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Meier IM, Eikemo M, Trøstheim M, Buen K, Jensen E, Gurandsrud Karlsen S, Reme SE, Berna C, Leknes S, Ernst G. Factors associated with use of opioid rescue medication after surgery. Reg Anesth Pain Med 2024; 49:265-271. [PMID: 37479238 DOI: 10.1136/rapm-2023-104412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Opioid exposure after surgery increases risk of persistent opioid use. Here, we characterize at-home use of opioid rescue medication during 1-2 days after outpatient surgery (N=270) in a postoperative opioid-sparing context at a Norwegian hospital. METHODS The postsurgical pain management plan included non-steroidal anti-inflammatory drugs and up to six pills of 5 mg oxycodone as rescue analgesics. In this observational study we assessed risk factors for taking rescue opioids after surgery, by comparing patients who did, with those who did not. RESULTS Only 35% (N=228) of patients reported taking rescue opioids 1-2 days after discharge. Patients taking rescue opioids after surgery (opioid-takers) differed from non-takers by prevalence of preoperative chronic pain (>3 months; 74% vs 48%), higher pain severity and interference before and after surgery, reporting lower ability to cope with postsurgical pain, higher nervousness about the surgery, being younger, and having received more opioid analgesics in the recovery room. Exploratory predictive modeling identified opioid administration in the recovery room as the most important predictor of at-home rescue medication use. Follow-up after >4 months indicated low acute pain levels (mean±SD = 1.1±1.8), with only four patients (2%, N=217) reporting opioid analgesic use. CONCLUSION Factors related to at-home rescue medication use closely mirrored known risk factors for persistent opioid use after surgery, such as prior chronic pain, prior substance use, affective disturbances, and pain severity before surgery. These findings are potential targets in patient-centered care. Nevertheless, and reassuringly, findings are consistent with the idea that opioid-sparing postsurgical care can prevent large-scale chronic opioid use.
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Affiliation(s)
- Isabell M Meier
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Marie Eikemo
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Martin Trøstheim
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kaja Buen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Eira Jensen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Siri Gurandsrud Karlsen
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Silje E Reme
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Chantal Berna
- Centre of Integrative and Complementary Medicine, Division of Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Siri Leknes
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Gernot Ernst
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Anesthesiology, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
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Dunworth S, Barbeito A, Nagavelli H, Higgins D, Edward S, Williams M, Pyati S. Transitional Pain Service: Optimizing Complex Surgical Patients. Curr Pain Headache Rep 2024; 28:141-147. [PMID: 38117461 DOI: 10.1007/s11916-023-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The care of patients with complex postsurgical pain can be challenging and burdensome for the healthcare system. Transitional pain service (TPS) is a relatively new concept and has not been widely adopted in the USA. This article explores the benefits and barriers of transitional pain services and describes the development of a TPS at our institution. RECENT FINDINGS Evidence from a few institutions that have adopted TPS has shown decreased postsurgical opioid consumption for patients on chronic opioids and decreased incidence of chronic postsurgical opioid use for opioid-naïve patients. The development of a transitional pain service may improve outcomes for these complex patients by providing longitudinal and multidisciplinary perioperative pain care. In this article, we describe the implementation of a TPS at a tertiary medical center. Our TPS model involves a multidisciplinary team of anesthesiologists, pain psychologists, surgeons, and advanced practice providers. We provide longitudinal care, including preoperative education and optimization; perioperative multimodal analgesic care; and longitudinal follow-up for 90 days post-procedure. With our TPS service, we aim to reduce long-term opioid use and improve functional outcomes for our patients.
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Affiliation(s)
- Sophia Dunworth
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Atilio Barbeito
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Harika Nagavelli
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Diana Higgins
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Shibu Edward
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Melvania Williams
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University School of Medicine, PO Box 3094, Durham, NC, 27701, USA.
- Anesthesiology Service, Durham Veterans Affairs Healthcare Systems, Durham, NC, USA.
