Comparison of opioid consumption between intravenous patient-controlled analgesia and oral administration in open abdominal urologic procedures: an exploratory study

2021 ◽  
Author(s):  
Vivian H. Y. Ip ◽  
Genevieve Laurendeau-Salomon ◽  
Niels-Erik Jacobsen ◽  
Adrian S. Fairey
Keyword(s):  
Oral Administration ◽  
Exploratory Study ◽  
Opioid Consumption ◽  
Patient Controlled Analgesia

scholarly journals Impact of the Timing of Rocuronium Injection after Propofol Administration on Temporal Summation of Pain in Gynecologic Laparoscopic Surgery: A Prospective and Controlled Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jaehak Jung ◽  
Byoungryun Kim ◽  
Seong Nam Park ◽  
Jiheui Lee ◽  
Insung Choi ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Pain ◽  
Temporal Summation ◽  
Opioid Consumption ◽  
Controlled Study ◽  
Injection Pain ◽  
Pain Patient ◽  
Patient Controlled Analgesia ◽  
Pain Outcomes ◽  
The Impact

Purpose. Temporal summation of pain, which is defined as the perception of greater pain evoked by repetitive painful stimuli, varies among individuals. This study aimed at determining the impact of the timing of rocuronium after induction with propofol on the temporal summation of pain. Methods. One hundred patients aged 19–60 years underwent gynecologic laparoscopic surgery. Patients were randomly assigned to one of the two groups: group PRi received immediate injections of rocuronium after propofol administration and group PRd received rocuronium injections when the bispectral index score (BIS) decreased to <60 after propofol administration. The grade of rocuronium-induced withdrawal movement (RIWM) according to the timing of propofol injection, the incidence and severity of propofol injection pain (PIP), rescue analgesics, visual analog scale (VAS) score after surgery for postoperative pain, patient-controlled analgesia (PCA) opioid consumption, association between PIP and the grade of RIWM, and associations between PIP, the grade of RIWM, and postoperative pain outcomes were measured. Results. The differences between the incidence and severity of PIP in the two groups were not significant. The grade of the RIWM in the PRd group was significantly reduced compared with the PRi group. Rescue analgesics, severity for postoperative pain, and PCA opioid consumption were not significant. Correlations between the incidence and severity of PIP and the grade of RIWM were weakly negative. Correlations between the grade of RIWM and pain outcomes were moderately positive, but correlations between the severity for PIP and the postoperative pain outcomes were negligible. Conclusion. The timing of rocuronium administration after propofol injection played a role in reducing RIWM. The grade of RIWM was significantly related to pain outcomes compared with the severity of PIP. Therefore, delayed rocuronium injection after induction with propofol reduced temporal summation of pain.

scholarly journals S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: a randomized, double-blind, placebo-controlled clinical trial

2021 ◽  
Author(s):  
Elina C.V. Brinck ◽  
Taru Virtanen ◽  
Sanna Mäkelä ◽  
Venla Soini ◽  
Ville-Veikko Hynninen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Controlled Clinical Trial ◽  
Dependent Manner ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

AbstractBACKGROUNDSpinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.METHODSWe randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml−1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.RESULTSOf the 100 patients analyzed, patients receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml−1 (74.7 mg) or 0.25 mg ml−1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: −20.6 mg; 95% confidence interval [CI]: −41 to −0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups.CONCLUSIONSOxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

scholarly journals Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sha Li ◽  
Xian Ding ◽  
Yong Zhao ◽  
Xiao Chen ◽  
Jianfeng Huang
Keyword(s):  
Postoperative Pain ◽  
Thoracoscopic Surgery ◽  
Opioid Consumption ◽  
Psychoeducational Intervention ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Opioid Medications ◽  
The Impact

Abstract Background The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery. Methods In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Results The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240). Conclusions Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.

scholarly journals Electronically monitored single-use patient-controlled analgesia pumps in postoperative pain control

2005 ◽  
Vol 1 (5) ◽  
pp. 267
Author(s):  
Michael Zimmermann, MD ◽  
Karin Friedrich, MD ◽  
Rolf Kirchner, MD
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Pain Control ◽  
Opioid Consumption ◽  
Dose Titration ◽  
Patient Controlled Analgesia ◽  
Analgesic Consumption ◽  
Group A ◽  
Single Use ◽  
Group B

