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Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2024; 49:581-601. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [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: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
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Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Amin D, Conner D, Umorin M, Bouloux GF. Liposomal Bupivacaine Suspension Can Reduce the Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture. J Oral Maxillofac Surg 2024; 82:538-545. [PMID: 38373697 DOI: 10.1016/j.joms.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Poorly controlled postoperative pain results in prolonged length of stay (LOS). The use of liposome bupivacaine injectable suspension (LB) for postoperative pain control is a relatively recent practice. PURPOSE The purpose of this study was to investigate the following. In patients undergoing open reduction and internal fixation of mandibular fracture(s), does the use of LB reduce LOS compared with regular bupivacaine? STUDY DESIGN, SETTING, SAMPLE We implemented a retrospective cohort study of consecutive patients with mandibular fracture(s) presented to Grady Memorial Hospital in Atlanta, GA, from January 2021 to January 2022. Adult patients diagnosed with 1 or more isolated mandibular fracture(s) and treated by open reduction and internal fixation were included. We excluded patients with non-isolated mandibular fracture(s), isolated condyle, infected, previously treated fractures, and documented allergy to amide local anesthetics and/or its preservatives. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE Primary predictor variable was local anesthetic (regular bupivacaine alone or LB/regular bupivacaine). MAIN OUTCOME VARIABLE(S) Primary outcome variable was LOS, defined as the number of days from surgical procedure until discharge. Secondary outcome variables were number of opioid prescription refill(s) and postoperative pain at discharge, determined with visual analogue scale. COVARIATES The covariates were Demographics, American Society of Anesthesiologists classification, smoking, alcohol exposure, illicit drug use, etiology, location, laterality, number of fracture(s), surgical approach, and method of maxillomandibular fixation. ANALYSES Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS Sixty-two subjects met the inclusion criteria (31 subjects in each group). The mean ages in LB/regular bupivacaine and regular bupivacaine alone groups were 33.3 (±12) and 35.1 (±15.6), respectively (P = .94), the mean LOS in days was 0.23 (±0.44) in LB/regular bupivacaine and 1.48 (±1.77) in regular bupivacaine alone (P= < .001), and the mean VAS pain scores for LB/regular bupivacaine and regular bupivacaine alone groups were 0.53 (±1.07) and 1.87 (±2.66), respectively (P = .02). Mean number of opioid prescription refill(s) was 0 in LB/regular bupivacaine and 1 in regular bupivacaine alone group, respectively (P = .01). CONCLUSION AND RELEVANCE The use of LB/regular bupivacaine for mandibular fracture(s) results in decrease in LOS and number of opioid refills compared to regular bupivacaine alone.
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Affiliation(s)
- Dina Amin
- Associate Professor, Residency Program Director, Department of Oral and Maxillofacial Surgery, University of Rochester, Rochester, NY.
| | - Drake Conner
- Resident-in-training, Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mikhail Umorin
- Assistant Professor, Department of Biomedical Sciences, School of Dentistry, Texas A&M University, Dallas, TX
| | - Gary F Bouloux
- Professor, Oral and Maxillofacial Surgery, Chief Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
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Chang JS, Lee DH, Kang MW, Kim JW, Kim CH. Effectiveness of Intravenous Non-Opioid Analgesics for Postoperative Pain Management of in Patients Undergoing Hip Surgery: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1904. [PMID: 38003953 PMCID: PMC10673097 DOI: 10.3390/medicina59111904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Intravenous (IV) non-opioid analgesics (NOAs) have been extensively investigated as a multimodal analgesic strategy for the management of acute pain after hip surgery. This pair-wise meta-analysis examined IV NOA effects following hip surgery. Materials and Methods: A systematic search of the MEDLINE (PUBMED), Embase, and Cochrane Library databases was performed for studies investigating the effect of IV NOA for postoperative pain management following hip surgery up to 7 June 2023. We compared in-admission opioid use, postoperative VAS (visual analogue scale) score, hospital stay duration, and opioid-related adverse events between IV NOA and control groups. Results: Seven studies were included with a total of 953 patients who underwent hip surgery. Of these, 478 underwent IV NOA treatment, and 475 did not. The IV NOA groups had lower opioid use within 24-h following hip surgery (SMD, -0.48; 95% CI, -0.66 to -0.30; p < 0.01), lower VAS score (SMD, -0.47; 95% CI, -0.79 to -0.16; p < 0.01), shorter hospital stay (SMD, -0.28; 95% CI, -0.44 to -0.12; p < 0.01), and lower incidence of nausea and vomiting (OR, 0.32; 95% CI, 0.15 to 0.67; p < 0.01) compared with the control groups. Conclusions: This meta-analysis demonstrated that IV NOA administration following hip surgery may have more favorable postoperative outcomes than those in control groups.
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Affiliation(s)
- Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea; (J.S.C.); (D.H.L.); (M.W.K.)
| | - Dong Hwan Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea; (J.S.C.); (D.H.L.); (M.W.K.)
| | - Min Wook Kang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea; (J.S.C.); (D.H.L.); (M.W.K.)
