A prospective study of opioid use for postoperative pain management after breast operation

2020 ◽  
Vol 219 (1) ◽  
pp. 8-14
Author(s):  
Kristen E. Limbach ◽  
SuEllen J. Pommier ◽  
Kristen P. Massimino ◽  
Rodney F. Pommier ◽  
Arpana M. Naik
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Prospective Study ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
A Prospective Study

Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

2005 ◽  
Vol 102 (2) ◽  
pp. 421-428 ◽  
Author(s):  
Philippe Richebé ◽  
Cyril Rivat ◽  
Jean-Paul Laulin ◽  
Pierre Maurette ◽  
Guy Simonnet
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Weight Bearing ◽  
Experimental Studies ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Short Term ◽  
Postoperative Rehabilitation ◽  
Pain Hypersensitivity ◽  
Plantar Incision

Background Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management. Methods During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 microg/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test. Results Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine. Conclusions By opposing postoperative pain hypersensitivity and subsequent short-term tolerance induced by perioperative opioid use, ketamine not only improves exaggerated postoperative pain management but also provides better postoperative rehabilitation.

Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery

2019 ◽  
Vol 102 (2) ◽  
pp. 383-387 ◽  
Author(s):  
Meghana Yajnik ◽  
Jonay N. Hill ◽  
Oluwatobi O. Hunter ◽  
Steven K. Howard ◽  
T. Edward Kim ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Education ◽  
Knee Replacement ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Knee Replacement Surgery ◽  
Replacement Surgery

Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management

2019 ◽  
Vol 44 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Yvette N Martin ◽  
Amy C S Pearson ◽  
John R Tranchida ◽  
Toby N Weingarten ◽  
Phillip J Schulte ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Recovery Room ◽  
Severe Pain ◽  
Receptor Agonist ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Intravenous Morphine ◽  
Matched Study

Background and objectivesBuprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).MethodsWe identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.ResultsNineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).ConclusionsAnalgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.

Oxycodone/naloxone in postoperative pain management of surgical patients

2018 ◽  
Vol 14 (1) ◽  
pp. 52 ◽  
Author(s):  
Ioannis D. Gkegkes, MD, PhD ◽  
Evelyn Eleni Minis, MD ◽  
Christos Iavazzo, MD, MSc, PhD
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Recovery Period ◽  
Postoperative Pain Management ◽  
Bowel Function ◽  
Postoperative Recovery ◽  
Orthopedic Procedures ◽  
Advantages And Disadvantages ◽  
Recent Addition ◽  
A Prospective Study

Background: The role of analgesia is crucial in the management of postoperative pain. Different combinations of oral analgesics have been proposed in the past. The oxycodone/naloxone (OXN) combination is a recent addition and is being used by different surgical specialties. The aim of our study was to clarify the possible role, advantages, and disadvantages of OXN in the pain management of surgical patients.Method: The authors retrieved the included studies after performing a systematic search in PubMed and Scopus.Results: Ten studies (six randomized controlled trials, three retrospective studies, and a prospective study) were eligible for inclusion in this review. In total, 1,996 patients were included. Six studies reported on orthopedic procedures while four studies referred to colorectal, gynecologic, cardiac, and thoracic surgery procedures, respectively. The analgesic effect of OXN was evaluated in nine out of 10 studies, where OXN showed superiority only in two out of nine studies. Postoperative bowel function was evaluated in seven out of 10 studies. Patients treated with OXN did not show any significant differences in bowel function when compared to control groups. No superiority was found regarding the possible adverse events.Conclusion: Analgesia is crucial to postoperative recovery. Pain control can be achieved a combination of different analgesics, including OXN. This oral analgesic combination can have the potential to minimize side effects, such as opioid-induced constipation and optimize the recovery period.

American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery

2021 ◽  
Author(s):  
Jivianne T. Lee ◽  
Corinna G. Levine ◽  
Jonathan B. Overdevest ◽  
Thomas S. Higgins ◽  
R. Peter Manes ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Opioid Use ◽  
Expert Practice

scholarly journals Postoperative Pain Management of Non–“Opioid-Naive” Patients Undergoing Hand and Upper-Extremity Surgery

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 651-658
Author(s):  
Kelvin A. Wong ◽  
Kanu S. Goyal
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Management ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Opioid Use ◽  
Opioid Users

Background: Patients with prior opioid use are often difficult to manage postoperatively. We examined potential strategies for managing these patients: (1) prescribing a different opioid; and (2) encouraging the use of nonopioid analgesics over opioids. Methods: A pain control program was implemented at an outpatient hand and upper-extremity center. Patients were recruited before (n = 305) and after (n = 225) implementation. Seventy of them were taking opioids prior to surgery. Information about pain control satisfaction and opioid use was collected. The Fisher exact test was used to compare categorical variables with small expected frequencies. Wilcoxon rank sum test was used to compare nonnormally distributed continuous variables. Results: Opioid users used 28.8 ± 25.6 opioid pills; nonopioid users used 14.5 ± 21.5 pills. Furthermore, 41.4% of opioid users sought more pills after surgery compared with 14.0% among nonopioid users. The pain control program was more effective in reducing opioid consumption and waste and increasing nonopioid consumption for nonopioid users than for opioid users. Prior opioid users who were prescribed a different opioid after surgery used 24.6 ± 22.0 opioid pills. Patients prescribed the same opioid used 37.9 ± 30.8 pills. Conclusions: Patients taking opioids prior to hand and upper-extremity surgery use more opioid pills, seek more pills after surgery, and are less satisfied with their pain control than their nonopioid user counterparts. Furthermore, the comprehensive pain plan was less effective in this patient population. Prescribing a different opioid reduced medication requirements for these patients, but additional strategies are needed to address postoperative pain management.

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