- Present address: Department of Anesthesiology, Duke University School of Medicine, Durham Veterans Affairs Healthcare System, PO Box 3094, Durham, NC, 27701, USA.
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Senthil G, Selvaganesh S, Nessapan T, Veeraragavan VP, Eswaramoorthy R. Comparison of pre and post-operative stresses among Indian patients undergoing intra-oral grafting procedures. Bioinformation 2023; 19:484-487. [PMID: 37822831 PMCID: PMC10563578 DOI: 10.6026/97320630019484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/30/2023] [Accepted: 04/30/2023] [Indexed: 10/13/2023] Open
Abstract
With the advent of implantology as an important means to rehabilitate the edentulous patients, the neglect over the years post extraction leads to severe bone loss. This can be corrected by grafting procedures. Grafting procedures are complex as it takes into account various factors such as the type of graft material, surgical site, surgeon's skill and the patient's compliance. Totally 20 patients ( male n=10 ; female n=10) were included in the study, 14 patients underwent GBR, 4 patients underwent direct sinus lifts and 2 underwent block grafts. The stress levels of the patient also is an important factor to consider as varying cortisol levels will be detrimental to the healing of the surgical site. Premedication with painkillers and corticosteroids can help patients comply with the treatment and feel less anxious. The stress levels of the patient were assessed using State trait anxiety index, 50.6± 6.9 was the pre-operative stress and 36.95± 9.3 was the post-operative stress. Stress levels were significantly greater before the procedure than after it, according to statistical analysis. The females were significantly having increased stress both pre and post-operatively. Also, the patients in the age group of 41-50 years showed increased amounts of stress.
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Affiliation(s)
- Giri Senthil
- Department of Implantology , Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science(SIMATS), Saveetha university, Chennai 600077, India
| | - Sahana Selvaganesh
- Department of Implantology , Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science(SIMATS), Saveetha university, Chennai 600077, India
| | - Thiyaneswaran Nessapan
- Department of Implantology , Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science(SIMATS), Saveetha university, Chennai 600077, India
| | - Vishnu Priya Veeraragavan
- Department of Biochemistry , Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science(SIMATS), Saveetha university, Chennai 600077, India
| | - Rajalakshmanan Eswaramoorthy
- Department of Biomaterials (Green Lab), Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science(SIMATS), Saveetha university, Chennai 600077, India
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Altinbas BC, Gürsoy A. Nurse-led web-based patient education reduces anxiety in thyroidectomy patients: A randomized controlled study. Int J Nurs Pract 2023:e13131. [PMID: 36691286 DOI: 10.1111/ijn.13131] [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: 03/02/2021] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023]
Abstract
AIM The aim of this study was to determine the effect of web-based patient education on anxiety in patients scheduled for thyroid surgery. A secondary aim was to evaluate the patients' postoperative recovery outcomes. DESIGN This study is a randomized controlled trial. METHOD The study was conducted at a university hospital in Turkey between September 2018 and May 2019 with 76 patients scheduled for thyroidectomy surgery and randomly assigned into two groups. Patients in the intervention group received web-based education, while those in the control group were given only routine care. Measurements were performed before surgery, on the day of surgery, and 1 week after discharge. RESULTS On the day of surgery, intervention group anxiety levels were lower than those of the control group, and the majority of early recovery parameters were significantly better in the intervention group than in the control group. One week after discharge, the intervention group patients' anxiety levels were significantly lower. Web-based education had no impact on pain, time in the operating room, readmission to the hospital after discharge, or length of hospitalization. CONCLUSIONS Nurse-led web-based education reduced patients' anxiety regarding surgery. The results also show that it may improve postoperative early recovery.
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Affiliation(s)
- Bahar Candas Altinbas
- Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Ayla Gürsoy
- Nursing Department, Faculty of Health Sciences, Antalya Bilim University, Antalya, Turkey
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