The present study was performed to establish whether analgesic consumption in the first four postoperative hours is a suitable basis for selecting the demand dose and predicting the likely analgesic requirement over the next 20 hours with single-use patient-controlled analgesia (PCA) pumps, and to establish whether this method provides effective pain control.Forty-two patients who had undergone a laparotic gynecological procedure (hysterectomy) were given an electronic PCA pump (Abbott Lifecare, Abbott Laboratories, Abbott Park, IL) for four hours (phase I) with a demand dose of 1 mg piritramide and a lockout period of five minutes for dose titration. Piritramide’s potency is comparable with that of morphine. The patients then received single-use PCA pumps (Baxter Infusor/Watch, Baxter, Deerfield, IL) for the next 20 hours (phase II) with a demand dose of 0.75 mg in Group A and 1.5 mg in Group B, depending on whether more or less than 10 mg pritramide had been consumed in phase I. A specially designed electronic recorder was used to measure the exact amount consumed and number of demands. Patients experiencing pain were free to receive additional piritramide at any time as rescue medication; however, these patients were withdrawn from the study.Ninety percent of the patients in group A said they were satisfied with or undecided as to the level of analgesia. The corresponding figure in group B was 95 percent. Piritramide consumption was significantly higher in group B than in group A. There were no significant differences between the groups regarding demographic data or duration of surgery, nor did either of these two parameters affect postoperative piritramide consumption. Significant alleviation of pain and improvement in visual analog scale scores from phase I [group A, 4.7 (range, 2.0 to 6.8); group B, 4.6 (range, 3.0 to 8.3)] to phase II [group A, 3.1 (range, 0.4 to 5.2); group B, 3.2 (range, 0.4 to 6.0)] was achieved in both groups. A significant difference in analgesic consumption up to 18 hours postoperatively was seen after dose titration. In the first four hours, the rate of successful demands was significantly higher in group A (80.9 percent) than in group B (40.9 percent). The number of successful demands was comparable in the two groups during phase II (A, 98.8 percent; B, 94.5 percent).In summary, total opioid consumption during the first four hours after operation showed two groups of patients with significantly different needs for piritramide (< 10 mg per 4 hours or > 10 mg per 4 hours). Two different dose regimes were applied using a high and a low bolus size in the following 20 hours. We concluded that effective pain control without respiratory depression was achieved with single-use PCA pumps. Opioid consumption varied significantly, whereas pain levels did not.

Role of VVZ-149, a Novel Analgesic Molecule, in the Affective Component of Pain: Results from an Exploratory Proof-of-Concept Study of Postoperative Pain following Laparoscopic and Robotic-Laparoscopic Gastrectomy

Pain Medicine ◽  
2021 ◽  
Author(s):  
Inkyung Song ◽  
Sunyoung Cho ◽  
Srdjan S Nedeljkovic ◽  
Sang Rim Lee ◽  
Chaewon Lee ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Laparoscopic Gastrectomy ◽  
Statistical Significance ◽  
Opioid Consumption ◽  
Phase 2 ◽  
Patient Controlled Analgesia ◽  
Rescue Analgesia ◽  
Affective Component ◽  
Phase 2 Study

Abstract Objective VVZ-149 is a small molecule that both inhibits the glycine transporter type 2 and the serotonin receptor 5 hydroxytryptamine 2 A. In a randomized, parallel-group, and double-blind trial (NCT02844725), we investigated the analgesic efficacy and safety of VVZ-149 Injections, which is under clinical development as a single-use injectable product for treating moderate to severe postoperative pain. Methods Sixty patients undergoing laparoscopic and robotic-laparoscopic gastrectomy were randomly assigned to receive a 10-hour intravenous infusion of VVZ-149 Injections or placebo, initiated approximately 1 hour before completion of surgical suturing. Major outcomes included pain intensity and opioid consumption via patient-controlled analgesia and rescue analgesia provided “as needed.” The treatment efficacy of VVZ-149 was further examined in a subpopulation requiring early rescue medication, previously associated with the presence of high levels of preoperative negative affect in a prior Phase 2 study (NCT02489526). Results Pain intensity was lower in the VVZ-149 (n = 30) than the placebo group (n = 29), reaching statistical significance at 4 hours post-emergence (P &lt; .05), with a 29.5% reduction in opioid consumption for 24 hours and fewer demands for patient-controlled analgesia. In the rescued subgroup, VVZ-149 further reduced pain intensity (P &lt; .05) with 32.6% less opioid consumption for 24 hours compared to placebo patients. Conclusions VVZ-149 demonstrated effective analgesia with reduced postoperative pain and opioid requirements. Consistent with the results from the previous Phase 2 study, patients with early rescue requirement had greater benefit from VVZ-149, supporting the hypothesis that VVZ-149 may alleviate the affective component of pain and mitigate excessive use of opioids postoperatively.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S13-S13
Author(s):  
Arpan A Patel ◽  
Corey T Walker ◽  
Virginia Prendergast ◽  
John J Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Adverse Events ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 592-601 ◽  
Author(s):  
Arpan A Patel ◽  
Corey T Walker ◽  
Virginia Prendergast ◽  
John J Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pain Scores ◽  
High Consumption ◽  
Lumbar Spinal

Abstract BACKGROUND Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion. OBJECTIVE To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices. METHODS A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients were divided into cohorts on the basis of postoperative treatment with PCA or NCA. Postoperative pain scores, length of stay, and total opioid consumption data were collected. Patients were stratified according to preoperative opioid consumption as opioid naive (0 morphine milligram equivalents [MME] daily), low consumption (1-60 MME), high consumption (61-90 MME), or very high consumption (&gt;90 MME). RESULTS A total of 240 patients were identified, including 62 in the PCA group and 178 in the NCA group. PCA patients had higher mean preoperative opioid consumption than NCA patients (49.2 vs 24.3 MME, P = .009). PCA patients had higher mean opioid consumption in the first 72 h in all 4 of the preoperative opioid consumption subcategories. Pain control and adverse event rates were similar between PCA and NCA in the low to high preoperative opioid consumption groups. CONCLUSION Postoperative PCA is associated with significantly more opioid consumption in the first 72 h after surgery and equal or worse postoperative pain scores compared with NCA after lumbar spinal fusion surgery.

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