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
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Wu YWK, Mitchell DJ. Tramadol as a patient-initiated component of multimodal pain management: a pilot study of 364 lower limb arthroplasty cases. ANZ J Surg 2023; 93:2112-2118. [PMID: 36929136 DOI: 10.1111/ans.18361] [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: 01/06/2022] [Revised: 12/28/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Multimodal therapy (MMT) for analgesia following joint arthroplasty continues to reduce cost and the requirement of strong opioids post-operatively. Tramadol immediate release is an important MMT component providing synergistic pain relief via dual μ-opioid agonism and serotonin and noradrenaline reuptake inhibition. Case reports have shown tramadol when combined with antidepressants cause serotonin syndrome, but this has yet to be demonstrated in larger studies. We undertook a pilot study assessing the functional outcomes and incidence of side effects associated with tramadol in lower limb arthroplasty patients with a focus on those taking concomitant antidepressants. METHODS Primary and revision hip and knee arthroplasties performed in 2018-2019 by a senior surgeon were included (n = 364). Patient records were assessed to determine pain scores, length of hospitalization, prescription of tramadol and antidepressants, self-reported side effects and previous adverse reactions associated with tramadol. RESULTS Nine-five percentage of patients had been prescribed tramadol, and 16% had concurrent prescription of tramadol and one or more antidepressants. The total rate of adverse effects associated with tramadol before and during the study was 7% (n = 25) including two cases of concomitant tramadol and antidepressant use. For patients on tramadol, median 2-week post-operative pain score was 1.5 (IQR 1-2.5) out of 10 and hospitalization length was 1 (IQR 1-2) days. CONCLUSION Tramadol immediate release appears to be well tolerated among our patient population with no significantly increased prevalence of side effects when co-administered with low and moderate dose antidepressants.
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Affiliation(s)
| | - David James Mitchell
- Orthopaedic Surgeon, Novar Musculoskeletal Research Institute, Lake Wendouree, Victoria, Australia
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The association between opioid misuse or abuse and hospital-based, acute care after spinal surgery. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sioshansi PC, Xiong M, Tu NC, Bojrab DI, Schutt CA, Babu SC. Comparison of Cranioplasty Techniques Following Translabyrinthine Surgery: Implications for Postoperative Pain and Opioid Usage. Otol Neurotol 2021; 42:e1565-e1571. [PMID: 34411065 DOI: 10.1097/mao.0000000000003295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess differences in postoperative pain, opioid usage, and surgical outcomes between cranioplasty using abdominal fat graft (AFG) versus hydroxyapatite cement (HAC) following translabyrinthine surgery. STUDY DESIGN Retrospective case control. SETTING Tertiary referral center. PATIENTS Sixty translabyrinthine procedures were evaluated, including 30 consecutive HAC patients and 30 matched AFG patients. Patients were matched by age, gender, body mass index, and tumor size. INTERVENTION Cranioplasty using HAC or AFG following translabyrinthine resection of vestibular schwannoma. MAIN OUTCOME MEASURES Postoperative patient pain ratings, narcotic usage, inpatient length of stay, and complication rates. RESULTS Patients who underwent HAC cranioplasty had lower postoperative pain scores on several measures (p < 0.05) and less postoperative narcotic usage (mean difference of 36.7 morphine equivalents, p = 0.0025) when compared to those that underwent AFG closure. HAC cranioplasty patients had shorter average length of hospital stay (2.2 vs 3.4 days, p = 0.0441). Postoperative cerebrospinal fluid leaks (one in HAC group, two in AFG group) and skin reactions in AFG closure patients (n = 1) were infrequent. CONCLUSION HAC cranioplasty is a safe technique comparable to AFG closure following translabyrinthine surgery which can decrease postoperative pain, narcotic usage, and hospital length of stay.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, Michigan
- Department of Otolaryngology - Head & Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mulin Xiong
- Michigan State University, College of Human Medicine, East Lansing, Michigan
| | - Nathan C Tu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, Michigan
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, Michigan
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, Michigan
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, Michigan
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Linzey JR, Foshee R, Moriguchi F, Adapa AR, Koduri S, Kahn EN, Williamson CA, Sheehan K, Rajajee V, Thompson BG, Muraszko KM, Pandey AS. Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs. Neurosurgery 2021; 88:E259-E264. [PMID: 33370820 DOI: 10.1093/neuros/nyaa535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.
