein H, Arends G, Gundert-Remy U. Unerwartete Blutungskomplikationen im Zusammenhang mit Celecoxib. Anaesthesist 2014; 63:958-60. [DOI: 10.1007/s00101-014-2385-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gritsenko K, Khelemsky Y, Kaye AD, Vadivelu N, Urman RD. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol 2014; 28:59-79. [PMID: 24815967 DOI: 10.1016/j.bpa.2014.03.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 12/22/2022]
Abstract
This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.
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Affiliation(s)
- Karina Gritsenko
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, NY, USA; Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, NY, USA; Acute Pain, Regional, Chronic Pain, Montefiore Medical Center, Bronx, New York, NY, USA; Albert Einstein College of Medicine, Yeshiva University, Montefiore Medical Center, Bronx, New York, NY, USA.
| | - Yury Khelemsky
- Anesthesiology, Icahn School of Medicine of Mount Sinai, New York, NY, USA; Pain Medicine Fellowship Program, Icahn School of Medicine of Mount Sinai, New York, NY, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA; Interventional Pain Services, LSU School of Medicine, New Orleans, LA, USA; Department of Pharmacology, LSU School of Medicine, New Orleans, LA, USA; Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA; Department of Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
| | - Nalini Vadivelu
- Anesthesiology Department, Yale University School of Medicine, New Haven, CT, USA
| | - Richard D Urman
- Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Brigham and Women's Hospital, USA
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Gerstein NS, Gerstein WH, Carey MC, Kong Lam NC, Ram H, Spassil NR, Schulman PM. The thrombotic and arrhythmogenic risks of perioperative NSAIDs. J Cardiothorac Vasc Anesth 2013; 28:369-78. [PMID: 24125630 DOI: 10.1053/j.jvca.2013.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Indexed: 01/12/2023]
Affiliation(s)
| | - Wendy Hawks Gerstein
- Department of Internal Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM
| | | | | | - Harish Ram
- Department of Anesthesiology, University of New Mexico, Albuquerque, NM
| | | | - Peter Mark Schulman
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR
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Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc 2013; 27:2275-82. [DOI: 10.1007/s00464-012-2759-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/21/2012] [Indexed: 12/17/2022]
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LUNN TH, KRISTENSEN BB, GAARN-LARSEN L, HUSTED H, KEHLET H. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia. Acta Anaesthesiol Scand 2012; 56:1139-45. [PMID: 22571671 DOI: 10.1111/j.1399-6576.2012.02709.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-anaesthesia care unit (PACU) admission must be well founded and the stay as short as possible without compromising patient safety. However, within the concept of fast-track surgery, studies are limited in addressing the question: why are patients staying in the PACU? METHODS All patients operated with primary unilateral total hip or knee arthroplasty (THA or TKA) under spinal anaesthesia were included in this hypothesis-generating, prospective, observational cohort study during a 4-month period. Surgical technique, analgesia, and perioperative care were standardized. Well-defined PACU discharge criteria that had to be met on two successive assessments were evaluated every 15 min until discharge. The primary outcome was time to meet PACU discharge criteria. Secondary outcomes were actual discharge time from the PACU, specific factors detaining patients in the PACU, and potential complications at the surgical ward at follow-up 24 h post-operatively. RESULTS One hundred sixty-three patients were included in the final analysis (69 THA and 94 TKA). Time to meet PACU discharge criteria was [median (interquartile range)(95% confidence interval)]: 15 min (15-15)(15-116) for THA and 15 min (15-15)(15-75) for TKA. Actual discharge time from PACU was: 25 min (20-35)(16-198) for THA and 25 min (20-31)(15-107) for TKA. Reasons for not meeting PACU discharge criteria in 15 min were mainly low oxygen saturation and pain. The short stay in the PACU did not impose complications at the surgical ward. CONCLUSION The vast majority of patients (> 85%) operated with THA and TKA under low-dose spinal anaesthesia may achieve pre-defined PACU discharge criteria in 15 min. Large-scale studies should be performed to evaluate safety aspects after short PACU stay.