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Affiliation(s)
- Joseph R Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Rachel Foshee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Arjun R Adapa
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Elyne N Kahn
- Saint Joseph Mercy Health System, Ypsilanti, Michigan
| | | | - Kyle Sheehan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Boulter JH, Curry BP, Szuflita NS, Miller CA, Spinelli J, Delaney JJ, Neal CJ, Spevak CJ, Bell RS. Protocolization of Post-Transforaminal Lumbar Interbody Fusion Pain Control with Elimination of Benzodiazepines and Long-Acting Opioids. Neurosurgery 2020; 86:717-723. [PMID: 31274165 DOI: 10.1093/neuros/nyz232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/08/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The opioid epidemic continues to worsen with a concomitant increase in opioid-related mortality. In response, the Department of Defense and Veterans Health Agency recommended against the use of long-acting opioids (LAOs) and concurrent use of opioids with benzodiazepines. Subsequently, we eliminated benzodiazepines and LAOs from our postoperative pain control regimen. OBJECTIVE To evaluate the impact of removing benzodiazepines and LAOs on postoperative pain in single-level transforaminal lumbar interbody fusion (TLIF) patients. METHODS A retrospective cohort study of single-level TLIF patients from February 2016-March 2018 was performed. Postoperative pain control in the + benzodiazepine cohort included scheduled diazepam with or without LAOs. These medications were replaced with nonbenzodiazepine, opioid-sparing adjuncts in the -benzodiazepine cohort. Pain scores, length of hospitalization, trigger medication use, and opioid use and duration were compared. RESULTS Among 77 patients, there was no difference between inpatient pain scores, but the -benzodiazepine cohort experienced a faster rate of morphine equivalent reduction (-18.7%, 95% CI [-1.22%, -36.10%]), used less trigger medications (-1.55, 95% CI [-0.43, -2.67]), and discharged earlier (0.6 d; 95% CI [0.01, 1.11 d]). As outpatients, the -benzodiazepine cohort was less likely to receive opioid refills at 2 wk (29.2% vs 55.8%, P = .021) and 6 mo postoperatively (0% vs 13.2%, P = .039), and was less likely to be using opioids by 3 mo postoperatively (13.3% vs 34.2%, P = .048). CONCLUSION Replacement of benzodiazepines and LAOs in the pain control regimen for single-level TLIFs did not affect pain scores and was associated with decreased opioid use, a reduction in trigger medications, and shorter hospitalizations.
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Affiliation(s)
- Jason H Boulter
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brian P Curry
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicholas S Szuflita
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Charles A Miller
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Joseph Spinelli
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - John J Delaney
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christopher J Spevak
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Randy S Bell
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Rodrigues S, Shin D, Conway M, Smulski S, Trenker E, Shanthanna H, Vanniyasingam T, Thabane L, Paul J. Hydromorphone versus morphine: a historical cohort study to evaluate the quality of postoperative analgesia. Can J Anaesth 2020; 68:226-234. [PMID: 33170454 DOI: 10.1007/s12630-020-01849-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Opioids are the most widely used therapy for pain during the postoperative period. It has been suggested by some that hydromorphone is clinically superior. Our primary objective was to determine if there is a difference in postoperative pain score ratings between adult patients receiving intravenous hydromorphone vs intravenous morphine on discharge from the post-anesthesia care unit (PACU). METHODS For this historical cohort study, convenience sampling was used to identify the first 605 patients ≥ 18 yr undergoing elective, non-cardiac surgery. Patients were categorized based on treatment in the PACU with hydromorphone (n = 326) or morphine (n = 279). Pain scores (scale of 0-10), nausea/vomiting (scale of 0-3), pruritis (scale of 0-3), and sedation (scale of 0-4), as well as total opioid dose administered from arrival in the PACU until readiness to discharge were evaluated. RESULTS For the primary outcome of pain reported at discharge from the PACU, there was no significant difference between the mean (standard deviation) hydromorphone numeric rating scale (NRS) [2.8 (1.6)] and the morphine NRS [2.5 (1.5)] after adjusting for potential confounders (adjusted mean difference, 0.10; 95% confidence interval, -0.21 to 0.42; P = 0.53). Similarly, there were no significant between-group differences in length of stay in the PACU, satisfactory analgesia, nausea/vomiting, and sedation. CONCLUSION This study serves to help guide the decision-making process for selecting either morphine or hydromorphone for acute postoperative analgesia. Overall, we found no significant difference for analgesia or for common opioid-related adverse effects between these two opioids in the postoperative period at the time of discharge from the PACU. Furthermore, according to this data, the equipotency ratio of hydromorphone to morphine is closer to 1:6.5 rather than the commonly employed 1:5 ratio.
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Affiliation(s)
- Shannon Rodrigues
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - David Shin
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Matthew Conway
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Stefanie Smulski
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Emily Trenker
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Harsha Shanthanna
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Thuva Vanniyasingam
- Department of Health Research Methods, Evidence & Impact, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, Health Sciences Centre, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesiology, McMaster University, Health Sciences Centre, 2V9, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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Linzey JR, Kahn EN, Shlykov MA, Johnson KT, Sullivan K, Pandey AS. Length of Stay Beyond Medical Readiness in Neurosurgical Patients: A Prospective Analysis. Neurosurgery 2018; 85:E60-E65. [DOI: 10.1093/neuros/nyy440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 09/20/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Elyne N Kahn
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Maksim A Shlykov
- University of Michigan Medical School, Ann Arbor, Michigan
- Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri
| | - Kyle T Johnson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Katie Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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