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Affiliation(s)
| | | | - L. GAARN-LARSEN
- The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty; Hvidovre University Hospital; Copenhagen; Denmark
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Health services research: what is it and what has it done for anaesthesia and critical care? Eur J Anaesthesiol 2011; 28:547-9. [PMID: 21734503 DOI: 10.1097/eja.0b013e3283454ca1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Borendal Wodlin N, Nilsson L, Carlsson P, Kjølhede P. Cost-effectiveness of general anesthesia vs spinal anesthesia in fast-track abdominal benign hysterectomy. Am J Obstet Gynecol 2011; 205:326.e1-7. [PMID: 22083055 DOI: 10.1016/j.ajog.2011.05.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 04/15/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study objective was to compare total costs for hospital stay and postoperative recovery for 2 groups of women who underwent fast-track abdominal benign hysterectomy: 1 group under general anesthesia; 1 group under spinal anesthesia. Costs were evaluated in relation to health-related quality of life. STUDY DESIGN Costs of treatment were analyzed retrospectively with data from a randomized multicenter study at 5 hospitals in Sweden. Of 180 women who were scheduled for benign abdominal hysterectomy, 162 women were assigned randomly for the study: 80 women allocated to general anesthesia and 82 women to spinal anesthesia. RESULTS Total costs (hospital costs plus cost-reduced productivity costs) were lower for the spinal anesthesia group. Women who had spinal anesthesia had a faster recovery that was measured by health-related quality of life and quality adjusted life-years gained in postoperative month 1. CONCLUSION The use of spinal anesthesia for fast-track benign abdominal hysterectomy was more cost-effective than general anesthesia.
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Wodlin NB, Nilsson L, Kjølhede P. Health-related quality of life and postoperative recovery in fast-track hysterectomy. Acta Obstet Gynecol Scand 2011; 90:362-8. [PMID: 21306322 DOI: 10.1111/j.1600-0412.2010.01058.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast-track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA). DESIGN Secondary analysis from an open randomized controlled multicenter study. SETTING Five hospitals in south-east Sweden. POPULATION One hundred and eighty women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 with GA and 82 with SA. METHODS The HRQoL was measured preoperatively using the EuroQoL EQ-5D and the Short-Form-36 health survey (SF-36) questionnaires. The EQ-5D was used daily for 1 week; thereafter, once weekly for 4 weeks and again 6 months after operation. The SF-36 was completed at 5 weeks and 6 months. Dates of commencing and ending sick leave were registered. MAIN OUTCOME MEASURES Changes in HRQoL; duration of sick leave. RESULTS The HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications. In particular, the mental component of HRQoL was negatively affected by minor complications, even 6 months after the operation. CONCLUSIONS Spinal anesthesia with intrathecal morphine provided substantial advantages in fast-track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia.
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Affiliation(s)
- Ninnie Borendal Wodlin
- Division of Women and Child Health, Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Wodlin NB, Nilsson L, Arestedt K, Kjølhede P. Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting. Acta Obstet Gynecol Scand 2011; 90:369-79. [PMID: 21332679 DOI: 10.1111/j.1600-0412.2010.01059.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. DESIGN Secondary analysis from a randomized, open, multicenter study. SETTING Five hospitals in south-east Sweden. POPULATION One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. METHODS The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. MAIN OUTCOME MEASURES Occurrence, intensity and duration of postoperative symptoms. RESULTS Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. CONCLUSIONS Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy.
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Affiliation(s)
- Ninnie Borendal Wodlin
- Division of Women and Child Health, Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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TAP block avec pose bilatérale d’un cathéter pour analgésie postopératoire après chirurgie gynécologique. ACTA ACUST UNITED AC 2011; 30:67-9. [DOI: 10.1016/j.annfar.2010.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 08/21/2010] [Indexed: 11/17/2022]
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Gómez Ríos MA, Vázquez Barreiro L, Nieto Serradilla L, Diz Gómez JC, López Alvarez S. [Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:417-424. [PMID: 19856688 DOI: 10.1016/s0034-9356(09)70422-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the quality of postoperative analgesia provided by intravenous administration of paracetamol and ketorolac plus morphine in bolus doses with or without continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. Patient satisfaction was included among the outcomes assessed. MATERIAL AND METHODS Prospective pilot study in ASA 1-2 patients randomized to 2 groups: women in the subcutaneous catheter group received intravenous analgesics plus a continuous infusion (2 mL/h) of 0.25% bupivacaine whereas women in the control group received only the intravenous analgesics. The outcome measures were pain intensity assessed on a verbal numerical scale at rest and with movement, morphine requirements in the first 48 hours after surgery, and complications related to the drugs used or the technique. RESULTS Twenty-six patients were enrolled; 10 were randomized to the catheter group and 16 to the control group. Statistically significant between-group differences in pain both at rest and with movement were found while the women were in the postoperative recovery unit. Postoperative pain with movement was also significantly different at 24 hours (P<.004) and 48 hours (P<.02). Similarly, mean (SD) morphine requirements in the recovery unit were significantly greater in the control group, at 8 (2.27) mg, compared with 3.20 (1.79) mg in the catheter group (P<.002). Walking began earlier in the catheter group. No differences were found in the incidences of complications. CONCLUSIONS Postoperative pain is effectively relieved by continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. This technique provides good analgesia with less morphine consumption and scarce adverse effects. Patient satisfaction and the sense of receiving quality pain management are high.
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Affiliation(s)
- M A Gómez Ríos
- Servicio de Anestesiología y Reanimación, 1Complexo Hospitalario Universitario A Coruña, Coruña.
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